Abstract:Objective Patellar morphology abnormalities are considered as a high-risk factor for patellar dislocation,and animal experiments have shown that early patellar dislocation can lead to abnormal development of patellar morphology.The purpose of this experiment is to study whether early reduction can improve the development of patellar morphology in rabbits in a patellar dislocation model.Methods 45 rabbits aged 2 months were selected and randomly divided into 3 groups,with 15 rabbits in each group.Group 1 and Group 2 underwent patellar dislocation surgery,while Group 3 underwent sham surgery.One month later,Group 2 underwent patellar reduction.The changes in patellar morphology of each group were analyzed at 1 month and 3 months after patellar reduction.Results At 1 month postoperatively,compared with Group 1,Group 3 demonstrated greater patellar width and a smaller Wiberg angle(P＜0.05).The Wiberg angle in Group 2 was smaller than that in Group 1(P＜0.05),while no statistically significant differences were observed in the remaining parameters.At 3 months postoperatively,compared with Group 1,both Groups 2 and 3 exhibited greater patellar width and thickness,along with a smaller Wiberg angle(P＜0.05).Additionally,the patellar articular surface in Group 1 appeared significantly flattened.The Wiberg index in Group 3 was lower than that in Group 1(P＜0.05).Conclusion Patellar dislocation can lead to morphological changes in the patella,and early reduction of the patella can improve the degree of patellar morphological abnormalities.

Abstract:Objective To observe changes in serum sphingosine-1-phosphate(S1P)levels in patients with osteoporosis and pathological fractures before and after treatment with Denosumab or Teriparatide,and to analyze the correlation between S1P and bone mineral density(BMD)as well as bone metabolism markers.Methods This retrospective cohort study enrolled 72 patients with osteoporosis and fragility fractures diagnosed at the Second Hospital of Shanxi Medical University between June 2023 and March 2024.The cohort included 11 males and 61 females,aged 51～88 years with a mean age of(70.89±9.66)years.The mean age at menopause for female patients was(49.51±3.84)years.Based on the specific anti-osteoporosis medication initiated,the 72 patients were divided into two groups:A Denosumab treatment group(n=40)and a Teriparatide treatment group(n=32).We analyzed baseline biochemical parameters,S1P,total procollagen type Ⅰ N-terminal propeptide(P1NP),and β-isomerized C-terminal telopeptides(β-CTX)levels before and after 6 months of treatment in both groups.Changes in bone mineral density(BMD)at the hip and lumbar spine were also assessed.Results The baseline serum S1P concentrations in the denosumab and teriparatide groups were(1.32±0.12)μmol/L and(1.37±0.13)μmol/L,respectively.After 6 months of treatment,the concentrations decreased to(1.11±0.11)μmol/L and(1.13±0.13)μmol/L,respectively.Correlation analysis revealed that the changes in S1P concentration were closely correlated with changes in P1NP and lumbar spine bone mineral density in both groups.Conclusion Both denosumab and teriparatide can reduce the serum S1P level in patients with osteoporotic fractures.The changes in S1P levels are closely associated with improvements in bone mineral density,suggesting that S1P may be influenced during treatment with these two drugs that have distinct mechanisms of action.

Abstract:Objective To investigate the clinical efficacy of minimally invasive internal screw-rod system versus cannulated screw fixation in treating anterior pelvic ring fractures.Methods A retrospective analysis was performed on data of 37 patients with anterior pelvic ring fractures admitted to the Tangshan Second Hospital from November 2016 to March 2021.According to different internal fixation methods for the anterior pelvic ring,patients were divided into two groups.The internal screw-rod group comprised 17 cases[ll males,6 females;age 25～65 years,mean(51.2±11.3)years].The cannulated screw group comprised 20 cases[13 males,7 females;age 22～69 years,mean(49.2±11.1)years].Operative time,intra-operative blood loss,peri-operative complications and fracture healing time were compared between the two groups.At the final follow-up,fracture reduction quality was assessed using Matta scoring criteria and functional recovery was evaluated using the modified Merle d'Aubigné-Postel hip function score.Results Post-operative follow-up lasted 10～20 months,mean(13.5±4.2)months.All 37 fractures healed uneventfully.No significant differences were found between the two groups in operative time,complication rate or fracture healing time(P＞0.05).Intra-operative blood loss in the internal screw-rod group was greater than that in the cannulated screw group(P＜0.05).At the final follow-up,the excellent-good rates of fracture reduction and functional recovery did not differ significantly between the two groups(P＞0.05).Conclusion The minimally invasive internal screw-rod system and cannulated screw technique provide equivalent clinical efficacy for anterior pelvic ring fractures.The optimal fixation method can be selected according to specific clinical circumstances.

