Abstract:[Objective] To compare the preliminary clinical outcomes of arthroscopic reconstruction of anterior talofibular ligament (ATFL) versus the traditional open reconstruction for chronic lateral ankle instability (CLAI) . [Methods] A retrospective study was done on a total of 46 patients who underwent ATFL reconstruction for chronic lateral ankle instability in our hospital from February 2015 to March 2020. Among them, 24 patients underwent arthroscopic ATFL reconstruction, while the other 22 patients underwent conventional open AT- FL reconstruction. The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups were successfully operated on without serious complications. The arthroscopic group proved significantly superior to the open group in terms of total incision length, intraoperative blood loss and hospital stay (P＜0.05) , despite of the fact that no significant differences were noted in operation time and incision healing between them (P＞0.05) . The arthroscopic group resumed walking and full weight-bearing ac- tivity significantly earlier than the open group (P＜0.05) . Compared with those preoperatively, the anterior drawer test and varus test signifi- cantly improved (P＜0.05) , AOFAS scores significantly increased (P＜0.05) , the ankle dorsal extension- planter flexion range of motion (ROM) remained unchanged (P＞0.05) , and VAS score significantly decreased (P＜0.05) at the latest follow up in both groups. The ar- throscopic group was significantly better than the open group in the abovementioned indicators at the last interview (P＜0.05) . Radiographi- cally, talus anterior displacement and talus lateral inclination measured on stress X-ray films were significantly reduced in both groups at the last follow-up compared with those preoperatively (P＜0.05) , which was not significantly different between the two groups at any corre- sponding time points (P＞0.05) . [Conclusion] The arthroscopic ATFL reconstruction achieves better clinical outcome over the conventional open reconstruction for chronic lateral ankle instability.

Abstract:[Objective] To explore the risk factors of periprosthetic joint infection (PJI) secondary to primary total knee arthroplasty (TKA) . [Methods] A retrospective study was conducted on 525 patients who underwent primary TKA in our department from January 2010 to January 2020. The patients were divided into two groups according to whether PJI was diagnosed definitively after TKA. Univariate com- parison and binary logistic regression analysis were conducted to search the factors related to PJI. [Results] Among 525 patients, 14 pa- tients were definitively diagnosed of PJI, accounting for 2.67%, with bacteria identified by bacterial culture of staphylococcus epidermidis in 3 cases, staphylococcus aureus in 3 cases, hemolytic streptococcus in 2 cases, escherichia coli in 3 cases, pseudomonas aeruginosa in 2 cases and enterobacter cloacis in 1 case. As consequence of univariate comparison, the PJI group was significantly greater than the non-PJI group in terms of male proportion, age, body mass index (BMI) , underling diabetes, preoperative bacteriuria, the operation time, intraopera- tive blood loss, postoperative drainage, and ratio of postoperative allogeneic blood infusion (P<0.05) , whereas the former had significantly lower preoperative albumin and hemoglobin than the latter (P<0.05) . As results of logistic regression analysis, the age (OR=1.024, P= 0.005) , underling diabetes mellitus (OR=3.243, P=0.002) and postoperative allogeneic blood infusion (OR=2.003, P=0.008) were risk fac- tors for postoperative PJI, whereas female (OR=0.786, P=0.007) and preoperative albumin (OR=0.941, P=0.026) were protective factors for PJI. [Conclusion] Male, advanced age, underling diabetes, low preoperative albumin and postoperative allogeneic blood infusion are risk factors for PJI after primary TKA in this study.

