Abstract:Congenital clubfoot is one of the most common birth defects. In the past, surgery was the main choice of treatment, which might lead to joint stiffness, pain, functional limitation, early onset osteoarthritis and other problems. After decades of long-term follow-up studies, it has been demonstrated that the patients can obtain the painless, flexible and strong foot and ankle with the treatment using the non-surgical method advocated by Dr. Ponseti from the United States, and the complications and sequalae caused by surgical treatment can be avoided to the significant extent. Through international exchanges, the clinicians in China recognized the advantages and value of Ponseti method, organized a special team for spreading the method, and implement the “Healthy Walk” project. A change in philosophy and knowledge dissemination, technical training, active participation of patients' parents, and continuous concretization of the project's goals and implementation steps occurred during the past ten years.

Abstract:[Objective] To explore the anatomical distribution of deep vein thrombosis (DVT) in the low extremity and factors related to the proximal DVT after primary total knee arthroplasty (TKA) . [Methods] A retrospective study was performed on 824 patients who under- went primary total knee arthroplasty in our hospital from January 2016 to December 2018. The anatomic characteristics of the DVT were an- alyzed, while the related factors of lower extremity deep vein thrombosis were analyzed by univariate comparison and multivariate logistic regression. [Results] Of the 824 patients, 97 patients (11.77%) (97/824) were diagnosed of DVT by postoperative ultrasonography. One case (0.12%) (1/824) was diagnosed as pulmonary embolism by CTPA. After operation, there were 40 cases (41.24%) (40/97) of symptomatic thromboses, and 57 cases (58.76%, 57/97) of asymptomatic thromboses. According to whether the DVT involved the popliteal vein or not it was divided into two categories. Of them, 15 patients suffered from proximal DVT, accounting for 15.46% (15/97) , whereas the remaining 82 patients were of distal DVT, accounting for 84.54% (82/97) . In term of detection time point, 60 patients had DVT detected 1 day after operation, accounting for 61.86% (60/97) , while 37 patients had DVT found newly 3 days after operation, accounting for 38.14% (37/97) . As results of univariate comparison, the proximal DVT group had significantly longer operation time and anesthesia time than the distal DVT group (P＜0.05) , and the former had significantly higher ratio of preoperative varicosity than the latter (P＜0.05) . However, there were no significant differences in terms of general documents, preoperative blood tests, and other information related to operation between the two groups (P＞0.05) . As consequences of multivariate logic analysis, the longer operative time (OR=1.111, 95%CI: 1.011~1.220, P=0.028) was an independent risk factor for proximal DVT after total knee arthroplasty. [Conclusion] The distal DVT is the most common type of them after total knee arthroplasty. However, longer operative time is a risk factor for proximal DVT.

Abstract:[Objective] To compare the clinical efficacy of unilateral and bilateral decompression under unilateral biportal endoscopy (UBE) for moderate and severe lumbar spinal stenosis (LSS) with unilateral symptoms. [Methods] A retrospective study was conducted on 120 patients who received decompression by UBE for moderate and severe LSS in our department from March 2020 to February 2021. Ac- cording to preoperative doctor- patient communication, 60 patients underwent unilateral decompression, while the remaining 60 patients had bilateral decompression performed. The data regarding to perioperative period, follow-up and radiographs were compared between the two groups. [Results] All patients were operated on smoothly without serious complications. Although the unilateral group consumed signifi- cantly less operation time than the bilateral group (P＜0.05) , there was no significant difference in other perioperative indicators between the two groups (P＞0.05) . The VAS and ODI scores decreased significantly (P＜0.05) , while the JOA score increased significantly in both groups over time (P＜0.05) . The bilateral group proved significantly superior to the unilateral group in terms of abovementioned scores at 7 days, 3 months after operation and the latest follow-up (P＜0.05) . Radiographically, the dural sac area significantly increased immediately after operation and at the latest follow-up compared with that preoperatively in both groups (P＜0.05) , which in bilateral group was better than the unilateral group (P＜0.05) . However, the intervertebral space height and local lumbar lordosis angle remained unchanged in both groups postoperatively by comparison with those preoperatively (P＞0.05) , which were not statistically significant between the two groups at matching time points (P＞0.05) . [Conclusion] Both unilateral and bilateral decompression by using UBE do effectively treat moderate and severe LSS with unilateral symptoms. By contrast, the bilateral decompression does more effectively expand the dural sac area with better clinical outcomes over the unilateral decompression.

