Abstract:Objective A prospective study was conducted to compare the efficacy of unilateral biportal endoscopic(UBE)discectomy and percutaneous transforaminal endoscopic discectomy(PTED)in the treatment of single-level lumbar disc herniation.Methods Eighty patients with single-level lumbar disc herniation treated in Qingpu Branch of Zhongshan Hospital between February 2023 and February 2024 were prospectively enrolled.They were randomly allocated into the UBE group[n=40;27 males,13 females;age 26～53 years,mean(42.5±6.8)years]and the PTED group[n=40;22 males,18 females;age 25～54 years,mean(43.2±7.1)years].Operative time,intra-operative fluoroscopy frequency,length of hospital stay,hospitalization cost,and postoperative complications were recorded.Pre-and postoperative assessments included the visual analogue scale(VAS)for pain,Oswestry disability index(ODI),cross-sectional area of the spinal canal,and cross-sectional area of the intervertebral foramen.Results Follow-up lasted 5～8 months,mean(7.1±0.2)months.Operative time and total hospitalization cost in the UBE group were significantly greater than in the PTED group(both P＜0.001).Fluoroscopy frequency and length of hospital stay did not differ between the two groups(P＞0.05).Postoperative complications were comparable(P＞0.05).VAS and ODI improved significantly in both groups after surgery(P＜0.001).At 1 week postoperatively,PTED yielded better VAS and ODI scores than UBE(P＜0.05).At 1 month and 3 months,no significant inter-group differences were observed(P＞0.05).Postoperative cross-sectional area of the spinal canal and intervertebral foramen increased significantly in both groups(P＜0.05).The increase in spinal-canal area was greater in the UBE group than in the PTED group(P＜0.001).Intervertebral-foramen area did not differ between the groups(P＞0.05).Conclusion Both UBE and PTED are effective for single-level lumbar disc herniation.The choice of procedure should be individualized according to patient-specific factors.

Abstract:Objective To analyze the influencing factors of reoperation after internal fixation in patients with displaced femoral neck fractures and to construct a nomogram.Methods From January 2020 to January 2024,342 patients with displaced femoral neck fractures who underwent internal fixation at the First Affiliated Hospital of Kangda College of Nanjing Medical University were enrolled.Patients were allocated 1∶1 into a modeling group(n=171)and a validation group(n=171).Follow-up lasted 1 year.In the modeling group,76 patients who required reoperation formed the reoperation group and 95 who did not formed the non-reoperation group.The incidence of reoperation after surgery was 44.44％.Multivariate logistic regression was used to identify independent risk factors for modeling group reoperation,and a nomogram was constructed using R software.Model discrimination and calibration were assessed by receiver operating characteristic(ROC)curve and Hosmer-Lemeshow(H-L)test.Results Multivariate logistic regression analysis revealed that age＞50 years,smoking,Garden classification,intraoperative reduction quality,and time from injury to surgery were significant influencing factors for reoperation after internal fixation in patients with displaced femoral neck fractures(P＜0.05).The area under the ROC curve(AUC)for predicting reoperation in the modeling group was 0.854[95％CI(0.792,0.903),P＜0.05],with a sensitivity of 88.16％and specificity of 71.58％.The H-L test yielded x2=9.389(P=0.310),and the calibration curve closely approximated the ideal curve,with a mean absolute error of 0.058.For the validation group,the AUC was 0.878[95％CI(0.820,0.923),P＜0.05],with a sensitivity of 85.92％and specificity of 79.00％.The H-L test result was x2=6.185(P=0.627),and the calibration sely matched the ideal curve,curve clowith a mean absolute error of 0.047.Decision curve analysis demonstrated that the constructed nomogram model exhibited favorable clinical validity.Conclusion Early assessment of reoperation risk in patients with displaced femoral neck fractures using the constructed nomogram can guide timely interventions to reduce reoperation rates.