Abstract:[Objective] To compare the clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) versus percuta- neous endoscopic interlaminar discectomy (PEID) for severely prolapsed lumbar disc herniation. [Methods] A total of 60 patients who admit- ted to our hospital from January 2018 to January 2019 for severely migrated lumbar disc prolapse were randomly divided into two groups. Among them, 30 patients were undergoing PETD, while the other 30 patients were undergoing PEID. The perioperative, follow-up and imag- ing data of the two groups were compared. [Results] In the PETD group, 3 patients were withdrawn from this study due to unable complete of the operation on plan, therefore a total of 57 patients were included in the study finally. Although there were no significant differences between the two groups in terms of incision length, volume of nucleus pulposus resected, ambulation time, early complications and hospital stay be- tween the two groups (P＜0.05) , the PEID group proved significantly superior to the PETD group in terms of operation time, intraoperative blood loss and fluoroscopy times (P＜0.05) . The VAS scores for low back pain and leg pain, as well as ODI scores decreased significantly (P＜ 0.05) , whereas JOA scores increased significantly in both groups over time (P＜0.05) . However, there was no statistically significant differ- ence between the two groups in aforesaid scores at any matching time points (P＞0.05) . Radiographically, the height of the intervertebral space significantly declined (P＜0.05) , while lumbar lordosis angle remained unchanged significantly (P＞0.05) in both groups at the latest follow up compared with those preoperatively. There were no significant differences in intervertebral height and lumbar lordosis angle between the two groups at any corresponding time points (P＞0.05) . [Conclusion] Both PETD and PEID are effective for treatment of severely prolapsed lum- bar disc herniation, by comparison, the PEID takes more advantages.

Abstract:[Objective] To evaluate the clinical outcomes of mere endoscopic lumbar interbody fusion by using expandable cage (EC) for degenerative lumbar spinal instability. [Methods] From March 2018 to December 2019, 108 patients with degenerative lumbar spine in- stability were surgically treated in our department. According to the consequence of preoperative doctor- patient communication, 52 pa- tients underwent spinal endoscopic EC fusion, while 56 patients received traditional open posterior lumbar interbody fusion (PLIF) . The perioperative, follow-up and radiographic documents were compared between the two groups. [Results] All patients in both groups had op- eration performed successfully without serious postoperative complications. There was no statistical difference in operation time between the two groups (P＞0.05) , however, the EC group was significantly better than the PLIF group in terms of intraoperative blood loss, postoper- ative drainage and hospital stay (P＜0.05) . As time went during the follow-up period lasted for more than 12 months, the VAS and ODI scores decreased significantly (P＜0.05) , while the JOA score increased significantly in both groups (P＜0.05) . At 8 weeks postoperatively, the EC group were significantly superior to the PLIF group in terms of VAS, ODI and JOA scores (P＜0.05) , but which became not statisti- cally significant between the two groups at the last follow-up (P＞0.05) . With respect of radiographic evaluation, there was no statistical dif- ference in the time of intervertebral fusion between the two groups (P＞0.05) . The local lumbar lordosis angle increased significantly at the last follow-up in both groups compared with that preoperatively (P＜0.05) , however, there was no a significant difference in the local lumbar lordosis angle between the two groups at any corresponding time point (P＞0.05) . [Conclusion] The endoscopic lumbar interbody fusion by EC alone does achieve better short-term clinical outcome, with less surgical trauma than the traditional PLIF.

Abstract:[Objective] To evaluate the clinical outcomes of oblique lumbar interbody fusion (OLIF) combined with pedicle screw fixa- tion through Wiltse approach for upper degenerative lumbar spondylolisthesis. [Methods] A retrospective study was done on 43 patients who received surgical treatment for upper degenerative lumbar spondylolisthesis in our hospital from March 2018 to June 2019. Based on preoperative doctor-patient communication, 20 patients were treated with OLIF combined with pedicle screw fixation through Wiltse ap- proach (the OLIF group) , while the other 23 patients underwent transforaminal lumbar interbody fusion (the TLIF group) . The periopera- tive, follow-up and imaging data of the two groups were compared. [Results] All patients had operation finished successfully, with the OLIF group significantly superior to the TLIF group in terms of operation time, incision length, intraoperative blood loss, postoperative drainage, postoperative walking time and hospital stay (P＜0.05) . All patients were followed up for more than 12 months, with a mean of (22.70±6.51) months. The OLIF group resumed full weight-bearing activity significantly earlier than the TLIF group (P＜0.05) . The VAS and ODI scores decreased significantly (P＜0.05) , while JOA score increased significantly in both groups over time (P＜0.05) . At any corresponding time points, no significant differences in VAS, ODI and JOA scores were noticed between the two groups (P＜0.05) . Radiographically, interverte- bral space height, intervertebral foraminal height, and lumbar lordosis angle significantly increased (P＜0.05) , whereas the slippage degree of vertebral body decreased significantly in both groups at the latest follow- up compared with those preoperatively (P＜0.05) . The OLIF group proved significantly superior to the TLIF group in term of Lenke interbody fusion scale at 3 months, 6 months and the latest follow-up (P＜0.05) . [Conclusion] OLIF combined with pedicle screw fixation through Wiltse approach has advantages of minimizing iatrogenic trau- ma, enhancing recovery and reducing postoperative complications over the TLIF for treatment of upper degenerative spondylolisthesis.

