Abstract:Objective To compare the clinical effect of the keystone-design perforator island flap and posterior tibial artery perforator flap in repairing small and medium-sized defects of lower leg and ankle.Methods From April 2018 to June 2024,the clinical data of 60 patients with small and medium-sized defects of lower leg and ankle in second hospital of Tangshan were retrospectively analyzed.According to the different surgical techniques of wound repair,they were divided into the keystone group(30 cases)and posterior tibial artery group(30 cases).The cases repaired by the keystone-design perforator island flap in the keystone group,included 21 males and nine females,aged 25 to 68 years[mean(47.97±10.76)years].The wound area in the keystone group ranged from 2.5 cm× 1.5 cm to 6.0 cm×3.0 cm,with a mean of(9.36±3.31)cm2.The other cases repaired by posterior tibial artery perforator flap included 23 males and seven females,aged 28 to 65 years[mean(45.43±11.57)years].And the sizes of the defects in posterior tibial artery group ranged from 2.8 cm× 1.5 cm to 5.6 cm×3.2 cm,with an average of(8.94±3.03)cm2.The operation time,intraoperative blood loss,primary survival rate of the flaps,and static two-point discrimination(TPD)of the flaps,the Vancouver scar scale(VSS)scores of the flaps and donor sites appearance,and American orthopaedic foot and ankle society(AOFAS)ankle and hindfoot function score were compared between the two groups.Results All the operations were successfully completed between the two groups.The operative time of the flap harvested and the intraoperative blood loss in keystone group were less than those in posterior tibial artery group(P＜0.05).The primary survival rate of the flaps in keystone group(100％)was higher than that in posterior tibial artery flap group(80.00％),with a statistically significant difference(P＜0.05).The duration of follow-up time in keystone and posterior tibial artery group were(16.27±4.35)months and(15.90±2.75)months,respectively.At the final follow-up,the static TPD of the flap and VSS scores of the flap and donor site in keystone flap group(29.80±8.17)mm and(4.07±1.08),were better than(39.13±7.33)mm and(5.17±1.32)in posterior tibial artery group with a statistically significant difference(P＜0.05).The AOFAS of the injured limbs in keystone group were excellent in 27 cases and good in 3 cases,and excellent in 25 casesand good in 5 cases in posterior tibial artery group,with no statistically significant difference(P＞0.05).Conclusion Compared with the posterior tibial artery perforator flap,the keystone-design perforator island flap can provide a shorter operative time,less intraoperative blood loss,higher primary survival rate,and better sensation and appearance recovery,which is more suitable for repairing small and medium-sized defects of lower leg and ankle.

Abstract:Objective To investigate the characteristics of craniocervical sagittal alignment in patients with basilar invagination with atlantoaxial dislocation,and to evaluate the effect of occipitocervical fusion on craniocervical sagittal parameters as well as the efficacy of different fixation strategies for the occipitocervical angle.Methods A retrospective analysis was conducted on the clinical data of 4 3 patients(patient group)with basilar invagination with atlantoaxial dislocation who were admitted to the first affiliated hospital of Xinjiang medical university from January 2009 to December 2023,including 28 males and 15 females,aged 18 to 76 years with a mean age of(43.12±15.79)years.Meanwhile,the data of 86 healthy subjects(healthy group)were matched from the outpatient department and physical examination center of the hospital.(1)The chin-brow vertical angle(CBVA),cranial slope(CS),occipital-C2 angle(O-C2a),C2～C7 Cobb angle(C2～7a),C2～C7 sagittal vertical axis(CSVA),C2 slope(C2S),T1 slope(T1S),thoracic inlet angle(TIA),neck tilt(NT),T1 slope minus C2～C7 Cobb angle(T1 S-CL),as well as the visual analogue scale(VAS)score for pain,modified Japanese orthopaedic association(mJOA)score,neck disability index(NDI),physical component summary(PCS)and mental component summary(MCS)of the 36-item short form health survey(SF-36)were evaluated in the patient group before and after surgery.(2)The imaging parameters were compared between the patient group and the healthy group.(3)According to the postoperative O-C2a,the patients were divided into four subgroups:the kyphosis subgroup(O-C2a＞0 °)with 10 cases,the low-angle subgroup(-10 °≤O-C2a≤0 °)with 9 cases,the moderate-angle subgroup(-20 °＜O-C2a＜-10 °)with 9 cases,and the high-angle subgroup(O-C2a≤-20 °)with 15 cases.Results(1)All 43 patients in the patient group successfully underwent surgery,with a postoperative follow-up of 12 to 48 months and a mean follow-up of(15.58±9.53)months.The VAS,mJOA,NDI,PCS and MCS scores at post-operation and the last follow-up were significantly improved compared with those before surgery(P＜0.05).Compared with the preoperative values,the postoperative C2～7a,CSVA and T1S-CL increased significantly(P＜0.05),the C2S changed from retroversion to anteversion(P＜0.05),and the O-C2a decreased significantly(P＜0.05);the CSV A at the last follow-up was significantly lower than that at post-operation(P＜0.05).(2)Before surgery,at post-operation and the last follow-up,there were statistically significant differences in CBVA,CS,O-C2a,C2～7a,C2S and T,S-CL between the patient group and the healthy group(P＜0.05);before surgery and at the last follow-up,there was a statistically significant difference in CSVA between the two groups(P＜0.05).(3)The postoperative parameters in the moderate-angle subgroup were the most optimally improved and were closer to those of the healthy group(P＜0.05);the clinical indicators were significantly improved at post-operation and the last follow-up in all subgroups(P＜0.05),and there were intergroup differences in clinical indicators at the last follow-up(P＜0.05).The clinical efficacy of the moderate-angle subgroup was comparable to that of the low-angle subgroup and was superior to that of the high-angle subgroup(P＜0.05).Conclusion Patients with basilar invagination with atlantoaxial dislocation have obvious abnormalities in craniocervical sagittal alignment.Occipitocervical fusion can promote spontaneous compensatory correction of the lower cervical spine,and the postoperative sagittal alignment in the moderate-angle subgroup is closer to that of healthy subjects with remarkable clinical efficacy.In addition,occipitocervical fusion should avoid insufficient or excessive correction of O-C2a to prevent cervical compensatory imbalance.

