Abstract:Spinal tuberculosis, the most common extrapulmonary secondary tuberculosis, has been a common and frequently encoun- tered disease in spinal surgery. Standardized anti-tuberculosis treatment is the fundamental way to cure spinal tuberculosis in clinic. How- ever, for cases with huge paravertebral abscess, accompanied by nerve compression, spinal instability and kyphosis, surgical treatment is of- ten needed to remove tuberculosis foci, relieve nerve compression, correct deformity, and reconstruct spinal stability. Therefore, surgical treatment is an indispensable and important treatment for spinal tuberculosis. However, there are still many problems in the surgical treat- ment of spinal tuberculosis. According to the latest progress of surgical treatment of spinal tuberculosis at home and abroad in recent years, drawing on relevant foreign guidelines, following the principle of evidence-based medicine, 60 spinal tuberculosis experts were organized to develop this guideline by Orthopaedic Professional Committee of Chinese Society for Tuberculosis, Chinese Medical Associaition.

Abstract:Our hospital is one of the only two designated hospitals for tuberculosis (TB) treatment in Beijing, and it is also a Class III Grade A general hospital. The tuberculosis department and orthopedics department are the traditional superiority departments of the hospi- tal. In March 2006 and March 2011, the General Logistics Department of PLA approved the establishment of the Tuberculosis Research In- stitute of PLA and the Orthopedic Center of PLA, respectively. As early as 1991, our hospital orthopedic surgery has formed a professional team for joint surgery, with the techniques of arthroplasty and arthroscopy as characteristics, conducted joint surgery and cutting-edge tech- nique in the field of sports medicine earlier in the domestic. Relying on the army TB institute, we have the opportunity to treat more patients with TB involving the major joints by arthroplasty and arthroscopy. A number of basic and clinical studies related to joint tuberculosis have been carried out. Since 2006, one-stage debridement and arthroplasties have been explored for advanced or end-stage active hip and knee tuberculosis, and more than 300 cases have been operated on with encouraging clinical outcomes.

Abstract:[Objective] To compare the clinical outcomes of anti-tuberculosis chemotherapy combined with or without pedicle screw fixation for GATA type II thoracolumbar tuberculosis. [Methods] A retrospective study was conducted on 67 patients who received treat- ment for GATA type II thoracolumbar tuberculosis in our hospital from May 2017 to July 2019. Among them, 36 patients were treated with anti-tuberculosis chemotherapy alone (conservative group) , while the remaining 31 patients received anti-tuberculosis chemotherapy com- bined with pedicle screw fixation (operation group) . The documents regarding to early stage, follow-up, radiographs and laboratory tests were compared between the two groups. [Results] There was no significant difference in the incidence of early adverse reactions between the two groups (P＜0.05) . All the patients were followed up for (33.35±5.23) months, and the operation group resumed full weight-bearing activity significantly earlier than the conservative group (P＜0.05) . The VAS score, ODI score, JOA score, and ASIA neurological function grade in the two groups significantly improved over time (P＜0.05) . At the corresponding time points after treatment, the surgery group proved significantly superior to the conservative group in terms of ODI and JOA score (P＜0.05) , but there was no significant difference in ASIA grades between the two groups (P＞0.05) . The incidence of late complications in the surgery group was significantly lower than that in the conservative group (P＜0.05) . With regard to auxiliary examinations, the operation group proved significantly superior to conservative group in terms of the local kyphotic Cobb angle and lesion outcome observed on images after treatment (P＜0.05) , as well as C-reactive pro- tein (CRP) at 3 months after treatment and erythrocyte sedimentation rate (ESR) at 6 months after treatment (P＜0.05) . [Conclusion] Antituberculosis chemotherapy combined with pedicle screw fixation for GATA type II thoracolumbar tuberculosis does significantly relieve the early pain, accelerate rehabilitation, avoid the occurrence of kyphosis, and achieve clinical outcome considerably better than anti-tubercu- losis chemotherapy alone.

