使用普通X线平片评估肋软骨钙化

文献信息

中文摘要

背景： 肋软骨是结构性鼻整形术的重要自体移植物，但钙化会使手术规划和移植物处理复杂化。胸部计算机断层扫描是常规评估方法，但由于辐射暴露和费用问题并未常规使用。
目的： 使用普通肋骨系列X线摄影评估接受鼻整形术患者肋软骨钙化的患病率、形态学模式及预测因素。
方法： 两名评估者共同评估183例鼻整形患者（1,098个肋骨节段）术前胸片上的双侧第6-8肋软骨，对钙化进行分级（0-4级）并分类形态学模式（边缘型、颗粒型或中央型）。多变量logistic回归确定钙化存在和严重程度的独立预测因素。
结果： 54.1%的节段存在肋软骨钙化（≥1级），女性患病率（62.9% vs 46.6%，P < 0.001）和严重程度显著高于男性。男性钙化主要为边缘型（95.4%），而女性分别有15.1%和17.6%表现为颗粒型和中央型。重度钙化（≥3级）在40-49岁组意外达到峰值（25.8%），而非在更年长患者中。在多变量分析中，女性（OR 3.01；95% CI，1.11-8.12）和年龄40-49岁（OR 6.28；95% CI，1.69-23.36）是重度钙化的独立预测因素。
结论： 即使对于较年轻的候选者，也应考虑常规肋骨系列成像，以优化供区选择并避免意外的术中发现。

英文摘要

BACKGROUND: Costal cartilage is a vital autologous graft for structural rhinoplasty, but calcification complicates surgical planning and graft manipulation. Chest computed tomography is the conventional evaluation method but is not routinely used owing to radiation exposure and cost.
OBJECTIVES: To evaluate, using plain rib series radiography, the prevalence, morphological patterns, and predictors of costal cartilage calcification in patients undergoing rhinoplasty.
METHODS: Two reviewers jointly assessed bilateral 6th-8th costal cartilages from 183 rhinoplasty patients (1,098 rib segments) on preoperative chest radiographs, grading calcification (0-4) and classifying morphological pattern (marginal, granular, or central). Multivariable logistic regression identified independent predictors of calcification presence and severity.
RESULTS: Costal cartilage calcification (grade ≥1) was present in 54.1% of segments, with significantly higher prevalence (62.9% vs 46.6%, P < 0.001) and severity in females than males. Calcification was predominantly marginal in males (95.4%), whereas 15.1% and 17.6% of females showed granular and central patterns, respectively. Severe calcification (grade ≥3) peaked unexpectedly in the 40-49-year group (25.8%) rather than in older patients. On multivariable analysis, female sex (OR 3.01; 95% CI, 1.11-8.12) and age 40-49 years (OR 6.28; 95% CI, 1.69-23.36) were independent predictors of severe calcification.
CONCLUSIONS: Routine rib series imaging should be considered even in younger candidates to optimize donor site selection and avoid unexpected intraoperative findings.