Objective To study the operative methods and therapeutic effects of acetabulum reinforcement ring in the reconstruction of acetabular defects in primary and revisional artificial hip replacement. Methods From November 2000 to July 2005, 14 cases (15 hips) of severe acetabular defects in artificial hip replacement were treated with acetabulum reinforcement ring combined autogenous or allogenic bone transplantation, including 7 males and 8 females aged 34-72 years with an average of 55 years. Among them, 9 cases (9 hips) underwent artificial hip joint revision, which was 3-22 years (average8.9 years) far away from their primary replacement, and 5 cases (6 hi ps) received primary replacement, including 1 case of rheumatoid arthritis of both hips, 1 osteoarthritis caused by acetabular dysplasia, 1 femoral head resection due to debridement of hi p infection, 1 nonunion of acetabulum old fracture with the center dislocation of femoral head and 1 old acetabulum fracture. The disease course was 2-25 years (average 11.6 years). According to the American Academy of Orthopaedic Surgeons (AAOS) classification, the acetabulum defects of 7 hips were categorized into Type II, 6 hips were Type III and 2 hips were Type IV. Harris score was (59.1 ± 15.4) points preoperatively. Results All wounds were healed by first intention. The symptom of sciatic nerve simulation was occurred in 1 case and was rel ieved after taking neuroprotective drug for 5 months. All the cases were followed up for 33-90 months (average 51.3 months). Harris score at the final follow-up was (81.9 ± 10.4) points, indicating there was a significant difference between before and after operation (P lt; 0.01). X-ray film demonstrated that the displacement of acetabulum reinforcement ring and acetabular cup was less than 5 mm, the rotation was less than 5°, and there was no progressive radiolucent zone around acetabulum and screw. Conclusion Acetabulum reinforcement ring is beneficial to reconstruct severe acetabular defects, improve hip joints’ function and provide primary stabil ity for putting acetabular cup into an ideal biomechanical position.
During the past decades, the field of hip preservation in China has achieved great improvements. Theoretically, the blood supply of the femoral head and the acetabulum along with the mechanism of early-stage hip osteoarthritis has been gradually cleared. The knowledge and application of the periacetabular osteotomy, surgical hip dislocation, and hip arthroscopy has been vigorously promoted. Improved understanding of the mechanism, pathology, and prevention protocols of the secondary hip dysplasia have been obtained, despite the fact that lack of awareness of some mechanism and detail, for example, hip instability or borderline dysplasia, etc. On the basis of summing up those clinical progress, this article further elaborated the historical development of hip preservation through the review of several traditional treatment, and made objective assessment about the follow-up, evaluation, minimally invasive surgery, and individualized treatment newly reported.
ObjectiveTo investigate the clinical value of artificial intelligence (AI)-assisted chest computed tomography (CT) in the diagnosis of peripheral lung shadow. MethodsThe CT image data of 810 patients with peripheral pulmonary shadow treated by thoracic surgery in Tianjin Chest Hospital Affiliated to Tianjin University from January 2018 to July 2019 were retrospectively analyzed using AI-assisted chest CT imaging diagnosis system. There were 339 males and 471 females with a median age of 63 years. The malignant probability of preoperative AI-assisted diagnosis of peripheral pulmonary shadow was compared with the results of postoperative pathology. ResultsThe pathological diagnosis of 810 patients with peripheral pulmonary shadow was lung cancer in 627 (77.4%) patients, precancerous lesion in 30 (3.7%) patients and benign lesion in 153 (18.9%) patients. The median probability of malignant AI diagnosis before operation was 86.0% (lung cancer), 90.0% (precancerous lesion) and 37.0% (benign lesion), respectively. According to the analysis of receiver operating characteristic (ROC) curve of AI malignant probability distribution in this group of patients, the area under the ROC curve was 0.882. The critical value of malignant probability for diagnosis of lung cancer was 75.0% with a sensitivity of 0.856 and specificity of 0.814. A total of 571 patients were diagnosed with AI malignancy probability≥75.0%, among whom 537 patients were pathologically diagnosed as lung cancer with a positive predictive value of 94.0% (537/571). ConclusionThe AI-assisted chest CT diagnosis system has a high accuracy in the diagnosis of peripheral lung cancer with malignant probability≥75.0% as the diagnostic threshold.