Abstract:Objective To investigate the clinical efficacy of arthroscopic double-row anchor suture bridge technique in the treatment of Mutch type Ⅰ greater tuberosity fractures of the humerus.Methods A retrospective analysis was conducted on the data of 23 patients with Mutch type Ⅰ greater tuberosity fractures of the humerus who underwent double-row anchor suture bridge technique at Shanghai Tongren hospital from June 2021 to December 2023.Among them,14 were male and 9 were female.The age ranged from 25 to 68 years,with an average of(44.52±12.88)years.The university of California at Los Angeles(UCLA)score,Constant-Murley score,and visual analogue scale(VAS)were used to evaluate the therapeutic effect.Results The postoperative follow-up period was 12 to 24 months,with an average of(18.04±3.32)months.All the incisions achieved primary healing.At 12 months postoperatively,the fractures healed well,and the internal fixation devices were in good position without loosening.The UCLA score was(32.04±1.99)(excellent in 8 cases and good in 15 cases),the Constant-Murley score was(91.83±2.81),and the VAS was(1.17±0.94),all of which were significantly improved compared with those before the operation(P＜0.001).No complications such as surgical incision infection,internal fixation failure,re-displacement of the greater tuberosity fracture,or shoulder joint stiffness occurred.Conclusion The double-row anchor suture bridge technique for the treatment of Mutch type Ⅰ greater tuberosity fractures of the humerus has the advantages of minimal surgical trauma,precise reduction,no need for secondary surgery,early functional exercise,and rapid functional recovery,with satisfactory results.

Abstract:Objective To explore the application value of 3D-printed guide rod-assisted cannulated screw placement in the treatment of calcaneal fractures.Methods A prospective analysis was conducted on the data of 132 patients with calcaneal fractures admitted to Zhongwu hospital in Suqian from October 2020 to March 2025,including 85 males and 47 females,aged 45 to 68 years[mean age(55.32±6.84)years].The patients were randomly assigned in a 1∶1 ratio to two groups,with 66 cases in each group.The conventional group underwent routine open reduction or minimally invasive limited open reduction via the sinus tarsi approach,while the 3D group received 3D-printed guide rod-assisted insertion of channel screws in addition to the conventional method.The study compared the precise screw placement rates,perioperative indicators,Calcaneal width,Böhler angle,Gissane angle,American orthopaedic foot and ankle society(AOFAS)scores,Maryland scores,and complication rates between the two groups.Results Postoperative follow-up time≥6 months.The accurate placement rate of 3D group screws(98.48％)was significantly higher than that of the conventional group(83.33％)(P＜0.05).The operative time,hospitalization duration,fracture healing time,intraoperative blood loss,number of intraoperative fluoroscopies,and postoperative drainage volume in the 3D group were all lower than those in the conventional group(P＜0.05).At 3 and 6 months postoperatively,the 3D group exhibited smaller calcaneal width and Gissane angle but larger Böhler angle,along with higher AOFAS and Maryland scores compared to the conventional group(P＜0.05).The overall complication rate in the 3D group(4.55％)was significantly lower than that in the conventional group(18.18％)(P＜0.05).Conclusion For the treatment of calcaneal fractures,compared to conventional surgical procedures,3D printed guide rod assisted insertion of channel screws can improve screw placement accuracy,reduce surgical time,alleviate traumatic stress,and reduce complications.

Abstract:Objective To compare and analyze the clinical effects of retrograde tibial intramedullary nail(RTN)and minimally invasive percutaneous plate osteosynthesis(MIPPO)in the treatment of distal tibial fractures.Methods A total of 102 patients with distal tibial fractures admitted to Nanyang hospital of traditional Chinese medicine from April 2022 to April 2024 were selected as the research objects,including 64 males and 48 females,aged 28 to 58 years,with an average of(43.12±6.53)years.They were divided into intramedullary nail group and plate group by random number table method,51 cases in each group.The operation indexes,as well as the C-reactive protein,interleukin-1β,visual analogue scale(VAS),American orthopedic foot and ankle society(AOFAS)score,fracture reduction quality before and after operation,and complications were compared between the two groups.Results Postoperative follow-up time≥6 months.There was no significant difference in fluoroscopy times and fracture healing time between the two groups(P＞0.05).The operation time,full weight-bearing time and intraoperative blood loss in the intramedullary nail group were significantly less than those in the plate group(P＜0.05).At 24 h and 72 h after operation,C-reactive protein and interleukin-1β in the intramedullary nail group were significantly lower than those in the plate group(P＜0.05).At 3 months after operation,the VAS of the intramedullary nail group was significantly lower than that of the plate group(P＜0.05),and the AOFAS score was significantly higher than that of the plate group(P＜0.05).At 6 months after operation,there was no significant difference in AOFAS score between the two groups(P＞0.05).At the last follow-up,the excellent and good rate of fracture reduction in the intramedullary nail group was 100％,and that in the plate group was 97.83％,there was no significant difference between the two groups(P＞0.05).The incidence of complications was 7.84％in the intramedullary nail group and 13.73％in the plate group,there was no significant difference between the two groups(P＞0.05).Conclusion Both RTN and MIPPO have satisfactory efficacy and safety in optimizing the surgical process,reducing intraoperative blood loss,shortening the full weight-bearing time,alleviating early postoperative pain,and improving ankle joint function.