Abstract:Objective Discussing the efficacy of arthroscope double-pulley knotless suture-bridge fixation in osteoporotic patients with rotator cuff tears.Methods A retrospective analysis was conducted on 100 osteoporotic patients with rotator cuff tears treated at Zhuhai People's Hospital between January 2023 and December 2024.According to the repair technique,56 patients[28 males,28 females;age 25～71 years,mean(55.42±6.43)years]were assigned to the double-pulley knotless suture-bridge group and 44 patients[21 males,23 females;age 27～73 years,mean(55.76±6.56)years]to the single-row group.Visual analogue scale(VAS),American shoulder and elbow surgeons(ASES)score,university of California at Los Angeles(UCLA)shoulder score,Constant-Murley score,range of motion,postoperative complications and retear rate were compared.Results At 6-month follow-up.The VAS,ASES,UCLA,Constant-Murley scores,forward flexion and external rotation of the shoulder in the double-pulley knotless suture-bridge group were better than those in the single-row group(P＜0.05).The retear rate and overall complication rate in the double-pulley knotless suture-bridge group were lower than those in the single-row group(P＜0.05).Conclusion Compared with single-row fixation,arthroscopic double-pulley knotless suture-bridge fixation for rotator cuff tears in osteoporotic patients produces superior shoulder function and range of motionwith lower rates of joint stiffness and retear.

Abstract:Objective To compare the treatment outcomes of MultiLoc intramedullary nails versus PHILOS plates combined with titanium mesh support for elderly patients with varus-deformed proximal humeral fractures.Methods A retrospective analysis was conducted on 70 elderly patients with complex varus-deformed proximal humeral fractures admitted to Suzhou Municipal Hospital from January 2018 to January 2023.The intramedullary nail group comprised 35 cases treated with closed reduction and MultiLoc intramedullary nail internal fixation,including 20 males and 15 females.Ages ranged from 60 to 80 years,with a mean age of(68.42±4.26)years.The locking plate group comprised 35 cases treated with open reduction and internal fixation using PHILOS locking plates combined with titanium mesh support.This group included 19 males and 16 females,aged 60 to 80 years,with a mean age of(68.71±4.53)years.The two groups were compared in terms of surgical indicators,change in hemoglobin within 24 hours postoperatively,visual analogue scale(VAS)pain score within 24 hours postoperatively,fracture healing time,Constant-Murley score,loss of cervical angle at 24 months postoperatively,shoulder joint range of motion,and incidence of complications.Results Follow-up ranged from 24 to 28 months,with a mean duration of(25.70±1.34)months.The intramedullary nail group demonstrated significantly lower intraoperative blood loss,shorter operative time,smaller 24-hour postoperative hemoglobin change,lower 24-hour postoperative VAS score,less 24-month postoperative loss of glenohumeral angle,and shorter fracture healing time compared to the locking plate group(P＜0.05).No statistically significant differences were observed between groups in 24-month postoperative flexion-abduction range of motion,external rotation and abduction angles,Constant-Murley scores,or complication rates(P＞0.05).Conclusion For elderly patients with complex varus-deformed proximal humeral fractures,both the MultiLoc intramedullary nail and the PHILOS plate combined with titanium mesh support achieved favorable outcomes.However,the former demonstrated superiority in reducing surgical trauma,shortening fracture healing time,and preventing postoperative loss of the neck-shaft angle.

Abstract:Objective To determine the distribution of common pathogenic bacteria in prosthetic joint infection(PJI)and osteoarthritis(OA)through a meta-analysis of single-group rates.Methods A meta-analysis was conducted.Five databases,including PubMed,the Cochrane Library,China National Knowledge Infrastructure,Wanfang Data,and VIP Database for Chinese Technical Periodicals,were searched.The search period covered from the establishment of each database to the present.Stata 15.0 software was used to perform the meta-analysis.Results Finally,17 studies on PJI were included,involving a total of 2 440 bacterial strain data.The top 5 most common pathogenic bacteria were coagulase-negative staphylococci(31.6％),Staphylococcus aureus(19.2％),Enterococcus spp.(3.8％),Streptococcus spp.(3.4％),and Propionibacterium acnes(3.1％).For OA,5 studies were included,containing a total of 547 pathogenic bacteria.The top 5 pathogenic bacteria with the highest infection rates were Staphylococcus aureus(43.6％),coagulase-negative staphylococci(10.0％),Streptococcus spp.(8.3％),Escherichia coli(7.1％),and Mycobacterium spp.(3.6％).Conclusion Among the pathogenic bacteria causing PJI and OA,coagulase-negative staphylococci and Staphylococcus aureus have the highest detection rates,which provides certain references for clinical medication.