ObjectiveTo explore the clinical pattern of intrapulmonary lymph node metastasis and the significance of No.13 and No.14 lymph nodes biopsy in patients with non-small cell lung cancer (NSCLC).MethodsThe clinical data of 234 patients with primary peripheral NSCLC who underwent systemic dissection of intrathoracic lymph nodes and intrapulmonary lymph nodes in the First Affiliated Hospital of Chongqing Medical University between 2013 and 2015 were retrospectively analyzed. There were 159 males and 75 females, aged 36-89 (61.35±8.57) years. Statistical analysis was performed accordingly on hilar (No.10), interlobar (No.11), lobar (No.12) and segmental (No.13 and 14) sites of the samples of N1 lymph nodes after surgery.ResultsA total of 3 019 lymph nodes of No.10-14 were dissected in 234 patients (12.9 per patient). The 263 lymph nodes were positive with a rate of 8.71% (263/3 019) and lymph node metastasisa occured in 99 patients with a rate of 42.31% (99/234), among whom there were 40 patients of N1 metastasis, 48 of N1+N2 metastasis and 11 of N2 skipping metastasis. Routine pathological examination demonstrated No.13 and No.14 lymph nodes metastasis in 16 patients with a rate of 6.84% (16/234). In 886 dissected lymph nodes of No.13 and No.14, 86 lymph nodes showed metastasis with a rate of 9.71% (86/886). Of the patients with swelling hilar and mediastinal lymph nodes reported by preoperative CT scan, only 56.32% of them were confirmed with lymph node metastasis by postoperative histopathology; while 34.01% of the patients with normal size lymph nodes had lymph node metastasis.ConclusionIn the surgical treatment of NSCLC, it is necessary to detect the metastasis of No. 13 and 14 lymph nodes and non-tumor parabronchial lymph nodes, which is helpful to obtain accurate postoperative TNM staging and is of great significance for guiding postoperative treatment. Preoperative CT is not a reliable method to judge lymph node metastasis, particularly for intrapulmonary lymph node metastasis.
Objective To investigate the effects of femoral offset and mechanical axis of the lower extremity on hip after osteotomy for adult developmental dysplasia of the hip (DDH). Methods A clinical data of 62 adult patients with DDH (62 hips), who underwent periacetabular osteotomy combined with femoral osteotomy between January 2016 and May 2019 and met selective criteria, was retrospectively analyzed. There were 6 males and 56 females. The age ranged from 18 to 38 years, with an average of 24.4 years. Body mass index ranged from 15.8 to 31.8 kg/m2, with an average of 21.8 kg/m2. There were 44 cases of Hartofilakidis typeⅠ and 18 cases of typeⅡ. According to the modified Tönnis osteoarthritis staging, 46 cases were stage 0 and 16 cases were stageⅠ. There were 13 cases with pelvic anteversion, 40 cases with normal pelvis, and 9 cases with pelvic retroversion. Intraoperative blood loss, length of hospital stay, and complications were recorded. Postoperative hip function was evaluated by Harris score and International Hip Outcome Tool (iHOT) score. The femoral offset, collo-diaphyseal angle, hip-knee-ankle angle (HKA), knee valus angle, CE (Wiberg central-edge angle), anterior CE angle, and acetabular index angle were measured and the osteotomy healing was observed on X-ray films. Patients were grouped according to postoperative femoral offset (≥48 mm or <48 mm) and HKA [varus group (HKA<177°), normal group (HKA 177°-183°), and valgus group (HKA>183°)]. Harris score and iHOT score were compared between groups. Results Intraoperative blood loss ranged from 200 to 1 550 mL, with an average of 476 mL. The length of hospital stay ranged from 8 to 21 days, with an average of 13.3 days. All incisions healed by first intention. All patients were followed up 2.0-4.5 years, with an average of 2.8 years. At 1 year after operation, the Harris score and iHOT score of the hip joint significantly increased when compared with those before operation (P<0.05); there were significant differences in the femoral offset, collo-diaphyseal angle, HKA, knee valus angle, CE angle, anterior CE angle, and acetabular index angle between pre- and post-operation (P>0.05). According to the modified Tönnis osteoarthritis staging, 38 cases were stage 0 and 24 cases were stageⅠ; and there was no significant difference between pre- and post-operation (χ2=2.362, P=0.124). There were 11 cases with pelvic anteversion, 38 cases with normal pelvis, and 13 cases with pelvic retroversion, showing no significant difference when compared with that before operation (χ2=0.954, P=0.623). The pubic branch osteotomy did not heal in 9 cases, proximal femur osteotomy did not heal in 2 cases, and inferior pubic ramus stress fracture occurred in 5 cases. There were significant differences (P<0.05) in the Harris score and iHOT score between femoral offset≥48 mm group (n=10) and femoral offset<48 mm group (n=52). There was no significant difference (P>0.05) in Harris score and iHOT score between varus group (n=13), normal group (n=40), and valgus group (n=9). Conclusion Periacetabular osteotomy combined with femoral osteotomy can improve the femoral offset and mechanical axis of the lower extremity of patients with DDH, and improve the functional score of the hip. However, excessive increase of femoral offset during femoral osteotomy is not desirable, resulting in low postoperative functional score.
