Abstract:Since the 21^st century, sports medicine makes progress rapidly. However, hip arthroscopy development is relatively late due to the complexity, deep site of the joint structure that brings operation difficulty, compared to other major joint. As deepening researches on femoroacetabular impingement (FAI) , more and more hip arthroscopy techniques emerges, which leads incredible increase of the num- ber of hip arthroscopic procedures with technique advances by leaps and bounds. In recent years, domestic experts in hip arthroscopy in- herit the solid foundation laid by the older generation of experts, actively absorb international hip arthroscopy advanced concepts and tech- nology, adhere to self-innovation and development, hip arthroscopy has been well popularized, and gradually keep up with the pace of in- ternational development. During this period, a series of new ideas and techniques were generated, which laid a good foundation for the in- novation, development and popularization of hip arthroscopy in China, and also played a positive role in promoting the global development in this field.

Abstract:[Objective] To compare the clinical outcomes of supramolleolar osteotomy with or without fibular osteotomy for correction of ankle varus deformity in adolescents. [Methods] A retrospective study was conducted on 29 adolescent patients (29 feet) who received supra- molleolar osteotomy for correction of ankle varus deformity in our department from January 2010 to December 2019. According to the preop- erative doctor-patient communication, the patients were divided into two groups, including 18 patients who maintained fibula intact (FI) , while 11 patients who underwent fibular osteotomy (FO) simultaneously. The perioperative period, follow- up and imaging data of the two groups were compared. [Results] All the patients in both groups had operation performed successfully without serious complications. The FI group proved significantly superior to the FO group in terms of operation time and total incision length (P＜0.05) , though there were no signifi- cant differences in intraoperative blood loss, intraoperative fluoroscopy times, postoperative drainage volume, incision healing grade and hos- pital stay between the two groups (P＞0.05) . All the patients in both groups were followed up for (49.72±19.44) months on a mean. The FI group resumed walking and full weight-bearing activity significantly earlier than the FO group (P＜0.05) . The AOFAS ankle and hindfoot scores significantly increased (P＜0.05) , while the VAS scores significantly decreased (P＜0.05) , and the ankle dorsal extension and plantar flexion range of motion (ROM) remained unchanged in both groups at the latest follow- up compared with those preoperatively (P＞0.05) , which proved not statistically significant at any matching time points between the two groups (P＞0.05) . Radiographically, all patients got os- teotomy healed at latest follow-up without a significant difference in healing time between the two groups (P＞0.05) . The tibial articular sur- face angle (TAS) , tibial lateral surface angle (TLS) and tibiocrural angle (TC) significantly improved (P＜0.05) , whereas the talar tilt angle (TT) remained unchanged postoperatively compared with those preoperatively in both groups (P＞0.05) . The FO group proved significantly superior to the FI group in term of TC immediately after operation and at the latest follow-up (P＜0.05) . [Conclusion] Supramolleolar osteot- omies with both FI and FO are effective correction of ankle varus deformity. The FI is superior to the FO in terms of operation time, incision length, times to resume walking and full weight-bearing activity, while the FO is superior to the FI in term of correction of TC.

