The early posterior cortex pixel value ratio: a novel reliable indicator for distraction osteogenesis

Ze Liu; Qi Liu; Min Wang; Chenhan Zhou; Hongbin Guo; Jieyu Liang; Yi Zhang

doi:10.3389/fsurg.2023.1280332

The early posterior cortex pixel value ratio: a novel reliable indicator for distraction osteogenesis

Front Surg. 2023 Oct 30:10:1280332. doi: 10.3389/fsurg.2023.1280332. eCollection 2023.

Authors

Ze Liu^{1

2}, Qi Liu^{1

3}, Min Wang^{2

4}, Chenhan Zhou^{1

2}, Hongbin Guo^{1

2}, Jieyu Liang^{1

2}, Yi Zhang^{1

2}

Affiliations

¹ Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.
² National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
³ Department of Orthopaedics, Seventh Clinical Medical College, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
⁴ Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, China.

Abstract

Aims: We aimed to explore the associations of the early PVR in four cortices with Healing Index (HI), Lengthening Index (LI), and External Fixator Index (EFI) in the bone union and non-union groups.

Methods: A total of 52 patients, including 39 bone union and 13 bone non-union subjects, were recruited in this study. The general characteristics and PVR in four cortices in each group were explored. Afterward, the early PVR in four cortices, including medial, lateral, anterior, and posterior sides, were compared. Finally, the associations of the early PVR in four cortices with HI, LI, and EFI were also investigated.

Results: The general characteristics of these patients were consistent, except for HI (31.54 ± 12.24 vs. 45.08 ± 27.10, P = 0.018) and EFI (57.63 ± 18.15 vs. 71.29 ± 24.60, P = 0.046). The growth of regenerated callus was asymmetrical in the bone union group (the posterior PVR seems to grow faster), whereas no statistical difference was obtained in the bone non-union group. Furthermore, the posterior PVR in the bone union group was significantly higher than that in the bone non-union group (the first month: 0.96 ± 0.17 vs. 0.86 ± 0.06, p = 0.047; the second month: 0.98 ± 0.14 vs. 0.89 ± 0.09, p = 0.041; the third month: 1.00 ± 0.12 vs. 0.92 ± 0.09, p = 0.039). Most importantly, the posterior PVR was inversely associated with HI, LI, and EFI (the first month: r = -0.343, p = 0.041; r = -0.346, p = 0.042; r = -0.352, p = 0.041; the second month: r = -0.459, p = 0.004; r = -0.277, p = 0.101; r = -0.511, p = 0.002; the third month: r = -0.479, p = 0.003; r = -0.398, p = 0.018; r = -0.551, p = 0.001) in the bone union group, respectively. However, this finding was lost in the bone non-union group.

Conclusion: The early posterior cortex PVR seems to grow faster than the medial, lateral, and anterior sides in the bone union group, which represents an asymmetrical development pattern. Moreover, the posterior cortex PVR was negatively associated with HI, LI, and EFI, respectively. The posterior cortex PVR may be a novel and reliable detection index in the process of DO.

Keywords: bone regeneration index; bone union and nonunion; distraction osteogenesis; external fixator; external fixator index; healing index; lengthening index; pixel value ratio.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article.