Abstract:Objective To summarize the characteristics,diagnosis and treatment strategies of Ideberg type Ⅰ a fractures of the scapular pelvis combined with rotator cuff injuries.Methods A retrospective analysis was conducted on the data of 5 patients with scapular pelvis Ideberg type Ⅰ a fractures combined with rotator cuff injuries admitted to Guangdong Hospital of Traditional Chinese Medicine and Nanxiong Hospital of Traditional Chinese Medicine from January 2021 to April 2024.All patients were female,aged 60 to 86 years,with an average age of(71.40±9.02)years.All were fresh traumas.Four cases had dislocation of the shoulder joint at the time of injury.Three cases were simple Ideberg type Ⅰ a fractures of the scapular pelvis combined with rotator cuff injury.One case was combined with a proximal tibial fracture.One case was combined with an avulsion fracture of the greater tubercle of the humerus of the shoulder joint.Two cases of rotator cuff injury were initially missed at diagnosis.All were treated with arthroscopic exploration of the shoulder,reduction,and anchor fixation of glenoid fractures,and rotator cuff repair.Results The postoperative follow-up period ranged from 9 to 37 months,with an average of(19.60±9.62)months.No shoulder dislocation occurred during the follow-up period.After the operation,two cases had no pain in the shoulder joint,and the shoulder joint movement returned to normal.One case had no pain in the shoulder joint,and the movement of the shoulder joint was slightly limited,but it could meet the activity requirements of daily life.Two cases had occasional pain in the shoulder joint and mild limitation of shoulder joint movement,but could meet the activity requirements of daily life.Conclusion Ideberg type Ⅰ a fractures of the scapular pelvis combined with rotator cuff injuries are more common in the elderly.The accompanying rotator cuff injuries,nerve injuries,and osteoporosis may be overlooked.It is recommended that concurrent surgical treatment be carried out for combined rotator cuff fractures or greater tuberosity fractures of the humerus.The continuity between the lower part of the glenoid fracture and the labrum between the glenoid is conducive to the reduction and fixation of the fracture.When the reduction and fixation of the fracture are difficult,the double-row fixation technique or the Double pulley double-row anchor technique can be adopted.

Abstract:Objective To evaluate the clinical efficacy of slot drainage technique combined with drug-loaded calcium sulfate in treating postoperative infections following intramedullary nailing of lower limb fractures.Methods A retrospective analysis was conducted on 42 patients with postoperative infections after intramedullary nailing of lower limb fractures treated at the People's Hospital of Xinjiang Uygur Autonomous Region from June 2018 to June 2024.The cohort included 30 males and 12 females,aged 20～65 years[mean(35.0±3.0)years].Among them,15 cases involved femoral intramedullary nailing infections,and 27 cases involved tibial intramedullary nailing infections.The disease duration ranged from 3 to 10 months[mean(5.0±1.5)months].All patients were treated with slot drainage technique combined with drug-loaded calcium sulfate.Postoperative outcomes were comprehensively evaluated based on the time to resolution of clinical symptoms,normalization of infection markers(complete blood count,C-reactive protein,erythrocyte sedimentation rate,procalcitonin),radiographic findings,recurrence rate,and functional recovery.Results Postoperative follow-up ranged from 6 to 12 months[mean(10.0±1.5)months].Primary healing was achieved in 40 cases(95.2％),while 2 cases experienced recurrence but resolved after retreatment.The time to resolution of clinical symptoms postoperatively was 3～6 months[mean(4.0±0.5)months].Laboratory infection markers normalized within 3～7 months[mean(5.0±1.5)months],and radiographic recovery occurred within 5～10 months[mean(7.0±1.5)months).Functional recovery assessed by the Paley score was excellent in 34 cases(81.0％),good in 5 cases(11.9％),and fair in 3 cases(7.1％),with an excellent-to-good rate of 92.9％.Conclusion Slot drainage technique combined with drug-loaded calcium sulfate for postoperative infection after intramedullary nailing of lower limb fractures yields significant clinical results,low postoperative recurrence rate,markedly shortened fracture healing time,reduced antibiotic consumption,and lowered risk of drug toxicity,thus demonstrating clinical value for wider application.

