Abstract:Objective To evaluate the effectiveness and feasibility of enhanced recovery after surgery(ERAS)pathway in patients with early-onset scoliosis(EOS)undergoing posterior growing-rod fusion.Methods We retrospectively reviewed 70 EOS patients(25 males,45 females;age 10-16 years;osteotomy grade≤3)who underwent posterior growing-rod fusion at our institution between June 2014 and May 2023.Patients were managed either by an ERAS protocol or a traditional perioperative pathway(TP).Demographic and perioperative data collected included age,sex,height,weight,body mass index(BMI),pre-and postoperative hemoglobin levels,EOS etiology,intraoperative blood loss,number of fused segments,and number of pedicle screws.Postoperative outcomes comprised visual analog scale(VAS)pain scores(post-op days 1 and 3),drainage volume and duration,duration of analgesic use,time to first ambulation,length of hospital stay,and incidence of complications.Radiographic parameters included pre-and postoperative main-curve Cobb's angle and correction rate.Results Both groups achieved satisfactory deformity correction.In the ERAS cohort,the main-curve Cobb's angle improved from(89.03±12.51)° to(46.74±7.41)°,while the TP group improved from(84.86±10.53)° to(44.69±4.66)°.Estimated blood loss was significantly lower in the ERAS group(P<0.001).Postoperative VAS scores on days 1 and 3 were significantly reduced in the ERAS group compared with TP(P<0.001).Postoperative hemoglobin levels were higher in ERAS patients(P<0.001).The ERAS group also demonstrated significantly less drainage volume,shorter drainage duration,and reduced duration of analgesic use(all P<0.001).Furthermore,time to first ambulation and overall hospital stay were significantly shorter in the ERAS cohort(P<0.001).The incidence of postoperative complications(wound infection,nausea/vomiting,fever,anemia)was lower in the ERAS group.Conclusions Implementation of ERAS pathway in EOS correction surgery effectively reduces intraoperative blood loss,alleviates postoperative pain,decreases complication rates,and accelerates recovery,resulting in shorter hospitalization.

Abstract:Objective To investigate the correlation between sarcopenia,bone mineral density(BMD),and serum 25-hydroxyvitamin D3[25(OH)D3]levels in elderly patients with hip fractures.Methods A total of 200 patients with hip fractures(100 femoral neck fractures and 100 intertrochanteric fractures)who were treated in the Department of Orthopedics at our hospital from October 2020 to October 2024 were enrolled as the observation group.All examinations were performed within 48 hours after fracture occurrence and prior to surgery.An age-matched control group of 100 community-dwelling elderly individuals without fractures was randomly selected from the health examination center.Hemoglobin,albumin,parathyroid hormone(PTH),osteocalcin(OC),procollagen type 1 N-terminal propeptide(P1NP),C-terminal telopeptide of type 1 collagen(CTX),25(OH)D3,serum calcium(Ca),appendicular skeletal muscle index(ASMI),BMD,handgrip strength,and 6-meter walking speed were compared between hip fracture patients and controls,as well as between sarcopenic and non-sarcopenic patients within the fracture cohort.Results Compared with the control group,the observation group showed significantly lower handgrip strength,serum 25(OH)D3 levels,and BMD at the lumbar spine(L1-4),femoral neck,and total hip(all P<0.01).Within the observation group,patients were classified into sarcopenia and non-sarcopenia subgroups.Compared with the non-sarcopenia group,the sarcopenia group had significantly lower body mass index(BMI),handgrip strength,ASMI,6-meter walking speed,hemoglobin,albumin,and BMD at L1-4,femoral neck,and total hip,but higher age(all P<0.05).logistic regression analysis identified low BMI,reduced serum 25(OH)D3,and decreased BMD at L1-4,femoral neck,and total hip as independent risk factors for sarcopenia(all P<0.05).Conclusions Sarcopenia is highly prevalent among elderly patients with osteoporotic hip fractures.Low BMI,reduced serum 25(OH)D3 levels,and decreased BMD at L1-4,femoral neck,and total hip are significant risk factors.Nutritional optimization and vitamin D supplementation may help reduce the risk of sarcopenia in this population.

