Abstract:Objective To explore the efficacy of jointly assessing plasma D-dimer(D-D),fibrin degradation products(FDP),and ultrasonography in forecasting the onset of deep vein thrombosis(DVT)in the lower extremities following total knee arthroplasty(TKA).Methods 222 post-TKA patients admitted between April 2022 and September 2023 were enrolled and categorized into the DVT group(141 cases)and the non-DVT group(81 cases)based on the diagnostic results of postoperative ultrasound.The clinical data of the two groups were collected,and all patients underwent D-D and FDP level detection and ultrasonography before surgery and on the 1st,3rd,5th and 7th days after surgery to compare the differences in the levels of D-D and FDP between the two groups and to analyse the diagnostic value of D-D and FDP alone and in combination for the early prediction of postoperative DVT after TKA.Results There were no statistically significant differences in age,body mass index,gender,physical activity,smoking status,diabetes history,hypertension history,adoption of thromboprophylaxis,or surgical site between the two groups(P>0.05).D-D and FDP levels were significantly higher in the DVT group on postoperative day 3 than on postoperative day 1;with the prolongation of time,the subsequent D-D and FDP levels no longer increased significantly,and D-D and FDP levels in the group without DVT showed a trend of increasing and then decreasing,and reached a peak on postoperative day 1;D-D and FDP levels were consistently higher in the group with DVT than in the group without DVT in the postoperative period(P<0.05).The ROC curve showed that the combined D-D and FDP diagnostic AUC was the largest at 0.983 on day 3,with a sensitivity of 95.04%,a specificity of 98.77%,a positive predictive value of 99.26%,and a negative predictive value of 91.95%when comparing the postoperative days 1,3,5,and 7,indicating that the combined diagnostic value was high.Conclusions The combined detection of plasma D-D and FDP has a good diagnostic value for early prediction of DVT after TKA,optimising the clinical intervention pathway.

Abstract:Objective To explore the effects of a self-efficacy enhancement intervention on postoperative rehabilitation outcomes in total hip arthroplasty(THA)patients.Methods Ninety patients who underwent THA in our hospital between January 2023 and January 2025 were selected and divided into a control group(n=45)and an observation group(n=45)using a randomized numeric table.Both groups underwent an accelerated rehabilitation surgical program before discharge,and at the time of discharge and after discharge,the control group used a conventional orthopedic management program and the observation group used a self-efficacy enhancement intervention on top of that.At the time of discharge,3 months after discharge,and 6 months after discharge,the patients'self-efficacy was assessed by self-efficacy for rehabilitation outcome scale(SER);hip function was assessed by using the Harris Hip Function Scale(HHS),and the quality of life was assessed by using the EQ-5D-5L scale,respectively.Results At discharge,there was no statistically significant difference between the two groups in SER,hip range of motion,HHS,EQ-5D-5L,or EQ-VAS(P>0.05).At 3 months after discharge,the control group showed significantly lower scores than the observation group in:task self-efficacy(40.57±4.59 vs.43.28±3.54)and coping self-efficacy(27.9±4.50 vs.32.88±4.48)in SER;flexion-extension range of motion[(99.06±9.42)° vs.(105.02±11.02)°]and internal-external rotation range of motion[(32.27±1.55)° vs.(35.32±2.05)°]of the hip;the pain(29.76±5.84 vs.37.08±6.05),function(29.03±6.17 vs.36.20±5.38),range of motion(2.91±1.00 vs.3.53±0.82),and deformity(2.69±0.90 vs.3.09±0.70)domains of the HHS;and EQ-5D-5L(0.69±0.13 vs.0.77±0.11).At 6 months after discharge,the control group again demonstrated significantly lower scores than the observation group in:task self-efficacy(41.72±4.55 vs.44.99±3.88)and coping self-efficacy(31.12±3.93 vs.36.17±3.66)in SER;flexion-extension range of motion[(104.11±8.44)° vs.(121.04±10.68)°]and internal-external rotation range of motion[(37.87±2.19)° vs.(41.04±1.99)°]of the hip;the pain(32.17±6.01 vs.40.01±3.41),function(31.09±7.08 vs.38.95±5.64),range of motion(3.69±0.79 vs.4.27±0.75),and deformity(3.22±0.80 vs.3.69±0.56)domains of the HHS;EQ-5D-5L(0.74±0.13 vs.0.82±0.11);and EQ-VAS(65.58±9.32 vs.76.59±10.74).Conclusions Implementation of self-efficacy enhancement intervention in patients undergoing THA can significantly improve patients'self-efficacy,as well as enhance hip joint range of motion,hip joint function and quality of life.

