ObjectiveTo investigate the value of CT-based radiomics and clinical data in predicting the efficacy of non-vascularized bone grafting (NVBG) in hip preservation, and to construct a visual, quantifiable, and effective method for decision-making of hip preservation. Methods Between June 2009 and June 2019, 153 patients (182 hips) with osteonecrosis of the femoral head (ONFH) who underwent NVBG for hip preservation were included, and the training and testing sets were divided in a 7∶3 ratio to define hip preservation success or failure according to the 3-year postoperative follow-up. The radiomic features of the region of interest in the CT images were extracted, and the radiomics-scores were calculated by the linear weighting and coefficients of the radiomic features after dimensionality reduction. The clinical predictors were screened using univariate and multivariate Cox regression analysis. The radiomics model, clinical model, and clinical-radiomics (C-R) model were constructed respectively. Their predictive performance for the efficacy of hip preservation was compared in the training and testing sets, with evaluation indexes including area under the curve, C-Index, sensitivity, specificity, and calibration curve, etc. The best model was visualised using nomogram, and its clinical utility was assessed by decision curves. ResultsAt the 3-year postoperative follow-up, the cumulative survival rate of hip preservation was 70.33%. Continued exposure to risk factors postoperative and Japanese Investigation Committee (JIC) staging were clinical predictors of the efficacy of hip preservation, and 13 radiomic features derived from least absolute shrinkage and selection operator downscaling were used to calculate Rad-scores. The C-R model outperformed both the clinical and radiomics models in predicting the efficacy of hip preservation 1, 2, 3 years postoperative in both the training and testing sets (P<0.05), with good agreement between the predicted and observed values. A nomogram constructed based on the C-R model showed that patients with lower Rad-scores, no further postoperative exposure to risk factors, and B or C1 types of JIC staging had a higher probability of femoral survival at 1, 2, 3 years postoperatively. The decision curve analysis showed that the C-R model had a higher total net benefit than both the clinical and radiomics models with a single predictor, and it could bring more net benefit to patients within a larger probability threshold. Conclusion The prediction model and nomogram constructed by CT-based radiomics combined with clinical data is a visual, quantifiable, and effective method for decision-making of hip preservation, which can predict the efficacy of NVBG before surgery and has a high value of clinical application.
Objective To summarize our treatment experience for patients with chest injuries in “4•20” Lushan earthquake. Methods Medical records of 17 patients with chest injuries after 2013 Lushan earthquake who were admittedto the Department of Thoracic Surgery，West China Hospital were analyzed retrospectively. The diagnosis of chest injuries was mainly confirmed by medical history，physical examination，X-ray and CT scan of the chest. Clinical characteristics and treatment outcomes were analyzed. Among the 17 patients，there were 14 men and 3 women with their age of 57.3±16.1 years. Results There were 12 patients （70.6%）with crash injury of heavy objects，4 patients （23.5%） with fall injury and 1 patient with road traffic injury. Chest injuries were skin and soft tissue contusion in 17 patients （100%），rib fracturein 15 patients （88.2%） including 1 patient with abnormal respiratory movements，pulmonary contusion in 15 patients （88.2%），hemopneumothorax in 11 patients （64.7%），sternal fracture in 1 patient （5.9%） and bilateral pneumothorax with widespread subcutaneous emphysema in 1 patient （5.9%）. Thirteen patients （76.5%） had concomitant brain，abdominal，orthopedic or nerve injuries. One patient underwent left thoracotomy，clot removal and internal fixation of rib fractures for left coagulated hemothorax and left lower lobe atelectasis. All the 17 patients received timely and effective treatment and there was noin-hospital mortality. Conclusions Mechanisms of earthquake injuries are often complex，and patients often have multipleinjuries. The main types of chest injury are rib fractures and pulmonary contusion. Tube thoracostomy is a simple andeffective treatment strategy for them. Satisfactory pain management and bronchoscopy procedure can effectively help patientswith removal of respiratory secretions and maintenance of airway patency.