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Yang P, He W, Yang W, Jiang L, Lin T, Sun W, Zhang Q, Bai X, Guo D, Sun W. Panoramic heat map for spatial distribution of necrotic lesions. Bone Joint Res 2024; 13:294-305. [PMID: 38884556 PMCID: PMC11181948 DOI: 10.1302/2046-3758.136.bjr-2023-0181.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
Aims In this study, we aimed to visualize the spatial distribution characteristics of femoral head necrosis using a novel measurement method. Methods We retrospectively collected CT imaging data of 108 hips with non-traumatic osteonecrosis of the femoral head from 76 consecutive patients (mean age 34.3 years (SD 8.1), 56.58% male (n = 43)) in two clinical centres. The femoral head was divided into 288 standard units (based on the orientation of units within the femoral head, designated as N[Superior], S[Inferior], E[Anterior], and W[Posterior]) using a new measurement system called the longitude and latitude division system (LLDS). A computer-aided design (CAD) measurement tool was also developed to visualize the measurement of the spatial location of necrotic lesions in CT images. Two orthopaedic surgeons independently performed measurements, and the results were used to draw 2D and 3D heat maps of spatial distribution of necrotic lesions in the femoral head, and for statistical analysis. Results The results showed that the LLDS has high inter-rater reliability. As illustrated by the heat map, the distribution of Japanese Investigation Committee (JIC) classification type C necrotic lesions exhibited clustering characteristics, with the lesions being concentrated in the northern and eastern regions, forming a hot zone (90% probability) centred on the N4-N6E2, N3-N6E units of outer ring blocks. Statistical results showed that the distribution difference between type C2 and type C1 was most significant in the E1 and E2 units and, combined with the heat map, indicated that the spatial distribution differences at N3-N6E1 and N1-N3E2 units are crucial in understanding type C1 and C2 necrotic lesions. Conclusion The LLDS can be used to accurately measure the spatial location of necrotic lesions and display their distribution characteristics.
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Affiliation(s)
- Peng Yang
- Department of Orthopaedic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Orthopaedic Surgery, Shenzhen Second People's Hospital, Shenzhen, China
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Wei He
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Orthopaedic Surgery, Traumatology & Orthopedics Institute of Chinese Medicine of Guangdong, Guangzhou, China
| | - Weiming Yang
- Department of Orthopaedic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Luoyong Jiang
- Department of Orthopaedic Surgery, Shenzhen Second People's Hospital, Shenzhen, China
| | - Tianye Lin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weichao Sun
- Department of Orthopaedic Surgery, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qingwen Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Orthopaedic Surgery, Traumatology & Orthopedics Institute of Chinese Medicine of Guangdong, Guangzhou, China
| | - Xueling Bai
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Da Guo
- Department of Orthopaedic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Wei Sun
- Department of Orthopaedic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Orthopaedic Surgery, Shenzhen Second People's Hospital, Shenzhen, China
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Chen H, Xue P, Xi H, Gu C, He S, Sun G, Pan K, Du B, Liu X. A Deep-Learning Model for Predicting the Efficacy of Non-vascularized Fibular Grafting Using Digital Radiography. Acad Radiol 2024; 31:1501-1507. [PMID: 37935609 DOI: 10.1016/j.acra.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023]
Abstract
RATIONALE AND OBJECTIVES To develop a fully automated deep-learning (DL) model using digital radiography (DR) with relatively high accuracy for predicting the efficacy of non-vascularized fibular grafting (NVFG) and identifying suitable patients for this procedure. MATERIALS AND METHODS A retrospective analysis was conducted on osteonecrosis of femoral head patients who underwent NVFG between June 2009 and June 2021. All patients underwent standard preoperative anteroposterior (AP) and frog-lateral (FL) DR. Subsequently, the radiographs were pre-processed and labeled based on the follow-up results. The dataset was randomly divided into training and testing datasets. The DL-based prediction model was developed in the training dataset and its diagnostic performance was evaluated using the testing dataset. RESULTS A total of 339 patients with 432 hips were included in this study, with a hip preservation success rate of 71.52% as of June 2023. The hips were randomly divided into a training dataset (n = 324) and a testing dataset (n = 108). The ensemble model in predicting the efficacy of NVFG, reaching an accuracy of 78.9%, a precision of 78.7%, a recall of 96.0%, a F1-score of 86.5%, and an area under the curve (AUC) of 0.780. FL views (AUC, 0.71) exhibited better performance compared to AP views (AUC, 0.66). CONCLUSION The proposed DL model using DR enables automatic and efficient prediction of NVFG efficacy without additional clinical and financial burden. It can be seamlessly integrated into various clinical scenarios, serving as a practical tool to identify suitable patients for NVFG.