Abstract:Objective To observe the effect of core strength training combined with a progressive relaxation technique based on musical muscle stimulation on functional rehabilitation in patients suffering from chronic non-specific low back pain.Methods A total of 60 patients diagnosed with chronic non-specific low back pain and admitted to the department from December 2023 to December 2024 were selected for this study.The sample comprised 43 males and 17 females,with an age range of 19-52 years,yielding a mean age of(36.10±7.82)years.The participants were randomly divided into two groups:a conventional group and a combined group,with 30 cases in each group.The conventional group received daily exercise therapy,physiotherapy,acupuncture,massage and other conventional clinical rehabilitation programme,while the combined group performed core muscle strength training combined with musical muscle progressive relaxation techniques.The effectiveness of the rehabilitation treatment was measured using a variety of scales,including the visual analogue scale(VAS),the Roland-Morris disability questionnaire(RMDQ),the self-rating anxiety scale(SAS)and the self-rating depression scale(SDS).These scales were administered before and after the treatment,with the results of the SAS and SDS scores being particularly noteworthy.Results Following a period of six weeks of treatment,there was a significant improvement in the VAS,RMDQ,SAS,SDS scores of the two groups of patients when compared within the group(P<0.05);and the scores of VAS,RMDQ,SAS,SDS of the combined group were lower than those of the conventional group when compared between the groups,and the differences were statistically significant(P<0.05).Conclusions The present study has demonstrated that integrating core plyometric training with the progressive relaxation technique,as outlined in the musical muscle method,can yield substantial benefits with regard to the mental health status and lumbar spine function of patients diagnosed with chronic non-specific low back pain.The efficacy of this approach is further substantiated by the clinical outcomes observed.

Abstract:Objective To investigate the relationship between the percentage of cement volume bone fraction(CVBF)and bone cement leakage,adjacent vertebral fracture andpain relief in percutaneous kyphoplasty(PKP)in patients with osteoporotic vertebral compression fractures(OVCFs),and to explore the optimal interval of CVBF.Methods 141 patients with OVCF who underwent PKP treatment in our hospital between December 2022 and December 2024 were selected,and 3 months postoperatively was chosen as the end of follow-up.The study was optimized using a finite element analysis(FEA)model,and the patients were divided into a cement leakage group and a cement non-leakage group,a pain relief group and a pain non-relief group,and an adjacent vertebral fracture group and an adjacent vertebral non-fracture group according to their prognosis,and the CVBF values of the patients with different prognostic relationships were recorded for analysis and comparison.The accuracy of predicting bone cement leakage,adjacent vertebral fracture,and pain relief by CVBF was assessed using receiver operating characteristic(ROC)curves.Results Of the 141 patients,18 had bone cement leakage,23 had adjacent vertebral fractures,and 24 still had unrelieved pain after surgery.The group with cement leakage was significantly higher than the group without leakage,the group with no pain relief was significantly lower than the group with pain relief,and the group with adjacent vertebral fracture was significantly lower than the group with no adjacent vertebral fracture.The occurrence of bone cement leakage and adjacent vertebral fracture were concentrated in high CVBF,which was significantly higher than the occurrence of no bone cement leakage and no adjacent vertebral fracture(P<0.05),and the absence of pain relief was concentrated in low CVBF,which was significantly lower than that of the patients who had pain relief(P<0.05).The ROC curves constructed by the CVBF predicted the different prognostic relationships with an area under the curve(AUC)value of 0.847,respectively,0.877,and 0.867,which were all greater than 0.80.Conclusions There is a strong association between CVBF and the prognosis of OVCF patients after PKP.High CVBF has a significant analgesic effect,but the risks of adjacent vertebral fracture and bone cement leakage are also elevated.The rate of cement penetration is low,the rate of adjacent vertebral fracture is low,and there is a relief of pain when the CVBF is between 24.39%and 34.23%,which is the optimal distribution interval of CVBF.

