Abstract:Objective To analyze the effect of chronic co-morbidities on the length of hospital stay of elderly patients with femoral neck fracture and control the confounding factors by propensity score matching method to provide scientific basis for optimizing the perioperative management and shortening the length of hospital stay.Methods A retrospective cohort study was conducted on elderly patients with femoral neck fractures admitted to Honghui Hospital,Xi'an Jiaotong University,between January 1st,2021,and January 1st,2022.After applying exclusion criteria,1,091 patients were included and stratified into two groups:comorbidity group(476 patients)and non-comorbidity group(615 patients),based on the presence of two comorbid chronic diseases.Propensity score matching(PSM)with a caliper width of 0.05 was performed in a 1:1 ratio,resulting in 258 matched pairs(516 patients).Demographic and clinical data,laboratory parameters,and surgical variables were collected.Univariate and multivariate logistic regression analyses were used to identify factors associated with prolonged hospital stay(>9 days).The relationship between multimorbidity and prolonged hospital stay was further determined by multi-model regression strategy and stratified analysis.Results In 1091 patients,the incidence of prolonged hospital stay was 30.8%(336 patients).The incidence of prolonged hospital stay was significantly higher in the comorbidity group than in the non-comorbidity group(39.7%vs.23.9%,P<0.001).After PSM,univariate analysis showed that hemiarthroplasty had a higher risk of prolonged hospitalization than total hip arthroplasty(OR=1.74,95%CI:1.07-2.83,P=0.026).Hemoglobin(OR=0.99,95%CI:0.98-0.99,P=0.044)and serum albumin(OR=0.93,95%CI:0.89-0.98,P=0.004)were the protective factors.After PSM,multivariate results showed that multimorbidity was an independent risk factor for prolonged hospitalization in elderly femoral neck fractures(OR=1.58,95%CI:1.08-2.33,P=0.019);the multimodel regression strategy and stratification analysis further determined that multimorbidity patients had a higher risk of prolonged hospitalization than non-multimorbidity patients(P<0.05).Conclusions Multimorbidity significantly increases the risk of prolonged hospital stay in elderly patients with femoral neck fractures,which is further exacerbated by Semi-hip replacement,while higher hemoglobin and albumin levels reduce the risk.It is recommended to strengthen preoperative evaluation,optimize surgical selection and nutritional management for comorbid patients to improve clinical outcomes.

Abstract:Objective To analyze the clinical features of patients with liposarcoma and explore the risk factors affecting the disease-free survival of liposarcoma.Methods The clinical data of 198 patients who underwent the first liposarcoma resection in Cancer Hospital Chinese Academy of Medical Sciences from March 2005 to November 2022 were retrospectively analyzed,including age,sex,pathological type,primary tumor site,tumor size,radiotherapy and chemotherapy.The patients were followed up for a long time,and the end event was postoperative recurrence or death.The disease-free survival was used as the prognostic index.SPSS 29.0 was used to process the patient data and analyze the risk factors for disease-free survival of liposarcoma patients.P<0.05 indicated that the difference was statistically significant.Results 198 patients with liposarcoma were included in this study,among whom 97(49.0%)were atypical/highly differentiated,followed by 42(21.2%)dedifferentiated.131 patients(66.2%)were≥50 years old,and 117 male patients(59.1%)were included.Extremities were the primary site in 78 cases(39.4%),followed by retroperitoneal 67 cases(33.8%)and trunk 53 cases(26.8%).There were 68 patients(34.3%)with tumor diameter>5 cm and≤10 cm,followed by 58 patients(29.4%)with tumor diameter≥15 cm.There were 41 patients(20.7%)who received radiotherapy and 26 patients(13.1%)who received chemotherapy.At the end of follow-up,108 patients(54.5%)recurred and 37 patients(18.7%)died.Univariate analysis showed that age,sex,tumor diameter,radiotherapy and chemotherapy had no statistically significant effects on disease-free survival of liposarcoma at the P<0.05 significance level.Pathological type and primary site of tumor were prognostic factors for disease-free survival.Multivariate analysis suggested that non-atypical/highly differentiated pathological type(P=0.001)and retroperitoneal primary site(P=0.005)were independent risk factors for disease-free survival of liposarcoma.Conclusions A total of 198 patients with liposarcoma who undergo their first surgery are included in this study,with an overall recurrence rate of 54.5%.The analysis indicates that the clinicopathological characteristics of patients with liposarcoma are closely related to the postoperative prognosis.Among them,the pathological type(non-atypical/highly differentiated)and primary site(retroperitoneum)are independent risk factors affecting disease-free survival.