Abstract:Objective To evaluate the efficacy of Ilizarov external fixation and its combination with intramedullary nailingin the treatment of congenital pseudarthrosis of the tibia(CPT).Methods A retrospective analysis was performed on 19 children with CPT(all Boyd type Ⅱ)treated in the 964th Hospital of PLA,between January 2008 and December 2013.The cohort comprised 5 boys and 14 girls,aged 1～6 years[mean(3.2±1.3)years].Seven patients underwent Ilizarov external fixation alone(Group A),seven received Ilizarov external fixation plus intramedullary nailing(Group B),and five underwent Ilizarov external fixation plus bone transport(Group C).Clinical outcomes were compared among the three groups.Results All patients were followed up for＞4 years.In Group A,primary bony union was achieved in 100％of patients;refracture occurred in 71.4％,ankle valgus in 71.4％,residual knee deformity in 28.6％,residual limb shortening in 100％,and anterior tibial bowing in 14.3％.In Group B,primary bony union was 85.7％;refracture occurred in 14.3％,residual knee deformity in 14.3％,residual limb shortening in 28.6％,and anterior tibial bowing in 14.3％.In Group C,primary bony union was 100％;refracture occurred in 100％,ankle valgus in 80％,residual knee deformity in 50％,residual limb shortening in 80％,and anterior tibial bowing in 40％.Conclusion For CPT,Ilizarov external fixation combined with intramedullary nailing yields the lowest refracture rate.The intramedullary nail maintains bony union and significantly reduces postoperative complications.

Abstract:Objective To investigate the role of limited closed continuous irrigation in reducing the occurrence of vascular crisis and preventing necrosis of replanted bodies during the treatment of avulsed thumb.Methods A retrospective study was conducted on 104 patients with rotational avulsed thumb admitted to the department of orthopaedics of Beijing No.6 Hospital from January 2023 to June 2024[89 males and 15 females,aged 25～69 years,mean age(51.5±9.2)years].The patients in the control group underwent radial digital proper arterial of the index finger or combined with principal artery of thumb transference.The patients in the experimental group were placed a flushing tube and received continuous warm irrigation besides the same surgery as the control group.The following outcomes were compared between the two groups:incidence of vascular crisis within the first postoperative week;serum procalcitonin(PCT),C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)on postoperative days 1,3 and 7;incidence of replant edema within three weeks;hand function scores and survival rate at six months.Results All 104 patients completed six-month follow-up.Within the first postoperative week,the incidence of vascular crisis on days 1,3 and 7 was 3.8％,1.9％and 0 in the experimental group,respectively,versus 11.5％,9.6％and 7.7％in the control group(P＜0.05).On postoperative days 1,3 and 7,PCT levels in the experimental group were(2.3±0.9)ng/mL,(1.0±0.5)ng/mL and(0.4±0.2)ng/mL,compared with(2.4±0.8)ng/mL,(1.7±0.7)ng/mL and(0.7±0.5)ng/mL in the control group;the difference on day 1 was not significant(P=0.177),whereas levels on days 3 and 7 were significantly lower in the experimental group(P＜0.05).On postoperative days 1,3 and 7,ESR and CRP in the experimental group were(46.8±8.1)mm/h,(21.6±4.3)mm/h,(13.5±2.8)mm/h and(38.5±15.9)mg/L,(2.2±2.3)mg/L,(2.0±3.1)mg/L,respectively,while those in the control group were(65.5±7.2)mm/h,(49.2±8.5)mm/h,(21.8±3.9)mm/h and(88.7±24.2)mg/L,(15.0±8.6)mg/L,(8.1±2.9)mg/L;all values were significantly lower in the experimental group(P＜0.05)and decreased more rapidly over time.In the first and second postoperative weeks,the incidence of edema in the replanted thumb was 9.6％and 19.2％in the experimental group versus 57.7％and 38.5％in the control group(P＜0.05);in the third week,edema rates were 9.6％and 23.1％.with no significant difference(P＞0.05).At six months postoperatively,the excellent-to-good rate of hand function was 100％in the experimental group and 86.5％in the control group.Conclusion Arterial transference combined with limited closed continuous irrigation effectively reduces the inflammatory response,lowers the incidence of vascular crisis and early edema,and improves the survival rate and functional outcomes of replanted thumbs following avulsed thumb replantation.