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Affiliation(s)
- Hao Chen
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China (H.C., P.X., H.X., C.G., S.H., G.S., B.D., X.L.)
| | - Peng Xue
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China (H.C., P.X., H.X., C.G., S.H., G.S., B.D., X.L.)
| | - Hongzhong Xi
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China (H.C., P.X., H.X., C.G., S.H., G.S., B.D., X.L.)
| | - Changyuan Gu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China (H.C., P.X., H.X., C.G., S.H., G.S., B.D., X.L.)
| | - Shuai He
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China (H.C., P.X., H.X., C.G., S.H., G.S., B.D., X.L.)
| | - Guangquan Sun
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China (H.C., P.X., H.X., C.G., S.H., G.S., B.D., X.L.)
| | - Ke Pan
- Liyang Branch of Jiangsu Provincial Hospital of Chinese Medicine, Changzhou, 213300, Jiangsu, China (K.P.)
| | - Bin Du
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China (H.C., P.X., H.X., C.G., S.H., G.S., B.D., X.L.)
| | - Xin Liu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China (H.C., P.X., H.X., C.G., S.H., G.S., B.D., X.L.).
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陆 舜, 林 天, 何 敏, 何 晓, 何 宪, 田 佳, 魏 腾, 詹 芝, 林 锟, 魏 秋. [Finite element analysis for predicting osteonecrosis of the femoral head collapse based on the preserved angles]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:1394-1402. [PMID: 37987051 PMCID: PMC10662411 DOI: 10.7507/1002-1892.202308072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/27/2023] [Indexed: 11/22/2023]
Abstract
Objective To establish finite element models of different preserved angles of osteonecrosis of the femoral head (ONFH) for the biomechanical analysis, and to provide mechanical evidence for predicting the risk of ONFH collapse with anterior preserved angle (APA) and lateral preserved angle (LPA). Methods A healthy adult was selected as the study object, and the CT data of the left femoral head was acquired and imported into Mimics 21.0 software to reconstruct a complete proximal femur model and construct 3 models of necrotic area with equal volume and different morphology, all models were imported into Solidworks 2022 software to construct 21 finite element models of ONFH with LPA of 45°, 50°, 55°, 60°, 65°, 70°, and 75° when APA was 45°, respectively, and 21 finite element models of ONFH with APA of 45°, 50°, 55°, 60°, 65°, 70°, 75° when LPA was 45°, respectively. According to the physiological load condition of the femoral head, the distal femur was completely fixed, and a force with an angle of 25°, downward direction, and a magnitude of 3.5 times the subject's body mass was applied to the weight-bearing area of the femoral head surface. The maximum Von Mises stress of the surface of the femoral head and the necrotic area and the maximum displacement of the weight-bearing area of the femoral head were calculated and observed by Abaqus 2021 software. Results The finite element models of ONFH were basically consistent with biomechanics of ONFH. Under the same loading condition, there was stress concentration around the necrotic area in the 42 ONFH models with different preserved angles composed of 3 necrotic areas with equal volume and different morphology. When APA was 60°, the maximum Von Mises stress of the surface of the femoral head and the necrotic area and the maximum displacement of the weight-bearing area of the femoral head of the ONFH models with LPA<60° were significantly higher than those of the models with LPA≥60° ( P<0.05); there was no significant difference in each index among the ONFH models with LPA≥60° ( P>0.05). When LPA was 60°, each index of the ONFH models with APA<60° were significantly higher than those of the models with APA≥60° ( P<0.05); there was no significant difference in each index among the ONFH models with APA≥60° ( P>0.05). Conclusion From the perspective of biomechanics, when a preserved angle of ONFH is less than its critical value, the stress concentration phenomenon in the femoral head is more pronounced, suggesting that the necrotic femoral head may have a higher risk of collapse in this state.