Abstract:Objective To investigate the effect of early postoperative active grip strength training program on postoperative muscle strength and function in elderly radius fracture patients.Methods A total of 132 elderly patients with radial fractures who underwent volar locking plate internal fixation in our hospital between March 2021 and March 2023 were selected and randomly assigned to either a control group or an observation group using a random number table,with 66 cases in each group.Conventional grip strength training was adopted in the control group,and early active grip strength training was adopted in the observation group.Smedley-type hand dynamometer was used to compare the grip strength of the two groups.Standard goniometer was used to compare the joint mobility of the two groups.The Quick Disabilities of the Arm,Shoulder,and Hand(qDASH)questionnaire was used to compare the upper extremity function of the two groups.Visual analogue scale(VAS)was used to compare the pain level of patients in both groups.Activity of Daily Living(ADL)score and the Mos item short from health survey(SF-36)were used to compare the quality of life of patients in the two groups.Results At 3,6,and 9 months postoperatively,the observation group demonstrated significantly higher grip strength,dorsal flexion,palmar flexion,pronation,supination,ADL scores,and SF-36 scores compared to the control group(P<0.05).Conversely,the observation group exhibited significantly lower qDASH and VAS scores than the control group(P<0.05).Conclusions Early postoperative active grip strength training can effectively improve the muscle mass and joint range of motion of elderly patients with radius fracture,improve the function and quality of life of the upper limb,and effectively reduce pain,which is worthy of clinical promotion.

Abstract:Objective To explore the application value of establishing a differential analysis model for spinal tuberculosis under pulmonary tuberculosis using routine test data.Methods Routine test data were retrospectively collected for hospital visiting patients with tuberculosis,spinal TB,and extra-pulmonary TB from January 2011 to February 2024.A total of 346 cases of simple spinal tuberculosis,611 cases of extrapulmonary tuberculosis(with no spinal tuberculosis),233 cases of complicated spinal tuberculosis and 800 cases of tuberculosis were included.The training group and test group were set at the ratio of 8:2.Based on the model of deep learning neural network,two scenarios were modeled:identification between spinal tuberculosis and extrapulmonary TB,and differentiation between spinal tuberculosis and pulmonary TB.The feature contribution of the model was analyzed by the SHapley Additive exPlanations algorithm,and its performance was evaluated using the Receiver Operating Characteristic-Area Under the Curve(ROC-AUC)values,sensitivity,and specificity rate.Results The differentiation model of pure spinal tuberculosis and extrapulmonary tuberculosis showed excellent performance with ROC-AUC value of 0.861,accuracy rate of 81.18%,sensitivity of 72.12%and specificity of 86.34%,indicating that the model can effectively distinguish spinal tuberculosis from other external pulmonary tuberculosis;for the discrimination model of spinal tuberculosis and pure tuberculosis,the ROC-AUC value on test data set reached 0.858 with accuracy of 78.06%,sensitivity of 80.21%and specificity of 77.51%.This indicated that the model was not only more discriminative,but also can achieve accurate risk assessment in patients with different conditions.Conclusions The two machine learning models based on routine test data constructed in this study perform well in the identification of spinal tuberculosis and the risk assessment of secondary spinal tuberculosis from pulmonary tuberculosis.They can be used as important auxiliary tools for clinical decision-making,making up for the defects of traditional means of clinical identification of spinal tuberculosis.Big data technology is applied to the routine test data of pulmonary tuberculosis patients to achieve secondary risk assessment of spinal tuberculosis,forming a high-efficiency and low-cost auxiliary analysis tool.