Abstract:[Objective] To compare the clinical efficacy of arthroscopic anchor suture bridge technique and open reduction and inter- nal fixation in the treatment of avulsion fracture of the humeral greater tuberosity. [Methods] The databases, including PubMed, Cochrane, Embase, CNKI, Wanfang and VIP were searched by using computer to select the literatures on the treatment of avulsion fracture of humeral greater tuberosity by arthroscopic and open methods from the establishment of the database to May 2021. After the quality of the included literatures was evaluated, the data were extracted and analyzed by RevMan5.3 software. [Results] A total of 6 articles were included, involv- ing 390 patients. Of them, 188 patients received arthroscopic anchor suture bridge technique, whereas 202 patients underwent open reduc- tion and internal fixation (ORIF) . As results of meta-analysis, the arthroscopic group proved significantly superior the the ORIF group in term of shoulder flexion range of motion, abduction range of motion, 90° internal rotation,VAS score, ASES score and complication rate (P＜ 0.05) . However, the arthroscopic group consumed significantly longer operation time than the ORIF group (P＜0.05) . There was no signifi- cant difference between the two groups in intraoperative bleeding, shoulder extension range of motion, 0° external rotation and 90° external rotation (P＞0.05) . [Conclusion] Arthroscopic anchor suture bridge technique does alleviate postoperative pain and promote the recovery of shoulder function, is helpful to reduce the incidence of complications, whereas has disadvantage of longer operation time which lead to po- tential risk accordingly.

Abstract:Patella is the largest sesamoid bone in human body with relatively rare occurrence of tumors, and most of the primary patel- la tumors are benign, of which giant cell tumor is the most common. Giant cell tumor of bone (GCT) is frequently seen in 20-40 years old with female more dominate than male, and the metaphysis of long bone as common site involved. Due to the atypical clinical symptoms of GCT of the patella that usually manifests as pain and tenderness around the joint and limited motion, it might be misdiagnosed as other knee disease. Clinical diagnosis of GCT of the patella requires a combination of clinical manifestations, imaging and pathological data, addi- tionally surgical operation is the main treatment for it. How to completely remove the tumor to prevent recurrence remains a difficult prob- lem in the treatment of GCT of patella. In this paper, a case of GCT of patella admitted in our hospital was reported and relevant literatures at home and abroad were reviewed.

Abstract:Osteoporotic femoral neck fracture is a serious complication of osteoporosis. Due to the low bone mass and poor bone quality at the fracture site, the internal fixation is prone to loose, prolapse with fracture nonunion and other serious complications. Therefore, the in- ternal fixation surgical treatment of osteoporotic femoral neck fracture is challenging. With the deepening of biomechanical research and the development of internal fixation materials and design, the therapy idea is constantly updated. The choice of internal fixation device and the refinement of fixation mode have crucial impacts on the prognosis. Understanding the biomechanical characteristics and technical key points of various internal fixation devices play a decisive role in the successful completion of the operation. This paper reviews the domestic and foreign researches on the operative timing, internal fixation options and complications of internal fixation for osteoporotic femoral neck in recent years, providing reference for orthopedic surgeons and researchers.

Abstract:Rotational occlusion of the vertebral artery (ROVA) is a rare syndrome, in which vertebrobasilar artery insufficiency occurs due to mechanical compression of the vertebral artery during rotation or extension of the head and neck. This condition has complex etiolo- gy and is prone to be confused with cardiovascular and cerebrovascular diseases, leading to delay diagnosis or even misdiagnosis. Transient positional vertigo is the main clinical manifestation in the early stage of the disease, if not treated on time, serious complications such as posterior circulation stroke may occurred at the late stage. At present, the understanding of this disease is not enough to orthopaedic clini- cian. This article reviews the etiology, diagnosis and treatment of ROVA to improve the recognition of ROVA in clinical setting.