Abstract:[Objective] To evaluate the impact of subacromial spur location on the clinical outcome of arthroscopic rotator cuff repair. [Methods] A retrospective study was conducted on 75 patients who underwent arthroscopic treatment for rotator cuff tear complicated with subacromial osteophyte in our department from February 2018 to August 2020. According to the location of subacromial osteophyte deter- mined, 39 patients were fall into the anterior type, 22 cases were of the lateral type and 14 cases were of the medial type. The documents re- garding to perioperative period, follow- up and radiographs were compared among the three groups. [Results] All patients had operation completed successfully with no significant differences in operative time, total incision length, intraoperative blood loss, length of hospital stay and incision healing among 3 groups (P＞0.05) . The lateral type had significantly more greater osteophytes removed, associated with significantly larger rotator cuff tear, than the anterior type and medial type groups (P＜0.05) . As time went during the follow-up lasted for (15.39±1.08) months on average, the VAS scores decreased significantly (P＜0.05) , whereas Constant-Muley and UCLA scores increased significantly in all the 3 groups (P＜0.05) . Although there were no statistically significant differences in VAS scores among the three groups at the corresponding time points (P＞0.05) , the lateral type group had significantly lower Constant-Muley and UCLA scores than the anteri- or and medial type groups (P＜0.05) , whereas with no significant difference between the anterior and medial type groups (P＞0.05) . Radio- graphically, acromiohumeral distance (AHD) significantly increased in all the 3 groups, whereas critical shoulder angle (CSA) significantly decreased only in lateral type group (P＜0.05) , and acromion index (AI) remained unchanged in all the 3 groups by the end of follow-up compared with those before surgery (P＞0.05) . [Conclusion] The location of subacromial spur has a great influence on postoperative shoul- der function recovery, the anterior and medial subacromial osteophytes have better postoperative prognosis in term of shoulder function than lateral ones.

Abstract:[Objective] To compare the clinical results of locking plate (LP) versus retrograde intramedullary nailing (RIMN) for distal femur fractures. [Methods] From January 2018 to November 2019, 100 patients with distal femur fractures were enrolled in this study and underwent open reduction and internal fixation. According to preoperative doctor-patient communication results, 50 patients were treated with LP, while the remaining 50 were with RIMN. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had operation completed successfully without serious complications. The RIMN group proved signifi- cantly superior to the LP group in terms of operation time, incision length, intraoperative blood loss, postoperative drainage volume and hos- pital stay (P＜0.05) . However, there were no significant differences in the number of intraoperative fluoroscopy and wound healing between the two groups (P＞0.05) . All the patients in both groups were followed up for more than 12 months. The RIMN group resumed walking and full weight-bearing activity significantly earlier than the LP group (P＜0.05) . The VAS scores decreased significantly (P＜0.05) , whereas the knee extension-flexion range of motion (ROM) and HSS score increased significantly in both groups over time postoperatively (P＜0.05) . At the corresponding postoperative time point, there was no significant difference in VAS score between the two groups (P＞0.05) , but the RIMN group proved significantly superior to the LP group in terms of ROM and HSS score (P＜0.05) . Radiographically, there was no signifi- cant difference in fracture reduction quality between the two groups (P＜0.05) , however, the RIMN group got fracture healing on images sig- nificantly earlier than the LP group (P＜0.05) . [Conclusion] The retrograde intramedullary nailing for internal fixation of distal femoral frac- tures has advantages of less trauma and better postoperative functional recovery over the locking plate.