Abstract:Objective To compare the clinical efficacy of percutaneous curved kyphoplasty with unilateral puncture percutaneous kyphoplasty in the treatment of single-segment osteoporotic vertebral compression fractures(OVCFs).Furthermore,this study aims to investigate whether percutaneous curved kyphoplasty(PCKP)is more effective than unilateral puncture percutaneous kyphoplasty(UPKP).Methods Patients with single-segment OVCFs treated with PCKP and UPKP in the Department of Orthopaedics of the First People's Hospital of Zigong City from January 2022 to December 2023 were randomly divided into two groups:the PCKP group(31 cases)and the UPKP group(26 patients).The patients were followed up for a minimum of 12 months,during which functional parameters[pain visual analogue scale(VAS),Oswestry disability index(ODI)]and imaging parameters(distribution of bone cement,height of the leading edge of the vertebral body)were evaluated.These evaluations were measured before surgery,two days after surgery,three months after surgery and 12 months after surgery.Additionally,the number of intraoperative X-rays,cement dose and surgical complications(cement leakage rate,refracture rate)were recorded.Results There were no significant differences in VAS score,ODI index,average height of anterior vertebral column,operation time,number of intraoperative X-rays,and refracture rate between the two groups at different time points before and after surgery(P>0.05).The dose of bone cement in the PCKP group was higher than that in the UPKP group(P<0.05).The leakage rate of bone cement in the PCKP group was lower than that in the UPKP group(P<0.05),and the excellent distribution rate of bone cement in the PCKP group was better(P<0.05).Conclusions Both PCKP and UPKP kyphoplasty are safe and effective in the treatment of single-level OVCFs,and PCKP has the advantages of more cement,better distribution and less leakage,especially in patients with moderate and severe OVCFs.In addition,patients with good cement distribution have better pain relief in the early postoperative period,but during medium term follow-up,the treatment effects of PCKP and UPKP are similar.

Abstract:Objective To investigate the correlation between sarcopenia and pain catastrophizing(PC)in patients with lumbar spinal stenosis(LSS).Methods Ninety-four patients with LSS who were diagnosed and treated in our hospital from May 2022 to May 2024 were selected and divided into the sarcopenia group and the group without sarcopenia according to the patients'skeletal muscle mass index(SMI).Clinical data of LSS patients were collected,including age,gender,body mass index(BMI),symptom duration,grip strength,underlying diseases(hypertension,dyslipidemia,diabetes mellitus,cardiovascular disease,renal disease)and smoking.The pain catastrophizing scale(PCS)was used to assess the degree of PC in patients with LSS.The fear-avoidance belief questionnaire(FABQ)was used to assess patients'fear avoidance beliefs.Hospital anxiety depression scale(HADS)was used to assess the degree of anxiety(HADS-A)and depression(HADS-D)in patients.Multiple linear regression was used to analyze the factors affecting sarcopenia in patients with LSS.Simple linear regression to fit the curve was used to analyze the relationship between SMI and PCS scores.Results Thirteen(13.8%)of 94 LSS patients presented with sarcopenia.Age,proportion of females,proportion of cardiovascular disease,proportion of smokers,PCS-helplessness,PCS-exaggeration,PCS-contemplation,PCS-total score,HADS-A score,HADS-D score,and symptom duration were higher in the sarcopenia group than in the group without sarcopenia(P<0.05),and BMI and grip strength were lower than in the group without sarcopenia(P<0.05).Multiple linear regression analysis showed that HADS-A and PCS-Total scores were independently associated with sarcopenia(P<0.05).Fitted curve analysis showed that SMI was negatively correlated with PCS-total score,PCS-helplessness,PCS-exaggeration,and PCS-contemplation.Conclusions Patients with LSS are mostly combined with sarcopenia and are closely associated with PC.

