Abstract:Objective To construct and validate a risk prediction model for postoperative recurrent fracture in patients with osteoporotic vertebral fracture(OVF)based on serum insulin-like growth factor-1(IGF-1),cross-linked C-terminal peptide of type Ⅰ collagen(CTX)and total procollagen type Ⅰ N-terminal propeptide(P1NP)and other indicators.Methods The subjects were OVF patients who underwent vertebroplasty or posterior fusion in our hospital from May 2020 to May 2024,and a total of 215 patients were included.According to whether there was recurrent vertebral fracture during the 12-month follow-up after surgery,the subjects were divided into a non-recurrent fracture group(n=173)and a recurrent fracture group(n=42),and the subjects were divided into a training set and a validation set at a ratio of 7:3.LASSO regression and binary logistic regression analysis were used to explore the risk factors for recurrent fracture after surgery in patients with OVF.The static nomogram model was constructed using the"rms"package of R R 4.4.1 language and a web-based risk calculator was developed.The model was internally validated using the Bootstrap method(repeated sampling 1000 times),and the validity,calibration and discrimination of the model were evaluated by drawing decision curves,calibration curves and ROC curves.Results The results of multivariate logistic regression analysis showed that body mass index(BMI),bone mineral density(BMD),P1NP,IGF-1,CTX and osteoporosis course were independent risk factors for recurrent fracture after surgery in patients with OVF(P<0.05).Based on the six risk factors above,a nomogram model for risk prediction of recurrent fracture after surgery in patients with OVF was constructed.The ROC curve showed that the AUC of the model was 0.724[95%CI(0.628,0.821)],and the consistency index was 0.824;the decision curve indicated that the prediction model had a net benefit when the probability threshold was 0.050-0.950;the calibration curve of the model basically coincided with the ideal curve.Conclusions This study constructs and verifies a nomogram model for risk prediction of recurrent fracture after surgery in patients with OVF based on serum IGF-1,CTX,P1NP and clinical characteristics(BMI,BMD,osteoporosis course),and the model has good prediction performance.The developed web-based risk calculator can realize the real-time dynamic monitoring of the risk of recurrent fracture in patients after OVF surgery.

Abstract:Objective To estimate risk factors for both of respiratory complication(RC)and mortality after acute traumatic cervical spinal cord injury(TCSCI),to improve the clinical and nursing intervention decision.Methods Between Jan 2005 and Jan 2023,181 patients(142 males and 39 females;mean age 41.0 years)after acute TCSCI were analyzed.Compare the difference and odd ratio in the RC group(n=73)with the non-RC group(n=108),and the group of death(n=15)and survival(n=166).Collect injury-related information after half a year of injury as follows:cause of injury,time of surgery,intensive care unit(ICU)days,ventilator-days,American Spinal Injury Association(ASIA)classification,neurological injury,clinical pulmonary infection score(CPIS),body mass index(BMI),as well as general information such as age,gender,smoking history and steroid.Results Compared with non-RC,gender[OR=1.269,95%CI(0.609-2.646)],smoking history[OR=2.902,95%CI(1.564-5.385)],ASIA classification(grade A)[OR=6.439,95%CI(3.334-12.434)],neurological injury level(C1-4)[OR=2.714,95%CI(1.458-5.066)],and steroid use[OR=2.983,95%CI(1.276-6.969)]were significantly worse in RC group.Furthermore,between death and survival group,the aspect of age,non-surgical,CPIS,AIS grade,BMI had statistically significant differences.Survival analysis revealed significant differences in groups above.Conclusions In patients suffering from acute TCSCI,those who have senior age,long smoking history,complete SCI,injury C1-4,high CPIS and BMI would accompany with high incidence of RC and mortality.