Abstract:Objective To explore the efficacy and safety of pegylated liposome doxorubicin and dacarbazine for the treatment of leiomyosarcoma.Methods A retrospective analysis was conducted on patients with leiomyosarcoma who underwent pegylated liposomal doxorubicin and dacarbazine chemotherapy in the Department of Orthopedic Oncology at Peking University Cancer Hospital from August 2019 to July 2024.The clinical data of the patients were collected,and the overall survival(OS),progression-free survival(PFS),objective response rate(ORR),disease control rate(DCR),prognostic factors,and adverse reactions were analyzed.Results A total of 116 patients were enrolled.The mean follow-up period was 13 months.Disease progression occurred in 43 patients(37.1%),and 15 patients(12.9%)died.There were 20 males and 96 females,with a male-to-female ratio of 5:24.The average age was 53.There were 42 cases in the adjuvant chemotherapy group and 74 cases in the local advanced/distant metastatic chemotherapy group.The median OS for all patients was 48 months(range:44-52 months),and the median OS was not reached in the postoperative adjuvant chemotherapy and local advanced/distant metastatic chemotherapy groups.The median PFS for all patients was 18 months(range:10-26 months),not reached in the adjuvant chemotherapy group and 13 months(range:9-17 months)in the locally advanced/distant metastatic chemotherapy group.Data on tumor changes were available for 55 patients in the locally advanced/distant metastatic chemotherapy group,including 11 patients with partial response(PR)(20.0%),34 patients with stable disease(SD)(61.8%),10 patients with progressive disease(PD)(18.2%),an ORR of 20.0%,and a DCR of 81.8%.Univariate analysis revealed that the number of chemotherapy cycles was a risk factor for OS in the local advanced/distant metastasis group,and the median OS in the group with chemotherapy cycles>4(not reached)was longer than that in the group with chemotherapy cycles≤4(39 months)(P<0.05).Other factors showed no significant differences in OS and PFS among all groups(P≥0.05).No cardiac injury was observed in all patients.Other adverse reactions included liver injury in 7 cases(6.0%),nausea and vomiting in 6 cases(5.2%),neutropenia in 3 cases(2.6%),and anemia in 2 cases(1.7%).Conclusions The combination of pegylated liposome doxorubicin and dacarbazine in the treatment of leiomyosarcoma exhibits comparable efficacy,enhanced safety,and a lower incidence of myocardial damage compared to traditional regimens.Future studies with larger sample sizes and multi-center clinical trials are required to formulate more optimized treatment strategies for patients with leiomyosarcoma.

