Radiographically Apparent Acetabular Sourcil Landmarks Are Created by Comparable Regions of the Pelvis With Extraarticular Bone Variably Confounding Estimates of Joint Coverage.

IF 4.2 2区 医学 Q1 ORTHOPEDICS Clinical Orthopaedics and Related Research® Pub Date : 2024-10-09 DOI:10.1097/corr.0000000000003268
Dominic J L Rivas,Stuart Weinstein,Marcus Tatum,Holly D Aitken,Alison Ford,Spencer Dempewolf,Michael C Willey,Jessica E Goetz
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(2) How do intraobserver and interobserver agreement in LCEA and ACEA translate into agreement of the 3D anatomy being evaluated? (3) How distinct are regions around the acetabular rim circumference that are evaluated by LCEA and ACEA measurements on radiographs?\r\n\r\nMETHODS\r\nBetween January 2018 and May 2019, 72 patients were indicated for periacetabular osteotomy to treat hip dysplasia or acetabular retroversion at our institution. From these patients, a series of 10 patients were identified of the first 12 patients in 2018 who were treated with periacetabular osteotomy, excluding two with missing or low-quality clinical imaging. A second series of 10 patients was identified of the first 11 patients in 2019 who were treated with periacetabular osteotomy and concurrent hip arthroscopy, excluding one who was missing clinical imaging. Pelvis and femoral bone surface models were generated from CT scans of these two series of 10 patients. There were 15 female and five male patients, with a median patient age of 18 years (IQR 17 to 23 years), a preoperative LCEA of 22° (IQR 18° to 24°), and a preoperative ACEA of 23° (IQR 18° to 27°). Exclusion criteria included missing preoperative CT or standard clinical radiographic imaging or severe joint incongruity. To address our first study question, digitally reconstructed radiographs matching each patient's standing AP and false-profile clinical radiographs were created from the segmented CT volumes. A board-certified orthopaedic surgeon and three trained researchers measured LCEA and ACEA on the digitally reconstructed radiographs, and the selected sourcil points were projected back into coordinates in the 3D anatomic space. To address our second study question, intraobserver and interobserver agreement in radiographic coverage angles were related to variations in 3D coordinates of the selected bony anatomy. Lastly, to address our third study question, 3D locations around the acetabular rim identified as contributing to the lateral and anterior sourcil points were summarized across patients in a clockface coordinate system, and statistical analysis of the \"time\" separating the 3D acetabular contributions of the sourcil edges was performed.\r\n\r\nRESULTS\r\nThe 3D anatomy contributing to the lateral sourcil was a variable length (27 mm [IQR 15 to 34 mm]) span of the laterosuperior acetabular edges, with contributions by the anterior inferior iliac spine in 35% (7 of 20) of hips. The anterior sourcil reflected a 28-mm (IQR 25 to 31 mm) span of bone from the medial ilium (posterior-medial to the anterior-inferior iliac spine and anterior-lateral to the arcuate line) to the anterior and lateral edges of the acetabulum. Interobserver variability was good for LCEA (intraclass correlation coefficient [ICC] 0.82 to 0.83) and moderate to good for ACEA (ICC 0.73 to 0.79), whereas the agreement in identified 3D sourcil locations varied widely (ICC 0.32 to 0.95). The acetabular edge of the 3D anatomy contributing to the anterior sourcil overlapped the circumferential range of the acetabular rim contributing to the lateral sourcil.\r\n\r\nCONCLUSION\r\nProjection of two-dimensional radiographic landmarks contributing to the diagnosis of structural hip deformity into 3D allowed for the identification of the overlapping bony anatomy contributing to radiographically visible anterior and lateral sourcil edges.\r\n\r\nCLINICAL RELEVANCE\r\nThis work leveraging digitally reconstructed radiographs and 3D pelvis anatomy has found that bone outside the joint contributes to the radiographic appearance of the sourcil and may variably confound estimates of joint coverage. Furthermore, the substantial overlap between the acetabular bone contributing to measurement of the LCEA and ACEA would indicate that these angles measure similar acetabular deformity, and that additional measures are needed to assess anterior coverage independent of lateral coverage.","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"8 1","pages":""},"PeriodicalIF":4.2000,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Orthopaedics and Related Research®","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/corr.0000000000003268","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