Abstract:Objective To evaluate the efficacy of combined remimazolam sedation with ultrasound-guided fascia iliaca compartment block(FICB)in elderly patients undergoing hip arthroplasty(HA).Methods Eighty elderly patients who received HA treatment at our hospital from March 2023 to August 2024 were selected and divided into a control group and an observation group according to randomized numerical table method,with 40 cases each.The control group routinely underwent combined spinal-epidural anesthesia in the lateral decubitus position.The observation group received intravenous remimazolam at 0.15 mg/kg,followed by ultrasound-guided FICB on the affected side.Following successful block,the patient was positioned in the lateral decubitus position for combined spinal-epidural anesthesia.The heart rate and mean arterial pressure of the two groups were compared before anesthesia,during neuraxial puncture,during skin incision,and after surgery.The pain visual analogue score(VAS)was used to compare the pain levels of the two groups before anesthesia,during neuraxial puncture and positioning,and at 2 h,4 h,8 h,24 h,and 48 h after surgery.The incidences of postoperative salvage analgesia and adverse reactions(irritability,dizziness,nausea and dry mouth)were compared between the two groups.Results During the positioning for spinal canal puncture,the control group exhibited significantly higher heart rates[(91.53±5.12)beats/min vs.(82.25±3.57)beats/min]and mean arterial pressures[(102.31±8.55)mm Hg vs.90.53±8.21)mm Hg]compared to the observation group(P<0.05).Patients in the control group exhibited significantly higher VAS scores during the positioning phase for spinal canal puncture(8.62±0.49 vs.5.18±0.55)and at 8 hours post-operatively(3.76±0.49 vs.2.94±0.46),24 hours post-operatively(3.36±0.52 vs.2.64±0.47),and 48 hours post-operatively(2.07±0.50 vs.1.32±0.57)than the observation group(P<0.05).The incidences of postoperative rescue analgesia(20.0%vs.2.5%)and agitation(15.0%vs.0.0%)were higher in the control group than in the observation group(P<0.05).Conclusions Remimazolam sedation combined with ultrasound-guided FICB administration in elderly patients undergoing HA significantly enhances perioperative analgesia,promotes circulatory stability,and reduces postoperative complications.

Abstract:Objective To investigate the therapeutic effect of proprioceptive neuromuscular facilitation(PNF)technique combined with neuromuscular electrical stimulation(NMES)on glenohumeral subluxation(GHS)in hemiplegic patients.Methods Seventy patients with hemiplegic GHS admitted to our hospital from February 2021 to January 2024 were selected and divided into a control group(n=35)and an experimental group(n=35)according to the random number table method.The control group received conventional shoulder sling treatment,while the experimental group received additional PNF technique combined with NMES therapy.The Acromiohumeral Interval(AHI)was measured by X-ray,and the acromion-greater tuberosity distance(AGT),acromion-lesser tuberosity distance(ALT),and acromio humeral distance(AHD)of the affected shoulder joint were measured by musculoskeletal ultrasound diagnostic apparatus before treatment and 14 days after treatment.Shoulder joint range of motion(ROM)was assessed using the simplified Fugl-Meyer assessment of motor function(SFMA).Upper limb motor function was assessed using the Fugl-Meyer assessment scale(FMA).Pain level was assessed using the numerical rating scale(NRS).Upper limb spasticity was assessed using the modified Ashworth scale(MAS).Treatment effectiveness was evaluated by measuring the distance between the acromion and humerus via X-ray.Results Intra-group comparison showed that AHI,AGT,ALT,and AHD at 14 days post-treatment were significantly lower than those before treatment(P<0.05).Shoulder joint ROM and upper limb motor function at 7 and 14 days post-treatment were significantly higher than those before treatment,while upper limb spasticity and pain levels were significantly lower than those before treatment(P<0.05),with further significant improvement observed at 14 days compared to 7 days post-treatment.Inter-group comparison showed that the experimental group had significantly lower AHI,AGT,ALT,AHD,upper limb spasticity,and pain levels than the control group,and significantly higher shoulder joint ROM,upper limb motor function,and treatment effectiveness rate(P<0.05).Conclusions PNF technique combined with NMES can optimize the therapeutic effect of conventional shoulder sling treatment for hemiplegic GHS,reduce patient pain,and improve shoulder joint function.

Abstract:Objective To evaluate the feasibility and outcomes of the treatment for lumbar tuberculosis with severe vertebral bone defect by one-stage anterior debridement,bone grafting fusion and posterior single segment fixation.Methods The retrospective study evaluated the clinical data of 26 patients with lumbar spinal tuberculosis with vertebral bone defect admitted to the Department of Spine Surgery from June 2020 to June 2023.There were 19 males and 7 females,aged 20 to 69 years,with an average age of(39.00±15.38)years.All patients were treated with one-stage anterior debridement,bone grafting fusion and posterior single segment fixation.The demographics,disease characteristics,duration of the operation,blood loss and complications were recorded and investigated.Preoperative and postoperative visual analog scale(VAS),Oswestry disability index(ODI)and Frankel scale were compared to evaluate the symptoms and neurological function.C-reactive protein(CRP)levels,erythrocyte sedimentation rate(ESR)and imaging parameters were recorded to investigate clinical efficacy.Results The average period of follow-up was(18.42±5.23)months(range:12-33 months).The duration of the operation was(166.15±27.58)min(range:140-240 min)and the blood loss was(230.00±96.42)ml(range:90-440 ml).The VAS scores at postoperative 1 month,6 months and final follow-up were significantly lower than the preoperative data.The ODI at follow-up was improved compared with that preoperatively.At the last follow-up,neurological functions of 2 patients recovered to grade D,other patients recovered to grade E.CRP and ESR returned to normal at final follow-up in all patients.The Cobb's angles were decreased from preoperative(9.31±3.16)° to(3.23±1.39)°,and(3.42±1.53)° at final follow-up,without obvious angle loss at final follow-up.Fusion was achieved after intervertebral bone grafting at the last follow-up.During the follow-up,1 patient with recurrent lumbar tuberculosis was cured after drainage.No internal fixation failure was observed.Conclusions One-stage anterior debridement,bone grafting fusion and posterior single segment fixation are probably feasible and effective for patients with lumbar spinal tuberculosis and severe bone defect.