Abstract:[Objective] To evaluate the clinical outcomes of total hip arthroplasty (THA) for traumatic arthritis after internal fixation of acetabular fractures. [Methods] A retrospective study was done on 62 patients who underwent THA for traumatic arthritis after internal fixa- tion of acetabular fracture in our department from March 2014 to May 2019. According to the presentation of previous implants for internal fixation and doctor- patient communication results, 27 patients underwent THA with retaining the previous implants for internal fixation (the retaining group) , while the other 35 patients underwent THA after removing the original internal- fixation implants (the removing group) . The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had opera- tion performed smoothly without neurovascular injury and other serious complications. The retaining group proved significantly superior to the removing group in terms of operation time, incision length, intraoperative blood loss, transfusion rate, postoperative drainage volume and postoperative walking time (P＜0.05) . Early complications were 10/27 (37.0%) in the retaining group, whereas 12/35 (34.28%) in the remov- ing group, which was not significantly different between the two groups (P＞0.05) . All the patients were followed up for (4.41±2.23) years on an average, and the retaining group resumed full weight-bearing activity significantly earlier than the removing group (P＜0.05) . The Harris score, hip extension-flexion and internal-external rotation range of motions (ROMs) significantly increased in both groups postoperatively compared with those preoperatively (P＜0.05) , whereas which proved not statistically significantly different between the two groups at any corresponding time points (P＞0.05) . By the last follow-up, no dislocation, local pain deterioration, and revision surgery happened in any pa- tient of both groups. Radiographically, there was no statistically significant differences in terms of femoral anteversion, acetabular abduction angle and lower limb length discrepancy between the two groups at the latest follow-up (P＞0.05) . [Conclusion] For traumatic arthritis after internal fixation of acetabular fracture, THA with retaining previous implants according to the specific situation of the original internal fixa-tion and results of doctor-patients communication, does reduce the surgical trauma, and is more conducive to the early functional recovery.

Abstract:With the change of people's working style and living habits, chronic low back pain has become the main health problem in the most people, which leads to the increase of socioeconomic cost and the loss of life quality. Posterior lumbar interbody fusion (PLIF) has always been regarded as the first choice for the treatment of lumbar degenerative diseases. However, with the increase of research more re- ports describe the defects of fusion. To solve these problems, non-fusion technique came into being. Among them, Dynesys dynamic inter- nal fixation system is a widely used non-fusion technique of lumbar spine at present. Compared with fusion, Dynesys system archives good outcomes by stabilizing the structure with non-fusion pedicle screws. However, Dynesys system also has its complications and adverse events. This article reviews the researches on the most common complications of the Dynesys.

Abstract:In all the cancer development process, about 85% of the patients eventually develop bone metastases, of which spine is the most common site. The treatment methods of spinal metastases mainly include radiotherapy, chemotherapy and surgery. However, the effica- cy of radiotherapy and chemotherapy is limited, and some intractable pain still cannot be relieved effectively, while surgical operation has disadvantages of iatrogenic trauma, time consuming in operation and long time for postoperative recovery. Therefore, cautious should be tak- en in the treatment of spinal metastases. In the past 10 years, radiofrequency ablation has been developed rapidly in the treatment of spinal metastases, and its safety and therapeutic capacity have been recognized by clinicians. This paper reviews the principle, clinical status, ex- isting problems and temperature field distribution of radiofrequency ablation used in spinal metastases.

Abstract:[Objective] To investigate the effect of miR-145 transfection in vivo on articular cartilage of osteoarthritis (OA) model in mice. [Methods] Forty male C57 mice aged 8 weeks were randomly divided into 4 groups with 10 mice in each group, including normal con- trol group (NC) , osteoarthritis model group (OAM) , transfected normal animal (TNA) , and transfected OA model (TOAM) . The animals in the OAM and TOAM groups received total resection of medial meniscus-tibial ligament to create OA model. At 7 d and 10 d, 20 μl of ade- nosis vector carrying miR-145 was injected into the joint cavity of the mice in the TOAM group and TNA group. The animals were sacri- ficed after another 4 days by excessive anesthesia, and then gross and histological observation were conducted, while qPCR and western blot assays were used to detect corresponding markers. [Results] In terms of morphology, the structure of articular cartilage in OAM group was obviously disordered, with fibrocyte proliferation and matrix stained in mainly blue-green compared with the NC group, while which preserved intact in structure, but with vacuoles in the lacunae, and the matrix in blue-green in the TNA group, whereas intact cartilage structure was noted in the TOAM group with red color of articular cartilage matrix similar to the NC group. In term of immunohistochemis- try, the OD values of FRS2, LC3 and p62 staining were significantly increased in OAM group compared with those in the NC group and TNA group (P＜0.05) , whereas which in the TOAM group were significantly lower than those in OAM group and TNA group (P＜0.05) . In terms of the quantitative detections, mRNA expression level of miR-145 in OAM group was significantly decreased (P＜0.05) , while which significantly ramped up in the TNA group and TOAM group compared with NC group (P＜0.05) . In OAM group the LC3II/I ratio significant- ly decreased (P＜0.05) and p62 expression level were significantly increased compared with those in NC group (P＜0.05) , while which in the TOAM group was significantly lower than that in OAM group and TNA group (P＜0.05) . [Conclusion] In vivo transfection of miR-145 does alleviate cartilage impairment in this joint instable state for marking OA model, and its mechanism may be related to the change of autopha- gy function of cartilage.