Abstract:Objective This study aimed to compare the clinical efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF)and modified minimally invasive transforaminal lumbar interbody fusion(modified MIS-TLIF)in treating single-level lumbar degenerative disease(LDD).Methods A retrospective analysis was conducted on the clinical data of 70 patients with single-level lumbar degenerative disease who were admitted to Wuhu Second People's Hospital between March 2021 and January 2024.According to the repair technique,70 patients were assigned to the tow groups.The UBE-TLIF group comprised 35 patients(19 males and 16 females),aged 58～79 years,with a mean age of(67.17±7.76)years.The modified MIS-TLIF group also comprised 35 patients(22 males and 13 females),aged 48～77 years,with a mean age of(66.97±6.56)years.The following parameters were compared between the two groups:operative time,intraoperative blood loss,drainage volume,length of hospital stay,time to ambulation after surgery,visual analogue scale(VAS)scores for low back pain and leg pain,Oswestry disability index(ODI),excellent and good rate according to the modified MacNab criteria,interbody fusion rate,and incidence of complications.Results Postoperative follow-up was ≥12 months.The UBE-TLIF group had longer operative time(P＜0.001)but better intraoperative blood loss,postoperative drainage volume,time to ambulation,and hospital stay(P＜0.001).At 3 weeks postoperatively,VAS scores in the UBE-TLIF group were lower than those in the modified MIS-TLIF group(P＜0.001),while at 6 weeks,6 months,and final follow-up,no significant differences were observed(P＞0.05).ODI scores showed no statistically significant differences between the two groups at 3 weeks,6 weeks,6 months,and final follow-up(P＞0.05).At 6 months postoperatively,the excellent and good rate in the UBE-TLIF group(80.00％)was slightly lower than that in the modified MIS-TLIF group(85.71％,P＞0.05).At 1 year postoperatively,the interbody fusion rate in the UBE-TLIF group(88.57％)was slightly higher than that in the modified MIS-TLIF group(85.71％,P＞0.05).The complication rates were 14.3％(5/35)in the UBE-TLIF group and 20％(7/35)in the modified MIS-TLIF group,with no statistically significant difference between the groups(P＞0.05).Conclusion Both UBE-TLIF and modified MIS-TLIF can achieve good clinical outcomes in treating single-level lumbar degenerative disease.UBE-TLIF is associated with less intraoperative blood loss and better early improvement of low back and leg pain.

Abstract:Objective To investigate whether intra-operative bone-cement plugging plus bone-wax application without drainage-tube placement can effectively reduce post-operative blood loss in unicompartmental knee arthroplasty(UKA).Methods A total of 100 patients scheduled for medial mobile platform UKA at Affiliated Hospital of Hebei University between August 2022 and August 2024 were enrolled.The cohort comprised 40 males and 60 females aged 65～73 years,with a mean age of(69.38±3.73)years.Patients were randomly assigned to four groups of 25 each:Group A received bone cement packing combined with bone wax application without drainage tube placement,Group B received bone cement packing combined with bone wax application with drainage tube placement,Group C received neither bone cement nor bone wax techniques without drainage tube placement,Group D received neither bone cement nor bone wax techniques with drainage tube placement.Compare the pre-and postoperative visual analogue scale(VAS)scores,American knee society score(KSS),hemoglobin levels,hematocrit,and postoperative complications such as deep vein thrombosis in the lower extremities and wound bleeding between the four groups.Additionally,compare the drainage volume at 48 hours postoperatively between Groups B and D.Results Postoperative follow-up was ≥6 months.Comparisons of the lowest postoperative day 7 hematocrit levels,lowest postoperative day 7 hemoglobin levels,and differences between preoperative and postoperative day 7 hemoglobin levels among the four groups showed that Groups A and B were superior to Groups C and D(P＜0.05).Comparisons between Groups A and B,and between Groups C and D showed no statistically significant differences(P＞0.05).Comparisons of postoperative 24-hour VAS and postoperative 7-day KSS scores among the four groups showed that Groups A and D were superior to Group C(P＜0.05).Comparisons between Group A and Group B,and between Group B and Group D showed no statistically significant differences(P＞0.05).Comparisons of postoperative 6-month VAS and KSS scores among the four groups showed no statistically significant differences(P＞0.05).Group D had significantly higher 48-hour drainage volume than Group B(P＜0.05).There were no statistically significant differences in postoperative complication rates among the four groups(P＞0.05).Conclusion The combination of bone cement packing and bone wax application effectively reduces intra-articular hemorrhage following UKA surgery,thereby avoiding the adverse effects associated with the use of drainage tubes.