Abstract:Objective To analyze the risk factors for superficial surgical site infection(SSSI)in patients with tibial plateau fracture(TPF)undergoing open reduction and internal fixation(ORIF),providing a theoretical basis for postoperative management in TPF patients after ORIF surgery.Methods A total of 202 TPF patients who underwent ORIF between March 2023 and March 2025 at our institution were selected and clinical data were collected from the patients.Infection occurring within 30 days of surgery and involving only the incision skin or subcutaneous tissue was defined as SSSI.Risk variables for SSSI after ORIF in TPF patients were analyzed using multifactorial logistic regression.The accuracy of risk variables in predicting the risk of SSSI was analyzed using receiver operating characteristic(ROC)curves.Results Of the 202 patients,26 patients presented with SSSI,with an incidence rate of 12.9%.BMI,smoking,T2DM,Schatzker classification,operative time,IBL,and intraoperative temperature were higher in patients with SSSI than in patients without SSSI(P<0.05).Multifactorial Logistic regression analysis revealed that BMI,smoking,T2DM,Schatzker classification and operation time were independent risk variables for SSSI.ROC curve analysis showed that the AUCs of BMI,smoking,T2DM,Schatzker classification and operation time for predicting the risk of SSSI were 0.715(0.648-0.777),0.631(0.560-0.697),0.654(0.584-0.719),0.611(0.541-0.679),and 0.951(0.912-0.977),respectively.Conclusions BMI,smoking,T2DM,Schatzker classification,and time to surgery are associated with the risk of SSSI after ORIF in patients with TPF.

Abstract:Objective To explore the application effects of the doctor-nurse-patient collaborative model in postoperative rehabilitation for orthopedic patients.Methods A total of 100 patients who had undergone orthopedic surgery in our hospital over the past two years were randomly and equally divided into a control group and an experimental group.The control group received routine nursing care,while the experimental group was managed with the doctor-nurse-patient collaborative model,supplemented by smart device monitoring.Postoperative functional recovery,rehabilitation training compliance,pain levels,and quality of life were compared between the two groups.Results All patients in both groups achieved primary wound healing without any severe postoperative complications.Complete follow-up was obtained for all enrolled patients.The early postoperative recovery in the experimental group was significantly better than that in the control group.The time to first ambulation was(2.77±0.63)days in the experimental group,which was significantly shorter than(3.11±0.54)days in the control group(P=0.005).The time to resume oral intake was(1.75±0.34)days in the experimental group,significantly shorter than(2.59±0.47)days in the control group(t=10.239,P<0.001).The total length of hospital stay was(11.87±2.53)days in the experimental group,significantly shorter than(15.70±3.79)days in the control group(t=5.943,P<0.001).The incidence of postoperative complications was 6.00%(3/50)in the experimental group and 22.00%(11/50)in the control group,with a statistically significant difference(χ2=5.316,P=0.021);at 3 months postoperatively,the total REAS score in the experimental group was(58.57±4.74),significantly higher than(53.01±4.21)in the control group(t=6.201,P<0.001).Regarding pain evaluation,the BPI score for"pain intensity"on postoperative day 3 was(5.42±1.43)in the experimental group,significantly lower than(6.94±1.67)in the control group(t=4.889,P<0.001).On postoperative day 7,the scores were(3.36±1.15)and(4.21±1.23),respectively(t=3.569,P=0.001),with statistically significant differences.In terms of postoperative quality of recovery,the QoR-15 total score at 3 months was significantly higher in the experimental group[(116.02±11.54)vs.(108.57±10.84);t=3.327,P=0.001].Conclusions The doctor-nurse-patient collaborative model combined with smart technology assistance can significantly optimize postoperative functional recovery in orthopedic patients,enhance rehabilitation compliance and quality of life,effectively alleviate pain,and provide an innovative approach for clinical rehabilitation nursing.