Abstract:Objective To explore the phenotypic characteristics and mechanisms of peripheral blood effector follicular helper T cells(Tfh)and their subtypes in patients with rheumatoid arthritis(RA)of different disease activity levels,and determine their relationship with RA treatment responsiveness.Methods 126 RA patients admitted to our hospital from January 2021 to September 2023 were selected and divided into high activity group(n=42),medium activity group(n=39),and low activity group(n=45)based on disease activity.The levels of Tfh cells and their subtypes were compared between the two groups,and LOWESS regression analysis was used to investigate the correlation between Tfh and disease activity.Subsequently,patients were divided into a good response group(n=62)and a non response group(n=64)based on treatment responsiveness.The relationship between Tfh and their subtypes and treatment responsiveness was evaluated using a multi factor generalized linear mixed effects model,and their interaction with disease activity was analyzed.Using a restricted cubic spline model to analyze the relationship between Tfh and subtype levels and patient recurrence risk.Results Statistically significant differences were observed in Tfh(F=117.316,P<0.001),Tfh1(F=172.140,P<0.001),Tfh2(F=272.480,P<0.001)and Tfh17(F=20.228,P<0.001)among three groups.The LOWESS analysis results showed that the levels of Tfh,Tfh2,and Tfh17 were negatively correlated with DAS28 scores,while the level of Tfh1 was positively correlated with disease activity scores.Statistically significant differences were observed in Tfh(t=26.812,P<0.001),Tfh1(t=10.836,P<0.001),Tfh2(t=7.908,P<0.001)and Tfh17(t=3.397,P=0.001)between the two groups.The multi factor generalized linear mixed effects model showed that Tfh,Tfh2,and Tfh17 were negatively correlated with treatment non response(OR<1,P<0.05),while Tfh1 was positively correlated with treatment non response(OR>1,P<0.05).After adjusting for confounding factors,the correlation between Tfh,Tfh1,Tfh2,Tfh17 and treatment responsiveness still existed.In different disease activity groups,the Tfh,Tfh2,and Tfh17 of the non responsive subgroup patients were lower than those of the well responsive subgroup patients,and Tfh1 was higher than that of the well responsive subgroup patients.Tfh,Tfh1,Tfh2,Tfh17 had an interaction with disease activity,with Tfh,Tfh2,Tfh17 showing a negative interaction with high activity,and Tfh1 showing a positive interaction with high activity.The results of the restricted cubic spline model showed a non-linear dose-response relationship between Tfh,Tfh1,Tfh2,Tfh17 and prognostic risk(non-linear detection,P<0.001).As Tfh,Tfh1,Tfh2,Tfh17 increased,prognostic risk decreased;and as Tfh1 increased,prognostic risk increased.Conclusions The peripheral blood Tfh cells and their subtypes(Tfh1,Tfh2,Tfh17)are closely related to the disease activity and treatment responsiveness of RA.Tfh1 levels are positively correlated with disease activity and indicate no response to treatment and poor prognosis,while Tfh2 and Tfh17 may have protective effects.Clinical recommendations include dynamic monitoring of Tfh subgroups to optimize individualized treatment strategies.

Abstract:Objective To improve the segmentation accuracy and boundary alignment of the meniscus in knee MRI images,particularly in four key anatomical regions(anterior/posterior horns of lateral/medial menisci).This study proposes an improved TransUNet-based high-precision automatic meniscus segmentation model.Methods Using the publicly available MRNet dataset from Stanford University,we constructed a finely annotated meniscus segmentation subset labeled by experienced radiologists as training and evaluation samples.The dataset was split into an 8:2 ratio for training and testing.Through transfer learning,we developed an ECMA-TransUNet model,incorporating an Efficient Channel and Multi-Scale Attention(ECMA)module embedded into the CNN encoder stages and three skip connection paths of the TransUNet decoder.This model was applied to segment the four meniscal horns.Results The proposed model achieved the following segmentation performance across the four anatomical regions:lateral anterior horn(DSC=87.43%,HD=0.5678),lateral posterior horn(DSC=93.15%,HD=0.8455),medial anterior horn(DSC=91.48%,HD=0.7551)and medial posterior horn(DSC=94.00%,HD=0.7407).All metrics met clinical usability standards.Conclusions The proposed ECMA-TransUNet demonstrates significant advantages:(1)The introduced attention module enhances boundary alignment and small-structure recognition;(2)The anatomical segmentation accuracy meets clinical diagnostic requirements,providing reliable support for intelligent diagnostic assistance systems.