Abstract:Objective To compare the clinical efficacy of different treatment modalities for non-traumatic rotator cuff tears in middle-aged and elderly patients.Methods Between June 2019 and June 2023,326 patients[156 males,170 females;age 55～88 years,mean(69.9±15.5)years]with non-traumatic rotator cuff tears were followed up and divided into four groups:Group A(n=81)received basic care only,Group B(n=82)underwent progressive physical therapy,Group C(n=82)underwent acromioplasty plus progressive physical therapy,Group D(n=81)underwent acromioplasty,rotator cuff repair,and progressive physical therapy.Pain and function were assessed pre-and post-treatment using the visual analogue scale(VAS),Constant-Murley score,Dutch simple shoulder test(DSST),shoulder pain and disability index(SPADI),and American shoulder and elbow surgeons(ASES)evaluation form.3D motion trajectories were analyzed with the Vicon MX40 system,and MRI was used to grade rotator cuff fatty infiltration.Results Group D had longer operative time than Group C because of the additional cuff repair(P＜0.05).At 3-year follow-up,Group D showed superior VAS,SPADI,DSST,Constant-Murley,and ASES scores compared with Groups A,B,and C(P＜0.05).Short-term(6-month)outcomes were comparable across all groups;long-term benefits favored Group D(P＜0.05).3-year post-treatment,Group D demonstrated significantly greater 3D motion amplitude,coordination index,and movement fluency(P＜0.05),and the most pronounced improvement in MRI fatty infiltration grade(P＜0.05).Conclusion In middle-aged and elderly patients with non-traumatic rotator cuff tears,arthroscopic surgery combined with physical therapy offers comparable short-term efficacy to conservative treatment but provides superior long-term improvements in functional scores,3D motion coordination,and retardation of fatty infiltration.

Abstract:Objective To investigate the relationship between facet joint distraction(FJD)distance and postoperative axial neck pain in patients undergoing anterior cervical discectomy and fusion(ACDF).Methods A retrospective analysis was conducted on 138 patients[75 males,63 females;mean age(48.1±4.7)years,range 40～55 years]with cervical degenerative disorders treated at the Second Affiliated Hospital of Nanjing Medical University from March 2018 to September 2023.The FJD distance was measured on preoperative and postoperative day 3 cervical CT scans for all patients.These radiographic measurements were then correlated with clinical outcomes.Clinical evaluation included the assessment of neck pain and arm pain intensity using the visual analogue scale(VAS)and functional disability using the neck disability index(NDI),performed both preoperatively and postoperatively.Pearson's correlation coefficient was used to analyze the association between FJD distance and postoperative axial neck pain severity.Furthermore,receiver operating characteristic(ROC)curve analysis was performed to determine the optimal cutoff value for postoperative changes in FJD distance in predicting the occurrence of postoperative axial neck pain.Results All patients completed a minimum postoperative follow-up period of＞12 months.The intensity of neck pain,assessed by VAS,peaked at 3 weeks postoperatively,followed by a progressive decline thereafter.A significant positive correlation was observed between the FJD distance measured on postoperative day 3 and the neck pain VAS scores at 3 weeks postoperatively(r=0.661,P＜0.05).ROC curve analysis demonstrated excellent diagnostic performance for the change in FJD distance in predicting postoperative axial neck pain,with an area under the curve of 0.848[95％CI(0.784,0.911)].The optimal cutoff value for ΔFJD distance was determined to be 1.90 mm.Stratified by the ΔFJD distance cutoff of 1.90 mm,patients were categorized into normal-distraction(ΔFJD＜1.90 mm)and over-distraction(ΔFJD≥1.90 mm)groups.Both groups demonstrated significant improvements in VAS and NDI scores compared to preoperative baselines,with the normal-distraction group achieving statistically superior clinical outcomes across all measures.Conclusion Excessive distraction of the facet joints during ACDF can lead to early postoperative axial neck pain;therefore,surgeons should avoid over-distraction and select an appropriately sized interbody cage to prevent postoperative axial neck pain and adjacent nerve root compression.