Abstract:[Objective] To investigate the accuracy and efficacy of 3D printed patient-specific instrumented (PSI) high tibial osteotomy (HTO) for medial knee osteoarthritis (KOA) , by comparing with traditional HTO . [Methods] A retrospective study was conducted on 35 pa- tients who underwent medial open wedge HTO for medial KOA in our department from January 2019 to February 2021. Based on preopera- tive doctor-patient communication, 17 patients received 3D printed PSI HTO (the 3D group), while the remaining 18 patients underwent the traditional HTO (the traditional group) . The documents regarding to perioperative period, follow-up and radiographs were compared be- tween the two groups. [Results] All patients in both groups had the surgical procedures performed smoothly. The 3D group proved signifi- cantly superior to the traditional group in terms of total length of surgical incision, operative time, blood loss, fluoroscopy times, walking time and postoperative hospital stay (P＜0.05) , whereas without significant differences between them in the occurrence of early complica- tions (P＞0.05) . All the patients were followed up from 12 to 18 months with a mean of (14.34±2.03) months. The 3D group resumed full weight-bearing activity slightly earlier than the traditional group, despite of no statistically significant difference between them (P＞0.05) . The VAS and HSS scores and knee extension range of motion (ROM) in both groups significantly improved over time (P＜0.05) , which were not statistically significant between them at any matching time point (P＞0.05) . Radiographically, the weight bearing line ratio (WBLR) , me- dial proximal tibial angle (MPTA) and Kellgren- Lawrence (K- L) classification significantly improved, whereas the posterior tibial slope (PTS) remained unchanged in both groups postoperatively compared with those preoperatively (P＜0.05) . At 6 and 12 months after surgery, the 3D group was significantly superior to the traditional group in terms of WBLR and MPTA (P＜0.05) , whereas no a statistical difference in K-L grade between them (P＞0.05) . By the time of latest follow-up, bony healing achieved in all the patients, which was not significantly different between the two groups (P＞0.05) . [Conclusion] Compared with conventional osteotomy, 3D printed PSI OWHTO has advantages of fewer intraoperative fluoroscopy, shorter operative time and more accurate alignment of lower extremity correction.

Abstract:[Objective] To analyze the factors influencing the delayed diagnosis of developmental dysplasia of the hip (DDH) in our hos- pital, and to provide the scientific basis for the formulation and implementation of DDH-related public health policies. [Methods] A total of 325 children with DDH under 7 years old who were admitted to Xijing Hospital from January 2011 to December 2020 were enrolled into this study. According to the age of children at diagnosis, they were divided into the non-delayed group (0~6 months at diagnosis) and the de- layed group (7~84 months at diagnosis) . The basic information, including family history, birth, diagnosis, and treatment process of the chil- dren, were investigated. Spearman correlation analysis was performed on the relationship between the age at diagnosis and ultrasonic Graf scale, and radiographic Crowe grade. In addition, univariate comparison and multivariate logistic regression analysis were performed to ex- plore the factors related to the delayed diagnosis. [Results] Of the 325 patients (432 hips) , 72 children fall into the non-delayed group, ac- counting for 22.15%, while 253 cases were in the delayed group, accounting for 77.85%. The age at diagnosis was negatively correlated with ultrasonic Graf classification in the non-delayed group (R=-0.284, P=0.016) , whereas the age at diagnosis proved positively correlat- ed to imaging Crowe classification in the delayed group (R=0.144, P=0.023) . As results of multivariate logistic regression, poor family eco- nomic condition (OR=1.722, P=0.001) , poor maternal education (OR=1.429, P=0.047) , and lack of early hip screening (OR=7.215, P< 0.001) was the independent risk factor for delayed diagnosis of DDH. [Conclusion] There is a weak negative correlation between the age at the diagnosis under 6 months and ultrasonic Graf classification, and a weak positive correlation between the age at diagnosis over 7 months and radiographic Crowe classification. Poor family economic condition, poor maternal education level, and lack of early hip screening are the risk factors for delayed diagnosis of DDH in children.

