ABSTRACT
BACKGROUND: To determine the non-or collapsed osteonecrosis of the femoral head (ONFH) and degree of collapse, can help surgeons design reasonable treatment strategy for patients with ONFH. In China, articular cartilage collapse less than or greater than 2 mm, is a basis for choosing palliative surgery or hip replacement. However, the measurement of collapsed ONFH before replacement has not yet been confirmed. OBJECTIVE: To predict the collapse of femoral head before replacement by CT and X-ray examinations, and to compare with the intraoperative excised femoral head specimens.METHODS: This was a single-center, open-label and diagnostic trial, which was finished at the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China. Eighty-six patients with unilateral ONFH undergoing total hip replacement were recruited, and allocated into three groups, such as X-ray, CT and specimen groups. The X-ray group underwent X-ray examination at anteroposterior pelvic (bilateral hips) at 1 week before surgery, the CT group received CT scan at bilateral hips at 1 week before surgery, and the specimen group was subjected to the removal of affected femoral head, and then directly measured using ruler and vernier caliper. Primary outcome was the sensitivity of thesethree methods for measuring collapsed femoral head. Secondary outcomes were the specificity, positive predictive value,negative predictive value, positive likelihood ratio, and negative likelihood ratio of these three methods for the diagnosisof collapsed femoral head and the diagnostic accuracy; the diagnostic consistence of CT and X-ray examinations; the height of the lateral, middle and external femoral head measured by three methods. The study was approved by the Ethics Committee of the Third Hospital of Hebei Medical University, China, and will be performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Written informed consent will be obtained from all participants prior to the trial. DISCUSSION: In this study, the height of femoral head was measured and analyzed in all-dimensional and multi-anglemanner based on intraoperative removed specimens, so as to make an accurate prediction for collapsed femoral head, thus providing imaging reference for surgeons prior to choosing an appropriate operative scheme
ABSTRACT
BACKGROUND:Accumulating evidence shows that, low molecular heparin can prevent and treat early osteonecrosis of femoral head, but the mechanism remains unclear. The heparin exhibits a dynamic balance with heparanase in vivo, and inhibits heparanase expression. OBJECTIVE:To observe the changes of heparanase and tissue factor pathway inhibitor expression level in plasma and femoral head of patients with idiopathic osteonecrosis of femoral head, and investigate the pathophysiological role of heparanase in the progression of idiopathic osteonecrosis of femoral head. METHODS:A total of 36 patients with idiopathic osteonecrosis of femoral head were randomly divided into four groups according to ARCO I-IV period, with nine patients in each group. Patients with fresh femoral neck fracture for hip arthroplasty were included in the control group. Heparanase and tissue factor pathway inhibitor levels in preoperative venous plasma were measured by ELISA, and in subchondral necrosis bone of ARCO II-IV groups were observed for western blot analysis and hematoxylin-eosin staining. RESULTS AND CONCLUSION:In plasma, heparanase and tissue factor pathway inhibitor levels were significantly increased along with the development of idiopathic osteonecrosis of femoral head compared with control group, the highest levels were found in ARCO III period, and then slightly decreased in ARCO IV period, showing significant differences. The protein levels of heparanase and tissue factor pathway inhibitor in necrosis bone were increased significantly compared with control group, the highest levels occurred in ARCO III period, no obvious difference was found between ARCO II and IV periods. Heparanase and tissue factor pathway inhibitor levels are gradual y increased along with the development of the necrosis, and heparanase plays an important role in idiopathic osteonecrosis of femoral head.