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Abstract

BACKGROUND The severity of hip dysplasia is characterized by radiographic measurements that require user definition of the acetabular sourcil edge, a bony landmark for which the corresponding three-dimensional (3D) anatomy is not well defined in any imaging plane. QUESTIONS/PURPOSES To use digitally reconstructed radiographs to determine: (1) What 3D anatomy is contributing to the "acetabular sourcil" location used to make lateral center-edge angle (LCEA) and anterior center-edge angle (ACEA) measurements in standing AP and false-profile radiographic views, respectively? (2) How do intraobserver and interobserver agreement in LCEA and ACEA translate into agreement of the 3D anatomy being evaluated? (3) How distinct are regions around the acetabular rim circumference that are evaluated by LCEA and ACEA measurements on radiographs? METHODS Between January 2018 and May 2019, 72 patients were indicated for periacetabular osteotomy to treat hip dysplasia or acetabular retroversion at our institution. From these patients, a series of 10 patients were identified of the first 12 patients in 2018 who were treated with periacetabular osteotomy, excluding two with missing or low-quality clinical imaging. A second series of 10 patients was identified of the first 11 patients in 2019 who were treated with periacetabular osteotomy and concurrent hip arthroscopy, excluding one who was missing clinical imaging. Pelvis and femoral bone surface models were generated from CT scans of these two series of 10 patients. There were 15 female and five male patients, with a median patient age of 18 years (IQR 17 to 23 years), a preoperative LCEA of 22° (IQR 18° to 24°), and a preoperative ACEA of 23° (IQR 18° to 27°). Exclusion criteria included missing preoperative CT or standard clinical radiographic imaging or severe joint incongruity. To address our first study question, digitally reconstructed radiographs matching each patient's standing AP and false-profile clinical radiographs were created from the segmented CT volumes. A board-certified orthopaedic surgeon and three trained researchers measured LCEA and ACEA on the digitally reconstructed radiographs, and the selected sourcil points were projected back into coordinates in the 3D anatomic space. To address our second study question, intraobserver and interobserver agreement in radiographic coverage angles were related to variations in 3D coordinates of the selected bony anatomy. Lastly, to address our third study question, 3D locations around the acetabular rim identified as contributing to the lateral and anterior sourcil points were summarized across patients in a clockface coordinate system, and statistical analysis of the "time" separating the 3D acetabular contributions of the sourcil edges was performed. RESULTS The 3D anatomy contributing to the lateral sourcil was a variable length (27 mm [IQR 15 to 34 mm]) span of the laterosuperior acetabular edges, with contributions by the anterior inferior iliac spine in 35% (7 of 20) of hips. The anterior sourcil reflected a 28-mm (IQR 25 to 31 mm) span of bone from the medial ilium (posterior-medial to the anterior-inferior iliac spine and anterior-lateral to the arcuate line) to the anterior and lateral edges of the acetabulum. Interobserver variability was good for LCEA (intraclass correlation coefficient [ICC] 0.82 to 0.83) and moderate to good for ACEA (ICC 0.73 to 0.79), whereas the agreement in identified 3D sourcil locations varied widely (ICC 0.32 to 0.95). The acetabular edge of the 3D anatomy contributing to the anterior sourcil overlapped the circumferential range of the acetabular rim contributing to the lateral sourcil. CONCLUSION Projection of two-dimensional radiographic landmarks contributing to the diagnosis of structural hip deformity into 3D allowed for the identification of the overlapping bony anatomy contributing to radiographically visible anterior and lateral sourcil edges. CLINICAL RELEVANCE This work leveraging digitally reconstructed radiographs and 3D pelvis anatomy has found that bone outside the joint contributes to the radiographic appearance of the sourcil and may variably confound estimates of joint coverage. Furthermore, the substantial overlap between the acetabular bone contributing to measurement of the LCEA and ACEA would indicate that these angles measure similar acetabular deformity, and that additional measures are needed to assess anterior coverage independent of lateral coverage.