Abstract:Objective To explore the relationship between postoperative fluctuations in coronal angles and joint stability in patients with lateral ankle instability accompanied by osteochondral lesion of the talus(OLT).Methods A total of 126 patients with lateral ankle instability and OLT,treated at our hospital from June 2022 to June 2024,were enrolled for this study.At the final follow-up,the functional status of the affected ankle joints was assessed using Mazur's scoring system.Patients were categorized into four groups:excellent,good,fair,and poor(excellent>92 points,good 87-92 points,fair 65-86 points,and poor<65 points).The Generalized Estimation Equation(GEE)model was employed to analyze differences in coronal and sagittal ankle angles among patients with varying prognoses.The Locally Weighted Scatterplot Smoothing(LOWESS)method was utilized to examine the two-dimensional curve relationships of continuous variables.Additionally,logistic regression analysis was conducted to assess the independent correlation between changes in coronal and sagittal angles of ankle acupoints one months after surgery and the risk of ankle joint dysfunction.Restricted cubic spline method was used to explore the correlation between the changes of coronal and sagittal angles of ankle points and the risk of ankle joint dysfunction.Results There were statistically significant differences(P<0.05)among the four groups of patients regarding age,Hepple stage,early functional exercise,and complications.The relative peak moment of the ankle joint(RPT),active position perception,and lower limb Y-balance(YBT-LQ)gradually decreased in the excellent,good,fair,and poor groups;Dynamic control rate(DCR),passive position perception,ankle coronal angle,and sagittal angle gradually increased(P<0.05).As the degree of poor prognosis increased,the coronal and sagittal angles of the ankle acupoints significantly increased(P<0.05).The coronal and sagittal angles of the ankle acupoints exhibited a certain nonlinear relationship with joint stability indicators.There was an independent correlation between the coronal angle(OR=1.623,95%CI=1.452-1.754,P<0.05)and the sagittal angle(OR=1.513,95%CI=1.387-1.629,P<0.05)within one month after surgery and the risk of ankle joint dysfunction.The trend test of the coronal and sagittal angles from low to high in the 5th percentile array revealed statistically significant differences(Ptrend<0.001).The coronal and sagittal angles of ankle points are non-linearly correlated with the risk of ankle dysfunction in OLT patients with lateral ankle instability(Pnon-linearity=0.026,0.041).Conclusions The changes of coronal and sagittal angles of ankle points have a nonlinear relationship with the joint stability index,and are independently related to the risk of ankle dysfunction.

Abstract:Objective To compare the clinical outcomes of arthroscopic partial repair combined with biceps tendon augmentation(PBA)and partial repair alone(PR)for irreparable massive rotator cuff tears(IMRCT)through a Meta-analysis.Methods A systematic search of MEDLINE,Embase,and the Cochrane Library up to December 2024 was conducted to identify clinical studies comparing PBA and PR for IMRCT.Outcome measures included retear rates,pain scores,functional scores,and range of motion.Literature screening followed PRISMA guidelines,study quality was assessed using the Methodological Index for Non-Randomized Studies(MINORS),and data analysis was performed using RevMan 5.3.Results Five retrospective studies(Level Ⅲ evidence)involving 299 patients were included.Meta-analysis revealed no significant difference between PBA and PR groups in postoperative retear rates(37.32%vs.40.76%;OR=0.72,95%CI 0.31-1.65,P=0.44),VAS pain scores(MD=0.02,95%CI-0.41-0.45,P=0.93),ASES scores(MD=-1.27,95%CI-8.02-5.48),or Constant scores(MD=0.31,95%CI-3.11-3.73).Range of motion(forward flexion and external rotation)also showed no statistical differences.Conclusions PBA and PR demonstrate comparable outcomes in retear risk,pain relief,functional recovery,and joint mobility for IMRCT.However,limitations such as retrospective design,small sample sizes,and procedural heterogeneity warrant further validation through high-quality randomized controlled trials.

Abstract:Objective To analyze the distribution characteristics of cervical curvature using the vertebral centroid measurement cervical lordosis(CCL)method based on a key point algorithm in a population of 10 000 individuals with varying gender,age,and symptom status.Methods The study included 9095 symptomatic patients from Dongzhimen Hospital of Beijing University of Chinese Medicine and 905 asymptomatic individuals undergoing health check-ups at the International Department of the same hospital.CCL values were calculated using a key point algorithm developed by the research team.The samples were categorized into seven age groups:10-19,20-29,30-39,40-49,50-59,60-69,and 70-79 years,and then further stratified by gender and symptom status for inter-group analysis using one-way ANOVA.Results The findings indicated that the CCL values in the symptomatic group were significantly lower than those in the asymptomatic group,and the trend of change in the CCL values in the symptomatic group became more pronounced with increasing age.Gender analysis showed that across all age groups,males had significantly higher CCL values than females,with the CCL values in males changing more markedly with age,while females exhibited more stable values.Conclusions CCL values,as a method for measuring cervical curvature,demonstrate high accuracy.Large sample data reveal significant influences of symptom status,age,and gender on CCL values.In clinical practice,integrating these patient characteristics may provide more precise support for the early diagnosis,prevention,and treatment of cervical-related diseases.

