Prediction of pathological fracture in patients with lower limb bone metastasis using computed tomography imaging
Prediction of pathological fracture in patients with lower limb bone metastasis using computed tomography imaging
复制标题
CT预测下肢骨转移患者病理性骨折
DOI：
10.1007/s10585-020-10053-z
复制
发表时间：
2020
影响因子：
4
通讯作者：
Tanaka Sakae
中科院分区：
文献类型：
--
作者：
Shinoda Yusuke;Sawada Ryoko;Ishibashi Yuki;Akiyama Toru;Zhang Liuzhe;Hirai Toshihide;Oka Hiroyuki;Ohki Takahiro;Ikegami Masachika;Okajima Koichi;Okuma Tomotake;Kobayashi Hiroshi;Goto Takahiro;Haga Nobuhiko;Tanaka Sakae
骨转移引起的下肢病理性骨折可严重影响日常生活活动，因此认识骨折风险至关重要。在生物力学研究中，股骨近端内侧皮质受累（MCI）已被证明会影响骨强度，但尚未在真实的患者中进行研究。在2012年至2019年期间，回顾性检查了161例骨转移瘤的计算机断层扫描（CT）图像。观察到29处骨折，其中14处转移瘤在首次检查时出现病理性骨折，并对50处转移瘤进行了预防性手术。我们使用CT图像提取临床病理学数据，包括患者的背景、股骨近端MCI、部位、大小、周围皮质受累（CCI）、疼痛和转移的性质。进行了考克斯比例风险回归分析，我们建立了预测骨折的整数评分。单因素分析显示MCI、CCI、溶胞性显性病变及疼痛为显著性因素。多变量分析显示MCI和各25%CCI均具有显著性，根据风险比将整数分设为1。满分为4分，其中股骨近端MCI（1分），CCI ≥ 75%（3分）。以2为整数分，预测60天内骨折的敏感性为88.9%，特异性为81.2%。结论：CT检查MCI和CCI是病理性骨折的危险因素。CCI ≥ 50%是一个广为人知的风险因素，但此外，如果在CCI为25-50%的转移瘤中观察到股骨近端MCI，则最好考虑手术。
Lower limb pathological fractures caused by bone metastases can severely impair activities of daily living, so recognizing fracture risk is essential. Medial cortical involvement (MCI) in the proximal femur has been demonstrated to affect bone strength in biomechanical studies, but it has not been investigated in real patients. Between 2012 and 2019, 161 bone metastases with computed tomography (CT) images were retrospectively examined. Twenty-nine fractures were observed including 14 metastases with pathological fractures at the first examination, and prophylactic surgery was performed for 50 metastases. We extracted clinicopathological data using CT images, including patient’s background, MCI in the proximal femur, site, size, circumferential cortical involvement (CCI), pain, and nature of metastasis. Cox proportional hazard regression analyses were performed, and we created integer scores for predicting fractures. We revealed that MCI, CCI, lytic dominant lesion, and pain were significant factors by univariate analyses. By multivariable analysis, MCI and each 25% CCI were significant and integer score 1 was assigned based on hazard ratio. The full score was four points, with MCI in the proximal femur (one point) and ≥ 75% CCI (three points). With integer score two, sensitivity was 88.9% and specificity was 81.2% for predicting fracture within 60 days. In conclusion, MCI and CCI examined by CT images were the risk factors for pathological fracture. CCI ≥ 50% is a widely known risk factor, but in addition, it may be better to consider surgery if MCI in the proximal femur is observed in metastasis with 25–50% CCI.