Abstract:[Objective] To investigate the safety and efficacy of a novel intervertebral bone grafting technique with a self-developed de- vice by comparison with the conventional technique in transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases. [Methods] A retrospective study was conducted on 119 patients who received TLIF for lumbar degenerative diseases from September 2018 to August 2019. According to doctor-patient communication, 61 patients had TLIF performed with the novel intervertebral bone grafting by a self-developed device (the NIBG group) , while the other 58 patients were with traditional intervertebral bone grafting (the TIBG group) . The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had surgical procedures conducted successfully with no iatrogenic injuries to nerve roots or dura sac. The NIBG group had significantly less time spend for intervertebral bone grafting than the TIBG group (P＜0.05) , although there were no significant differences in operative time, intraopera- tive blood loss, postoperative drainage and postoperative walking time between the two groups (P＞0.05) . In addition, there was no signifi- cant difference in the time to resume full weight-bearing activity between the two groups (P＞0.05) . As time went during follow-up lasted for (22.94±2.28) months, the VAS and ODI scores decreased significantly (P＜0.05) , while JOA score increased significantly in both groups (P＜0.05) . At any corresponding time points, there was no a significant difference in the above items between the two groups (P＞0.05) . Ra- diographically, intervertebral height, local Cobb angle, and L2~S1 lordosis angle significantly increased in both groups at 1 month postopera- tively and the latest follow-up compared with those preoperatively (P＜0.05) . The Lenke scale for interbody fusion improved significantly over time in both groups (P＜0.05) , which in the NIBG group proved significantly superior to the TIBG group at 3 months postoperatively, whereas became not statistically significant between the two groups at 6 months and the latest follow-up (P＞0.05) . [Conclusion] This novel intervertebral bone grafting technique with the self-developed device does improve the safety, efficacy and interbody fusion of TLIF.

Abstract:Due to relatively low incidence, there are no universal surgical treatment strategies for the proximal radial bone tumors, with rare reports about the surgical complications at present. This paper reported 2 patients who had the proximal radial bone tumor curetted or resected, followed by proximal radial reconstruction with fibular segment bone autograft or tumor segment inactivated and reimplantation in our hospital in recent years. Both patients achieved satisfactory results, especially with good forearm rotation function. Combined with the review of relevant literature reported at home and abroad, it was found that the malignant degree of the tumor in this area was relatively low, and the surgical methods were diverse. Most patients have postoperative complications, such as limited forearm rotation function, limited wrist dorsiflexion activity, radial nerve palsy, and inferior radioulnar joint dislocation. This article summarizes the surgical efficacy and com- plications of different surgical procedures for proximal radial bone tumors, and provides a reference for clinical practice.

Abstract:Application of orthoses for treatment of adolescent idiopathic scoliosis (AIS) originated in the 1930s to 1940s. During the last few decades, orthotic treatment has been shown to modify the natural history of AIS and reduce the incidence of surgery. Although the biomechanical principles of orthotic treatment are well established, the magnitude of the forces exerted by orthoses and the optimal orthotic design are not well understood. This article reviews the past orthotic biomechanical research to provide a reference for conservative treat- ment of AIS.

Abstract:Osteogenesis imperfection is a genetic bone metabolic disorder characterized by increased bone fragility, repeated fracture and bone deformity. In this paper, we reported a case of osteogenesis imperfecta type V. The patient presented were bilateral bony protuber- ance of the elbow with limited elbow motion, and his mother had the same phenotype. X-ray examination showed calcification of the interos- seous membrane and dislocation of the radial head. Genetic test showed heterozygous variation of IFITM5 gene c-14C＞T located on chromo- some 11, which was reported as a pathogenic variation and inherited from his mother. By reviewing the literature, this article will introduce the pathogenesis, clinical manifestations, imaging features and treatment of osteogenesis imperfection type V.