Abstract:Objective To develop a specialized anatomical locking plate for sternoclavicular joint fracture-dislocation and verify its advantages in treating this condition.Methods(1)Design and fabrication of a dedicated sternoclavicular joint plate,consisting of three components:A manubrial plate,a clavicular plate,and a sternoclavicular joint plate.The manubrial plate is hook-shaped to fit the anterior and posterior surfaces of the sternal manubrium and the sternal notch;the clavicular plate is flat,designed for intimate contact with the superior and anterior surfaces of the proximal clavicle;and the sternoclavicular joint plate connects the manubrial and ipsilateral clavicular plates.The length of the clavicular plate can be extended according to clinical needs,and the plate is manufactured from titanium alloy.(2)Twenty sternoclavicular joints from 10 cadaveric specimens were prepared as complete dislocation models and randomly divided into two groups(n=10 each):the experimental group was fixed with the dedicated sternoclavicular joint plate,while the control group was fixed with a distal radius oblique T-shaped locking plate.After embedding and fixation,both groups were subjected to mechanical testing using a universal testing machine to simulate injury mechanisms,including compression,torsion,and pull-out tests.Results Under loads of 0～25 N,the angular deformation increased linearly with loading in both groups,with the experimental group demonstrating superior resistance to compressive deformation compared to the control group(P＜0.05).At a torsion angle of 0 °～10 °,the torque of the specimens in both groups increased linearly with the increase of torsion angle,and the torsional deformation resistance of the experimental group was stronger(P＜0.05).There was a statistically significant difference in the maximum pull-out force between the experimental group and the control group(P＜0.0 5),and the experimental group had higher fixation strength.Conclusion The custom-made sternoclavicular joint plate developed in this study features a structural design highly consistent with the biomechanical characteristics of the sternoclavicular joint,providing stable mechanical support with straightforward surgical application.Future clinical studies will be conducted to further validate its therapeutic efficacy.

Abstract:Objective To investigate the effect of blood flow restriction training(BFRT)on lower limb function in patients with incomplete spinal cord injury.Methods A prospective analysis was conducted on 80 patients with incomplete spinal cord injury treated at Lianyungang hospital of traditional Chinaese medicine from August 2022 to Decement 2024,including 56 males and 24 females,aged 18 to 78 years[mean(54.40±14.08)years].They were randomly divided into a control group(27 cases),experimental group A(26 cases)and experimental group B(27 cases).All subjects in the three groups received routine symptomatic support treatment,rehabilitation treatment and basic rehabilitation nursing.On this basis,the control group was given routine muscle strength training of both lower limbs;experimental group A and experimental group B were applied with BFRT on the basis of the control group,among which the application frequency of BFRT in experimental group A was 2 times/week,and that in experimental group B was 4 times/week.The key muscle strength of both lower limbs,modified Barthel index,muscle thickness of rectus femoris,muscle thickness of tibialis anterior,as well as the latency and amplitude of motor evoked potential(MEP)of tibialis anterior were compared among the three groups before treatment and after 8 weeks of treatment.Results Compared with before treatment,the key muscle strength of both lower limbs,modified Barthel index,muscle thickness of rectus femoris and tibialis anterior of the three groups were significantly improved after treatment(P＜0.05);the latency of tibialis anterior MEP was significantly decreased,and the amplitude was significantly increased(P＜0.05).After treatment,the key muscle strength of both lower limbs,modified Barthel index,muscle thickness of rectus femoris and tibialis anterior,as well as the latency and amplitude of tibialis anterior MEP in experimental group A and experimental group B were all superior to those in the control group(P＜0.05).There were no statistically significant differences in the key muscle strength of both lower limbs,modified Barthel index,muscle thickness of tibialis anterior,and the latency and amplitude of tibialis anterior MEP between experimental group A and experimental group B(P＞0.05);the muscle thickness of rectus femoris in experimental group B was superior to that in experimental group A(P＜0.05).Conclusion BFRT can improve the motor function and muscle thickness of both lower limbs,as well as the neurological function and activities of daily living in patients with incomplete spinal cord injury.

Abstract:Objective To investigate the incidence and causes of disease-related unplanned surgical cancellation in patients with intertrochanteric femoral fractures,and to provide evidence for quality improvement in perioperative management.Methods A retrospective analysis was conducted on 543 patients who underwent surgery for intertrochanteric femoral fractures in the Shanghai Ninth people's hospital,Shanghai Jiao Tong university school of medicine,between January 2020 and June 2024.The cohort included 192 men and 351 women,with a mean age of(81.7±4.6)years(range,62 to 99 years).Patients were divided into a cancellation group and a non-cancellation group according to whether the scheduled surgery was performed as planned.Unplanned surgical cancellation occurred in 75 patients(13.8％),while 468 patients(86.2％)completed surgery as scheduled.Data on demographic characteristics,disease-related causes of surgical cancellation,and the timeliness of abnormal laboratory result reporting and intervention were extracted from the electronic medical record system and compared between groups.Results The overall incidence of unplanned surgical cancellation was 13.8％(75/543).Compared with the non-cancellation group,patients in the cancellation group had a significantly longer length of hospital stay,with a mean increase of 3.9 days(P＜0.05).The three-leading disease-related causes of surgical cancellation were cardiovascular disorders(40.0％),respiratory diseases(20.0％),and poor glycaemic control(16.0％).Analysis of abnormal laboratory result management revealed that in 40.0％(30/75)of cancelled cases,the initial intervention response time exceeded the recommended time window(＞4 h),and 24.0％(18/75)of cancellations demonstrated potential for further process optimization.Conclusion Unplanned surgical cancellation is common among elderly patients with intertrochanteric femoral fractures and is closely associated with multimorbidity and the timeliness of perioperative management.Implementing early risk assessment and improving the identification and timely intervention of abnormal laboratory findings may help reduce surgical cancellation rates and enhance perioperative management efficiency.