Abstract:Objective To compare the efficacy of single row suture and double row suture under arthroscopy in the treatment of rotator cuff injury,and to analyze the risk factors of postoperative chronic pain.Methods The clinical data of 80 patients with rotator cuff injury who underwent surgical treatment in our hospital from January 2020 to December 2022 were retrospectively analyzed,and they were divided into single row group(n=42)and double row group(n=38)according to surgical methods.Visual analogue scale(VAS),Constant-Murley score and UCLA shoulder joint(UCLA)score were compared before surgery,3 months and 12 months after surgery.Patients were divided into CPSP group(n=12)and non-CPSP group(n=68)according to whether they had chronic post-surgical pain(CPSP).Logistic regression was used for multivariate analysis to screen the risk factors of CPSP.Results At 3 months and 12 months after the operation,the VAS scores of the two groups significantly decreased.The single-row group had a preoperative score of(3.31±0.62)at 3 months after the operation,and a score of(1.21±0.25)at 12 months after the operation;the double-row group had a preoperative score of(6.50±1.18),a score of(3.40±0.57)at 3 months after the operation,and a score of(1.18±1.30)at 12 months after the operation,(P<0.05).There was no significant difference between the two groups(P>0.05).At 3 months and 12 months after the operation,the Constant-Murley scores and UCLA scores of the single-row group and the double-row group significantly increased compared with those before the operation(P<0.05).Specifically,the Constant-Murley score of the single-row group was(62.50±8.34)before the operation,increased to(80.52±10.15)at 3 months after the operation,and further reached(82.36±9.87)at 12 months after the operation;the Constant-Murley score of the double-row group was(63.54±6.26)before the operation,increased to(82.33±8.89)at 3 months after the operation,and reached(89.85±7.78)at 12 months after the operation.In terms of UCLA scores,the single-row group had a preoperative score of(10.15±2.21),increased to(26.35±3.87)at 3 months after the operation,and had a score of(29.16±3.66)at 12 months after the operation;the double-row group had a preoperative score of(10.69±1.87),increased to(27.58±4.12)at 3 months after the operation,and had a score of(32.15±3.10)at 12 months after the operation.Moreover,the Constant-Murley scores and UCLA scores of the double-row group at 12 months after the operation were significantly higher than those of the control group(P<0.05).Of the 80 patients with rotator cuff tear,12(15.00%)developed CPSP 3 months after surgery,while 68(85.00%)did not.Multivariate Logistic regression analysis showed that female,sleep disorder and total tear were independent risk factors for postoperative CPSP in patients with rotator cuff tear.Conclusions Both single-row suture and double-row suture under arthroscopy can effectively relieve pain symptoms and improve joint function in the treatment of medium rotator cuff tear,but the early recovery effect of shoulder joint function after double-row suture is better.Female,sleep disturbance,and full-thickness tear are independent risk factors for postoperative CPSP in patients with rotator cuff tear.

Abstract:Objective To explore the value of ultrasound,X-ray,and CT in the diagnosis and treatment of distal fibular epiphyseal avulsion fractures in children.Methods Collect clinical data of 77 children with distal fibular fractures who were treated in the hospital from June 2019 to June 2022.Within 48 hours of admission,high-frequency ultrasound,X-ray,and CT examinations were performed.Using CT examination results as the gold standard,the diagnostic and therapeutic value of ultrasound,X-ray,and CT examinations for distal fibular epiphyseal avulsion fractures were compared.Results CT examination confirmed that 69 cases were of distal fibular epiphyseal avulsion fractures,with a male majority of 63.77%.The main cause was sports injury,accounting for 40.58%.Ogden Ⅶ type fractures were more common,accounting for 39.13%.Reduction fixation and ankle joint fixation were more common,accounting for 46.38%.The sensitivity of X-ray and high-frequency ultrasound diagnosis was 71.01%and 94.20%,respectively(χ2=12.912,P=0.000);the specificity was 50.00%and 87.50%,respectively(χ2=2.618,P=0.106);and the diagnostic accuracy was 68.83%and 93.51%,respectively(χ2=15.336,P=0.000).The diagnostic accuracy of high-frequency ultrasound for Ogden Ⅶ type fracture was 96.30%,which was higher than the accuracy of X-ray examination by 77.78%.The differences between the two were statistically significant(χ2=4.103,P=0.043).There was no significant difference in the diagnostic accuracy of Salter Harris Ⅰ,Salter Harris Ⅱ,Salter Harris Ⅲ,Salter Harris Ⅳ,and Range Ⅵ fractures between the two examinations(P>0.05).The area under the curve of high-frequency ultrasound and X-ray signs in diagnosing distal fibular epiphyseal avulsion fracture was above 0.7,and the area under the curve of high-frequency ultrasound was greater than that of X-ray.Conclusions Compared with X-ray,high-frequency ultrasound has important application value in the diagnosis and treatment of distal fibular epiphyseal avulsion fracture in children.It is an indispensable auxiliary diagnostic and treatment method for distal fibular epiphyseal avulsion fractures in children by its high image resolution,high quality,economic simplicity,safety,non-radiation property,and good repeatability.