Abstract:Nontraumatic osteonecrosis of the femoral head (NONFH) is a common clinical orthopaedic disease, while blood circulation impairment has been considered as one of the main reasons of this disorder. Therefore, improving blood circulation is of great significance for the prevention and treatment of NONFH in the early and middle stages. Multiple signal pathways might prevent and treat NONFH by im- proving blood circulation, including PI3K/Akt signal pathway. This paper mainly discusses the role of PI3K/Akt signaling pathway in affect- ing NONFH by many factors related to blood circulation, such as lipid metabolism disorder and vascular regeneration. In addition, PI3K/ Akt signaling pathway might improve blood circulation by affecting upstream and downstream factors such as vascular endothelial growth factor, P2Y12 receptor and nitric oxide synthase, so as to provide a new reference and basis for the prevention and treatment of NONFH.

Abstract:[Objective] To explore the effect of adenovirus-mediated stromal cell-derived factor-1 (SDF-1) and Nel-like molecule-l (NELL-1) genes transfection on osteogenic differentiation of the rabbit adipose stem cells (ADSCs) in vitro. [Methods] ADSCs isolated from rabbit adipose tissue were divided into 5 groups, including the original cell control (OCC) group, the empty vector control (EVC) group, the SDF-1 transfected group, the NELL-1 transfected group and the SDF-1/NELL-1 transfected group, which received corresponding treatment involving transfection by adenovirus vectors carrying different target genes. Subsequently, alizarin red staining for calcium nodule formation and alkaline phosphatase (ALP) assay were conducted 14 days of osteoinductive culture, additionally, western blot and RT-PCR assays were done to detect expression levels of related proteins and mRNA of genes. [Results] Both SDF-1 and NELL-1 gene transfections, as well as the co-transfection of them significantly increased the expressions of target proteins, especially the co-transfection. In terms of calcium nodule accounts with alizarin red staining and ALP activity assay, the SDF-1 group, the NELL-1 group and the SDF-1/NELL-1 group proved significantly greater than the OCC and EVC groups (P＜0.05) , with the co-transfection group the highest among the 5 groups. In terms of RT-PCR assays, the SDF-1 group, the NELL-1 group and the SDF-1/NELL-1 group had significantly greater expression of mRNAs of osteopontin (OPN) and osteocalcin (OCN) than the OCC and EVC groups (P＜0.05) , among which the co-transfection group was the highest. [Conclusion] ADSCs transfected by both SDF-1 and NELL-1 genes, as well as co-transfection of them do highly express the target proteins, which considerably enhance osteogenesis in vitro, especially the adenovirus-mediated co-transfection of the two genes.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of minimally invasive internal fixation at the second stage for open Schatzker type VI tibial plateau fractures. [Methods] A total of 16 patients were treated by debridement and vacu- um sealing drainage (VSD) in the first stage, and minimally invasive plate fixation in the second stage for open Schatzker VI tibial plateau fractures. In the second-stage operation, minimal invasive plate osteosynthesis (MIPPO) under antagonistic traction were conducted. As two Steinman pins were inserted parallelly at the femoral supracondyle and distal tibia respectively, antagonistic traction force was applied grad- ually to restore the alignment and reduction of the fractures, and then percutaneous fixation of the fractures with a proximal tibial anatomi- cal locking plate was completed by the MIPPO technique. [Results] All the 16 patients had the two-stage surgical procedures performed successfully without serious complications. The clinical fracture union was achieved in 4~8 months, with (6.14±1.35) months on an average, and HSS function score ranged from 86 to 92, with an average of (89.44±2.43) at the latest follow-up. Radiographically, all the patients got satisfactory fracture reduction with smooth articular surface, while the Rasmussen scores of tibial plateau anatomy ranged from 12 to 18, with an average of (14.12±1.60) . [Conclusion] This technique does achieve good reduction and reliable fixation of the fractures with great- ly reducing iatrogenic trauma, which is beneficial to fracture healing, and avoid further necrosis of the severely injured skin and soft tissue of the open Schatzker type VI tibial plateau fractures.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of oval forceps assisted repair of acute Achilles tendon rupture through a small incision. [Methods] A total of 23 patients underwent abovementioned surgical treatment for acute Achilles tendon in our hospital. During operation, the ruptured gap was located by palpation, and a small longitudinal incision was made. An oval forceps was inserted into the tendon sheath through the incision to catch the ruptured ends proximally and distally respectively. Spi- nal needles were placed percutaneously to penetrate the tendons between the oval holes of the forceps on both sides to the opposite side. Af- ter that, sutures were introduced through the spinal needles and the needles were removed. As the forceps was pull out, the sutures were in- troduced out the incision. The ankle was placed plantar flexion extremely, the ends of ruptured Achilles tendon were closed to each other, and then corresponding sutures were tied to finish the repairing. Finally, the incision was closed in layers. [Results] All patients had opera- tion performed successfully without sural never injury intraoperatively, with operation time of (42.82±6.88) min. The incisions healed well in all the patients, whereas no re-rupture of tendon happened in anyone of them during the follow-up period. The AOFAS score increased from (91.57±4.22) at 3 months to (97.22±2.32) at 6 months postoperatively, while the ankle flexion-extension range of motion increased from (32.57±2.46)° at 3 months to (43.13±2.94)° at 6 months postoperatively. [Conclusion] This oval forceps assisted repair of acute Achil- les tendon rupture through a small incision is minimally invasive, safe, reliable and easy to learn.