Abstract:Objective To investigate the relationship between body mass index(BMI)and preoperative rotator cuff muscle fat infiltration grading(Goutallier classification)on functional recovery after arthroscopic rotator cuff repair,aiming to evaluate the potential role of fat infiltration.Methods A retrospective cohort study included 143 patients[48 males and 95 females;aged 50 to 84 years,mean age(62.88±7.67)years]who underwent arthroscopic rotator cuff repair treated at Xinhua hospital affiliated to Shanghai Jiao Tong university school of medicine and completed follow-up between January 2023 and June 2024.BMI was categorized into underweight,normal,and overweight groups[underweight＜18.5 kg/m2(34 patients),normal BMI=18.5～24.9 kg/m2(41 patients),high BMI≥25.0 kg/m2(68 patients)].Data collected included BMI,preoperative MRI Goutallier grade of supraspinatus fat infiltration,preoperative and postoperative range of motion(ROM),visual analogue scale(VAS)for pain,and American shoulder and elbow surgeons(ASES)score.Spearman correlation analysis assessed the relationship between BMI and fat infiltration.A regression model using 12-month postoperative ROM as the primary endpoint analyzed the independent association between BMI and functional recovery.Results All patients were followed up for at least 12 months.BMI positively correlated with preoperative supraspinatus fat infiltration grade(P＜0.05),with a significantly higher proportion of moderate-to-severe infiltration in the higher BMI group.Follow-up at 1 and 12 months postoperatively revealed significant differences in 1 2-month ROM,VAS and ASES between the high BMI group and the other two groups,with a linear decline trend as BMI grade increased(P＜0.01).The proportion of Goutallier grade≥2 also showed an increasing distribution with rising BMI.Multivariate regression analysis revealed that BMI was an independent adverse predictor of 12-month ROM(P＜0.001),while fat infiltration grade had no significant independent effect on ROM(P＞0.05).Conclusion Increased rotator cuff muscle fat infiltration is closely associated with elevated BMI,and BMI serves as an independent predictor of poor functional recovery after rotator cuff repair.Preoperative emphasis should be placed on imaging evaluation and prognostic communication for patients with high BMI,complemented by individualized management strategies during the perioperative and rehabilitation phases to optimize postoperative recovery outcomes.

Abstract:Objective To analyze the clinical efficacy of total hip arthroplasty combined with greater trochanteric osteotomy for the treatment of severe coxa vara deformity.Methods A retrospective analysis was conducted on 8 patients(10 hips)with severe coxa vara deformity treated at Beijing Jishuitan hospital from June 2018 to July 2022,including 2 males and 6 females,aged 35～69 years[mean(56.10±9.70)years].All patients underwent greater trochanteric osteotomy during surgery.The Wagner Cone stem was used on the femoral side to adjust prosthesis anteversion and limb length.After implantation of the hip prosthesis,a greater trochanteric plate was used for reduction and fixation of the greater trochanter.Evaluation indicators included the Harris hip score,Charnley Hip Score,visual analogue scale(VAS)for pain,improvement in limb length,healing of the greater trochanteric osteotomy,and complications.Results The mean operative time was(168.50±50.70)min,and the mean intraoperative blood loss was(810.00±287.92)mL.Postoperative follow-up ranged from 2.0 to 7.1 years,with a mean of(3.86±1.37)years.The affected limb was lengthened by an average of(29.40±4.27)mm postoperatively.The postoperative Harris hip score(84.50±3.85),Charnley score(13.80±0.87)and VAS(1.50±0.81)showed significant improvement compared to preoperative scores(P＜0.05).At the final follow-up,all patients exhibited good healing of the greater trochanteric osteotomy,with no complications such as prosthesis loosening,dislocation,or internal fixation failure.Conclusion Total hip arthroplasty combined with greater trochanteric osteotomy is an effective treatment for severe coxa vara deformity.It significantly improves joint function and lengthens the limb,with a low risk of osteotomy displacement and nonunion,making it a feasible treatment option.

Abstract:Objective To evaluate the clinical efficacy of endoscopic debridement combined with autologous iliac bone interbody fusion and percutaneous pedicle screw fixation in the treatment of thoracolumbar spinal tuberculosis.Methods A retrospective study was performed on 44 patients with thoracolumbar spinal tuberculosis treated at Liuzhou people's hospital from June 2020 to December 2023,including 24 males and 20 females,aged 20～77 years[mean(54.00±12.00)years].Patients were divided into an experimental group(n=22),treated with endoscope-assisted debridement combined with autologous iliac bone interbody fusion and percutaneous pedicle screw fixation,and a control group(n=22),treated with conventional posterior open surgery.Surgical parameters,visual analogue scale(VAS),Oswestry disability index(ODI),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),Cobb angle,and postoperative complications were compared.Results All patients were followed up for at least 12 months.The experimental group had significantly less intraoperative blood loss,shorter operative time,and shorter hospital stay than the control group(P＜0.05).Postoperative VAS scores at 1,3,6,and 12 months and ODI scores at 1 and 6 months were significantly improved in the experimental group(P＜0.05).The Cobb angle correction at 1,6,and 12 months and ESR and CRP levels at 6 and 12 months were also significantly better in the experimental group(P＜0.05).In the experimental group,three cases of postoperative lower limb numbness occurred,with no secondary surgeries required.In the control group,3 cases of abscess and poor wound healing occurred(requiring secondary surgery),along with 2 cases of lower limb numbness and sensory decline,and 1 case of lower limb muscle weakness.Conclusion Endoscopic debridement combined with autologous iliac bone interbody fusion and percutaneous pedicle screw fixation is a minimally invasive,effective,and safe surgical approach for the treatment of thoracolumbar spinal tuberculosis.