Abstract:Objective To compare the clinical efficacy of Kirschner-wire levering with blocking-screw assistance during closed reduction and intramedullary nailing of extra-articular distal tibial fractures.Methods A retrospective analysis enrolled 44 patients treated between January 2019 and January 2024.Kirschner-wire levering group:23 patients[9 males,14 females;age 20～60 year mean(45.5±15.1)year].Blocking-screw group:21 patients[10 males,11 females;age23～69 year,mean(52.7±15.6)year].All patients underwent intramedullary nailing.We compared general data,peri-operative variables(operation time,blood loss,incision length),fracture healing time,hospital stay,partial and full weight-bearing times,VAS pain scores at 3 d,7 d,1 month,3 month and 6 month,and the Johner-Wruhs tibial fracture score at 12 month.Results No significant differences were observed between the two groups in general characteristics,operation time,blood loss,incision length,fracture healing time,hospital stay,partial or full weight-bearing time,VAS scores at any post-operative interval,or 12 month Johner-Wruhs scores(P＞0.05).At the last follow-up,the distance from the distal-most fracture line to the articular surface,angulation of the fracture fragments,coronal and sagittal angles of the nail tip,and distances from the nail tip to the medial/lateral and anterior/posterior cortices differed significantly(P＜0.05).Conclusion Compared with blocking screws,Kirschner-wire levering increases intramedullary fixation points,aids reduction,strengthens fixation,and allows more accurate central placement of the nail tip within the distal metaphyseal canal,resulting in better reduction quality.Therefore,Kirschner-wire levering offers a valuable reference for selecting an auxiliary technique in intramedullary nailing of distal tibial fractures.

Abstract:Objective To investigate the role of microRNA-23a(miR-23a)overexpression in the chondrogenic and hypertrophic differentiation of mouse embryonic mesenchymal stem cell line C3H10T1/2,and to provide new insights for stem cell-based treatment of osteoarthritis and cartilage injury repair.Methods A lentiviral vector overexpressing miR-23a was constructed to infect C3H10T1/2 cells(miR-23a group),with miR-NC-infected cells as the control group(miR-NC group).Transforming growth factor(TGF)-β3 was used to induce chondrogenic differentiation in both groups.Real-time quantitative polymerase chain reaction(RT-qPCR),Western blot,safranin O staining,and immunohistochemistry were performed to detect the expression of cartilage markers[SRY-related high mobility group-box gene 9(SOX9),aggrecan(ACAN),collagen type Ⅱ alpha 1 chain(COL2A1)]and hypertrophy marker[collagen alpha-1(X)chain(COL10A1)].Results During the first 14 days of chondrogenic induction,miR-23a expression continuously increased(P＜0.05),peaking on day 10.Compared with the miR-NC group,the miR-23a group exhibited higher expression of cartilage markers(P＜0.05)and lower expression of the hypertrophy marker(P＜0.05).Further investigation showed that overexpression of miR-23a down-regulated the expression of Runt-related transcription factor 2(Runx2).Conclusion miR-23a is highly expressed in the early stage of chondrogenic differentiation of C3H10T1/2 cells.Overexpression of miR-23a promotes chondrogenic differentiation while inhibiting hypertrophic differentiation,possibly by suppressing the hypertrophy-associated transcription factor Runx2.