Abstract:[Objective] To measure lower extremity alignment parameter on coronal plane in healthy Chinese people for a reference in high tibial osteotomy (HTO) . [Methods] A total of 100 healthy subjects who had full-length radiographs of the bilateral low extremities tak- en were enrolled in the study. The hip-knee-ankle angle (HKA) , anatomic femorotibial angle (aFTA) , anatomic lateral distal femoral angle (aLDFA) , mechanical lateral distal femoral angle ( mLDFA) , medial proximal tibial angle (MPTA) , joint line convergence angle (JLCA) and tibial bone varus angle (TBVA) were measured, and compared in term of genders and ages, as well as with those in western countries. [Results] The overall HKA, aFTA, aLDFA and mLDFA were of (178.32±2.84)°, (175.01±3.28)°, (80.71±2.55)°, (86.83±2.41)°, respective- ly. While the MPTA, TBVA and JLCA were of (87.59±3.02)°, (1.61±2.95)°, (1.82±1.27)°, respectively. The male had significantly lower JL- CA than the female (P＜0.05) , whereas the middle age had significantly lower JLCA than the elder group (P＜0.05) . In addition, JLCA and MPTA measure in the population of this study were significantly higher, while mLDFA was significantly lower than those of western healthy population (P＜0.05) . [Conclusion] In this study, the population has a varus tendency in low extremity alignment, mainly originating intraar- ticularly, especially in women and the elderly, which have reference significance for HTO.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcomes of 3D printed guider on body surface for removing cannulated screw at ankle. [Methods] A total of 5 patients underwent abovesaid procedure to remove cannulated screw in the an- kle. As 3 annular metal spacers were pasted on the body surface of the ankle before surgery to locate the anchor points, and the position of annular spacers was marked on the body surface with a marker pen, CT scan and 3D reconstruction were performed with the positioning spacers, and the scanning data were imported into e3D software to design a body-surface guider with positioning holes. Intraoperatively, the positioning hole of the guider was anastomosed with the marked gasket hole on the body surface, and then the guide wire was inserted into the guider hole, finally, the screw was removed. Intraoperatively, C-arm fluoroscopy was used to evaluate the safety and effectiveness of this surgical method. [Results] Of the 5 patients with 13 screws in total, 4 patients had guide wire placed successfully at one time, while the re- maining 1 patient failed to place the guide wire at the first time with an internal malleolus cannulated screw, and got successful placement at the second time after adjusting the position of the guider. The incision for each screw was about 0.5 cm with time from guider placement to removal of screw of (5.62±2.47) min, the first time success rate of 92.30%, without neurovascular injury and other complications. [Conclusion] This 3D printed guider on body surface has a high success chance to remove cannulated screw in the ankle, additionally, the prepa- ration of guide plate has low material requirements with low cost.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of double cutaneous nerves anastomosed lo- cal pedicle flap for repair of thumb defect. [Methods] From May 2018 to June 2020, a total of 20 patients received double cutaneous nerves anastomosed pedicle flap for repair of thumb tip or palmar defects. After debridement, the flap was designed according to the size and loca- tion of tissue defect. The proximal edge of the flap was firstly cut to expose the terminal branches of superficial radial nerve and the termi- nal ramus of the lateral cutaneous nerve of the forearm. As harvesting the flap, the 2 cutaneous nerves were labelled and cut off sharply with preservation of their distribution in the flap, which had vascular pedicle of subcutaneous fascia tissue about wide 1.0 cm retained. The flap was transferred to cover the distal wound by an open tunnel. Subsequently, the two cutaneous nerves were anastomosed end-to-end with the stumps of two digital nerves under microscope. The flap donor site was sutured directly. [Results] All the 20 patients had the flap sur- vived, and followed up for (12.20±1.70) months. At the last follow-up, all the patients got the thumb in nice appearance, and only linear scar remained in the radial donor area. The static two-point discrimination of the flap ranged from 4 to 8 mm, with an average of (6.25± 0.91) mm. [Conclusion] Compared with pedicle flap innervated by a single cutaneous nerve, this double-nerve-anastomosed local pedicle flap, including terminal branches of superficial radial nerve and the terminal ramus of the lateral cutaneous nerve of the forearm, is a feasi- ble technique for repair of the thumb defect, should be conducive to sensory recovery