Abstract:Objective To analyze the effect of kinetic chain training and rehabilitation program on the postoperative recovery outcomes of patients with tibial plateau fracture(TPF).Methods 120 cases of TPF patients who were surgically treated between January 2022 and April 2024 in our hospital were selected,and the patients were randomly assigned to a control group and an observation group using a random number table,with 60 patients in each group.The control group adopted conventional rehabilitation training,and the observation group adopted joint kinetic chain rehabilitation training.Joint mobility and common postoperative complications were compared between the two groups.Lysholm Knee Scale was used to assess the knee function of the two groups.Tinetti balance and gait scale(Tinetti performance oriented mobility assessment,POMA)was used to assess the mobility and balance of the two groups.Results At 1,3 and 6 months after surgery,the joint mobility,knee function,mobility and balance of patients in the observation group were higher than those of patients in the control group(P<0.05).The total postoperative complication rate of patients in the control group was higher than that of patients in the observation group(18.3%vs.5.0%,P=0.023).Conclusions The kinetic chain training and rehabilitation program can effectively improve the joint mobility of TPF patients,improve knee joint function,mobility and balance,and reduce postoperative complications,which is worthy of clinical promotion.

Abstract:Objective To investigate the effects of long-term back-specific rehabilitation training on rehabilitation after lumbar fusion(LIF)in patients with lumbar degenerative disease(LDD).Methods 138 patients with LDD who were treated with LIF from January 2022 to January 2024 in our hospital were selected.The patients were divided into control group and observation group according to the randomized numerical table method.69 cases were included in each group,but a total of 12 patients withdrew from the study(6 cases in each group).So that 63 cases were included in each of the control group and observation group.Both groups implemented the same postoperative routine rehabilitation training during the perioperative period,and the observation group combined long-term back-specific training on this basis.The 6-minute walk test(6MWT)and chair stand test(CST)were used to assess the patients'balance ability;the spine assessment system(Finnish DAVID)was used to assess the patients'lumbar spine range of motion;the Oswestry Disability Index(ODI)scores and Japanese Orthopaedic Association scores(JOA)were used to assess the spine function of the patients;the Visual Analog Scale(VAS)was used to assess the pain level of the patients;The Tampa Scale of Kinesiophobia(TSK)was used to assess the patients'psychological fear of exercise;and the Short Form Health Survey(SF-36)was used to assess the patients'quality of life.Results At 6 and 9 months postoperatively,the 6MWT distance and the number of CSTs were higher in patients in the observation group than in patients in the control group(P<0.05).Anterior flexion,posterior extension,left lateral flexion and right lateral flexion were higher in patients in the observation group than in patients in the control group(P<0.05).The ODI score of patients in the observation group was lower than that of patients in the control group(P<0.05),and JOA was higher than that of patients in the control group(P<0.05).The VAS score and TSK score of patients in the observation group were lower than those of patients in the control group(P<0.05),and the SF-36 score was higher than those of patients in the control group(P<0.05).Conclusions Long-term back-specific training can effectively improve the balance ability and lumbar spine mobility after LIF in patients with LDD,improve lumbar spine function,reduce the degree of pain and psychological fear in patients,and improve the quality of life.

Abstract:Objective To investigate the efficacy of treating osteoporotic vertebral compression fractures(OVCF)and re-fractures after percutaneous kyphoplasty(PKP)using the"tail-dragging"method with PMMA(polymethyl methacrylate)-modified bone cement in percutaneous vertebroplasty(PVP).Methods A retrospective analysis was conducted on 16 patients with recurrent vertebral fractures after PKP treated with PVP at our hospital from December 2020 to August 2022.Among them,9 were male and 7 were female;their ages ranged from 60 to 80 years,with an average age of(70.91±8.25)years;the duration of illness ranged from 2 to 7 days,with an average of(4.04±0.87)days.The bone cement was mixed with PMMA modified bone powder and fixed in the pedicle of vertebral arch.Visual analog scale(VAS)was used to evaluate pain,Oswestry disability index(ODI)was used to evaluate lumbar function and vertebral height recovery rate to evaluate the preoperative and postoperative vertebral recovery.Results All patients successfully completed the operation,no leakage occurred during the operation,and the blood pressure and heart rate of patients were stable without infection.The follow-up time of 16 patients ranged from 6 to 12 months,with an average of(6.84±1.02)months.The VAS score after revision was significantly lower than that before revision(0.36±0.04 vs.7.64±1.32;t=22.051,P<0.05).The ODI score after revision was significantly lower than that before revision(9.13±0.85 vs.29.78±0.83;t=69.527,P<0.05).The preoperative vertebral height was(10.12±1.23)cm,and the postoperative vertebral height was(13.54±1.41)cm,accounting for 59%of the total height before revision and 80%after revision.Conclusions The bone cement of PMMA modified bone powder can produce more inlay and occlusion for the growth of bone tissue,effectively preventing the loosening and falling off of bone cement.The"tailing"can also enhance the"anchoring"effect of bone cement,reduce the risk of bone cement displacement again,and promote the healing of vertebral fracture.