Abstract:Objective To explore the evolutionary prognosis of lumbar disc high-intensity zone(HIZ)in order to advance the understanding of HIZ pathologies.Methods A retrospective analysis was conducted on imaging data from patients experiencing low back pain who presented with HIZ in their intervertebral discs at the orthopedic department of our hospital between January 2015 and June 2023(at least two lumbar MRIs,with an interval of more than 12 months).The objective was to ascertain the morphological changes observed in the last MRI-HIZ and evaluate the dynamic relationship between disc herniation and HIZ.Results Among the 49 patients included in this study,the average interval between MRI examinations was(60.1±46.1)months(range:12-168 months).Of these patients,21 showed no significant changes in their HIZ,while 4 experienced improvement,7 exhibited worsening,and 2 demonstrated both deterioration and inconsistent improvement.Notably,15 patients presented with HIZ accompanied by morphological changes in the nucleus pulposus of the herniated disc.Among these cases,7 patients exhibited HIZ prior to disc herniation,while 8 patients developed HIZ subsequent to intervertebral disc herniation.In the latter group,the HIZ tended to remain stable or exhibit slight size reduction in the later stages.Conclusions HIZ represents a commonly observed imaging manifestation associated with disc degeneration,reflecting a relatively slow and benign pathological progression.The majority of HIZ lesions demonstrate morphological stability over time.However,certain instances of HIZ are closely linked to intervertebral disc nucleus pulposus herniation,which could occur sequentially in the later stages.Alternatively,such HIZ may signify a residual tissue repair and healing process occurring subsequent to intervertebral disc herniation.

Abstract:Objective To analyse the clinical effects of open small incision acromioplasty and rotator cuff repair in the treatment of rotator cuff injury in middle-aged and elderly people.Methods The relevant data of 100 middle-aged and elderly patients with rotator cuff injury admitted to Orthopaedic Department of Zhuozhou Hospital from February 2021 to February 2024 were reviewed.All were grouped according to different surgical methods.50 patients with open small incision acromoplasty and intraoperative rotator cuff suture were listed in the observation group.50 patients with conventional arthroscopic rotator cuff repair were listed in the control group.Postoperative shoulder function,acromion morphological parameters,complications,etc.were compared between the two groups.Results Surgical operation time:observation group(75.28±8.82)minutes vs.control group(89.96±9.27)minutes(t=8.112,P<0.05),with statistically significant difference.Treatment costs:observation group(14 200 yuan)vs.control group(19 600 yuan)(t=4.969,P<0.05),with statistically significant difference.Intraoperative blood loss:observation group(31.48±5.28 ml)vs.control group(19.97±5.36 ml)(t=10.817,P<0.05),with statistically significant difference.Hospitalization duration:observation group(5.78±1.67)days vs.control group(6.01±1.82)days(t=0.658,P>0.05),with no statistically significant difference.Rotator cuff healing time:observation group(68.82±9.68)days vs.control group(70.01±9.74)days(t=0.613,P>0.05),with no statistically significant difference.Joint function scores at 1,3,and 6 months post-surgery:observation group(62.82±4.16),(78.84±5.27),(92.20±2.48);control group(63.19±4.20),(77.98±5.30),(91.82±2.50)(t=0.443,0.814,0.763;P>0.05),with no statistically significant difference.Postoperative joint pain severity at 1,3,and 6 months:observation group scored(6.20±1.18),(3.12±1.01),and(1.16±0.48),while the control group scored(6.16±1.24),(3.08±1.05),and(1.21±0.51)(t=0.165,0.194,0.505;P>0.05),showing no statistically significant difference.Shoulder joint flexion,abduction,and external rotation angles at 3 months post-surgery:observation group was measured(148.84±13.06),(151.20±15.36),and(52.18±5.36)degrees,while the control group(145.70±15.16),(149.74±16.70),and(51.74±4.98)degrees(t=1.110,0.455,0.974;P>0.05).Shoulder acromion head center-edge angles(ACEA),acromion thickness(AT),and acromioclavicular distance(AHD)were measured(17.18±2.52),(38.78±3.28),(7.06±0.47),and(8.38±1.01)mm for the observation group,while(18.30±2.63),(36.01±3.32),(7.68±0.50),and(7.68±1.02)mm for the control group(t=2.174,6.389,4.197,3.448;P<0.05),demonstrating statistically significant differences.Complication rate:2%in the observation group and 6%in the control group(χ2=0.260,P=0.610),with no significant differences.Conclusions Both open small-incision acromioplasty and rotator cuff repair can improve the shoulder joint function and relieve the degree of joint pain in middle-aged and elderly patients with rotator cuff injuries.However,the small-incision surgical operation time is shorter,the cost of treatment is lower,and the shape of the acromion is significantly improved after surgery.

