ObjectiveTo investigate the early effectiveness of proximal femur reconstruction combined with total hip arthroplasty (THA) in the treatment of adult Crowe type Ⅳ developmental dysplasia of the hip (DDH).MethodsBetween May 2015 and March 2018, 29 cases (33 hips) suffering from Crowe type Ⅳ DDH were treated with proximal femur reconstruction combined with THA. Of the 29 cases, there were 6 males (7 hips) and 23 females (26 hips), aged from 24 to 74 years with an average age of 44.9 years. The preoperative Harris hip score was 44.0±12.0. Gait abnormalities were found in all of the 33 hips with positive Trendelenburg sign, and the lower limb discrepancy was (3.8±1.6) cm. Preoperative X-ray films and CT both indicated serious anatomical abnormalities, including complete dislocation of the affected hip with significant move-up of the greater trochanter, abnormal development of the femoral neck, abnormal anterversion angle and neck-shaft angle, dysplasia of proximal femur and dysplasia of medullary cavity. The operation time, intraoperative blood loss, transfusion rate, and complications were recorded. The Gruen and DeLee-Charnley zoning methods were used to evaluate the aseptic loosening of the prosthesis on X-ray films. The Harris score was used to evaluate hip function. The lower limb discrepancy was calculated and compared with the preoperative value.ResultsThe operation time ranged from 80 to 240 minutes, with an average of 124.8 minutes. The intraoperative blood loss ranged from 165 to 1 300 mL, with an average of 568.4 mL. Seventeen patients (51.5%) received blood transfusion treatment. All the incisions healed by first intention without infection or deep vein thrombosis. All patients were followed up 19-53 months, with an average of 33 months. One patient had posterior hip dislocation because of falling from the bed at 4 weeks after operation, and was treated with manual reduction and fixation with abduction brace for 4 weeks, and no dislocation occurred during next 12-month follow-up. Two patients developed sciatic nerve palsy of the affected limbs after operation and were treated with mecobalamin, and recovered completely at 12 weeks later. Trendelenburg sign was positive in 3 patients and mild claudication occurred in 4 patients after operation. X-ray films showed that all the osteotomy sites healed at 3-6 months after operation, and no wire fracture was observed during the follow-up. The Harris score was 89.8±2.8 and lower limb discrepancy was (0.6±0.4) cm at last follow-up, both improved significantly (t=–22.917, P=0.000; t=11.958, P=0.000). The prosthesis of femur and acetabulum showed no obvious loosening and displacement, and achieved good bone ingrowth except 2 patients who had local osteolysis in the area of Gruen 1 and 7 around the femoral prosthesis, but no sign of loosening and sinking was observed.ConclusionThe treatment of Crowe Ⅳ DDH with proximal femur reconstruction and THA was satisfactory in the early postoperative period. The reconstruction technique of proximal femur can effectively restore the anatomical structure of proximal femur, which is one of the effective methods to deal with the deformity of proximal femur.
ObjectivesTo evaluate the accuracy of liver cancer screening techniques to inform screening intervention and early diagnosis.MethodsWe searched PubMed, The Cochrane Library, EMbase, Web of Science, CNKI, WanFang Data, CBM, VIP databases to collect relevant diagnostic accuracy studies of screening technologies for liver cancer from January 1980 to December 2017. Two reviewers independently screened the literature, extracted the data and assessed the risk of bias of included studies. Then meta-analysis was performed by using Meta-Disc 1.4 software.ResultsA total of 54 publications with 47 728 individuals were included. In terms of pooled sensitivity from the meta-analysis, it was estimated as 0.71 (95%CI 0.70 to 0.72), 0.57 (95%CI 0.56 to 0.59) and 0.43 (95%CI 0.41 to 0.45); the pooled specificity was estimated as 0.92 (95%CI 0.92 to 0.93), 0.95 (95%CI 0.94 to 0.96) and 0.95 (95%CI 0.94 to 0.96); the pooled positive likelihood ratio was 5.65 (95%CI 4.37 to 7.30), 13.24(95%CI 4.25 to 41.22) and 11.39 (95%CI 4.01 to 32.35); the pooled negative likelihood ratio was 0.35 (95%CI 0.31 to 0.39), 0.38 (95%CI 0.29 to 0.52) and 0.49 (95%CI 0.39 to 0.62); the diagnosis odds ratio was 17.23 (95%CI 12.26 to 24.20), 33.79 (95%CI 12.65 to 90.24) and 24.41(95%CI 9.23 to 64.53) for AFP alone with cut-off of 20, 200 and 400 ng/mL, respectively. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnosis odds ratio were 0.65 (95%CI 0.62 to 0.69), 0.97 (95%CI 0.97 to 0.97), 16.48 (95%CI 9.55 to 28.42), 0.27 (95%CI 0.18 to 0.42) and 64.54 (95%CI 30.16 to 138.11) for ultrasound examination alone. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnosis odds ratio were 0.96 (95%CI 0.94 to 0.98), 0.96 (95%CI 0.96 to 0.96), 10.76 (95%CI 2.62 to 44.27), 0.07 (95%CI 0.02 to 0.22) and 160.59 (95%CI 31.61 to 816.03) for the combined strategy.ConclusionFor liver cancer screening technologies, the overall accuracy of serum AFP test alone is the optimum at cut-off of 20 ng/mL, and the sensitivity increased substantially when combined with ultrasound examination.