Abstract:[Objective] To explore the effect of exosomes derived from rat cartilage endplate stem cells (CESC) on nucleus pulposus cells (NPC) and intervertebral disc degeneration (IVDD) . [Methods] The CESC and NPC were isolated and cultured from rat intervertebral disc. The Nor-Exos from normal CESC and Eld-Exos from high glucose induced aging CESC were extracted and purified by super centrifu- gation, and co-cultured with NPC, respectively. The Tunel staining and flow cytometry were used to detect apoptotic cells, while western blot was used to detect the protein expression levels of Bax, Bcl-2, Cyclin D1 and Cyclin D3 in NPC. In addition, 9 SD rats were randomly divided into three groups, namely blank control group, Nor-Exos group and Eld-Exos group. IVDD model was established by acupuncture method and corresponding treatment was given. MRI scan was performed 5 weeks after operation, and scores were marked according to Pfir- rmann criteria. [Results] In vitro, the cell apoptosis was ranked down-up in order of: blank control group ＜ Nor-Exos group ＜ Eld-Exos group, with statistically significant differences in term of total groups and pairwise comparison (P＜0.05) . The protein expression of Bax was down-up of blank control group ＜ Nor-Exos group ＜ Eld-Exos group, whereas the expression levels of Bcl-2, Cyclin D1 and Cyclin D3 in ascending order were of Eld- Exos group ＜ Nor- Exos group ＜ blank control group, with statistically significant differences among total groups and pairwise comparison (P＜0.05) . In vivo, Pfirrmann score was marked from low to high as blank control group ＜ Nor- Exos group ＜ Eld-Exos group, with statistically significant differences (P＜0.05) . [Conclusion] The Eld-Exos does considerably promote apopto- sis of NPC, increase the presentation of apoptotic protein in intervertebral disc tissue, and accelerate the progression of IVDD.

Abstract:[Objective] To reveal the key differentially expressed genes and regulatory mechanisms associated with tumor necrosis fac- tor-α (TNF-α) in human degenerative intervertebral disc by analyzing microarray data using bioinformatics, and to explore the related sig- naling pathways and interactions network, providing clues for future investigations on the molecular mechanisms of disc degeneration. [Methods] The microarray data on degenerative intervertebral disc after stimulation with TNF-α were downloaded from the public data- base GEO (Gene Expression Omnibus) , to find the differential expressed genes between degenerative disc cells and those stimulated with TNF-α by a screening tool, and the analyses on gene ontology, signaling pathways and interaction networks for differentially expressed genes were conducted using DAVID, STRING and other online tools. [Results] A total of 754 key differentially expressed genes were found in degenerated annulus fibroblasts stimulated by TNF-α, of which 461 were up-regulated and 293 were down-regulated. In term of gene ontology annotation analysis, these differentially expressed genes were mainly related to extracellular matrix, injury reaction, inflammation, apoptosis regulation. In term of signal pathway analysis, these differentially expressed genes were mainly related to signal pathways such as cytokine interaction, apoptosis, NOD-like receptors, chemokine transduction. In term of interaction network analysis, genes, such as JUN, CCL3 and ANHK may play a key role in the intervertebral disc degeneration. [Conclusion] It has found that CCL3 and other genes may play a certain role in the development of disc degeneration by inflammatory reactions using bioinformatics analysis of gene expression profil- ing of degenerative intervertebral disc stimulated by TNF-α, suggesting that bioinformatics methods can find a number of potential target genes to provide new ideas for the research of degenerative intervertebral disc.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcome of nanofracture allogenic osteochondral transplantation in the treatment of large osteochondral defect of the knee. [Methods] After arthroscopic location of the large osteochondral defect of the knee, a small incision was made to expose the lesion, followed by a thorough debridement. An allogeneic osteochondral graft was trimmed to meet the recipient area in size and shape, then pressed into the recipient area and fixed with a countersunk screw. Subse- quently, a Kirschner wire 1mm in diameter was used to conduct nanofracture on the graft and recipient area, with the hole was about 9 mm deep the subchondral bone. [Results] The patient completed the operation successfully without serious complications. At 19 months of fol- low-up postoperatively, the HSS score and ROM of the knee significantly improved, and the patients were satisfied with the treatment out- come. The postoperative DR and MRI showed no degradation of the osteochondral graft, whereas with smooth articular surface. [Conclusion] The technique can be used to repair large osteochondral defect of the knee without adverse reaction, whereas good preliminary results.