Abstract:[Objective] To explore the early clinical outcomes of arthroscopic debridement combined with proximal fibular osteotomy for medial knee osteoarthritis. [Methods] A total of 25 patients with medial knee osteoarthritis in Kellgren-Lawrecne Stage II and III under- went minimally invasive surgeries in our hospital from July 2017 to July 2019. Of them, 12 patients received arthroscopic debridement only (the AD group), while the remaining 13 patients received arthroscopic debridement combined with proximal fibular osteotomy (the com- bined group). The documents regarding to clinical presentations and radiographs were compared between the two groups. [Results] All the patients in both groups had surgical procedures performed smoothly without serious complications, such as neurovascular injuries. The com- bined group proved significantly superior to the AD group in terms of VAS and HSS scores, as well as femorotibial angle (FTA) measured on anteroposterior X- ray film at 12 months postoperatively (P＜0.05) . [Conclusion] The arthroscopic debridement combined with proximal fibular osteotomy does treat the medial KOA in early and middle-stage effectively, with an advantage of improvement of lower limb align- ment over the arthroscopic debridement only.

Abstract:[Objective] To explore the clinical outcomes of V-Y advanced flap combined with reversed dorsal digital artery island flap for repairing degloving injury or amputation of distal thumb. [Methods] From March 2017 to August 2019, 23 patients were surgically treat- ed for degloving injury or amputation of distal thumb without indication of replantation. Of them, 10 patients had traumatic amputation, while 13 patients were of degloving injury of distal thumbs. V-Y advanced flap combined with a reversed dorsal digital artery island flap was used to repair the volar and dorsal defects of distal thumb respectively, with direct closure of donor-site defects of the two flaps. [Results] All flaps survived uneventfully in the 23 patients. The follow-up period lasted from 8 to 18 months with an average of (12.30±2.46) months. The appearance of the distal thumbs looked good, without pain and cold intolerance at the fingertip of the thumb, whereas only lin- ear scars were remained at donor site of the dorsal thumb in all the patients. The static 2-point discrimination of the V-Y advanced flap and reversed dorsal digital artery island flap ranged from 4 to 7 mm and 5 to 9 mm respectively. There was no statistical difference of the to- tal range of motion between the injured and healthy thumbs (P＞0.05) . Based on the criteria of the hand appearance evaluation, 15 patients were satisfied very much, and 8 patients were satisfied. [Conclusion] The V-Y advanced flap combined with reversed dorsal digital artery island flap is a good option for repairing degloving injury or amputation of distal thumb, with advantages of simple operation, less donor-site morbidity and satisfactory clinical results.