Abstract:Objective To investigate the correlation of lower limb alignment with knee pain as well as function in patients with knee osteoarthritis(KOA).Methods A total of 143 patients with KOA who were treated at the Affiliated Lianyungang Hospital of Xuzhou Medical University between December 2022 and December 2023 were enrolled in this study.The cohort comprised 39 males and 104 females,with an age range of 47 to 86 years and a mean age of 67.90±6.69 years.A total of 143 knees were involved,including 72 left knees and 71 right knees.Weight-bearing full-length radiographs of the lower limbs were obtained to measure the following alignment parameters:The hip-knee-ankle angle(HKA),joint line convergence angle(JLCA),mechanical lateral distal femoral angle(mLDFA),medial proximal tibial angle(MPTA),lateral proximal femoral angle(LPFA),and lateral distal tibial angle(LDTA).Joint function was assessed using the Western Ontario and McMaster Universities(WOMAC)Osteoarthritis Index.Pearson correlation and ridge regression analyses were employed to analyze the correlation between the lower limb alignment parameters and knee pain and function in KOA patients.Results Pearson correlation analysis revealed that the WOMAC score showed a significant positive correlation with the JLCA and mLDFA(P＜0.05).Larger JLCA and mLDFA were associated with higher WOMAC scores,indicating more severe knee pain and dysfunction.Conversely,the WOM AC score demonstrated a significant negative correlation with the HKA and MPTA(P＜0.05).Smaller HKA and MPTA were associated with higher WOMAC scores,suggesting greater severity of symptoms.No significant correlation was found between the WOMAC score and the LPFA or LDTA(P＞0.05).Ridge regression analysis indicated that JLCA had a significant positive influence on the WOMAC score,while HKA had a significant negative influence,with this model explaining 70.1％of the variance.Conclusion HKA and JLCA are closely related to pain and function in KOA and can serve as important parameters for assessing disease severity and guiding treatment.

Abstract:Objective To evaluate the osteotomy accuracy and clinical efficacy of 3D-printed patient-specific instrumentation(PSI)assisted high tibial osteotomy(HTO)in the treatment of varus knee osteoarthritis(KOA).Methods Sixty-nine patients(34 male,35 female;age 45～69 years,mean 59.36±5.96 y)who underwent HTO for KOA between October 2024 and April 2025 were prospectively enrolled and divided into a PSI group(n=29)and a conventional instrumentation(CI)group(n=40).Osteotomy accuracy was assessed by comparing pre-operative planning targets with post-operative measurements of the hip-knee-ankle(HKA)angle,weight-bearing line percentage(WBL)and medial proximal tibial angle(MPTA).Clinical outcomes were compared using the number of intra-operative fluoroscopic images,drainage volume and knee injury and osteoarthritis outcome score(KOOS).Results After a minimum follow-up of 3 months,post-operative HKA,WBL and MPT A in the PSI group did not differ significantly from the planned targets(P＞0.05).The absolute deviations(Δ)of HKA(1.76±2.11)°,WBL(5.66±4.94)％and MPT A(0.63±0.72)° were significantly smaller than those in the CI group[(3 22±2.89)°,(9.67±7 20)％,(2.78±1.90)°,respectively;P＜0.05].KOOS sub-scores at 1 and 3 months showed no inter-group differences(P＞0.05).The PSI group required fewer fluoroscopic images and had less drainage than the CI group(P＜0.05).Conclusion 3D-printed PSI improves the accuracy of coronal alignment during HTO,reduces intra-operative fluoroscopy and blood loss,and offers a safer alternative to conventional instrumentation.