Abstract:Objective To analyze the occurrence and related influencing factors of early osteonecrosis of the femoral head(ONFH)in patients aged under 50 years with femoral neck fractures after internal fixation surgery.Methods A retrospective analysis was performed on 109 young adult patients(≤50 years old)with femoral neck fractures admitted to Mianyang Central Hospital from January 2014 to September 2024.All patients underwent internal fixation surgery.Within one year after surgery,patients were divided into two groups based on the occurrence of femoral head necrosis:the ONFH group and the non-ONFH group.The incidence of ONFH was analyzed,and its influencing factors were explored.Results Univariate analysis showed that age,smoking status,fracture line location,time interval from fracture to surgery,reduction quality,and Garden classification were significantly different between the two groups(P<0.05).The Garden classification showed statistically significant associations with the occurrence of necrosis.The necrosis rate in stable types was 4.54%,significantly lower than that in unstable types(35.30%),indicating a reduced risk of necrosis,and the differences were statistically significant(P<0.01).Regarding fracture location,the necrosis rate in subcapital fractures was 42.50%,significantly higher than that in transcervical fractures(16.10%)and basicervical fractures(7.80%).These differences were also statistically significant(P<0.05),suggesting that subcapital fractures were a high-risk type for osteonecrosis.However,gender,body mass index(BMI),long-term alcohol consumption,hypertension,diabetes mellitus,removal of internal fixators,and reduction methods showed no statistically significant differences(P>0.05).Multivariate logistic regression analysis showed that age,smoking status,fracture line location,time from fracture to surgery,reduction quality,and Garden classification were statistically significant(P<0.05).Conclusions The incidence of ONFH after internal fixation is relatively high(22.93%)in the 109 patients,with 25 cases of ONFH(13 females and 12 males).Age,smoking status,fracture line location,time from fracture to surgery,reduction quality,and Garden classification are closely related to clinical outcomes.Medical professionals should pay close attention and implement targeted therapeutic measures in a timely manner to prevent or reduce the occurrence of postoperative ONFH,optimize treatment effects,and improve the quality of life.

Abstract:Objective To investigate the clinical effect of Mimics assisted closure reduction and screw fixation in the treatment of calcaneal intra-articular fracture.Methods A retrospective analysis was conducted on 31 patients with intraarticular calcaneal fractures(Sanders type Ⅱ fracture in 20 cases and Sanders type Ⅲ fracture in 11 cases)admitted to the Fourth Medical Center of PLA General Hospital from March 2017 to September 2019.After Mimics assisted preoperative design,they were treated with prying reduction and percutaneous screw fixation under traction of external fixator.Postoperative imaging parameters,such like ankle function scores and complications were evaluated.Results The average length of stay was(7.30±3.10)days,mean operative time(87.74±30.30)min,mean intraoperative bleeding volume(41.45±34.16)ml.The AOFAS mean score was(93.84±7.92)points,including 24 excellent,6 good and 1 fair,with an excellent rate of 96.8%.At final follow-up,the mean range of ankle flexion-extension motion on the injured side was(64.35±1.38)°,showing no statistically significant difference compared to the healthy side(P>0.05).The mean inversion-eversion range of the subtalar joint on the injured side was(29.26±1.63)°,achieving 88.6%of the healthy side's mobility.Follow-up radiographs demonstrated satisfactory restoration of calcaneal length,height,width,Böhler's angle,and Gissane's angle.Postoperative CT scans revealed that 83.8%of patients achieved good or excellent reduction of the subtalar articular surface.Conclusions Mimics-assisted closed reduction and screw fixation is safe,effective,minimally invasive and accurate for intra-articular calcaneal fractures,with satisfactory short-term clinical results.