Abstract:[Objective] To introduce the surgical technique and preliminary outcomes of taking out broken guide wire in femoral neck with intramedullary bone endoscopy. [Methods] Between March 2011 and May 2020, 7 patients had broken guide wire in femoral neck re- moved by intramedullary bone endoscopy in our department. After imaging check to determine the depth of the broken wire, the original fixed cannulated screw was taken out, and the original bone tunnel was enlarged with a cannulated drill, which stopped as just beyond the distal end of the broken wire under X-ray fluoroscopy. As the arthroscope was introduced into the bone tunnel, the broken wire was identi- fied with a small curett. A grasp forceps was introduced into the tunnel to hold the retained wire, and pulled back to take out the broken wire. Finally, bone grafts were inserted into the tunnel. [Results] All patients underwent successful operation with operation time of (23.30± 3.90) min, blood loss of (16.20±4.40) ml and the distance between proximal bone tunnel and articular surface of (1.80±1.00) cm. Radio- graphs at the latest follow-up showed bone union in the bone tunnel graft area with no loosening of fixation or bone resorption around fixa- tion, and no femoral neck fracture. The Harris score was of (84.40±4.64) at the latest follow up. [Conclusion] Removal of broken guide wire in femoral neck with intramedullary bone endoscopy is efficient, and has benefits of minimalizing iatrogenic trauma, no additional damage to the tunnel, and maintaining the original internal fixation.

Abstract:[Objective] To investigate the value of arthrography used in the diagnosis and treatment of Monteggia fracture in children. [Methods] A total of 46 children with Monteggia fracture were included in this study. All patients underwent elbow arthrography, followed by different treatments based on fracture type and arthrographic results. The clinical and imaging data were evaluated. [Results] Among the 46 patients, 3 underwent manipulation reduction and external fixation with plaster cast, 15 underwent elastic intramedullary nailing, 8 under- went plate and screw fixation, 7 underwent Kirschner wire tension band fixation, 8 underwent mini-Ilizarov external fixator, and 5 underwent unilateral external fixator. All patients had the corresponding treatments performed successfully without serious complications, with the ar- thrography time of (5.83±2.75) min, therapeutic operation time of (46.58±10.45) min. The patients were followed up for (13.06±3.27) months, and resumed full weight-bearing activity in (12.16±1.31) weeks. The clinical fracture healing time was of (11.53±1.06) weeks, with the el- bow flexion-extension range of motion (ROM) of (145.65±6.16)° and the forearm rotation ROM of (163.20±3.62)° at the latest follow up. According to Mayo score, the clinical results were marked as excellent in 43 cases and good in 3 cases, with an excellent/good rate of 100%. Radiographically, the radial axis passed through the center of capitellum with well humeroradial alignment was proved after the treatments, and callus formation on the fracture ends was observed in all patients on images 4 weeks after treatments. [Conclusion] Elbow arthrography does clearly show the congruence of the joint, which accurately reflect the reduction consequence in children with Monteggia fractures.

Abstract:[Objective] To explore the clinical outcomes of low- profile plate fixation combined with rotator cuff anchoring for splittype humeral greater tuberosity fractures. [Methods] From June 2017 to June 2019, 34 patients underwent surgical treatment for split-type humeral greater tuberosity fractures in our hospital. The patients who had glenohumeral dislocation of joint were treated with manual reduc- tion immediately after admission, and all of them received open reduction and internal fixation with low-profile plate and suture anchoring of rotator cuff through anterior middle deltoid splitting approach. [Results] All patients had operation completed successfully, with an opera- tion time of (86.56±10.37) min, intraoperative blood loss of (72.44±12.42) ml, and primary incision healing, whereas without iatrogenic nerve and vascular injury. As time went during the follow-up lasted for (14.48±2.36) months, the VAS score significantly decreased (P＜ 0.05) , while Constant-Murley score significantly increased (P＜0.05) . No adverse imaging manifestations, such as subacromial impinge- ment, delayed fracture union, and loosening of the implant were noted in anyone of them. [Conclusion] This low-profile plate and rotator cuff anchoring are an effective treatment for split humeral greater tuberosity fractures.