Abstract:Objective To explore the application of 3D printed osteotomy and snap-tooth repositioning guides in corrective osteotomy for severe lower-limb varus deformity.Methods A 32-year-old man with bilateral lower-limb varus deformity for more than 20 years and progressive bilateral knee and ankle pain for 2 years was diagnosed with bilateral knee and ankle osteoarthritis.Pre-operative CT of the pelvis and entire lower limbs was performed to construct a 3D model.Femoral and tibial deformity angles were measured in the coronal,sagittal and transverse planes,and patient-specific osteotomy and snap-tooth repositioning guides were designed.Post-operative full-length anteroposterior radiographs of the lower limbs were obtained and mechanical lateral distal femoral angle,anatomical lateral distal femoral angle,medial proximal tibial angle,lateral distal tibial angle and hip-knee-ankle angle were measured to assess correction.The hospital speical surgery(HSS)is used to evaluate patients' knee joint function.Results Post-operative alignment of both lower limbs was markedly improved compared with pre-operative values.The HSS scores showed significant improvement at 3 and 6 months postoperatively compared to preoperative levels.By the 6-month mark,the deformities in the lower limbs' appearance had markedly improved,and the knee joint flexion-extension function had been fully restored.Conclusion For patients with multiplanar deformities of both lower limbs,3D-printed osteotomy and snap-tooth repositioning guides can achieve and maintain triplanar correction,facilitate internal fixation,reduce intra-operative fluoroscopy and yield satisfactory post-operative limb alignment.

Abstract:Objective To explore the clinical efficacy and gait of arthroscopic debridement combined with high tibial osteotomy in patients with varus-type knee osteoarthritis.Methods Sixty-two patients(66 knees)with varus-type knee osteoarthritis admitted from January 2022 to June 2023 were enrolled,23 males and 39 females;aged 46～65 years,average(51.4±7.3)years.After routine full-length weight-bearing X-rays,the femorotibial angle(FTA)determined the osteotomy amount.Under spinal or general anesthesia,high tibial osteotomy was performed after arthroscopic exploration and debridement.Follow-up was conducted at 3,6,9 and 12 months post-operatively.The femorotibial angle,Insall-Salvati(IS)index,visual analogue scale(VAS)and hospital for special surgery(HSS)knee score were recorded.Three-dimensional gait data including knee flexion/extension,varus/valgus,internal/external rotation angles and coronal plane moment were collected and compared with ten healthy volunteers.Results All patients were followed for 12～18 months(mean 14.2±3.3 months).Bone healing time was 12～20 weeks,mean(13.3±2.1)weeks.At 12-month follow-up,the femorotibial angle decreased from(187.3±2.6)°pre-operatively to(167.0±2.1)°;the IS index increased from(1.0±0.2)to(1.1±0.1);the VAS decreased from(5.4±1.3)to(0.9±0.2);and the HSS score increased from(68.2±5.3)to(88.2±4.9)(P＜0.05).The excellent-good rate was 93.9％.At 9 and 12 months,knee varus/valgus,internal/external rotation,flexion/extension angles and coronal adduction moment showed no significant differences compared with normal gait(P＞0.05).Conclusion For varus-type knee osteoarthritis patients,arthroscopic debridement combined with high tibial osteotomy can significantly improve lower-limb varus deformity,promote knee function recovery and relieve pain.At 9 months post-operatively,gait is not significantly different from normal gait,with significant clinical effects.

Abstract:Objective To develop a nomogram model based on individualized mechanical alignment targets for predicting the risk of poor outcomes after high tibial osteotomy(HTO)in patients with knee osteoarthritis(KOA).Methods A prospective cohort study enrolled 331 KOA patients scheduled for high tibial osteotomy at the Second Affiliated Hospital of Hunan University of Chinese Medicine between May 2022 and May 2024;328 patients were finally analyzed.One-year postoperative efficacy was evaluated using the hospital for special surgery knee score(HSS≥70=good outcome;HSS＜70=poor outcome).Patients were divided into an effective group(n=266)and a poor-outcome group(n=62).The effective group comprised 136 male and 130 female patients,aged 36-65 years(mean:52.33±8.02).The suboptimal outcome group included 38 male and 24 female patients,aged 33-71 years(mean:53.16±8.41).Baseline characteristics and alignment-correction deviations—mechanical femorotibial angle(mFTA),lateral distal femoral angle(LDFA)and medial proximal tibial angle(MPTA)-were compared.Independent risk factors for poor outcomes were identified by binary logistic regression,and a nomogram was constructed and internally validated by bootstrapping.Model discrimination was quantified with the concordance index(C-index)and receiver operating characteristic(ROC)curve.Results The poor-outcome group showed significantly higher body-mass index(BMI),Western Ontario and McMaster Universities(WOMAC)Osteoarthritis Index scores,proportion of Kellgren-Lawrence(K-L)grade Ⅲ,and rates of alignment deviation(＞3 ° or＜-3 °)in ΔmFTA,ΔLDFA and ΔMPTA(P＜0.05).Logistic regression indicated that high BMI,high WOMAC score,K-L grade Ⅲ,ΔmFTA＞3 ° or＜-3 °,and ΔLDFA＞3 ° or＜-3 ° were independent risk factors for poor outcomes(OR＞1,P＜0.05).The nomogram achieved a C-index of 0.857.ROC analysis yielded an area under the curve(AUC)of 0.857[95％CI(0.810,0.905),P＜0.001]with cut-off 50 20 points,specificity 81.60％,sensitivity 75.80％and Youden index 0.574.A decision-tree model highlighted five key variables-K-L grade,ΔmFTA,ΔLDFA,WOMAC score and BMI-with ΔmFTA as the most important root node(30.10％poor-outcome rate when ΔmFTA was abnormal).Conclusion Individualized alignment deviations(ΔmFTA,ΔLDFA),BMI,K-L grade,and WOMAC score are independent predictors of poor outcomes after HTO.The nomogram model exhibits high clinical predictive value.