Abstract:Objective By using bioinformatics methods to construct and validate of a prognostic prediction model for genes related to lactate modification in osteosarcoma patients based on GEO and TARGET databases.Methods The GSE42352 dataset was downloaded from GEO database.The R language"limma"package was used to perform the differential analysis between osteosarcoma tissue samples and normal tissue samples.The differentially expressed genes were intersected with lactate related genes to obtain the differentially expressed lactate related genes.Firstly,the mRNA gene expression and clinical survival data of osteosarcoma patients from the Therapeutically Applicable Research to Generate Effective Treatments(TARGET)database were downloaded.Lactate related prognostic genes were screened by using univariate Cox regression and Least Absolute Shrinkage and Selection Operator(LASSO)regression analysis.Secondly,a prognostic risk model was constructed based on the risk score of lactate modification related genes.Gene Set Enrichment Analysis(GSEA)was used to perform GO and KEGG enrichment analysis on lactate related prognostic risk models,to predict the potential biological functions and pathways involved.Finally,a clinical prognostic nomogram or osteosarcoma based on lactate related genes was constructed and validated in TARGET and GSE21257 cohorts respectively.Results A total of 852 differentially expressed genes were screened in the GSE42352 dataset,and we further intersected with lactate related genes by using Venn diagram and a total of 30 differentially expressed lactate related genes were obtained.The survival analysis results showed that WAS,NDUFB9,SLC7A7,ZYX,TPM4,and S100A4 were associated with the prognosis of osteosarcoma,and a prognostic risk model based on six lactate related genes was constructed.The overall survival rate of the low-risk group was significantly higher than that of the high-risk group(TARGET cohort P<0.001,GSE21257 cohort P=0.025).GSEA enrichment analysis results showed that the risk genes were mainly enriched in immune related biological processes.A prognostic nomogram for osteosarcoma was constructed by using risk scores and clinical characteristics with TARGET cohort and the area under receiver operating characteristic(ROC)curve(AUC),calibration curve,and decision curve analysis(DCA)all showed it had good clinical predictive performance,which was further validated in GSE21257 cohort.Conclusions The prognosis model of osteosarcoma constructed based on lactate related genes has clinical predictive value and can be used to guide individualized treatment of osteosarcoma patients.

Abstract:Objective To analyze the relationship between pre-treatment coagulation indices and prognosis in patients with first diagnosis of conventional osteosarcoma(COS),to assess its predictive value,and to construct a column-line graph model for predicting overall survival.Methods Clinical data and laboratory blood sampling indexes of 141 patients with pathological type of conventional osteosarcoma that met the NAE criteria and received treatment for the first time during the period of January 2017 to December 2022 at the Department of Orthopaedics of Yunnan Cancer Hospital were retrospectively collected,and the optimal thresholds of PT,FIB,D-D,and PLT were determined by using the analysis of the receiver operating characteristic curve(ROC),and the PT was analyzed by using chi-square test,FIB,D-D,PLT levels in relation to the clinical characteristics of the patients,and the Kaplan-Meier method and Cox proportional risk model were used to study the effects of PT,FIB,D-D,PLT on overall survival.A column-line diagram prediction model was established based on independent risk factors for patient prognosis.Results High FIB level before treatment was correlated with tumor diameter,pathological fracture,and lymph node metastasis(P<0.05),and high F-D level before treatment was correlated with tumor diameter and lymph node metastasis(P<0.05).The 3-year survival rate and mean overall survival of the group with high PT,FIB,D-D,and PLT levels were lower than those of the group with low PT,FIB,D-D,and PLT levels(3-year survival rate:47.20%,50.07%,48.80%,and 49.00%vs.66.70%,67.10%,70.08%,and 64.80%;mean overall survival:41.70 months,42.09 months,42.90 months,51.77 months vs.59.52 months,62.92 months,64.35 months,53.87 months;the difference in overall survival between the two groups was statistically significant).The results of univariate Cox regression analysis showed that lung metastasis,tumor diameter,Enneking stage,PT,FIB,D-D,and PLT levels were correlated with overall survival(P<0.05),and the results of multivariate Cox regression analysis showed that lung metastasis,FIB,and D-D levels were independent risk factors affecting the prognosis of COS patients.A column-line diagram was constructed based on the independent risk factors screened by the Cox regression model,and the C-index(C-index)suggested that the model had a good predictive performance,which was known to have good accuracy by the prediction model calibration curve.Conclusions The prognosis of COS patients with high pre-treatment PT,FIB,D-D,and PLT levels is poor,and the prediction model constructed on the basis of pre-treatment FIB,D-D levels,and lung metastasis has a good predictive efficacy,which could guide the diagnosis and treatment of COS patients.