Abstract:[Objective] To evaluate the effect of additional ultrasound-guided erector spinae plane block in general anesthesia for lum- bar fusion. [Methods] A total of 60 patients who received lumbar fusion under general anesthesia were included in this study. According to the results of doctor- patient communication, 30 patients had erector spine block added before surgery, while the remaining 30 patients were treated with conventional general anesthesia without block anesthesia. The clinical outcomes of the two groups were compared. [Results] All patients in both groups were successfully operated on. The mean artery pressure (MAP) and heart rate (HR) remained stable in the block group at each time point (P＞0.05) , whereas which significantly increased at skin cutting and disc resection in the routine group (P＜0.05) , with statistically significant differences between them (P＜0.05) . The block group proved significantly superior to the routine group in terms of amount of sufentanil used and stay time in recovery room (P＜0.05) . In addition, the block group was also superior to the routine group in the qOR-15 score 24 h after surgery (P＜0.05) , despite that became not significant between the two groups 48 h after sur- gery (P＞0.05) . Furthermore, the block group proved significantly superior to the routine group in the resting and active NRS scores at 6 h and 12 h after surgery, whereas which became not statistically significant between them at 24 h after surgery (P＞0.05) . Moreover, the block group had significantly lower dosage of sufentanil consumed than the routine group 48 h after operation (P＜0.05) , with significantly lower incidence of adverse reactions (P＜0.05) . [Conclusion] The additional ultrasound-guided erector spinae plane block does improve the anal- gesic effect and reduce the adverse reactions in general anesthesia for lumbar fusion surgery in this study.

Abstract:[Objective] To evaluated the clinical outcomes of free deep femoral artery perforator flap used to repair traumatic soft tissue defects of hand and forearm by comparison with the anterolateral femoral flap. [Methods] A retrospective study was conducted on 106 pa- tients who underwent surgical treatment for traumatic soft tissue defects of the hand and forearm in our hospital from February 2015 to Au- gust 2019. Of them, 56 patients received free deep femoral artery perforator flap for repairing (DAPF group) , while 50 patients received an- terolateral femoral flap (ALFF group) . The patients in the two groups were compared regarding to perioperative and follow-up data. [Results] The patients in both groups had operation completed successfully. The DAPF group was significantly superior to the ALFF group in terms of operation time, intraoperative blood loss, incision length, excellent healing rate of the wound and percentage of flap survival area (P＜0.05) , but the DAPF group had a significantly smaller flap area than the ALFF group (P＜0.05) . All the patients were followed up for more than 12 months. There were no statistically significant differences between the two groups regarding to the time to start active motion, the time to resume full- weight bearing activity, and the TAM function score (P＞0.05) . [Conclusion] The free deep femoral artery perfora- tor flaps for repairing traumatic soft tissue defects of the hand and forearm has the advantages of high safety, simplicity and efficiency, and does effectively reduce the operation time and intraoperative blood loss compared with the anterolateral femoral flap.

Abstract:[Objective] To explore the effect of dexmedetomidine (Dex) combined with erector spinal block on analgesia in percutane- ous transforaminal endoscopic discectomy (PTED) . [Methods] From March 2019 to March 2020, a total of 89 patients who were undergo- ing PTED in our hospital were enrolled in this study, and were divided into two groups by random number table method. Of them, 45 pa- tients in the Dex group were treated with Dex combined with erector spine block, while the other 44 patients in the non-DEX group were given conventional local anesthesia. The patients in the two groups were compared regarding to the variation of vital signs and analgesic ef- fect. [Results] Although there were no statistically significant differences in mean artery pressure (MAP) and heart rate (HR) between the two groups before operation (P＞0.05) , the Dex group had significantly lower MAP and HR than the non-DEX group at the beginning of sur- gery, the removal of the facet, the removal of the nucleus pulposus and the end of surgery (P＜0.05) . However, there were no significant dif- ferences in SPO₂ between the two groups at corresponding time points (P＞0.05) . The Dex group got significantly lower VAS scores than the non-DEX group at all matching time points (P＜0.05) . The Dex group was significantly superior to the non-DEX group in terms of intraoper- ative sufentanil consumption, intraoperative comfort NRS score, recovery room stay, and PCIA pressing times 6 and 12 h after operation (P＜ 0.05) . [Conclusion] The Dex combined with erector spinal block does prolong the analgesic time and improve the perioperative comfort in PTED.