Abstract:Objective To investigate the early clinical efficacy and safety of 3D printed customized acetabular prostheses in hip revision surgery with severe acetabular bone defects.Methods A retrospective analysis was conducted on 13 patients who underwent hip revision surgery using 3D printed customized acetabular prostheses at our center from August 2020 to March 2022.Among them,4 cases were accompanied with Paprosky type Ⅱ acetabular bone defect,and the other 9 cases were accompanied with type Ⅲ bone defect.The reasons of revision included 11 cases of aseptic loosening of the prosthesis and 2 cases due to prosthetic joint infection(PJI)Ⅱ stage revision.The average follow-up time after surgery was 21.6 months.There was mean 1.4 hip arthroplasty surgeries performed before operation.Harris hip score(HHS),36-Item short form(SF-36),and Visual Analog Scale(VAS)score were recorded before surgery and at the last follow-up.Discrepancy of lower limbs(LLD)and orientation of acetabular prostheses were measured via pelvis radiography.Surgical time,intraoperative blood loss and postoperative complications were recorded respectively.Results HHS significantly increased from(52.5±14.1)before surgery to(79.4±6.7)at the last follow-up;SF-36 significantly increased from preoperative period(76.0±3.4)to the last follow-up(105.8±7.0);VAS significantly decreased from(6.0±0.8)before surgery to(1.5±0.9)at the last follow-up;LLD was improved from(25.8±13.4)mm before surgery to(4.7±3.8)mm after surgery,which showed statistical difference(P<0.001).The average surgical time was(192.9±79.4)min,and the average intraoperative blood loss was(931±386)ml.The incidence of complications was 23.1%during follow-up.One case of periprosthetic fracture of the distal femur occurred during surgery.One case of hip dislocation occurred after surgery.There were no complications such as PJI,prosthesis loosening,poor wound healing,or deep vein thrombosis of lower limbs observed during follow-up.The survival rate of the prostheses was 100%until last follow-up.Conclusions 3D printed customized acetabular prostheses have achieved satisfactory clinical results in hip revision surgery with severe acetabular bone defects,simplifying surgical process.However,more clinical cases are needed to verify safety and effectiveness in the future.

Abstract:Objective To investigate the correlation between the expression of serum alkaline phosphatase(ALP),Dickkopf related protein 1(DKK1),and transforming growth factor-β1(TGF-β1)and the healing of traumatic fractures.Methods From September 2020 to September 2023,128 patients with traumatic tibial plateau fractures who were admitted to our hospital were included as the disease group.Another 120 individuals who underwent health check ups at our hospital were labeled as control group.Detect the serum ALP,DKK1,and TGF-β1 in patients with traumatic fractures.Pearson method was used to analyze the relationship between serum ALP,DKK1,TGF-β1 and bone biochemical indicators in patients with traumatic fractures.In addition,ROC curve was used to analyze the predictive power of serum ALP,DKK1,and TGF-β1 on the healing of traumatic fractures in patients.Results The disease group had conspicuously higher serum ALP and DKK1,and conspicuously lower serum TGF-β1 than control group(P<0.05).The delayed healing group had manifestly higher serum ALP and DKK1,and manifestly lower serum TGF-β1 than normal healing group(P<0.05).The delayed healing group had conspicuously lower serum PINP,β-CTX,and 25(OH)D3 than normal healing group and the control group.The normal healing group had manifestly lower serum PINP,β-CTX,and 25(OH)D3 than control group(P<0.05).The serum ALP and DKK1 in patients were negatively correlated with PINP,β-CTX,and 25(OH)D3,while serum TGF-β1 was positively correlated with PINP,β-CTX,and 25(OH)D3(P<0.05).The area under the curve(AUC)of the combination of serum ALP,DKK1,and TGF-β1 in predicting traumatic fracture healing was 0.949,which was better than their individual predictions(Ztriple combination-ALP=2.727,Ztriple combination-DKK1=3.656,Ztriple combination-TGF-β1=3.373,P=0.006,P=0.000,P=0.001).The sensitivity and specificity of combined prediction were 87.50%and 91.25%,respectively.Conclusions Serum ALP and DKK1 are manifestly elevated in patients with traumatic fracture,while serum TGF-β1 is manifestly reduced.They are closely related to the healing status of patients,and the combined detection of the three has a higher predictive power for the healing of traumatic fracture.

Abstract:Objective To explore pelvic girdle compression band fixation in the diagnosis and treatment of sacroiliac joint dysfunction.Methods From Mar.1st,2023 to Sept.30,2023,42 patients diagnosed as sacroiliac joint dysfunction were treated with pelvic girdle compression band fixation.Before and after pelvic girdle compression band fixation,VAS score and the age of the patients were recorded and analyzed statistically.Results In 42 patients with sacroiliac joint disorder,there were significant differences in VAS scores before treatment and 20 minutes,1 week,1 month and one year after treatment(P<0.01).Conclusions Sacroiliac joint dysfunction is common in middle-aged and elderly patients and pelvic girdle compression band fixation could effectively relieve symptoms.