Abstract:Objective To compare the clinical efficacy of unicompartmental knee arthroplasty(UKA)and total knee arthroplasty(TKA)in the treatment of single compartment knee osteoarthritis(KO A).Methods A retrospective analysis was conducted on 100 patients[36 males,64 females;age 51～73 years,mean(61.78±8.59)years]who underwent surgery for unicompartmental KOA in Ningde Municipal Hospital Affiliated to Ningde Normal University from January 2021 to January 2024.Fifty patients received UKA and 50 received TKA.Peri-operative indices-including intra-operative blood loss,post-operative drainage,operation time,length of stay and time to first straight-leg raise—were recorded.Pain visual analogue scale(VAS),the hospital for special surgery(HSS)knee score and knee range of motion(ROM)were evaluated before surgery and at post-operatively.Complications such as venous thrombosis,joint stiffness/instability,swelling and infection were compared.Results Postoperative follow-up was≥12 months.All peri-operative indices were lower in the UKA group than in the TKA group(P＜0.05).VAS,HSS scores and ROM improved significantly in both groups compared with baseline(P＜0.05).VAS at 1 month was lower after UKA(P＜0.05);no inter-group difference was observed at 6 or 12 months(P＞0.05).ROM was consistently better in the UKA group at all time points(P＜0.05).HSS score at 12 months was higher after UKA(P＜0.05);the deduction item of the HSS scale was 0 in both groups.The 12-month complication rate was 6％after UKA versus 22％after TKA(P＜0.05).The complication rate(6.00％)of the UKA group is significantly lower than complication rate(22.00％)of the TKA group.Conclusion Compared with TKA,UKA for unicompartmental KOA is associated with less intra-operative blood loss,lower early post-operative pain,better knee ROM and fewer complications.

Abstract:Objective To explore the application of EndoButton combined with distal clavicle locking plate in the treatment of Neer type ⅡB distal clavicle fractures.Methods A retrospective analysis was performed on data of 52 patients with Neer type ⅡB distal clavicle fractures who underwent surgical treatment at Dongnan Hospital of Xiamen University between January 2021 and January 2023.Twenty-four patients who received EndoButton combined with distal clavicle locking plate internal fixation were enrolled as the trial group[14 males,10 females;age 19～60 years,mean(38.45±11.58)years];twenty-eight patients who received clavicular hook plate internal fixation were enrolled as the control group[17 males,11 females;age 21～63 years,mean(41.36±12.94)years].The two groups were compared in terms of operative time,intra-operative blood loss,number of intra-operative fluoroscopies,length of hospital stay,shoulder range of motion,pain visual analogue scale(VAS),Constant-Murley shoulder function score,post-operative reduction quality,fracture healing time and complications.Results Post-operative follow-up lasted 12～18 months,mean(12.16±5.34)months.No significant difference was found in hospital stay between the two groups(P＞0.05).Operative time,intra-operative blood loss and number of intra-operative fluoroscopies in the trial group were greater than those in the control group(P＜0.05).Post-operative VAS scores,shoulder range of motion and Constant-Murley shoulder function scores in the trial group were superior to those in the control group(P＜0.05).No significant differences were observed in fracture reduction quality,fracture healing time or post-operative complication rate between the two groups(P＞0.05).Conclusion Compared with clavicular hook plate internal fixation,EndoButton combined with distal clavicle locking plate internal fixation for Neer ⅡB distal clavicle fractures entails longer operative time,greater intra-operative blood loss and more fluoroscopies,but provides lower post-operative pain,better shoulder range of motion and improved shoulder function.