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of closed reduction and percutaneous inter- nal fixation with modified distracting cannulated screws for calcaneal fractures. [Methods] A total of 24 patients received closed reduction and percutaneous internal fixation with modified distracting cannulated screws for calcaneal fractures. Firstly, the length, width and angle of the calcaneus were initially restored by the traditional osteopath technique combined with needle prying, and the articular surface was ac- curately reduced. As two guide pins were inserted percutaneously, two suitable modified distracting cannulated screws were selected and in- serted following the guide pins for percutaneous fixation, which further reduced the fracture compression by the anteroposterior thread spac- ing difference of the screws. Zhang Tie-liang foot function scoring system was used to evaluate the outcomes. [Results] All 24 patients (24 feet) had operation performed successfully, and were followed up for 10~25 months. No complications, such as infection, bone nonunion and traumatic arthritis were found in anyone of them. According to Zhang Tie-liang foot function scoring, 4 cases were marked of 100 points, 7 of 99 points, 8 of 97 points, 1 of 93 points, 2 of 85 points, and 2 cases of 69 points. The excellent and good rate was of 91.67%. [Conclusion] The closed reduction and percutaneous internal fixation with modified distracting cannulated screw for calcaneal fractures have the advantages of less trauma, fewer complications and good curative outcomes.

Abstract:[Objective] To explore the effect of methylene blue (MB) , a disclosing agent, on bacterial culture in periprosthetic joint in- fection (PJI) . [Methods] A total of 116 patients who received two-stage revision surgeries for PJI secondary to hip or knee arthroplasty from October 2017 to October 2019 were included in the study. At least 3 periprosthetic tissues were harvested during surgery for bacterial cul- ture. Each tissue sample was divided into two equal parts, one was stained with 0.1% MB solution, while other one was used as a control group without MB staining. The consequences of bacterial culture and identification were compared between the two groups. [Results] The positive rate of bacterial culture was of 81.89% in the MB group, whereas 86.21% in the non-MB group, which proved not statistically signifi- cant between them (P=0.370) . As results of bacterial identification, MB had antimicrobial effects in some extent on Klebsiella oxytoca and Coagulase-negative Staphylococcus other than Staphylococcus haemolyticus. [Conclusion] MB solution might impact the detection of cer- tain bacteria in PJI.

Abstract:[Objective] To evaluate the clinical outcomes of arthroscopic debridement combined with core decompression in the treat- ment of knee osteoarthritis (KOA) with bone marrow edema (BME) . [Methods] A retrospective study was conducted on 48 patients who re- ceived surgical treatment for KOA complicated with BME in our department From May 2018 to May 2020. According to doctor-patient com- munication, 26 patients were treated with arthroscopic debridement and core decompression of the BME area with fine needles (the decom- pression group) , while the remaining 22 patients were treated with arthroscopic debridement alone (debridement group) . The clinical and imaging data of the two groups were compared. [Results] All patients in both groups had operation performed successfully, and were fol- lowed up for (8.25±1.32) months. VAS and WOMAC scores in 2 groups were significantly decreased over time (P＜0.05) , which in the de- compression group proved significantly superior to the debridement group at 2 months postoperatively and the latest follow-up (P＜0.05) . In terms of imaging, the WORMS grade for BME significantly improved in both groups at the latest follow-up compared with those before oper- ation (P＜0.05) , which in the decompression group was significantly better than that in the debridement group (P＜0.05) . [Conclusion] The arthroscopic debridement combined with core decompression treatment does effectively relieve pain and improve joint function for KOA complicated with BME.