Abstract:[Objective] To establish the prediction models of deep vein thrombosis (DVT) after total knee arthroplasty (TKA) based on the logic regression and the extreme gradient boosting (XGBoost) . [Methods] A retrospective study was conducted on 3 711 patients who re- ceived TKA in the Department of Orthopaedics, Anhui Provincial Hospital from December 2017 to October 2021. The prediction models for DVT after TKA were established based on the factors related the DVT by logical regression and XGBoost algorithm respectively, which were compared in term of prediction efficiency. [Results] Of 3 711 patients, 889 patients proved DVT after TKA, with a total incidence of 23.96%. In term of univariate comparison, the DVT group proved significantly older (P＜0.05) , higher ratio of low-grade heparin and X factor inhibi- tors used (P＜0.05) , lower early anti-coagulation 6 hours after the operation (P＜0.05) , shorter preoperative preparation time (P＜0.05) , lon- ger postoperative hospital stay (P＜0.05) , longer operation time (P＜0.05) , higher preoperative blood D-dimer (P＜0.05) , lower preoperative coagulation activity (P＜0.05) , higher level of postoperative blood phosphate (P＜0.05) and higher postoperative ratio of urea nitrogen to creati- nine (P＜0.05) than the non-DVT group. As results of logical regression, higher postoperative ratio of urea nitrogen to creatinine (OR=1.576, P＜0.05) , longer postoperative hospital stay (OR=1.393, P＜0.05) , older age (OR=1.214, P＜0.05) , higher postoperative serum phosphorus (OR=1.160, P=0.05) , higher preoperative D-dimer (OR=1.058, P=0.05) were risk factors for DVT events. In term of XGBoost model, the age, postoperative hospital stay, postoperative D-dimer, serum urea nitrogen/creatinine ratio, and use of low molecular weight heparin were important feature vectors. The AUC of ROC analysis of the two prediction models were of 0.709 and 0.840 respectively. [Conclusion] XG- Boost model has a good ability to predict DVT events in the perioperative period of TKA. The age, postoperative hospital stay, postoperative D-dimer, serum urea nitrogen/creatinine ratio, and low molecular weight heparin used are potential important predictors.

Abstract:[Objective] To explore the risk factors related to bone cement leakage secondary to percutaneous vertebroplasty (PVP) for Kümmell’s disease in the elderly. [Methods] A retrospective study was conducted on 106 elderly patients (134 vertebrae) who underwent PVP for Kümmell’s disease in our department from May 2018 to May 2021. Based on whether or not bone cement leakage happened second- ary to PVP, the patients were fall into the leakage group or non-leakage group. Univariate comparison and binary multiple logistical regres- sion were conducted to search the factors related to the bone cement leakage in PVP. [Results] Of the 106 patients (134 vertebrae) , 57 verte- brae proved of bone cement leakage, accounting for 42.54% (57/134) . In term of univariate comparison, the leakage group was of significant- ly more severe Kümmell’s staging, higher ratio of lumbar involved in the location, higher ratio of vertebral fissures found in vertebral injury typing, greater bone cement volume used, and higher ratio of diffused distribution of bone cement than the non-leakage group (P＜0.05) . As results of logistic regression, diffused distribution of bone cement (OR=4.450, 95% CI: 1.989~9.957, P＜0.001) , the lumbar involved in frac- ture site (OR=4.380, 95% CI: 1.880~10.202, P=0.004) , greater bone cement amount injected (OR=3.896, 95% CI: 1.133~13.401, P＜0.001) and the fissure-like lesion in vertebral body injury (OR=3.518, 95% CI: 1.239~9.995, P＜0.001) were independent factors related to bone ce- ment leakage secondary to PVP for Kümmell’s disease in the elderly. [Conclusion] Fracture site in lumbar, diffused distribution of bone ce- ment, more amount of bone cement, and fissure-like lesion are the risk factors for bone cement leakage in PVP, which should be paid atten- tion to for prevention of bone cement leakage in clinical setting.

Abstract:[Objective] To explore the effect of platelet-rich plasma (PRP) on clinical outcomes of open reduction and internal fixation (ORIF) of patella fractures. [Methods] From June 2018 to March 2021, a total of 50 patients with acute closed patella fracture were includ- ed in this study, and were randomly divided into two groups by lottery. Of them, 25 patients in the PRP group had ORIF combined local in- jection of 4~4.5 ml PRP, while the other 25 patients in the non-PRP group had ORIF only. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had operation performed successfully with no serious com- plications. There were no statistically significant differences between the two groups in operation time, incision length, intraoperative blood loss, postoperative walking time, hospital stay, incision healing, and the early VAS scores (P>0.05) . The patients in both groups were fol- lowed up for (18.62±2.63) month on an average. A statistically significant difference was noticed between the two groups in time of clinical fracture healing (P<0.05) . The VAS scores significantly declined (P<0.05) , while Bostman score and the knee flexion-extension range of motion (ROM) significantly upgraded in both group over time (P<0.05) . The VAS score, Bostman score, and knee extension and flexion ROM of the PRP group were significantly better than those of the non-PRP group at all time points postoperatively (P<0.05) . Radiographi- cally, there were no statistically significant differences between the two groups in fractures reduction quality and fracture healing time on images (P>0.05) . Although there was trend of deterioration over time in Kellgren-Lawrence osteoarthritis classification of patellofemoral joint, it proved not statistically significant (P>0.05) , additionally, the difference between the two groups in Kellgren-Lawrence osteoarthri- tis grade was not statistically significant at any matching time point (P>0.05) . [Conclusion] The local injection of PRP in the ORIF of patel- lar fracture is conducive to improving fracture healing and the recovery of knee functions.