Abstract:Objective To investigate the short to medium-term clinical efficacy of reverse total shoulder arthroplasty with humeral prosthesis implanted at 30 ° and 0 ° retroversion angles for the treatment of irreparable massive rotator cuff tears.Methods A retrospective analysis was conducted on the data of 25 patients with irreparable massive rotator cuff tears who underwent reverse total shoulder arthroplasty in Foshan traditional Chinese medicine hospital from January 2016 to September 2022.They were divided into two groups according to the retroversion angle of the humeral prosthesis.There were 17 cases in the 30 ° humeral prosthesis retroversion angle group,including 5 males and 12 females,aged 58～81 years with an average age of(69.35±5.31)years.There were 8 cases in the 0 ° humeral prosthesis retroversion angle group,including 3 males and 5 females,aged 58～81 years with an average age of(64.63±6.28)years.The postoperative American shoulder and elbow surgeons(ASES)score,Constant-Murley score,visual analogue scale(VAS),University of California Los Angeles(UCLA)shoulder score,shoulder range of motion,and postoperative complications were compared between the two groups.Results 25 patients were included with mean followed up of(39.68±17.90)months(26.00～90.95 months).Both groups showed improvements in postoperative ASES scores,Constant scores,UCLA scores,VAS scores,as well as forward flexion,external rotation,and internal rotation.There was a statistically significant difference in external rotation angle between the two groups(P＜0.05),with the 30 retroversion angle group at(41.18±9.61)°and the 0 ° retroversion angle group at(30.63±15.68)°.No statistically significant differences were observed in the remaining indicators(P＞0.05).One case of scapular notching was observed in the 0 °retroversion angle group and one case of acromial fracture was observed in the 30 °retroversion angle group respectively.Conclusion Reverse total shoulder arthroplasty has a good clinical effect in the treatment of irreparable massive rotator cuff tears.Implantation of the humeral prosthesis at a 30 ° retroversion angle is more conducive to improving the postoperative shoulder external rotation angle.

Abstract:Objective To investigate the efficacy of personalized osteotomy plate-assisted total knee arthroplasty(TKA)in the treatment of post-traumatic knee osteoarth around the knee joint.Methods A retrospective analysis was conducted on the data of 32 patients with post-traumatic knee osteoarthritis due to periknee fractures admitted to the 909 hospital from February 2020 to August 2023.Among them,there were 18 males and 14 females,aged 52 to 75 years with an average of(64.36±10.31)years.28 patients had undergone open reduction and plate fixation for periknee fractures,while 4 patients received conservative treatment.30 patients had preoperative varus deformity of the knee joint,and 2 patients had concomitant valgus deformity.All patients underwent personalized osteotomy guide plate-assisted TKA.Among them,31 patients underwent one-stage personalized osteotomy guide plate-assisted TKA(25 cases without removal of internal fixation,and 6 cases with partial screw removal).One patient underwent two-stage personalized osteotomy guide plate-assisted TKA after removal of internal fixation due to preoperative inflammatory markers being three times higher than normal.The operation duration,intraoperative blood loss,hospital for special surgery(HSS),visual analogue scale(VAS),hip-knee-ankle angle(HKA),and displacement angles of the frontal femoral component(FFC),frontal tibia component(FTC),lateral femoral component(LFC),and lateral tibia component(LTC)in the coronal plane were recorded.Results 32 patients successfully completed the operation.The average operation time was(75.53±20.67)min,and the intraoperative blood loss was(80.26±17.14)mL.Patients were followed up for 13 to 42 months,with an average follow-up of(17.80±4.46)months.There were no infection,collateral ligament injury,prosthetic loosening,periprosthetic fracture during follow-up.Postoperative VAS and HSS scores were significantly improved compared to those before surgery(P＜0.01).The average HKA was(178.4±1.7)° at 3 months after surgery,which was significantly increased compared to before surgery(P＜0.01).At three months postoperatively,the average FFC deviation angle was(1.2±0.5)°,the average FTC deviation angle was(1.8±0.8)°,the average LFC deviation angle was(1.8±0.6)°,and the average LTC deviation angle was(1.5±0.7)°.All of them were within the normal deviation range.Conclusion Personalized osteotomy guide assisted TKA for post-traumatic knee osteoarthritis with knee periarticular fractures,most of the patients did not need to remove internal fixation,and all of them had good lower limb alignment,prosthetic position and knee joint function after the operation,with significant curative effect.