Abstract:[Objective] To investigate the efficacy of arthroscopic Bankart repair combined with the biceps long head tendon transfer for recurrent anterior shoulder instability accompanied with partial bony glenoid defect. [Methods] From September 2016 to January 2018, 14 patients received arthroscopic repair of Bankart lesion combined with the biceps long head tendon transfer for recurrent anterior shoulder instability accompanied with partial bony glenoid defect. All the patients, including10 males and 4 females aged 24~47 years, pre- sented shoulder instability with history of recurrent dislocation. [Results] All the patients got surgical incision healed well, and 12 patients of them were followed for 12 to 28 months with an average of (21.38±3.49) months. At the latest follow-up, all patient had negative appre- hension test and anterior drawer test, without re-dislocation, whereas with the significantly improved ASES score and Rowe score compared with those preoperatively (P＜0.05) . [Conclusion] The arthroscopic repair of Bankart lesion combined with biceps long head tendon transfer does effectively enhance the glenohumeral stability, is an effective treatment method for recurrent anterior shoulder instability accompanied with partial bony glenoid defects.

Abstract:[Objective] To observe the effect of integrated education combined with rehabilitation training on improving motor and cog- nitive abilities and hand dysfunction for cerebral palsy (CP) in children. [Methods] A total of 60 children who were admitted into the reha- bilitation treatment center of our hospital from January 2019 to December 2020 were included in this study. The children were randomly di- vided into the integrated group (n=30) and the conventional group (n=30) , and were given the integrated education combined with routine rehabilitation training and the routine rehabilitation training only, respectively. The intervention consequences were evaluated and com- pared between the two groups. [Results] All children in both groups had the whole process of intervention completed successfully, and fol- lowed up for 12 to 24 months. The integrated group got significantly improvement in terms of GMFCS grade, MACS grade, WeeFIM score and ADL score (P＜0.05) , while the conventional group had significant improvements in WeeFIM score and ADL score only after interven- tion compared with those before intervention (P＜0.05) . Although there was no significant difference in the above items between the two groups before intervention (P＞0.05) , the integrated group proved significantly superior to the conventional group in terms of the WeeFIM score and ADL score 3 months after intervention (P＜0.05) , whereas in terms of GMFCS grade, MACS grade, WeeFIM and ADL scores 6 months after intervention (P＜0.05) . [Conclusion] The integrated education combined with rehabilitation training is more beneficial to im- prove motor function, cognitive ability and self-care ability of CP children in appropriate age.

Abstract:[Objective] To introduce the surgical and nursing techniques, as well as preliminary clinical outcomes of Nice self-locking slide-suture stretching for delayed closure of skin and soft tissue defects. [Methods] Abovementioned techniques were used in 32 patients who suffered from skin and soft tissue defects secondary to traumatic skin necrosis, tension-reduction incision, skin scar resection and oth- er reasons. Based on characteristics of the skin viscoelasticity and creep of the extension, the Nice self-locking of slide suture system was set up by high tension suture in double bundles with interrupted skin suture and tied by the Nice knot. Firstly, the loop side of the wire was wound to the end side wire to form an ascending single knot, and tightened, and then, the end of the wire was threaded through the loop, and the double ends were separated. As the knot was tightened, the skin edges were close to each other. According to the skin blood supply, the suture knot was gradually tightened, the skin defect wound was delayed closed by the stretching, simultaneously, the perioperative period care and rehabilitation were conducted. The wound healing, as well as skin sensation, color, tension and hair growth were evaluated. [Re- sults] All the wounds in the 32 patients were closed in 2~4 weeks. The skin regained the normal sensation and the color with well hair growth and elasticity, whereas without obvious edema and scar hyperplasia. [Conclusion] Nice self-locking slide-suture stretching tech- nique is a simple, economical and effective treatment for delayed closure of skin defect wounds.