Abstract:Objective To evaluate the clinical efficacy of hip arthroplasty(HA)based on soft tissue fixation of the greater trochanteric fragment for treating osteoporotic intertrochanteric femoral fractures(IFF)in elderly patients.Methods This retrospective study analyzed the clinical data and outcomes of 36 elderly patients with osteoporotic IFF treated with soft tissue fixation combined with artificial HA from March 2018 to April 2024.The cohort study included 7 males and 29 females,with a mean age of(84.36±6.77)years.Left-sided cases numbered 19,while right-sided cases numbered 17.Surgical procedures included 8 total hip replacements and 28 hemiarthroplasties.Fractures were classified using the Evans-Jensen system,with 22 cases classified as type Ⅲ and 14 as type Ⅳ.Fractures were classified using the AO/OTA system,with 24 cases classified as 31A2.2 and 12 as 31A2.3.Preoperative and postoperative parameters,Harris Hip Scores(HHS),Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)scores,and complication rates were recorded and analyzed.Results The mean follow-up duration was 21.06 months(range:6-48 months).The mean operative time was(62.17±11.51)min,with a mean postoperative hemoglobin loss of(19.53±6.98)over 3 days.Patients resumed walking at a mean of(2.42±1.42)days postoperatively,and the mean hospital stay was(9.33±1.69)days.At the final follow-up,significant improvement was observed in HHS and WOMAC scores(P=0.000;P=0.002).Imaging results confirmed satisfactory fracture healing,and the 1-year postoperative mortality rate was 5.51％.Conclusions HA based on soft tissue fixation for osteoporotic IFF in elderly patients offers advantages such as lower surgical difficulty,reduced surgical trauma,and effective fixation It allows patients to get out of bed early for weight bearing with favorable early clinical outcomes.

Abstract:Objective To investigate the accuracy of prosthesis placement and clinical efficacy of domestic robot-assisted total hip arthroplasty(THA)in the treatment of complex hip joint diseases.Methods We retrospectively collected data from 21 elderly patients(22 hips)who underwent robot-assisted THA at Shenzhen Pingle Orthopedic Hospital(Shenzhen Pingshan District Hospital of Traditional Chinese Medicine)from December 2020 to May 2025.Among these,15 hips had developmental dysplasia of the hip(DDH),5 hips had flat hip,and 2 hips had femoral head necrosis after acetabular fracture internal fixation.Additionally,22 patients(22 hips)who underwent conventional manual THA,all with DDH,were included.All patients received a standard posterior-lateral surgical approach.Surgical time,Harris hip score(HHS)at 3 months postoperatively,postoperative acetabular cup anteversion and abduction angles,leg length discrepancy(LLD),and the hip joint center offset were compared between the two groups.Results The mean surgical time was(136.36±51.20)minutes in the robot-assisted group and(101.32±43.13)minutes in the manual group,showing statistically significant differences(P=0.021).Both groups exhibited significant improvement in HHS at 3 months postoperatively compared with preoperative scores(P<0.001),with no significant difference between the groups(P>0.05).The anteversion angles were(19.1±4.0)° and(25.7±7.4)° in the robot-assisted and manual groups,respectively,with significant differences(P<0.001).The abduction angles showed no significant differences between the two groups(P=0.985).The LLD were(3.5±0.6)mm and(5.8±0.9)mm,respectively,with significant differences(P<0.001).The hip joint center offset showed no significant difference between the two groups(P=0.224).Compared with the manual group,the robot-assisted group had a longer surgical time but achieved more accurate prosthesis placement and reduced leg length discrepancy.Conclusions Domestic robot-assisted THA for complex hip joint diseases can enhance surgical accuracy,improve hip joint function,and achieve satisfactory clinical outcomes.