Abstract:Objective To evaluate the clinical outcomes of medial patellofemoral ligament(MPFL)reconstruction combined with distal derotational femoral osteotomy(DDFO)for the treatment of failed primary MPFL reconstruction.Methods A retrospective analysis was conducted on data of 15 patients(15 knees)with recurrent patellar dislocation treated at Beijing Jishuitan Hospital,Capital Medical University,between January 2012 and January 2024.The cohort included 2 males and 13 females,aged 15～30 years with a mean age of(21.2±4.6)years.All patients had undergone primary MPFL reconstruction,with a mean time to failure of(21.2±4.6)months.The revision procedures were as follows:10 knees underwent MPFL reconstruction combined with DDFO;2 knees underwent MPFL reconstruction combined with DDFO and medial tibial tubercle transfer;and 3 knees underwent MPFL reconstruction combined with DDFO,medial tibial tubercle transfer,and distal tibial tubercle transfer.Radiographic parameters and functional scores were compared before and after surgery.Results The mean postoperative follow-up duration was(34.1±9.4)months(range,20～42 months).Significant improvements were observed in all radiographic parameters postoperatively:The patellar tilt angle decreased from(42.3±15.4)° to(18.6±14.2)°;the femoral anteversion angle decreased from(41.3±13.0)° to(13.6±6.2)°;the Caton index decreased from(1.3±0.3)to(1.1±0.1);the tibial tubercle-trochlear groove distance decreased from(24.3±6.6)mm to 15.3±4.9 mm;and the patellar laxity index decreased from(84.4±20.6)％to(17.2±8.9)％(P＜0.001).The proportio n of patients with a high-grade"J-sign"decreased from 100％preoperatively to 7％postoperatively.At the final follow-up,all patient-reported outcome measures—including the Tegner score,Kujala score,Lysholm score,and international knee documentation committee subjective score—showed significant improvement compared to preoperative values(P＜0.001).Conclusion For revision surgery in patients with failed MPFL reconstruction and severe femoral anteversion,MPFL reconstruction combined with DDFO can improve both radiographic parameters and subjective functional scores.Furthermore,malposition of the femoral tunnel was not identified as the primary cause of failure.

Abstract:Objective To compare the efficacy of anchor and hollow lag screw in the treatment of humerus greater tubercle fracture.Methods A retrospective analysis was conducted on the data of 40 patients with simple greater tuberosity fractures of the humerus admitted to Qianhai Life Insurance Guangxi Hospital and the First Affiliated Hospital of Guangxi Medical University from January 2014 to January 2019.There were 20 cases in the anchor nail group,including 7 males and 13 females,aged 33 to 62 years,with an average age of(48.20±14.68)years.There were 20 cases in the hollow nail group,including 5 males and 15 females,aged 30 to 60 years,with an average age of(45.65±14.75)years.The anchor nail group was fixed with two anchors through a small lateral acromion incision via the deltoid approach.The hollow nail group was fixed with two hollow lag screws via the deltoid approach.Postoperatively,the affected limb was immobilized with a medical forearm fixation belt for suspension braking in the first 4 weeks,and the medical forearm fixation belt was removed after 4 weeks.Pendulum motion exercise of the shoulder joint was started on the second day after surgery,and active exercise of the shoulder joint in all directions was started at 4～6 weeks.Regular reexaminations and follow-ups were performed at the hospital in the first six months after surgery and every six months thereafter.DR films of the shoulder were taken,and CT examinations were performed if necessary to better understand the fracture healing.At the last follow-up,the fracture healing time,Fudan university shoulder score(FUSS),visual analogue scale(VAS),postoperative complications such as fracture redisplacement and acromial impingement,and the rate of secondary operations were recorded.Results All 40 patients were followed up for 12 to 24 months,with an average of(18.00±6.00)months,and all achieved good bony union.The average bone healing time was(12.40±1.35)weeks in the anchor nail group and(12.50±1.15)weeks in the hollow nail group,with no statistically significant difference between the two groups(P＞0.05).At the last follow-up,the FUSS score was(95.10±2.07)points in the anchor nail group and(90.90±2.94)points in the hollow nail group,with a statistically significant difference(P＜0.05).The VAS score was(1.35±0.93)points in the anchor nail group and(2.10±0.85)points in the hollow nail group,with a statistically significant difference(P＜0.05).Regarding postoperative complications,the incidences of fracture redisplacement,acromial impingement,and reoperation in the anchor nail group were lower than those in the hollow nail group,and the differences between the two groups were statistically significant(P＜0.05).Conclusion For the treatment of greater tuberosity fractures of the humerus,anchor fixation has significant efficacy compared with hollow lag screw fixation.It provides stronger mechanical stability,achieves better recovery of shoulder joint function,and significantly reduces the incidence of complications(especially acromial impingement and fracture redisplacement)and the rate of secondary operations.