Abstract:[Objective] To investigate the significance of halo-pelvic traction in correction of severe rigid congenital scoliosis compli- cated with diastematomyelia. [Methods] A retrospective study was conducted on 18 patients who underwent two-stage surgical treatment for severe rigid congenital scoliosis complicated with diastematomyelia in our hospital from August 2015 to August 2020. All the patients had halo-pelvic traction device set up in the primary stage, followed by continuous traction applied and then spinal osteotomy and instru- mented correction performed in the second stage. The clinical and imaging parameters were analyzed before and after traction, correction surgery and at the latest follow-up. [Results] The traction period lasted for (35.22±8.32) days on an average in the 18 patients. The height and weight of the 18 patients increased significantly after traction compared with those before traction (P＜0.05) . The second-stage correc- tion operation lasted for (301.71±82.12) min with intraoperative blood loss of (861.15±462.60) ml. All the patients were followed up for 12 to 36 months. The body height, deltoid skin wrinkling and SRS-22 score were significantly increased at the latest follow-up compared with those before surgery (P＜0.05) . In addition, the main curve Cobb's angle on coronal plane and kyphotic angle on the sagittal plane signifi- cantly decreased after traction, correction surgery and at the last follow-up (P＜0.05) . At the latest follow-up, vital capacity and forced expi- ratory volume in one second significantly increased (P＜0.05) , moreover, the plasma albumin significantly increased compared with those before traction (P＜0.05) . No implant displacement, loosening and fracture were noticed in anyone of them until the last follow-up. [Conclusion] The halo-pelvic traction is a safe and effective treatment for severe rigid congenital scoliosis complicated with diastematomyelia.

Abstract:[Objective] To evaluate the clinical efficacy of endoscope-assisted transforaminal lumbar interbody fusion (MIS-TLIF) for single-level lumbar disc herniation with functional scoliosis. [Methods] A retrospective study was conducted on 51 patients who underwent surgical treatment for single-level lumbar disc herniation with functional scoliosis from June 2014 to December 2020. According to doctorpatient communication, 20 patients received MIS- TLIF (the MIS group) , while the other 31 patients underwent open TLIF (the open group) . The clinical and imaging data of the two groups were compared. [Results] All patients in both groups had operation completed suc- cessfully without serious complications. The MIS group proved significantly superior to the open group in terms of intraoperative bleeding, incision length and hospital stay (P＜0.05) . As time went during the follow-up lasted for (19.55±4.28) months, the VAS scores for lumbar and leg pain, as well as ODI score in both groups significantly decreased (P＜0.05) , whereas which were not statistically significant between the two groups at any corresponding time points (P＞0.05) . Radiographically, the scoliotic Cobb angle significantly decreased (P＜0.05) , while the height of intervertebral space and L₁~S₁ lordotic angle significantly increased in both groups at the latest follow-up compared with those preoperatively (P＜0.05) . [Conclusion] This endoscope-assisted TLIF has advantages of smaller surgical incision, less intraoperative bleeding, and shorter hospital stay over the open TLIF for single-level lumbar disc herniation with functional scoliosis.

Abstract:[Objective] To explore the outcomes of predictive nursing based on Caprini risk assessment for deep venous thrombosis (DVT) after surgical treatment of lower extremity fractures. [Methods] From December 2020 to May 2022, 90 patients with lower extremity fractures were enrolled in this study. They were divided into two groups using random number table method, including 46 patients who were given predictive care (PC) based on Caprini risk assessment and 44 patients who received routine care (RC) . The documents of clinical evaluation, laboratory test and ultrasonic examination were compared between the two groups. [Results] All patients in both groups were successfully operated on without serious intraoperative complications. The PC group was significantly better than the RCl group in terms of VAS score 3 days postoperatively, hospital stay and incidence of early onset complications (P＜0.05) . In terms of laboratory tests, the PC group had significantly longer PT and aPTT, while significantly lower PLT and Fbg than the RC group at 7 days postoperatively (P＜0.05) . In addition, the PC group had significantly lower D-D, PIC and TAT than RC group 7 days postoperatively (P＜0.05) . In terms of ultrasonog- raphy, the incidence of DVT at 3 days after surgery was of 4/46 (8.70%) in the PC group, whereas 11/44 (25.00%) in the RC group (P= 0.002) , with lower limb venous blood stream velocity of (25.26±3.58) cm/s in the PC group than (22.34±2.24) cm/s in the RC group (P＜ 0.001) . [Conclusion] Predictive nursing based on Caprini risk assessment after surgical treatment of lower extremity fractures does relieve postoperative hypercoagulability state, decline thrombotic molecular markers and occurrence of DVT, reduce complications and is benefit to patients' postoperative recovery.