Abstract:Objective To summarize the current research status,hotspots and trends of developmental dysplasia of the hip(DDH),aiming to provide references for subsequent research.Methods The relevant literatures on DDH research included in the Web of Science Core Collection(WOSCC)database and the China National Knowledge Infrastructure(CNKI)database from January 1st,2014 to January 1st,2024 were retrieved.Excel 2021 and CiteSpace 6.3.R1 software were used to conduct a visual analysis of the literature and draw a knowledge map.Results A total of 3,854 articles were included in the WOSCC database and 1,008 articles in the CNKI database.The number of articles published in the WOSCC database showed a slow upward trend,while that in the CNKI database presented a wave-like trend and began to decline in recent years.The United States was the country with the highest number of articles published in the WOSCC database,and also had the highest total citation count.Harvard University was the institution with the highest number of English articles published,and the Department of Pediatric Orthopedics of Shengjing Hospital Affiliated to China Medical University was the institution with the highest number of Chinese articles published.The co-occurrence analysis of keywords in English articles showed that the main research hotspots of DDH were the pathogenesis,susceptibility genes and treatment status.The co-occurrence analysis of keywords in Chinese articles indicated that the research hotspots of DDH were treatment methods,pathogenesis and auxiliary examinations.The top 3 emerging words in terms of emerging strength in English articles were"adults","bernese periacetabular osteotomy"and"survivorship",while the top 3 emerging words in Chinese articles were"osteoarthritis","high-frequency ultrasound"and"risk factors".The cluster analysis showed that there were 10 clusters for both English and Chinese keywords.Conclusions With the increasing incidence and number of patients with DDH,it is expected that the number of published literature on DDH research will continue to grow in the next decade.Future research will focus on the etiology and treatment methods of DDH,especially exploring its pathogenesis from the perspective of molecular genetics.

Abstract:Objective To analyze the effect of intraoperative hypotension(IOH)on postoperative complications in patients undergoing unilateral biportal endoscopy-posterior lumbar interbody fusion(UBE-PLIF).Methods Select patients who underwent UBE-PLIF treatment in our hospital from February 2021 to June 2024.According to a 1:1 propensity score matching,there were 63 patients in the IOH group and 63 patients in the non-IOH group.Compare perioperative indicators between two groups of patients,including intraoperative blood loss(IBL),number of surgical segments,surgical duration,time spent outdoors,and length of hospital stay;The complications during hospitalization[myocardial injury,nausea and vomiting,acute renal injury,postoperative cognitive dysfunction(POCD),ischemic stroke,lower limb vein thrombosis,neurological complications,postoperative intestinal obstruction,incision infection,ureteral injury,urinary retention]and the long-term incidence of complications(bone graft non fusion,fusion device sedimentation,pseudoarthrosis)were compared between the two groups.Results Patients in the IOH group had higher IBL,number of surgical segments,operation time,time to get off the floor,and hospitalization time than patients in the IOH group(P<0.05);there was no significant difference in Neurologic complications,postoperative bowel obstruction,incisional infections,ureteral injury,implant nonunion,fusion settling,pseudoarthrosis,lower extremity venous thrombosis,and urinary retention between the two groups(P>0.05),and the incidences of myocardial injury,nausea and vomiting,acute kidney injury,POCD,and ischemic stroke were higher in the patients of IOH group than those of patients in the non-IOH group(P<0.05),and the incidence of postoperative complication in the IOH group was significantly higher than that in the non-IOH group(69.8%vs.33.3%,χ2=16.811,P<0.001).Conclusions IOH increases the risk of postoperative complications in UBE-PLIF patients.Active intervention targeting risk factors can reduce the incidence of IOH and improve patient prognosis.