Abstract:Objective To analyze the distribution characteristics of the coronal plane alignment of the knee(CPAK)classification in patients with knee osteoarthritis in Northwest China,and to provide a theoretical basis for the selection of alignment in total knee arthroplasty.Methods A retrospective analysis was conducted on 282 knee osteoarthritis patients(involving 500 knees)at Honghui Hospital Affiliated to Xi'an Jiaotong University from August 2024 to September 2024.Among them,there were 92 male patients and 190 female patients,with ages ranging from 46 to 83 years and an average age of(67.2±6.4)years.The body mass index(BMI)ranged from 16.2 to 37.0 kg/m2,with an average of(25.5±3.5)kg/m2.CPAK classification was performed based on the preoperative medial proximal tibial angle(MPTA),lateral distal femoral angle(LDFA),arithmetic hip-knee-ankle angle(aHKA),and joint line obliquity(JLO)of the patients.Patients were grouped by gender and BMI:170 knees in the male group and 330 knees in the female group;228 knees in the normal BMI group(BMI＜25 kg/m2)and 272 knees in the overweight/obese group(BMI≥25 kg/m2).Subgrouping based on gender within BMI groups showed 85 knees in males and 143 knees in females in the normal BMI group,while 85 knees in males and 187 knees in females in the overweight/obese group.The CPAK classification patterns were compared among different groups.Results Among all patients,the distribution of CPAK classifications was as follows:Type Ⅰ accounted for 42.2％(211 knees),Type Ⅳ for 25.4％(127 knees),TypeⅡ for 11.4％(57 knees),Type Ⅴ for 8.0％(40 knees),Type Ⅲ for 5.2％(26 knees),Type Ⅵ for 3.8％(19 knees),Type Ⅶ for 3.0％(15 knees),Type Ⅸ for 0.8％(4 knees),and Type Ⅷ for 0.2％(1 knee).Type Ⅰ accounted for the highest proportion in both male and female groups,which were 47.1％(80 knees)and 39.7％(131 knees)respectively.Similarly,Type Ⅰ also had the highest proportion in both the normal BMI group and the overweight/obese group,accounting for 42.1％(96 knees)and 42.3％(115 knees)respectively.In the normal BMI group,Type Ⅰ was the most prevalent classification in both males and females,accounting for 48.2％(41 knees)and 38.5％(55 knees)respectively.In the overweight/obese BMI group,Type Ⅰ also ranked first in both genders,with proportions of 45.9％(39 knees)in malesand 40.6％(76 knees)in females.Conclusion Type Ⅰ is the most common CPAK classification in knee osteoarthritis patients in Northwest China,followed by Type Ⅳ and Type Ⅱ.Type Ⅰ remains the dominant classification among patients with different genders and BMI levels.This study provides a reliable theoretical basis for the selection of TKA alignment in knee osteoarthritis patients in Northwest China.

Abstract:Objective To compare the clinical efficacy of core decompression with bone grafting combined with platelet-rich plasma gel(PRG)treatment for early-stage osteonecrosis of the femoral head under orthopedic surgical robot guidance versus conventional C-arm guidance.Methods A retrospective analysis was conducted on the data of 42 patients(48 hips)with osteonecrosis of the femoral head who underwent core decompression with bone grafting combined with PRG at The Second Affiliated Hospital of Xuzhou Medical University from June 2022 to May 2024.All cases were classified as ARCO(Association Research Circulation Osseous)stages Ⅰ～Ⅱ.Twenty-two cases were assisted by orthopedic surgical robot(Robotic Group):15 males and 7 females;aged 23～59 years,with a mean age of(38.1±9.5)years.Twenty cases were assisted by C-arm fluoroscopy(C-arm Group):17 males and 3 females;aged 21～55 years,with a mean age of(37.6±9.7)years.The surgical condition were compared between the two groups.The preoperative and postoperative Harris scores and hip pain visual analog scale(VAS)scores of patients in the two groups were also compared.Results Patients were followed up for 9～12 months postoperatively,with a mean follow-up of(10.38±1.18)months.The Robotic Group was superior to the C-arm Group incision length,intraoperative blood loss,surgical operation time,total radiation exposure time,total number of fluoroscopic views,total number of punctures,and single-channel puncture success rate(P＜0.05).Both groups showed significant improvements in VAS scores and Harris scores at 1,3,and 9 months postoperatively compared with preoperative levels(P＜0.05).At all postoperative time points,the V AS scores of the Robotic Group were superior to those of the C-arm Group(P＜0.05);however,there was no statistically significant difference in Harris scores between the two groups(P＞0.05).Conclusion For the treatment of patients with early-stage osteonecrosis of the femoral head,compared with C-arm-assisted surgery,orthopedic robot-assisted surgery achieves better clinical outcomes,with smaller incision length,less intraoperative blood loss,shorter surgical operation time,lower total radiation exposure time,fewer total fluoroscopic views,fewer total punctures,and higher single-channel puncture success rate.

Abstract:Objective Hinge fracture is a common complication of medial open wedge high tibial osteotomy(MOWHTO).This study aims to explore the changes in mechanical stability of the osteotomy site after hinge fracture through finite element model analysis,so as to provide a reference for formulating treatment and rehabilitation plans.Methods CT scans were performed on the lower extremities of an adult male patient with knee osteoarthritis to obtain bone data.Finite element models of MOWHTO with intact hinge,as well as Takeuchi type Ⅰ,Ⅱ,and Ⅲ hinge fractures fixed with TomoFix plates and screws,were established.Loads were applied to different models to simulate the plate stress changes,displacement of the medial osteotomy site,and displacement around the lateral hinge under sitting-up state,walking state,and torsional load.Results In the sitting-up state,compared with the intact hinge model,the maximum plate stress in the type Ⅰ,Ⅱ,and Ⅲ hinge fracture models increased by 118.3％,178.3％,and 85.5％respectively;the maximum displacement of the medial osteotomy site increased by 27.2％,33.2％,and 6.0％respectively;the maximum displacement around the lateral hinge increased by 35.2％,51.0％,and 15.8％respectively.In the walking state,compared with the intact hinge model,the maximum plate stress in the type Ⅰ,Ⅱ,and Ⅲ hinge fracture models increased by 56.6％,113.1％,and 62.8％respectively;the maximum displacement of the medial osteotomy site increased by-3.4％,17.2％,and-3.4％respectively;the maximum displacement around the lateral hinge increased by 40.4％,389.4％,and 106.4％respectively.Under torsional load,compared with the intact hinge model,the maximum plate stress in the type Ⅰ,Ⅱ,and Ⅲ hinge fracture models increased by 154.2％,261.4％,and 25.5％respectively;the maximum displacement of the medial osteotomy site increased by 307.5％,362.6％,and 16.8％respectively;the maximum displacement around the lateral hinge increased by 286.0％,338.8％,and 8.5％respectively.Conclusion Hinge fractures can lead to increased plate stress at the MOWHTO osteotomy site and decreased mechanical stability.Among them,type Ⅰ hinge fracture has a minor impact,but the influence of torsional stress should be avoided as much as possible after surgery.Type Ⅱ hinge fracture has a significant impact;therefore,it is necessary to enhance the stability of the osteotomy site during surgery and delay full weight-bearing after surgery to reduce the incidence of internal fixation failure,postoperative loss of target alignment,and nonunion of the osteotomy site.The impact of type Ⅲ hinge fracture on stability is mainly reflected at the fracture site of the lateral tibial plateau;if necessary,fixation from lateral to medial can be added during surgery,and weight-bearing should be delayed after surgery to ensure the healing of the tibial plateau fracture.Sitting-up stress and torsional stress have the greatest impact on the stability of the osteotomy site.Therefore,in the early rehabilitation process of MOWHTO patients with hinge fractures,sitting-up and torsional movements should be avoided or performed under protection to reduce the occurrence of complications.The above research provides a reference for the treatment and rehabilitation of MOWHTO patients with hinge fractures,but further biomechanical studies are still needed for confirmation.