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影像学上明显的髋臼鞍骨地标由骨盆的相似区域创建,关节外骨会对关节覆盖范围的估计造成不同程度的影响。
背景髋关节发育不良的严重程度以射线测量为特征,需要用户定义髋臼窦边缘,这是一个骨性地标,其相应的三维(3D)解剖结构在任何成像平面上都没有很好的定义。问题/建议使用数字重建的 X 光片来确定:(1) 在立位 AP 和假剖面 X 光片视图中,"髋臼臼缘 "位置的三维解剖结构是什么,分别用于测量外侧中心边缘角 (LCEA) 和前侧中心边缘角 (ACEA)?(2)LCEA 和 ACEA 的观察者内和观察者间的一致性如何转化为所评估的三维解剖结构的一致性?(3)LCEA和ACEA在X光片上的测量所评估的髋臼边缘周缘区域有多明显?在这些患者中,从2018年首批接受髋臼周围截骨术治疗的12名患者中确定了10名系列患者,其中排除了两名临床影像缺失或质量较低的患者。从 2019 年首批 11 名接受髋臼周围截骨术并同时接受髋关节镜检查的患者中确定了第二个系列的 10 名患者,其中排除了一名临床成像缺失的患者。根据这两个系列 10 名患者的 CT 扫描结果生成了骨盆和股骨头表面模型。其中有15名女性患者和5名男性患者,患者年龄中位数为18岁(IQR为17至23岁),术前LCEA为22°(IQR为18°至24°),术前ACEA为23°(IQR为18°至27°)。排除标准包括术前 CT 或标准临床放射成像缺失或关节严重不协调。为了解决我们的第一个研究问题,我们根据分割后的 CT 图像制作了与每位患者的站立 AP 和假轮廓临床 X 光片相匹配的数字重建 X 光片。一名获得认证的骨科外科医生和三名训练有素的研究人员在数字重建的X光片上测量了LCEA和ACEA,并将选定的源点投影到三维解剖空间的坐标中。针对我们的第二个研究问题,观察者内和观察者间的放射覆盖角一致性与所选骨骼解剖结构的三维坐标变化有关。最后,为了解决第三个研究问题,我们在钟面坐标系中汇总了所有患者髋臼边缘周围被确定为有助于外侧和前侧酸钙点的三维位置,并对酸钙边缘的三维髋臼贡献之间的 "时间 "进行了统计分析。结果造成外侧sourcil的三维解剖结构是髋臼后上方边缘的不同长度(27 mm [IQR 15 - 34 mm])跨度,35%的髋关节(20 例中有 7 例)的外侧sourcil是由髂前下棘造成的。前源髂骨反映了从髂骨内侧(髂前下棘的后-内侧和弧形线的前-外侧)到髋臼前缘和外侧边缘的 28 毫米(IQR 25 至 31 毫米)的骨量跨度。LCEA 的观察者间变异性良好(类内相关系数 [ICC] 0.82 至 0.83),ACEA 的观察者间变异性中等至良好(ICC 0.73 至 0.79),而确定的三维髋臼位置的一致性差异很大(ICC 0.32 至 0.95)。结论将有助于诊断髋关节结构性畸形的二维放射学地标投影到三维中,可识别造成放射学上可见的前方和外侧酸模边缘的重叠骨性解剖结构。临床意义这项利用数字重建X光片和三维骨盆解剖学的研究发现,关节外的骨质会影响髋关节的X光外观,并可能对关节覆盖范围的估计造成不同程度的混淆。此外,有助于测量 LCEA 和 ACEA 的髋臼骨之间存在大量重叠,这表明这些角度测量的是类似的髋臼畸形,因此需要额外的测量方法来评估独立于侧方覆盖的前方覆盖。
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来源期刊
CiteScore
7.00
自引率
11.90%
发文量
722
审稿时长
2.5 months
期刊介绍: Clinical Orthopaedics and Related Research® is a leading peer-reviewed journal devoted to the dissemination of new and important orthopaedic knowledge. CORR® brings readers the latest clinical and basic research, along with columns, commentaries, and interviews with authors.
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