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Affiliation(s)
- 舜 陆
- 广州中医药大学第三临床医学院(广州 510405)Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China
| | - 天烨 林
- 广州中医药大学第三临床医学院(广州 510405)Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China
- 广东省中医骨伤研究院(广州 510378)Guangdong Academy of Traditional Chinese Medicine Orthopedics and Traumatology, Guangzhou Guangdong, 510378, P. R. China
| | - 敏聪 何
- 广州中医药大学第三临床医学院(广州 510405)Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China
- 广东省中医骨伤研究院(广州 510378)Guangdong Academy of Traditional Chinese Medicine Orthopedics and Traumatology, Guangzhou Guangdong, 510378, P. R. China
| | - 晓铭 何
- 广州中医药大学第三临床医学院(广州 510405)Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China
- 广东省中医骨伤研究院(广州 510378)Guangdong Academy of Traditional Chinese Medicine Orthopedics and Traumatology, Guangzhou Guangdong, 510378, P. R. China
| | - 宪顺 何
- 广州中医药大学第三临床医学院(广州 510405)Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China
| | - 佳庆 田
- 广州中医药大学第三临床医学院(广州 510405)Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China
| | - 腾飞 魏
- 广州中医药大学第三临床医学院(广州 510405)Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China
| | - 芝玮 詹
- 广州中医药大学第三临床医学院(广州 510405)Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China
| | - 锟 林
- 广州中医药大学第三临床医学院(广州 510405)Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China
| | - 秋实 魏
- 广州中医药大学第三临床医学院(广州 510405)Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China
- 广东省中医骨伤研究院(广州 510378)Guangdong Academy of Traditional Chinese Medicine Orthopedics and Traumatology, Guangzhou Guangdong, 510378, P. R. China
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Lin T, Zhang W, He X, He M, Li Z, He W, Chen Z, Zhang Q, Wei Q. Lateral classification system predicts the collapse of JIC type C1 nontraumatic osteonecrosis of the femoral head: a retrospective study. BMC Musculoskelet Disord 2023; 24:757. [PMID: 37749534 PMCID: PMC10521389 DOI: 10.1186/s12891-023-06890-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 09/16/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSES The aim of this study was to construct a lateral classification system for nontraumatic osteonecrosis of femoral head (NONFH) through three-dimensional reconstruction of the necrotic area to assist in evaluating the prognosis of patients with JIC type C1. METHODS Retrospective analysis of patients with JIC type C1 NONFH from January 2018 to December 2020. All patients were followed up for more than 3.5 years. The patients were divided into collapse group and non-collapse group according to whether the femoral head collapsed during the follow-up.Lateral classification system for femoral head necrosis is constructed through three-dimensional reconstruction of the necrotic area.Comparison of lateral classification system,midsagittal necrosis angle(MNA)and general data between the two groups.Furthermore, ROC curve analysis and survival analysis were performed. RESULTS 318 patients were included in this study.There was a significant difference between the two groups in the lateral classification system (P < 0.05). In addition, the MNA in the collapsed group was significantly greater than that in the non-collapse group(P < 0.05). As revealed by the results of ROC analysis, the cutoff point of MNA was 104.5° (P < 0.05).According to the survivorship analysis, the mean survival time of the hips of patients with MNA less than 104.5°was greater than that of patients with MNA over 104.5° (P < 0.05). The survival rates of 3.5 years femoral head were 45.8%, 33.7%, 14.8%, 93.0%, and 100% for lateral classification system 1, 2, 3, 4, and 5, respectively. CONCLUSION Necrosis involving the anterior aspect of the femoral head is an important risk factor for collapse. The Lateral classification system can effectively predict the femoral head collapse in JIC C1 type NONFH patients, supplementing the deficiency of JIC classification in evaluating the front of the femoral head.