Abstract:Objective To explore the clinical efficacy of robot-assisted sacroiliac joint screw combined with anterior subcutaneous internal fixator(INFIX)in the treatment of unstable pelvic fractures.Methods A retrospective analysis was conducted on the data of 63 patients with unstable pelvic fractures who were treated at the Traumatic Orthopedics Department of Taihe Hospital in Shiyan City using the Tianji Orthopedic Robot-assisted posterior ring percutaneous sacroiliac joint screws combined with anterior ring INFIX from September 2021 to September 2024 including 29 males and 34 females,ageing from 18 to 60 years old[mnean(44.3±11.6)years old].According to Tile classification:There were 21 patients of B2 type,18 patients of B3 type,13 patients of C1 type,8 patients of C2 type,and 3 patients of C3 type.The following parameters were recorded:Surgical time,intraoperative blood loss,number of intraoperative fluoroscopies,the excellent rate of the initial screw placement position,the quality of fracture reduction(assessed by the Matta criteria),fracture healing time,and complications.The last follow-up was evaluated using the Majeed standard to assess the recovery of pelvic function.Results The follow-up period ranged from 12 to 32 months[mean(16.0±3.5)months].The surgical time was 65 to 90 minutes[mean(78.5±5.2)minutes].The intraoperative blood loss was 20 to 80 mL[mean(45.0±8.3)mL].A total of 95 posterior sacroiliac joint screws were implanted,including 57 screws at the S1 level and 38 screws at the S2 level.All the procedures of inserting the guide pin and inserting screws were completed at one time.All sacroiliac screws were in satisfactory positions during the operation,without entering the sacral canal,sacral foramen,or penetrating the bone.The number of intraoperative fluoroscopies ranged from 12 to 26 times[mean(15.5±1.8)times].8 patients experienced injury to the lateral femoral cutaneous nerve after the operation.All patients' sacroiliac joint screws were found to be without loosening.There were 3 cases of failure of INFIX after the operation.The fractures of the other 60 patients healed well,with the healing time ranging from 3 to 5 months[mean(3.5±0.6)months].The quality of fracture reduction was evaluated according to the Matta scoring criteria:31 cases were rated as excellent,28 cases as good,and 4 cases as fair.The overall excellent and good rate was 93.7％.At the last follow-up,the functional status was evaluated using the Majeed pelvic fracture quantification assessment system:43 cases were rated as excellent,15 cases as good,and 5 cases as fair.The excellent and good rate was 92.1％.Conclusion The treatment of unstable pelvic fractures using sacroiliac joint screws combined with INFIX under the assistance of robots has the advantages of minimally invasive,high precision,reduced radiation exposure and fewer complications.It is one of the minimally invasive methods that can be chosen by clinicians.

Abstract:Objective To evaluate the analgesic efficacy and safety of local bupivacaine liposome injection after hallux valgus correction surgery.Methods A retrospective analysis was conducted on 60 patients who underwent Scarf osteotomy for hallux valgus in our center between December 2022 and December 2024.According to the postoperative analgesic protocol,30 patients[2 males,28 females;age 23～66 years,mean(42.5±10.2)years]received local injection of bupivacaine liposome(study group),whereas 30 patients[l male,29 females;age 21～67 years,mean(43.1±10.3)years]received conventional patient-controlled intravenous analgesia(PCIA,control group).Visual analogue scale(VAS)pain scores,analgesic consumption,postoperative recovery variables,complications and adverse events were compared between the two groups.Results VAS scores at 24 h,48 h and 72 h after surgery were significantly lower in the study group than in the control group(P＜0.05),and total analgesic consumption was also markedly reduced(P＜0.05).Time to first ambulation,time to first weight-bearing walk and length of hospital stay were all shorter in the study group(P＜0.05).The incidence of incisional infection was 3.3％in the study group and 6.7％in the control group,showing no statistical difference(P＞0.05).One case of respiratory depression,three of nausea,two of vomiting and one of dizziness occurred in the control group;no such adverse events were observed in the study group.Conclusion Local injection of bupivacaine liposome provides effective and safe analgesia after hallux valgus correction surgery.It significantly relieves postoperative pain,decreases analgesic requirement and accelerates recovery,thus deserving wider clinical application.