Abstract:Objective To explore the predictive value of column chart model and random forest model based on preoperative systemic inflammatory factors for postoperative infection in patients with open tibiofibular fractures.Methods 196 open tibiofibular fracture patients admitted to our Orthopedic Center from June 2023 to October 2024 were selected as the research subjects.They were randomly divided into training set(137 cases)and testing set(59 cases)in 7:3 ratio.Patients in the testing set were divided into infected group(39 cases)and uninfected group(98 cases)according to whether postoperative infection occurred.The general clinical data and the expression level of serum systemic inflammatory factors of patients between the two groups were compared.The independent predictors of postoperative infection in patients with open tibiofibular fractures were obtained by multivariate logistic regression analysis.A column chart model and random forest model was established.The predictive performance and net return of column chart model and random forest model were evaluated through ROC analysis and decision curve analysis,respectively.Results Multivariate logistic regression analysis showed that CRP,PCT,TNF-α and IL-6 before operation were independent predictors of postoperative infection in patients with open tibiofibular fracture(P<0.05).A column chart model and random forest model was constructed to predict the postoperative infection risk of open tibiofibular fractures patients based on CRP,PCT,TNF-α and IL-6.The ROC analysis results showed that the area under the curve(AUC)for predicting postoperative infection in open tibiofibular fracture patients in testing set of column chart model and random forest model were 0.807(95%CI:0.732-0.879)and 0.862(95%CI:0.778-0.925),respectively.The AUC of the random forest model was significantly higher than that of the column chart model,and the differences were statistically significant(Z=5.645,P<0.05);The decision curve analysis results showed that within the threshold probability range of 0.28-0.81,the predictive performance and net return of random forest model predicting postoperative infection in open tibiofibular fracture patients were higher than the column chart model in the testing set.Conclusions The nomogram model and random forest model constructed based on CRP,PCT,TNF-α,and IL-6 both demonstrate good predictive value for postoperative infections in patients with open tibiofibular fractures,with the random forest model showing higher predictive performance.

Abstract:Objective To compare the stress changes and displacement of radial head and neck fractures with different fixations under different loads.Methods The images of the elbow joint of one healthy male volunteer were randomly selected to establish a 3D model of Mason radial head and neck fracture,and the fracture models were fixed with different screw structures to compare the stress changes and displacement under different loads.Results Under the axial load of 100 N,the average maximum peak value of internal fixation stress was in group C(Short),and the average minimum peak value of internal fixation stress was in group B(Transverse).The average maximum bone stress peak was in group C,and the average minimum bone stress peak was in group B.The average maximum displacement of the model was in group C,and the average minimum displacement of the model was in group B.Under the axial 100 N load and the 20 N shear load,there was no significant difference between the average internal fixation stress peak value in group A(Standard)and group C,and it was higher than that in group B.The average maximum bone stress peak was in group C.The average maximum displacement of the model was in group C,and the average minimum displacement of the model was in group B.Conclusions In the tripod screw structure,the interfracture displacement is smaller and the overall structural strength is greater when the screw intersection is far away from the neck fracture line;the interfracture displacement is smaller and the overall structural strength is greater when combined with the transverse screw,which can increase the overall structural stability.