Abstract:Objective To investigate the application value of the oval fossa in total hip arthroplasty(THA)for patients with ankylosing spondylitis(AS)complicated by bony hip fusion.Methods A retrospective analysis was conducted on the clinical data of 23 patients with AS complicated by bony hip fusion who were admitted to the First Affiliated Hospital of Bengbu Medical University and Suzhou First People's Hospital between January 2023 and April 2024.The patients were divided into an oval fossa group(n=11)and a conventional positioning group(n=12)based on whether the oval fossa was used as a positioning landmark during surgery.All patients underwent preoperative imaging examinations,including hip X-ray,CT,and MRI.In the oval fossa group,the oval fossa was used as an anatomical reference marker for installing the acetabular prosthesis and restoring the hip joint rotation center during surgery,while in the conventional positioning group,prosthesis center positioning relied on conventional landmarks such as the acetabular rim,anterior and posterior acetabular columns,and obturator foramen.The operative time and intraoperative blood loss were recorded for both groups,along with postoperative measurements of abduction angle,anteversion angle,changes in lower limb length discrepancy,and horizontal acetabular cup coverage.Hip joint function was assessed using the Harris Hip Score(HHS),and activity-related pain was evaluated with the Visual Analogue Scale(VAS).Comparative analysis was performed between the two groups.Results The operative time for patients in the oval fossa group was(145.55±11.35)min,while that for patients in the conventional positioning group was(117.33±12.62)min.The intraoperative blood loss in the oval fossa group was(329.55±52.61)ml;compared to(283.42±45.27)ml in the conventional positioning group,the differences were statistically significant(P<0.05).The postoperative abduction angle in the oval fossa group was(39.09±3.05)°,while that in the conventional positioning group was(42.25±3.11)°,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the postoperative anteversion angle between the two groups(P>0.05).The postoperative HHS in the oval fossa group was(89.64±3.91)points,while that in the conventional positioning group was(80.58±4.12)points,and the differences were statistically significant(P<0.05).The postoperative VAS score during activity in the oval fossa group was(1.27±0.47)points;compared to(3.58±1.00)points in the conventional positioning group,the differences were statistically significant(P<0.05).The postoperative total horizontal coverage rate of the acetabular cup in the oval fossa group was(97.18±1.25)%,while that in the conventional positioning group was(93.58±1.98)%,and the differences were statistically significant(P<0.05).The postoperative lower limb length discrepancy in the oval fossa group was(0.92±0.30)cm;compared to(2.12±0.65)cm in the conventional positioning group,the differences were statistically significant(P<0.05).Conclusions The oval fossa serves as an anatomical reference marker for restoring the hip joint rotation center and holds significant application value in positioning the acetabular prosthesis during THA for AS patients with ankylosed hips.Although the oval fossa positioning technique increases operative time and intraoperative blood loss,it optimizes acetabular cup placement by reducing the postoperative abduction angle and lower limb length discrepancy.This approach significantly improves hip joint function,enhances total acetabular cup coverage,alleviates postoperative pain,and ultimately demonstrates superior clinical outcomes.

Abstract:Objective To investigate the clinical effect of self-made antibiotic-bone cement bead chains in early bone joint infection.Methods Clinical data from 28 patients with early bone and joint infectious diseases treated at the affiliated TCM hospital of Guangzhou Medical University from January 2021 to December 2024 were reviewed and analyzed.Based on physician experience,the patients were divided into a treatment group(n=14)and a control group(n=14).The treatment group included 2 cases of open fractures;6 cases of postoperative deep open wound infections following debridement,3 cases of surgical site infections after elective internal fixation of closed fractures,2 cases of infections following artificial femoral head replacement surgery for femoral neck fractures,1 cases of infection after total knee replacement arthroplasty surgery for knee osteoarthritis;the treatment group underwent a one-week placement of antibiotic-loaded bone cement bead chains,combined with vacuum sealing drainage(VSD)for wound coverage and drainage;the VSD system was removed during surgery after one week;a secondary debridement would be performed followed by replacement of the bead chains for an additional week of implantation when the wound continued to exhibit foul odor with significant purulent and necrotic discharge.The control group included 2 cases of open fractures,8 cases of deep open wound infections following debridement,3 cases of surgical site infections after elective internal fixation of closed fractures;and 1 case of infection subsequent to total knee replacement arthroplasty received conventional debridement combined with VSD for wound coverage and drainage.Results There were no statistically significant differences in baseline characteristics,underlying disease or infection severity between the two groups(P>0.05);patients in the treatment group exhibited significantly reduced wound exudate and necrotic tissue,with noticeably fresher granulation tissue formation.During the mean follow-up period of(13.71±3.95)months,the average number of debridement procedures was(1.71±0.73),and the mean wound healing time was(18.21±3.83)days,with no cases progressed to chronic osteomyelitis.In the control group,patients showed reduced wound secretion and necrotic material after treatment,with a mean follow-up of(12.64±2.34)months.This group required an average of(2.57±0.51)debridement procedures and achieved wound healing in(25.14±3.44)days,and two cases developed chronic osteomyelitis.Comparative analysis revealed statistically significant differences between the two groups(P<0.025),with the treatment group demonstrating significantly fewer debridement procedures and shorter wound healing time than the control group.Conclusions The clinical effect of self-made antibiotic-loaded bone cement beads is significant and sustains efficacy in early-stage bone and joint infections.