Abstract:Objective To evaluate the efficacy and safety of ultrasound-guided selective cervical nerve root block combined with optimized cervical traction in the treatment of cervical spondylotic radiculopathy(CSR).Methods A total of 90 patients with CSR admitted to Henan Luoyang Orthopedic Hospital between January 2022 and October 2024 were enrolled and randomly assigned into three groups(n=30 per group)using a random number table.The control group(traction alone)consisted of 14 males and 16 females,aged 18～65 years(mean age:38.53±11.94).The surface landmark-guided group(traction plus surface landmark-guided cervical nerve root block)included 16 males and 14 females,aged 18～65 years(mean age:38.13±11.78).The observation group(traction plus ultrasound-guided selective cervical nerve root block)comprised 17 males and 13 females,aged 18～65 years(mean age:37.77±11.53).Outcomes were assessed before and after treatment using the visual analogue scale(VAS),present pain intensity(PPI),Yasuhisa Tanaka 20-point scoring system for cervical spondylosis(YT20),and the neck disability index(NDI).Complications were recorded.Results(1)After treatment,all three groups showed significant improvements in VAS,PPI,YT20,and NDI scores compared to baseline(P＜0.05).No complications such as nerve injury occurred in the observation group.(2)The observation group demonstrated more reliable and stable therapeutic outcomes,with a significant reduction in the number of repeat puncture attempts compared to the surface landmark-guided approach(from 9 to 1 attempt,P＜0.05).Conclusion This study confirms that ultrasound-guided selective cervical nerve root block combined with traction not only provides synergistic therapeutic benefits but also offers superior precision in intervention for CSR.The technique reduced the need for repeat punctures by 88.9％,effectively minimizing the risks associated with traditional blind puncture techniques.

Abstract:Objective To evaluate the influence of dexmedetomidine added to infiltration between the popliteal artery and the capsule of the posterior knee(IPACK)block on postoperative analgesia in day surgery unilateral total knee arthroplasty(TKA).Methods Eighty patients scheduled for day surgery unilateral TKA at Honghui Hospital,Xi'an Jiaotong University from March 2024 to March 2025 were randomly allocated into two groups.All patients received standardized general anesthesia combined with ultrasound-guided adductor canal block(0.25％ropivacaine 25 mL)and IPACK block preoperatively.In the trial group the IPACK block was performed with 0.25％ropivacaine plus dexmedetomidine 0.5 μg/kg in a total volume of 12 mL,whereas the control group received 0.25％ropivacaine 12 mL.The trial group comprised 40 patients(13 males,27 females)aged 56～79 years,mean(65.18±5.92)years;the control group comprised 40 patients(9 males,31 females)aged 55～77 years,mean(66.65±5.42)years.Visual analogue scale(VAS)at 6 h,12 h and 24 h after surgery,systemic analgesic consumption within 24 h,number of nocturnal pain-induced awakenings,incidence of adverse reactions and patient satisfaction were compared between the two groups.Results VAS scores for movement at 12 h and for rest at 24 h in the trial group were lower than those in the control group(P＜0.05);VAS scores at other time-points showed no statistically significant inter-group differences(P＞0.05).The trial group had fewer nocturnal pain-induced awakenings than the control group(P＜0.05).There were no statistically significant differences between the groups in 24-h systemic analgesic consumption,incidence of adverse reactions or overall patient satisfaction(P＞0.05).Conclusion Dexmedetomidine combined with IPACK block significantly improves early postoperative analgesia and nocturnal sleep quality in TKA patients without increasing adverse reactions,representing an optimized choice for multimodal analgesia in day surgery of TKA.