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Affiliation(s)
- Tianye Lin
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Wensheng Zhang
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Xiaoming He
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Mincong He
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Ziqi Li
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Wei He
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Zhenqiu Chen
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Qingwen Zhang
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Qiushi Wei
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China.
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.
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Chen H, He S, Xi H, Xue P, Sun G, Du B, Liu X. Prognosis and risk prediction of bone impaction grafting through femoral head-neck fenestration: a retrospective cohort study. J Hip Preserv Surg 2023; 10:244-252. [PMID: 38162275 PMCID: PMC10757408 DOI: 10.1093/jhps/hnad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 01/03/2024] Open
Abstract
The bone impaction grafting through femoral head-neck fenestration was a favorable hip preservation procedure but without prognosis estimation. This study retrospectively reviewed 79 patients' clinical data (114 hips) with osteonecrosis of the femoral head (ONFH) who underwent this procedure from June 2009 to June 2019. By the end of June 2022, the median survival time of the hip was (74.13 ± 44.88) months, and the success rate of hip preservation was 68.42%. Lateral reserved angle (LPA) and combined reserved angle (CPA) had statistically significant differences (P < 0.001) both in univariate analysis and a multivariate logistic regression model. The multivariate logistic regression model of area under curve (AUC) area of the receiver operating characteristic (ROC) curve was 0.931(sensitivity = 95.00%, specificity = 88.40%, log-rank test: P < 0.01), and the calibration curve indicated good prediction accuracy. The ROC analysis and Cox proportional hazards regression model revealed that the cutoff point of LPA was 50.95° (sensitivity = 95.00%, specificity = 72.09%, log-rank test: P < 0.05) and the cutoff point of CPA was 90.51° (sensitivity = 90.00%, specificity = 90.70%, log-rank test: P < 0.05). A nomogram plot to predict the risk of failure (C-index = 0.873, 95% CI: 0.785 to 0.961) and nomograms for predicting the survival probability at 1, 2 or 3 years whose calibration curves showed excellent prediction accuracy were available for the clinician. Preserved angles (PAs) are valuable in the prediction of prognosis in surgical treatment. The bone impaction grafting through femoral head-neck fenestration can achieve better clinical efficacy, especially for patients with LPA >50.95° and CPA >90.51°.
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Affiliation(s)
- Hao Chen
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Shuai He
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Hongzhong Xi
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Peng Xue
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Guangquan Sun
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Bin Du
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Xin Liu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
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Clinical Application of Shock Wave in the Treatment of Avascular Necrosis of the Femoral Head in the Early and Middle Stages. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:3832670. [PMID: 36262990 PMCID: PMC9553465 DOI: 10.1155/2022/3832670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/20/2022] [Accepted: 09/08/2022] [Indexed: 01/26/2023]
Abstract
In order to observe the clinical efficacy of shock waves in the treatment of avascular necrosis of the femoral head in the early and middle stages, a clinical application method of a shock wave in the treatment of avascular necrosis of the femoral head in the early and middle stages was proposed. The method combines the CT image segmentation technology to further segment the hip joint image, thereby speeding up the treatment speed and achieving a better treatment effect. Experimental results show that CT image segmentation takes 10.9 hours with an average time of 8 seconds, which is faster than other methods. The shock wave is an effective treatment method for early avascular necrosis of the femoral head, and this method will become one of the main methods for the clinical treatment of this kind of disease.
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