دانلود رایگان مقاله سنجش و ارزیابی آسیب استخوان گلنوئید

abstract

The preoperative assessment of anterior glenoid bone loss is a critical step in surgical planning for patients with recurrent anterior glenohumeral instability. The structural integrity of the glenoid has been identified as one of the most important factors influencing the success of operative repair. The currently accepted gold standard for glenoid structural assessment among most orthopaedic surgeons is the use of 3-dimensional reconstructed computed tomography images with the humeral head digitally subtracted, yielding an en face sagittal oblique view of the glenoid. This view allows for evaluation of glenoid morphology and quantitative assessment of glenoid bone loss. In this article, we describe the practical application of ImageJ software (National Institutes of Health, Bethesda, MD) to quantify the amount of glenoid bone loss reported as a percentage of either total surface area or diameter. The following equations are used in this technical note for the diameter-based method and surface area method, respectively: Percent bone loss = (Defect width/Diameter of inferior glenoid circle) × 100% and Percent bone loss = (Defect surface area/Surface area of inferior glenoid circle) × 100%. The authors report the following potential conflict of interest or source of funding: J.T.H. receives support from Nuvasive and Novartis Ig. S.B. receives support from Nova Publishing (royalties as coeditor of book entitled “Ligamentous Injuries of the Knee”) and Stryker Pivot Sports Medicine and Smith & Nephew (educational support). A.A.R. receives support from American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Orthopedics, Orthopedics Today, SAGE, SLACK, Wolters Kluwer Health, Arthrex, Saunders/Mosby-Elsevier, and DJO Surgical, Ossur, and Smith & Nephew (research support). A.B.Y. receives support from Arthrex and NuTech (research support). N.N.V. receives support from American Shoulder and Elbow Surgeons, Arthroscopy Association Learning Center, Journal of Knee Surgery, SLACK, Minivasive, Orthospace, Smith & Nephew, Arthroscopy, Vindico Medical Orthopedics Hyperguide, Cymedica, Minivasive, Omeros, Arthrex, Arthrosurface, DJ Orthopaedics, Athletico, ConMed Linvatec, Miomed, and Mitek.

Discussion

In this technical note, we describe the use of the surface area method and diameter method for quantification of glenoid bone loss as a percentage using the ImageJ program. Currently, 3D CT imaging is the most reliable imaging modality to evaluate glenoid bone loss and morphology for preoperative surgical planning in cases of anterior stabilization procedures.7 Sugaya et al.10 first described the use of the circle method to quantify the percentage of bone loss by modeling the inferior glenoid as a perfect circle. The technique we present uses the same concept with the publicly available ImageJ program. ImageJ has previously been applied in the evaluation of the reproducibility of unilateral CT measurements of glenoid surface area.11 The authors found that the normal inferior glenoid surface is very similar to a perfect circle and can be modeled as such for preoperative assessment of glenoid bone loss. The diameter method is another commonly used method to evaluate glenoid bone loss, which we also demonstrate in this technical note. The line drawn within ImageJ that represents the diameter of the circle was drawn perpendicular to the defect border according to similar findings by Altan et al.12 The diameter method is frequently used because of its ease of use; however, Bhatia et al.13 reported that determining the percentage of glenoid bone loss based on the glenoid diameter is inconsistent with a surface areaebased method. They found that the diameter method calculation overestimated glenoid bone loss by approximately 4% when compared with the geometric calculation of surface area of a circular segment. The maximum error occurred when the glenoid defect width was 20% of the diameter of the glenoid/circle. Understanding the measurement differences between the surface area method and diameter-based method of bone loss (Tables 1 and 2) is critical when describing indications for bone reconstruction procedures. When authors or surgeons are providing recommendations regarding the amount of bone loss, which indicates bone reconstruction, they must specify which measurement method is being used for the calculation.