Abstract:Objective Osteoid osteoma is more common in adolescents and very rare in middle-aged and elderly patients.The purpose of this study is to analyze the clinical manifestations,imaging characteristics,surgical methods,and prognostic features of elderly patients with osteoid osteoma.Methods A total of 10 middle-aged and elderly patients with osteoid osteoma who underwent surgical treatment in our hospital from 2015 to 2024 were enrolled,with an average age of 55.1 years(range:51-65 years),including 6 males and 4 females.All patients received surgical treatment assisted by computer intelligence,including 8 cases with computer navigation assistance and 2 cases with robot assistance.The surgical methods included 8 cases of open curettage of the lesion and 2 cases of minimally invasive radio-frequency ablation.Results The average duration of pain for patients before surgery was 36.6 months(range:8-132 months).The lesion site included 5 cases of femur,2 cases of radius,1 case of ulna,1 case of humerus,1 case of tibia and 1 case of fibula.There were 4 cases of tumor nests located at the metaphysis,5 cases at the diaphysis,and 1 case near the articular surface.The relative position relationship between tumor nests and cortical bone included 4 cases in the cortex,4 cases outside the cortex,and 2 cases in the medullary cavity.The average pain VAS scores of patients were 4.7(3-6)points preoperative and 0.2(0-1)points postoperative.The postoperative scores were significantly lower than preoperative scores(P<0.001).The average follow-up period postoperative was 56.2 months(range:12-111 months),and there was 1 case of recurrence postoperatively.The recurrence rates of the navigation group and the robot group were 12.5%(1/8)and 0%(0/2),respectively,with no significant difference(P=0.621).There were significant differences in postoperative recurrence rate between open surgery(0%)and percutaneous radio-frequency ablation surgery(50%)(P=0.026).One case had delayed wound healing postoperatively and no other complications were observed.Conclusions The clinical manifestations of middle-aged and elderly patients with osteoid osteoma are similar to those of adolescent patients,but the history of pain preoperative is relatively long.Precise surgery assisted by robots or computer navigation can effectively treat osteoid bone tumors and provide satisfactory pain relief with good safety.

Abstract:Objective To investigate the effectiveness of MRI based Vertebral Bone Quality(VBQ)score in predicting fusion cage subsidence after spinal fusion surgery.Methods This study searched PubMed,Embase,Web of Science,China National Knowledge Infrastructure(CNKI),and China Biomedical Literature Database(CBM)for relevant literature from March 13,2022 to the latest date.Through strict screening,14 articles that met the criteria were included,involving 2086 patients.Meta analysis was conducted using RevMan 5.3 and Stata 12.0 software.Results Data analysis showed that higher VBQ scores were significantly associated with an increased risk of postoperative fusion device subsidence(MD=0.72,95%CI:0.58-0.85),further validating the predictive value of VBQ scores.However,there was significant heterogeneity among the studies(I2=81.0%,P<0.000 01),and heterogeneity decreased after subgroup analysis(I2=48.7%,P=0.08),indicating that heterogeneity may mainly come from different surgical methods.Patients with high VBQ scores are prone to internal fixation loosening or poor fusion,leading to revision surgery.A higher VBQ score is an important predictive factor for the settlement of the fusion cage after spinal fusion surgery.Conclusions A higher VBQ score is significantly associated with the risk of fusion cage subsidence after spinal fusion surgery,and VBQ score can be used as an independent predictor of fusion cage subsidence after spinal fusion surgery.