Abstract:[Objective] To compare the clinical outcomes of anchor suture reconstruction versus screw fixation for inferior tibiofibular syndesmosis injury (ITSI) . [Methods] From March 2019 to June 2020, a total of 64 patients received surgical treatment for ankle fractures accompanied with ITSI in our hospital. The patients were randomly divided into two groups by lottery, including 32 patients who underwent anchor suture reconstruction, while the other 32 patients who had screw fixation for the ITSI after fracture fixation. The clinical and imaging data of the two groups were compared. [Results] All patients had surgical procedures performed smoothly, with no significant differences in operative time, incision length, number of fluoroscopy and intraoperative blood loss between the two groups (P＞0.05) . All patients were fol- lowed up for more than 12 months, and the reconstruction group resumed weight- bearing activity significantly earlier than the fixation group (P＜0.05) . The extension-flexion ankle range of motion (ROM) and AOFAS scores in both groups improved significantly over time (P＜ 0.05) , which in the reconstruction group were significantly superior to those in the fixation group at 3 months postoperatively (P＜0.05) , whereas became not statistically significant between them at 6 months after operation and the latest follow-up (P＞0.05) . Radiographically, tibiofibular clear space (TFCS) and medial clear space (MCS) significantly decreased, while the tibiofibular overlap (TFO) significantly in- creased in both groups at the latest follow up compared with those preoperatively (P＜0.05) . However, there were no significant differences in the above imaging items between the two groups at any matching time points (P＞0.05) . [Conclusion] Both anchor suture reconstruction and screw fixation do effectively treat ITSI, by comparison, the former has the advantages of early weight bearing and faster functional recov- ery.

Abstract:[Objective] To summarize the teleconsultation service of the Department of Orthopaedics, The Second General Hospital of Guangdong Province. [Methods] As data were collected, classified and organized by information technology, 749 cases of orthopedic tele- consultation from January 2018 to March 2021 were described and analyzed. [Results] Among the 524 cases of teleconsultation applied by the primary hospitals, the Yangshan People's Hospital and the Deqing People’s Hospital were the first and second in number, involving 232 cases and 178 cases respectively. In term of specialty, the orthopaedic trauma and joint disorder were the first and second in number, involv- ing 241 cases and 155 cases respectively. The main result of the consultation was surgical guidance, reaching 426 cases. In addition, teleeducation on orthopaedics were conducted for 225 times, including 104 times on joint surgery and 77 times on trauma surgery. [Conclusion] The teleconsultation conducted by our department has obvious professional characteristics with wide coverage of sub- specialties, which provides a feasible model for solving the uneven distribution of medical resources.

Abstract:[Objective] To explore factors related to delirium after operation for hip fractures in the elderly. [Methods] A total of 308 elderly patients who underwent surgical treatment for hip fractures in our hospital from August 2015 to August 2019 were included in this study. The patients were divided into two groups based on whether delirium occurred postoperatively, and univariate comparison and binary multiple logistic regression were conducted to search the factors related the postoperative delirium. [Results] Among 308 patients, 62 pa- tients were diagnosed of delirium after operation, accounting for 20.13%. The onset time of delirium ranged from 1 to 7 days after operation, with an average time of (4.56±1.53) days. In term of univariate comparison, the delirium group proved significantly greater than the non-de- lirium group regarding to the age, type II diabetes incidence, ASA grade, general anesthesia ratio, intraoperative blood loss and operation time (P<0.05) . As results of multivariate logistic regression, the advanced age (OR=1.254, P<0.05) , type II diabetes (OR=4.602, P<0.05) , high ASA grade (OR=5.407, P<0.05) , general anesthesia (OR=4.766, P<0.05) and long operation time (OR=1.129, P<0.05) were of inde- pendent risk factors for postoperative delirium. [Conclusion] The risk factors of delirium after surgical treatment for hip fractures in the el- derly include advanced age, type II diabetes, high ASA grade, general anesthesia and long operation time.