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Objective:To investigate effects of bone-resorptive lesion on stress distribution of femoral head and on progression in patients with osteonecrosis of the femoral head (ONFH).Methods:From April 2014 to September 2018, a total of 155 femoral heads from 94 patients diagnosed with ARCO stage II and III ONFH were retrospectively reviewed, including 77 males and 17 females with aged 39.90±10.45 years old (ranged from 18-64 years). The hips were divided into two groups according to whether there were bone-resorptive lesions. Further, we compared whether there was statistical difference between the two groups in staging. Then, a case of ARCO II hip joint without bone-resorptive lesion was selected from the included patients. Six femoral head with different diameters of spherical bone-resorptive lesion of 5 mm, 7 mm, 10 mm, 14 mm, 18 mm, and 23 mm were simulated. The influence of bone-resorptive lesion on the stress distribution of necrotic area and a spherical shell extending 1 mm radially around the bone-resorptive lesion was investigated by finite element method in slow walking conditions.Results:Of the 155 ONFH hips, 67 hips are complicated by bone-resorptive lesions, of which 17 were ARCO II, 50 were ARCO III. A total of 88 hips did not contain bone-resorptive lesions, of which 58 were ARCO II, ARCO III 30 cases. The proportion of ARCO stage II in the group with bone-resorptive lesions was significantly higher than that in the group without bone-resorptive lesions (χ 2=25.03, P=0.000). The finite element stress distribution cloud diagram showed that there was a stress concentration area around the bone-resorptive lesions. The maximum von Mises stress around bone-resorptive lesions in the models that contained a synthetic bone-resorptive lesions were significantly higher than those reported in the matched, non-synthetic bone-resorptive lesions finite element models ( t=3.139, P=0.026). The values for maximum von Mises stress around bone-resorptive lesions were 6.94±1.78 MPa and 5.01±0.35 MPa for the group with synthetic bone-resorptive lesions and the group non-synthetic bone-resorptive lesions, respectively. There was a positive correlation between the diameter of bone-resorptive lesions and the maximum and mean von Mises stress of necrotic areas as well as the maximum von Mises stress around bone-resorptive lesions. Conclusion:Bone-resorptive lesions can increase the maximum stress and average stress in the necrotic area. The larger the bone-resorptive lesion, the more the stress increases. There is a stress concentration area around the bone-resorptive lesions, which may accelerate the collapse of the femoral head.
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Objective To analyze the diagnostic value of serum tumor markers in bone metastasis of non-small cell lung cancer (NSCLC).Methods The clinical data and follow-up data of 160 patients with NSCLC from March 2013 to September 2015 in Tangshan People's Hospital were retrospectively analyzed.According to the status of bone metastasis,the patients were divided into the observation group with bone metastasis (n =114) and the control group without bone metastasis (n =46).The positive rates and concentrations of 4 tumor markers including carcinoembryonic antigen (CEA),carbohydrate antigen CA125,CA19-9 and Ferritin were analyzed and compared.And their sensitivities and specificities to the diagnosis of NSCLC bone metastasis were analyzed.The Youden index was calculated to capture the performance of the diagnostic test.Results The concentrations of CEA,CA125,CA19-9 and Ferritin in the observation group were (19.74 ±6.71) μg/L,(45.62 ± 19.53) kU/L,(35.89 ± 15.66) kU/L and (334.02 ± 79.43) μg/L respectively,which were higher than those in the control group [(2.36 ± 0.92) μg/L,(14.37 ± 5.43) kU/L,(15.31 ±7.22) kU/L,(122.58 ± 69.46) μg/L],and the differences were statistically significant (t =7.200,P ＜0.001;t=7.180,P＜0.001;t =6.032,P ＜0.001;t=11.152,P＜0.001).The positive rates of CEA,CA125,CA19-9 and Ferritin in the observation group were 78.95％,68.42％,52.63％ and 73.68％ respectively,which were higher than those in the control group (8.70％,4.35％,4.35％ and 13.04％),and the differences were statistically significant (x2 =66.746,P ＜ 0.001;x2=53.822 P ＜ 0.001;x2 =32.193,P ＜0.001;x2 =48.975,P ＜ 0.001).The sensitivities of CEA,CA125,CA19-9 and Ferritin were 78.94％,68.42％,52.63％ and 73.68％ respectively,and the specificities of them were 91.30％,95.65％,95.65％ and 86.96％ respectively.The Youden indexes were 70.24％,64.07％,48.28％ and 60.64％ respectively.The sensitivity and specificity of multi-factorial combination were 99.17％ and 72.63％,and the Youden index was 71.80％.Conclusion Four tumor markers including CEA,CA125,CA19-9 and Ferritin were correlated with NSCLC,and combined detection has better performance of dignosis than single factor.
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Objective@#To investigate the methods and short-time clinical results of reconstruction of Paprosky type Ⅲ acetabulum bone defects by using tantalum augments.@*Methods@#A total of 17 patients (17 hips) with Paprosky type Ⅲ acetabulum bone defects, treated with tantalum augments in revision of total hip arthroplasty at Department of Orthopedics Surgery in General Hospital of Chinese People′s Liberation Army were retrospectively analyzed from March 2014 to May 2016.There were 6 males and 11 females aged from 23 to 74 years with an average of (50.2±16.3) years. Tantalum augments or TM-Cup augment (the cup-on-cup technique) were used to reconstruct the defects.The TM-Cup augment was the tantalum revision cup which was removed titanium ring. The cup-on-cup technique combined TM-Cup augment and biological acetabulum cup. Augments were served as the nonresorptive structural allograft in revision of total hip arthroplasty. Harris hip score was used to evaluate clinical effects. The vertical position of the rotation center was measured and analyzed. Radiographic assessments of the acetabular components were performed by DeLee-Charnley and the Anderson criteria and recorded postoperative complications.@*Results@#All the patients were followed up from 3 to 29 months with an average of (16.2±5.4) months, tantalum augments and biological acetabulum cup were used in 13 patients, the TM-Cup augment and biological acetabulum cup were used in 4 patients. At the time of the latest follow-up, the mean Harris hip score increased compared to preoperatively (86.8±8.3 vs. 30.0±12.0) (t=12.78, P<0.01), the average vertical location of the center of rotation was decreased ((25.3±9.8) mm vs.(47.6±10.5)) mm (t=4.95, P<0.01). All the tantalum augments and biological acetabulum cups were stable, there were no infection, dislocation and other complications.@*Conclusions@#The use of tantalum augments could be considered as an effective management of Paprosky type Ⅲ defects providing good clinical and radiographic outcomes in the short term.The cup-on-cup technique which was used in reconstruction of severe superior-invagination acetabular bone defects and restoration relatively normal center of rotation had special application value.