Abstract:Objective To explore the correlation analysis of imaging parameters to evaluate the efficacy and prognosis of plate internal fixation in patients with calcaneal fracture.Methods A total of 196 patients with calcaneal fractures admitted to our hospital from January 2020 to January 2024 were retrospectively analyzed.They were categorized into a good prognosis group(n=156)and a poor prognosis group(n=40)based on the Maryland foot score(MFS)and were followed up for 12 months post-surgery.Repeated measures analysis of variance was used to analyze data that satisfied a normal distribution and homogeneous variance.A stratified regression model was used to analyze the relationship between calcaneal X-ray indicators and the Maryland score in different patients.A multivariate Cox regression model,adjusted for confounding variables,was employed to identify independent risk factors for prognosis in patients with calcaneal fractures.The Local Weighted Regression Scatter Smoothing Method(LOWESS)was utilized to analyze the two-dimensional curve relationship of continuous variables.The predictive efficacy of imaging parameters on the prognosis of patients with calcaneal fractures was evaluated using Receiver Operating Characteristic(ROC)curves.Results There were statistically significant differences between the two groups in terms of the length of hospital stay[good prognosis group:(7.35±2.67)d,poor prognosis group:(10.68±3.52)d,t=6.567,P<0.001],fracture healing time[good prognosis group:(80.15±9.37)d,poor prognosis group:(95.92±13.98)d,t=8.506,P<0.001],incisional infection[good prognosis group:5 cases(3.21%),poor prognosis group:7 cases(17.50%),χ2=11.319,P=0.001],joint stiffness[good prognosis group:7 cases(4.49%),poor prognosis group:11 cases(27.50%),χ2=20.216,P<0.001],total incidence of complications[good prognosis group:34 cases(21.79%),poor prognosis group:32 cases(80.00%),χ2=48.292,P<0.001],AOFAS score[good prognosis group:(88.71±14.78)points,poor prognosis group:(68.64±14.89)points,t=7.650,P<0.001],MFS score[good prognosis group:(87.61±7.59)points,poor prognosis group:(66.40±9.24)points,t=15.055,P<0.001],and VAS score[good prognosis group:(1.72±0.71)points,poor prognosis group:(3.01±1.67)points,t=7.416,P<0.001].There were statistically significant differences between the two groups in the Gissane angle[good prognosis group:(108.19±6.36)°,poor prognosis group:(85.77±5.33)°,t=20.514,P<0.001],Böhler angle[good prognosis group:(28.50±6.57)°,poor prognosis group:(18.46±4.54)°,t=9.114,P<0.001],Fowler angle[good prognosis group:(18.35±3.05)°,poor prognosis group:(11.76±3.97)°,t=11.420,P<0.001],calcaneal compression angle[good prognosis group:(30.57±4.82)°,poor prognosis group:(25.13±3.86)°,t=6.611,P<0.001],calcaneal height[good prognosis group:(46.67±1.11)mm,poor prognosis group:(40.24±1.02)mm,t=33.209,P<0.001],calcaneal width[good prognosis group:(37.37±1.99)mm,poor prognosis group:(41.22±2.06)mm,t=10.838,P<0.001],and calcaneal axis length[good prognosis group:(52.76±3.61)mm,poor prognosis group:(43.57±2.54)mm,t=15.154,P<0.001]at 6 months after surgery.There were also statistically significant differences between the two groups in the Gissane angle[good prognosis group:(122.25±8.93)°,poor prognosis group:(76.78±5.48)°,t=30.720,P<0.001],Böhler angle[good prognosis group:(40.12±7.07)°,poor prognosis group:(18.02±4.09)°,t=18.950,P<0.001],Fowler angle[good prognosis group:(39.45±3.65)°,poor prognosis group:(11.93±3.14)°,t=43.699,P<0.001],calcaneal compression angle[good prognosis group:(35.90±5.31)°,poor prognosis group:(29.92±5.37)°,t=6.340,P<0.001],calcaneal height[good prognosis group:(50.79±2.82)mm,poor prognosis group:(40.43±0.73)mm,t=22.997,P<0.001],calcaneal width[good prognosis group:(30.26±1.70)mm,poor prognosis group:(40.41±1.81)mm,t=33.245,P<0.001],and calcaneal axis length[good prognosis group:(57.59±4.17)mm,poor prognosis group:(48.49±2.24)mm,t=13.301,P<0.001]at 12 months after surgery.The intra-group comparison results showed that in the good prognosis group,there were statistically significant differences between the preoperative and 6-month postoperative values of the Gissane angle[preoperative:(96.31±6.37)°,6 months postoperatively:(108.19±6.36)°,t=16.484,P<0.001],Böhler angle[preoperative:(18.28±5.65)°,6 months postoperatively:(28.50±6.57)°,t=14.731,P<0.001],Fowler angle[preoperative:(11.62±2.51)°,6 months postoperatively:(18.35±3.05)°,t=21.280,P<0.001],calcaneal