ObjectiveTo investigate the effects of meniscectomy and transplantation repair of the knee on the stress area and average pressure of the tibiofemoral articular surface so as to provide a reference for the relevant basic and clinical researches. MethodsSeven qualified right knee joints from adult men cadavers were selected. Required structure was retained after careful dissection. The pressure-sensitive paper was clipped to the proper size in accordance with the measured size of the tibial platform to reserve. The experiment was divided into 4 groups: normal knee group (group A), knee meniscus injury group (group B), knee meniscectomy group (group C), and knee meniscus transplantation group (group D). A horizontal incision above the meniscus was made in the position of knee joint capsule, and the pressure-sensitive paper was placed into the medial and lateral space of the knee joint, then the proximal tibia and distal femur were fixed stably and finally a universal mechanical machine was used for testing in appropriate environmental conditions (the knee joints were given longitudinal 700 N pressure at 0° extension and 30, 60, 90, and 120° flexion for continuous 120 seconds) until the full color reaction. The knee models were prepared, and then the universal mechanical machine was used to perform a test according to the method stated above respectively. The pressure-sensitive paper was removed, and the color negative films were separated and marked. Colorful image analysis system was used to calculate and analyze the stress area and average pressure after the scanner being used to collect image information. ResultsThe stress area was gradually reduced and the average pressure was gradually increased with increasing flexion angle of the knee. There was significant difference in the stress area and the average pressure between various flexion angles in 4 groups (P<0.05). Group C had significantly lower stress area and significantly higher average pressure than the other 3 groups (P<0.05), but no significant difference was found among groups A, B, and D (P>0.05). ConclusionThe stress of the tibiofemoral articular surface significantly increases after knee meniscus injury or resection, and the average pressure significantly increases. The stress of the tibiofemoral articular surface can be restored to almost normal after meniscus transplantation. Therefore, the injured meniscus should also be retained or repaired in the static state.
ObjectiveTo clarify the structure and biomechanical characteristics of the dura mater of the cervical, thoracic, and lumbar segments of sheep, in order to provide a theoretical reference for the study of artificial dura mater.MethodsFive adult male white sheep were sacrificed. The dura mater of C5, T10, and L3 planes were obtained. The histological HE staining was used to observe the internal structure and the thickness of dura mater; the inner and outer surfaces morphology of the dura was observed by scanning electron microscopy (SEM); transmission electron microscopy (TEM) was used to observe the internal structure of dura mater and to measure the diameter of collagen fibers in each part of dura mater. The dura mater of C6, C7, T11, T12, L4, and L5 planes were taken for uniaxial biomechanical test, and modulus of elasticity, tensile strength, and elongation at break were measured.ResultsHE staining showed that the thickness of the cervical, thoracic, and lumbar dura mater gradually decreased, and the thickness of the dura mater was (268.19±15.91), (198.16±27.25), (103.74±21.54) μm, respectively, and the differences were significant (P<0.05). SEM observation showed that there were more collagen fibers and fewer cells on the inner surface of the dura mater, while more cells were distributed on the outer surface, and the cells on the inner and outer surface were stretched along the longitudinal axis. TEM observation showed that the collagen fibers in the dura mater were interlaced and arranged in layers. The collagen fibers in the lamina were arranged in the same direction, and the collagen fibers between the lamina were arranged vertically. The diameters of collagen fibers in the cervical, thoracic, and lumbar dura mater were (68.04±21.00), (64.54±20.64), (60.36±19.65) nm, respectively, and the differences were not significant (P>0.05). Uniaxial biomechanical tests results showed that there was no significant difference in modulus of elasticity, tensile strength, and elongation at break between the axial and transverse dura mater of the cervical dura mater (P>0.05); the axial data of thoracic and lumbar segments were significantly larger than the transverse data (P<0.05). The axial modulus of elasticity, tensile strength, and elongation at break of the dura mater of the cervical, thoracic, and lumbar dura mater were significantly different (P<0.05) from the transverse ones, and showing a decreasing trend. Among them, the ratio of axial and transverse modulus of elasticity of cervical and thoracic dura were significantly smaller than that of lumbar segment (P<0.05), and there was no significant difference between cervical segments and thoracic segments (P>0.05).ConclusionThe thickness of dura mater in sheep decreased gradually from head to tail. There are more collagen fibers and fewer cells on the inner surface of dura mater, while the outer surface of dura mater is covered by cells. The collagen fiberboard layers in the dura mater are arranged alternately, and have obvious anisotropic biomechanical characteristics, and the anisotropic biomechanical characteristics get more significant from the head to the tail.