Abstract:Objective To investigate the clinical efficacy and surgical skills of three-needle double-wire combined tension band in the treatment of comminuted patellar fracture.Methods The clinical data of 21 patients with comminuted patellar fracture treated with three-needle double-wire combined tension band in Sichuan Orthopedic Hospital from January 2023 to December 2023 were retroactively analyzed,including 13 males and 8 females.There were 12 cases on the left side and 9 cases on the right side,with an average age of(52.6±11.5)years(range:19-69 years).The visual analogue score(VAS),knee range of motion(ROM)and hospital for special surgery(HSS)knee function score at 1 month,3 months and 12 months after surgery were used to evaluate the clinical efficacy.Results All 21 patients were followed up for≥12 months after surgery,and all patients had fracture healing.The VAS scores of the patients decreased over time at 1,3,and 12 months after surgery,being(3.38±0.84)points,(2.20±0.61)points,and(1.00±0.66)points,respectively,with statistically significant differences at different time points(P<0.05).The knee ROM of the patients increased over time at 1,3,and 12 months after surgery,being(94.43±5.83)°,(115.44±5.43)°,and(130.37±5.98)°,respectively,with statistically significant differences at different time points(P<0.05).The HSS scores of the knee joints increased over time at 1,3,and 12 months after surgery,being(50.17±1.38)points,(71.83±1.68)points,and(88.61±3.82)points,respectively,with statistically significant differences at different time points(P<0.05).At 12 months after operation,19 patients had knee HSS score greater than 85 points,and the efficacy was rated as excellent;2 patients had knee HSS score greater than 70 points,and the efficacy was rated as good,with an excellent rate of 100%.Conclusions The three-needle double-wire combined tension band is a product of Sichuan Orthopedic Hospital's improvement and development on the basis of the traditional AO K-wire tension belt,which is the key to the treatment of comminuted patellar fracture with firm fixation and satisfactory clinical efficacy.

Abstract:Objective To compare the short-term efficacy of total hip arthroplasty(THA)in patients with non-traumatic osteonecrosis of the femoral head(NONFH)based on pain or limited mobility as the primary medical need.Methods This study was a retrospective cohort study that included 101 patients with end-stage femoral head osteonecrosis who underwent unilateral THA for the first time at Honghui Hospital Affiliated to Xi'an Jiaotong University from June 2022 to June 2023.Based on the medical needs for selecting THA,patients were divided into a pain group comprising 63 cases,with 35 males and 28 females and a mean age of(51.75±13.11)years.The limited mobility group(hereinafter referred to as the functional limitation group)consisted of 38 cases,including 23 males and 15 females,with a mean age of(48.61±14.57)years.The disease progression period was calculated from the initial diagnosis of femoral head osteonecrosis to THA surgery,and patient outcomes were evaluated using pre-operative and final follow-up assessments,including the Harris Hip Score(HHS)and Numerical Rating Scale(NRS)for pain.Results All 101 patients were followed up postoperatively,with a follow-up duration ranging from 6 to 18 months and a mean of(11.91±0.31)months;no statistically significant differences were observed in baseline characteristics between the two groups(P>0.05).Preoperatively,there was no statistically significant difference in HHS between the two groups(P>0.05);The NRS score was(7.14±1.13)in the pain group and(6.47±1.64)in the functional limitation group,demonstrating a statistically significant difference between the groups(P<0.05);The activity level score was(0.95±0.90)in the pain group and(0.52±0.82)in the functional limitation group,indicating a statistically significant difference between the groups(P<0.05).At the final postoperative follow-up,no statistically significant differences were found in HHS,NRS scores,or activity levels between the two groups(P>0.05).In the comparison of score differences between pre-operative and final follow-up,the NRS score difference was(6.59±1.41)in the pain group and(5.66±1.66)in the functional limitation group,showing statistically significant differences between the groups(P<0.05).No statistically significant differences were observed in HHS score differences or activity level differences between the two groups(P>0.05).A statistically significant difference in recovery at the final postoperative follow-up was noted between the pain group and the functional limitation group(χ2=4.828,P<0.05),with the pain group exhibiting a higher excellent and good rate of hip joint function compared to the limited mobility group;No statistically significant difference was found in the disease progression time to THA between the two groups(χ2=0.127,P>0.05).Conclusions NONFH patients undergoing THA based on pain or limited mobility as the primary medical need can achieve satisfactory clinical outcomes postoperatively.The short-term efficacy of THA is superior in patients with pain as the primary medical need compared to those with limited mobility as the primary medical need.