DataSheet_1_Traumatic rib fracture patterns associated with bone mineral density statuses derived from CT images.docx

BackgroundThe impact of decreased bone mineral density (BMD) on traumatic rib fractures remains unknown. We combined computed tomography (CT) and artificial intelligence (AI) to measure BMD and explore its impact on traumatic rib fractures and their patterns.MethodsThe retrospective cohort comprised patients who visited our hospital from 2017–2018; the prospective cohort (control group) was consecutively recruited from the same hospital from February–June 2023. All patients had blunt chest trauma and underwent CT. Volumetric BMD of L1 vertebra was measured by using an AI software. Analyses were done by using BMD categorized as osteoporosis (120 mg/cm3). Pearson’s χ2, Fisher’s exact, or Kruskal–Wallis tests and Bonferroni correction were used for comparisons. Negative binomial, and logistic regression analyses were used to assess the associations and impacts of BMD status. Sensitivity analyses were also performed.FindingsThe retrospective cohort included 2,076 eligible patients, of whom 954 (46%) had normal BMD, 806 (38.8%) had osteopenia, and 316 (15.2%) had osteoporosis. After sex- and age-adjustment, osteoporosis was significantly associated with higher rib fracture rates, and a higher likelihood of fractures in ribs 4–7. Furthermore, both the osteopenia and osteoporosis groups demonstrated a significantly higher number of fractured ribs and fracture sites on ribs, with a higher likelihood of fractures in ribs 1–3, as well as flail chest. The prospective cohort included 205 eligible patients, of whom 92 (44.9%) had normal BMD, 74 (36.1%) had osteopenia, and 39 (19.0%) had osteoporosis. The findings observed within this cohort were in concurrence with those in the retrospective cohort.InterpretationTraumatic rib fractures are associated with decreased BMD. CT-AI can help to identify individuals who have decreased BMD and a greater rib fracture rate, along with their fracture patterns.

背景：降低的骨矿物质密度（BMD）对创伤性肋骨骨折的影响尚不明确。本研究通过结合计算机断层扫描（CT）与人工智能（AI）技术，测量BMD并探讨其对创伤性肋骨骨折及其形态的影响。方法：回顾性队列研究包括了2017至2018年间就诊于我院的患者；前瞻性队列（对照组）则连续招募自2023年2月至6月间同一医院的患者。所有患者均遭受钝性胸部创伤并接受了CT检查。通过AI软件测量L1椎骨的体积BMD。分析采用以骨质疏松（120 mg/cm³）为分界点的BMD分类。采用Pearson卡方检验、Fisher确切概率检验或Kruskal-Wallis检验，并进行Bonferroni校正进行对比。使用负二项回归分析和逻辑回归分析评估BMD状态的相关性和影响。还进行了敏感性分析。结果：回顾性队列包括2,076名符合条件患者，其中954名（46%）具有正常BMD，806名（38.8%）患有骨量减少，316名（15.2%）患有骨质疏松。调整性别和年龄后，骨质疏松与较高的肋骨骨折率显著相关，以及4至7肋骨折的更高可能性。此外，骨量减少和骨质疏松组在肋骨骨折数量和骨折部位上均显著增加，1至3肋骨折的可能性更高，以及连枷胸的发生。前瞻性队列包括205名符合条件患者，其中92名（44.9%）具有正常BMD，74名（36.1%）患有骨量减少，39名（19.0%）患有骨质疏松。此队列观察到的结果与回顾性队列一致。解释：创伤性肋骨骨折与降低的BMD相关。CT-AI有助于识别BMD降低、肋骨骨折率较高以及骨折模式的患者。