compression angle[preoperative:(20.01±2.32)°,6 months postoperatively:(30.57±4.82)°,t=24.656,P<0.001],calcaneal height[preoperative:(40.21±1.51)mm,6 months postoperatively:(46.67±1.11)mm,t=43.053,P<0.001],calcaneal width[preoperative:(43.94±2.01)mm,6 months postoperatively:(37.37±1.99)mm,t=29.012,P<0.001],and calcaneal axis length[preoperative:(38.79±2.57)mm,6 months postoperatively:(52.76±3.61)mm,t=39.375,P<0.001].Similarly,statistically significant differences were observed between the preoperative and 12-month postoperative values in the good prognosis group for the Gissane angle[preoperative:(96.31±6.37)°,12 months postoperatively:(122.25±8.93)°,t=29.537,P<0.001],Böhler angle[preoperative:(18.28±5.65)°,12 months postoperatively:(40.12±7.07)°,t=30.141,P<0.001],Fowler angle[preoperative:(11.62±2.51)°,12 months postoperatively:(39.45±3.65)°,t=78.469,P<0.001],calcaneal compression angle[preoperative:(20.01±2.32)°,12 months postoperatively:(35.90±5.31)°,t=34.250,P<0.001],calcaneal height[preoperative:(40.21±1.51)mm,12 months postoperatively:(50.79±2.82)mm,t=41.310,P<0.001],calcaneal width[preoperative:(43.94±2.01)mm,12 months postoperatively:(30.26±1.70)mm,t=64.905,P<0.001],and calcaneal axis length[preoperative:(38.79±2.57)mm,12 months postoperatively:(57.59±4.17)mm,t=47.937,P<0.001].In the poor prognosis group,statistically significant differences were found between the preoperative and 6-month postoperative values of the Gissane angle[preoperative:(96.35±6.34)°,6 months postoperatively:(85.77±5.33)°,t=8.079,P<0.001],calcaneal compression angle[preoperative:(19.99±2.25)°,6 months postoperatively:(25.13±3.86)°,t=7.276,P<0.001],calcaneal width[preoperative:(43.88±2.07)mm,6 months postoperatively:(41.22±2.06)mm,t=5.761,P<0.001],and calcaneal axis length[preoperative:(38.80±2.55)mm,6 months postoperatively:(43.57±2.54)mm,t=8.382,P<0.001].Additionally,statistically significant differences were noted between the preoperative and 12-month postoperative values in the poor prognosis group for the Gissane angle[preoperative:(96.35±6.34)°,12 months postoperatively:(76.78±5.48)°,t=14.770,P<0.001],calcaneal compression angle[preoperative:(19.99±2.25)°,12 months postoperatively:(29.92±5.37)°,t=10.787,P<0.001],calcaneal width[preoperative:(43.88±2.07)mm,12 months postoperatively:(40.41±1.81)mm,t=7.981,P<0.001],and calcaneal axis length[preoperative:(38.80±2.55)mm,12 months postoperatively:(48.49±2.24)mm,t=18.056,P<0.001].The influence of time factors on Gissane angle,Böhler angle,Fuller angle,calcaneal height,calcaneal width,and calcaneal axis length varied with different prognosis(Finteraction=86.013,101.223,56.732,101.205,81.182,84.358,all P<0.001).The results of multiple logistic regression analysis showed that Gissane angle,Böhler angle,Fowler angle,calcaneal compression angle,calcaneal height,and increased calcaneal axis length were independent protective factors affecting the prognosis of patients with calcaneal fractures,while increased calcaneal width was an independent risk factor affecting the prognosis of patients with calcaneal fractures(all P<0.05).LOWESS analysis found that there was a certain non-linear relationship between the incidence of poor prognosis in patients with calcaneal fractures and Gissane angle,Böhler angle,Fowler angle,calcaneal compression angle,calcaneal height,calcaneal width,and calcaneal axis length.There was no significant non-linear relationship between the incidence of poor prognosis in patients with calcaneal fractures and the posterior articular inclination angle.The imaging parameters of Gissane angle,Böhler angle,Fowler angle,calcaneal compression angle,calcaneal height,calcaneal width,and calcaneal axis length had good predictive efficacy for the prognosis of patients with calcaneal fractures.And the combination of calcaneal X-ray indicators predicted the prognosis of calcaneal fractures,with the best predictive performance.Conclusions Gissane angle,Böhler angle,Fowler angle,calcaneal compression angle,calcaneal height,and increased calcaneal axis length are independent protective factors affecting the prognosis of patients with calcaneal fractures,while increased calcaneal width is an independent risk factor affecting the prognosis of patients with calcaneal fractures.The combined prediction of calcaneal X-ray indicators for the prognosis of calcaneal fractures has good predictive efficacy.