Abstract:Objective To investigate the impact of altering the prosthesis open angle on heterotopic ossification(HO)following cervical disc arthroplasty(CDA)in an in vivo model,elucidate the role of intrinsic biomechanical changes in HO development and their pathophysiological mechanisms,and provide theoretical guidance for optimizing surgical techniques to prevent or reduce postoperative HO while maintaining long-term prosthetic mobility.Methods Goat CDA models with increased lordosis or kyphosis of prosthesis open angle were established and were divided into prosthesis open angle lordosis increase group(Group Ⅰ),kyphosis increase group(Group Ⅱ)and sham-operated group(Group Ⅲ).Postoperative imaging examinations include X-rays,CT,and Micro-CT.The items detected and evaluated included the index disc space angle(DSA),the intervertebral disc height(IDH),the position of the prosthesis,the location and volume of HO,and the ectopic bone and the bone-interplant interface bone tissue measurements.Results The DSA lordosis of the index segment in Group Ⅰ after surgery was significantly increased than that before surgery,and the DSA kyphosis of the index segment in Group Ⅱ was significantly increased than that before surgery.The IDH after surgery in both CDA groups was significantly greater than that before surgery and Group Ⅲ.The mean IDH in Group Ⅰ was higher than that in Group Ⅱ,but there was no significant difference(P＞0.05).Radiological examination found that HO in the index segment in Group Ⅰ occurred mainly in the posterior parts of vertebrae,while HO in Group Ⅱ mainly concentrated in the anterior parts of vertebrae.Bone tissue measurement analysis showed that the HO volume at the posterior parts of the arthroplasty level in Group Ⅰ was significantly larger than that at the anterior parts of the index level,and was significantly larger than the HO volume at the posterior parts of the arthroplasty segment in Group Ⅱ;while the HO volume at the anterior parts of the replacement segment in Group Ⅱ was significantly larger than its posterior parts,and was significantly larger than the HO volume in the anterior parts of replacement segment in Group Ⅰ.Conclusion During artificial cervical disc implantation,excessively changing the prosthesis open angle could affect the process of bone tissue remodeling and reconstruction by altering the local biomechanical environment,which was an important initiating and promoting factor for the occurrence and progress of HO after CDA.

Abstract:Objective To compare the clinical efficacy of the core-drill intramedullary nail system(CINS)and the traditional external targeting system(ETS)in interlocking intramedullary nailing for femoral shaft fractures.Methods A retrospective analysis was performed on data of 47 patients with femoral shaft fractures treated at Tongji Hospital of Tongji University,from January 2020 to December 2023.According to the surgical method,patients were assigned to CINS group and ETS group.CINS group contained 22 cases(8 males and 14 females),age 21～77 years,mean(50.4±19.3)years;ETS group contained 25 cases(17 males and 8 females),age 21～79 years,mean(50.8±20.4)years.Surgical-related parameters,fracture healing time,visual analogue scale(VAS)pain score,Harris score and complications were compared between the two groups.Results Post-operative follow-up lasted 11.6～18.3 weeks,mean(14.53±1.76)weeks.Intra-operative fluoroscopy frequency,operative time and peri-operative blood loss in CINS group were significantly better than those in ETS group(P＜0.01).Fracture healing time and post-operative Harris score showed no significant difference between the two groups(P＞0.05);post-operative VAS in CINS group was lower than that in ETS group,the difference being statistically significant(P＜0.01).Complication incidence showed no significant difference between the two groups(P＞0.05).One soft-drill breakage occurred in CINS group,related to high bone density and insufficient early operative experience.Conclusion In interlocking intramedullary nailing for femoral shaft fractures,CINS and traditional ETS provide equivalent clinical efficacy;CINS offers higher distal locking accuracy,less intra-operative radiation exposure and less blood loss,but its use in patients with high bone density requires caution.

Abstract:Objective To analyze the characteristics of the disease burden of spinal cord injury(SCI)in China and provide a scientific basis for the development of prevention measures and the establishment of a treatment system.Methods Using the global burden of disease 2021(GBD 2021)database,we analyzed the incidence and prevalence of spinal cord injury in China from 1990 to 2021.The Joinpoint regression model was employed to analyze the trends in SCI incidence and prevalence.Additionally,the Bayesian age-period-cohort(BAPC)model was used to forecast the changes in standardized rates from 2022 to 2035.Results From 1990 to 2021,the age-standardized incidence rate(ASIR)and prevalence rate(ASPR)of spinal cord injury in China showed no significant changes,with average annual percentage changes of-0.02％[95％CI(-0.50％to 0.47％)]and 0.09％[95％CI(-0.12％to 0.29％)],respectively.The number of new cases and existing cases increased by 43.27％and 63.27％,respectively.The age distribution of incidence and prevalence showed a trend towards aging.The disease burden of spinal cord injury was higher in males than in females.It is projected that the burden of spinal cord injury in China will decrease by 2035.Conclusion The incidence and prevalence of spinal cord injury in China are increasing year by year,which is an important public health issue that cannot be ignored.Targeted preventive measures and treatment systems should be developed for the elderly and male populations.