Abstract:[Objective] To investigate the clinical outcomes of circular external fixator combined with membrane induction for postoper- ative infectious bone defect secondary to internal fixation of proximal tibia fractures. [Methods] A retrospective study was conducted on 47 patients who received abovementioned surgical treatment for postoperative infectious bone defect secondary to internal fixation of proximal tibia fractures from 2013 to 2020. A thorough debridement, antibiotic cement space implantation and fixation by a circular external fixator were conducted in the stage I, followed by removal of the cement, bone autografting or bone transportation by the frame in the stage II. The clinical and laboratory results were summarized. [Results] All the patients were successfully operated on without serious complications. All of them were followed up for 6~62 months with an average of (23.62±4.54) months, and got the lesions subsided without infection recur- rence. The knee range of motion (ROM) and HSS scores increased significantly over time (P＜0.05) . In terms of laboratory tests, pathogenic bacteria were identified from the deep wound, including Staphylococcus aureus in 23 cases, Staphylococcus Lyons in 8 cases, Escherichia coli in 12 cases and Acinetobacter baumannii in 4 cases. The WBC, CRP and ESR significantly decreased 6 months postoperatively com- pared with those before operation (P＜0.05) . [Conclusion] The circular external fixator combined with membrane induction in two stages does achieve satisfactory clinical outcomes for treatment of postoperative infected bone defect secondary to internal fixation of proximal tib- ia fractures.

Abstract:[Objective] To explore the clinical outcomes of internal fixation and scapholunate interosseous ligament (SLIL) repair for distal radius fractures accompanied with scapholunate dissociation (SLD) . [Methods] A retrospective study was performed on 14 patients who underwent internal fixation and SLIL repair for acute distal radius fractures accompanied with SLD in our hospitals from June 2014 to December 2019. The clinical and radiographic consequences were evaluated. [Results] During operation partial rupture of SLIL was found in 9 patients, while complete SLIL tear was noted in 5 patients. All the patients had surgical procedures performed smoothly without serious complications, such as neurovascular injuries. As time went during the follow up lasted for (19.12±5.84) months on an average, the VAS score significantly decreased (P＜0.05) , whereas the Mayo wrist score significantly increased (P＜0.05) . At the latest follow up, there were no significant differences in terms of range of motions (ROMs) in dorsal extension, pronation and supination, as well as grip strength be- tween the affected and unaffected sides (P＞0.05) , despite that the affected side had significantly less palmar flexion than the unaffected side (P＜0.05) . Radiographically, the scapholunate space and angle significantly improved postoperatively compared with those preopera- tively to the normal ranges (P＜0.05) , associated with significant improvement in radial inclination and volar tilt (P＜0.05) , regardless of un- changed ulnar variation (P＞0.05) . All the patients got fracture healed with SLD corrected on imaging at the latest follow up. [Conclusion] The internal fixation and SLIL repair do achieve satisfactory clinical outcomes for acute distal radius fractures accompanied with SLD.

Abstract:[Objective] To evaluate the effect of perioperative multifactorial intervention on clinical outcomes and postoperative cogni- tion of surgical treatments for hip fractures in the elderly. [Methods] From May 2016 to May 2021, 216 elderly patients who received surgi- cal treatments for hip fracturs involving PFNA, HA and THA were randomly divided into the intervention group and the control group, with 108 cases in each group. Of them, the patients in the intervention group received systemic nutritional support, multimodal pain manage- ment, active blood transfusion to correct anemia, psychological counseling and early rehabilitation exercise during the perioperative period, while those in the control group received routine perioperative management. The clinical results in short term and the data of mini-Mental State Examination (MMSE) were compared between the two groups. [Results] All the patients in both groups were successfully operated on without serious complications. The intervention group proved significantly superior to the control group in term of walking time and hospital stay (P＜0.05) , additionally the former got significantly higher Harris score than the latter at 1 and 6 months after surgery (P＜0.05) . No cog- nitive impairment happened in anyone of the intervention group, whereas 6 patients presented cognitive impairment in the control group, ac- counting for 5.56%. Although there was no significant difference in MMSE score between the two groups 24 h before surgery (P＞0.05) , the intervention group proved significantly superior to the control group in term of MMSE score from 1 day to 5 days postoperatively (P＜0.05) . [Conclusion] This perioperative multifactorial intervention does effectively reduce the occurrence of cognitive impairment, whereas acceler- ate the rehabilitation after surgical treatments for hip fractures in the elderly.