Abstract:Objective To investigate the incidence and influencing factors of deep vein thrombosis(DVT)in orthopaedic patients receiving perioperative anticoagulant prophylaxis.Methods A retrospective study enrolled 8 114 consecutive orthopaedic patients who received standardized perioperative anticoagulant prophylaxis in our hospital between January 2023 and December 2023.Among them,3 739 were male and 4 375 were female,aged 9～100 years[(mean(60.58±16.09)years)].Lower-extremity DVT occurred in 2 116 patients(DVT group)and did not occur in 5 998 patients(non-DVT group),giving an overall incidence of 26.08％.Within the 2 116 DVT cases,62.38％were detected before surgery and 37.62％after surgery;7.14％were proximal DVT,59.17％isolated soleal vein thrombosis,and 33.69％other distal DVT.Under appropriate anticoagulant therapy,complete thrombus resolution was achieved in(6.79±3.69)days for proximal DVT,(7.23±5.86)days for soleal vein thrombosis,and(6.80±4.35)days for other distal DVT.Results Univariate analysis showed significant differences between the DVT and non-DVT groups in age,sex,timing of anticoagulant initiation,anticoagulant type,D-dimer,fibrinogen,injury site and surgical procedure(P＜0.05).Multivariate logistic regression identified age,sex,anticoagulant type,D-dimer,fibrinogen and injury site as independent risk factors for perioperative lower-extremity DVT.Conclusion Despite anticoagulant prophylaxis,DVT incidence in orthopaedic patients remains considerable,with distal DVT predominating.Advanced age,male sex,choice of anticoagulant,elevated D-dimer and fibrinogen,and injury site are independent predictors of DVT in this setting.

Abstract:Objective To analyze the pathogen spectrum and antibiotic susceptibility in patients with fracture-related infection(FRI),providing evidence for clinical prevention and treatment.Methods We retrospectively collected 190 consecutive FRI patients treated at our hospital between June 2018 and June 2024;142 were male and 48 female,aged 15～91 years[mean(52.29±14.65)years].Deep-tissue specimens were cultured and subjected to antimicrobial susceptibility testing.Positive results were statistically analyzed.Results Of the 190 cases,114 were culture-positive(positivity rate 60.00％)and 76 were negative.Among the 114 positive cases,107 showed monomicrobial infection and 7 polymicrobial infection.A total of 19 pathogen species(124 strains)were isolated:7 Gram-positive species(70 strains,56.45％),11 Gram-negative species(53 strains,42.74％),and 1 fungal species(1 strain,0.81％).Antimicrobial susceptibility testing revealed 29 multidrug-resistant(MDR)strains(23.39％),including two Klebsiella pneumoniae strains producing extended-spectrum β-lactamases(ESBLs).Conclusion Monomicrobial infection was predominant in our FRI cohort,with Gram-positive bacteria accounting for the largest proportion.The resistance profile and MDR rate were similar to previous findings.Rational antibiotic selection guided by susceptibility testing is essential for effective FRI management and for reducing antibiotic misuse.

Abstract:Objective To investigate the application of the fast-track surgery in the patients with total hip arthro-plasty because of fractured neck of femurMethods Seventy-nine patients undergoing primary THR were recruited pro-spectively.After randomization,one group with thirty-nine patients undergoing the fast-track surgery were taken as the experimental group and forty patients undergoing the traditional treatment as the control group.We compared the length in bed,complications,pain,physical activities of daily living and postoperative function.Results All patients were followed up for 6 months.The length of bed of traditional recoery group was about (3.5±1.0)days,and the length of bed of fast-track recoery group was about (2.1±0.6)days(P<0.001).The time of activities was about (25.5±14.4) h,and the fast-track group was about (37.4±10.4)h (P<0.001).Postoperative complications occurred in 5 patients in the fast-track group,while 10 cases in the traditional group(P<0.001).The difference on the pain was not significant. The results showed that the scores of Harris were significantly higher in the fast-track recovery group than the tradi-tional group on the day of discharge,3 months after operation and at the end of the 6 month after operation(P<0.001). Conclusion Compared with conventional care,fast-track surgery in patients undergoing total hip arthroplasty is safe and feasible.The application of FTS contributed to significant reduction of length in bed and complications.There is sig-nificant difference regarding mobilization,postoperative function besides pain.