Abstract:[Objective] To compare the clinical outcomes of open reduction and lag screw fixation through limited incision combined with unilateral external fixator (EF) versus closed reduction and intramedullary nail (IN) for tibial shaft fracture. [Methods] A retrospective study was done on 59 patients who received surgical treatment for tibial shaft fractures from January 2016 to January 2019. According to the preoperative doctor-patient communication, 31 patients underwent EF, while the other 28 patients had IN performed. The periopera- tive, follow-up and imaging documents were compared between the two groups. [Results] All patients had the operation completed success- fully without serious complications. The EF group proved significantly superior to the IN group in terms of operation time, total incision length, intraoperative blood loss, intraoperative fluoroscopy times and hospital stay (P＜0.05) . With time of the follow-up lasted for (23.32± 5.22) months on an average, the knee extension-flexion range of motion (ROM) and ankle dorsal extension-plantar flexion ROM significant- ly increased in both groups (P＜0.05) , of which the knee extension-flexion ROM in the EF group was significantly better than that in the IN group at 1 and 3 months after operation (P＜0.05) . At the latest follow-up, there were no significant differences in Johner-Wruhs grade, ex- tents of claudication and squat restriction between the two groups (P＞0.05) . Radiographically, the EF group was significantly superior to the IN group in terms of alignment of the affected tibia at all corresponding time points postoperatively (P＜0.05) , discrepancy of tibial length (P＜0.05) , and the fracture healing time (P＜0.05) . [Conclusion] This limited open reduction and combined fixation with lag screw and unilateral external frame has the advantages of simple operation, short operation time, less intraoperative bleeding, less intraoperative fluoroscopy times, and faster fracture healing, and achieve comparable clinical consequences to the intramedullary nail for tibial shaft frac- tures.

Abstract:[Objective] To compare the clinical outcomes of Weil osteotomy versus metatarsophalangeal release of 2~5 toes on the basis of first metatarsophalangeal fusion for rheumatoid forefoot deformities. [Methods] A retrospective study was conducted on 36 patients who un- derwent surgical treatment for rheumatoid forefoot deformities in our department from July 2016 to July 2020. According to the preoperative doctor-patient communication, the patients were divided into two groups. On the basis of the first metatarsophalangeal fusion, 16 patients re- ceived 2~5- toe Weil osteotomy on the metatarsal head (osteotomy group), while the remaining 20 patients received metatarsophalangeal re- lease of 2~5 toes (release group) . The documents regarding to perioperative period, follow-up and images were compared between the two groups. [Results] All the patients in both groups had operation performed successfully without serious complications. There were no signifi- cant differences between the two groups in terms of operation time, incision length, intraoperative blood loss, intraoperative fluoroscopy times, incision healing, hospital stay, and time to return ambulation (P>0.05) , but the treatment cost of osteotomy group was significantly higher than that of release group (P<0.05) . As time went in the follow- up lasted for (15.23±2.36) months, the VAS score significantly decreased (P< 0.05) , while the AOFAS and Maryland scores significantly increased in both groups (P<0.05) , additionally, the grip strength in osteotomy group significantly improved (P<0.05) , whereas remained unchanged in the release group (P>0.05) . At any corresponding time points, there were no significant differences in VAS, AOFAS and Maryland scores between the two groups (P>0.05) . However, the osteotomy groups proved significantly superior to the release group in term of grip strength at latest follow-up (P<0.05) . Radiographically, both the hallux valgus angle (HVA) and intermetatarsal angle (IMA) significantly decreased postoperatively in the two groups compared with those preoperatively (P< 0.05) , whereas which proved not statistically significant between the two groups at any corresponding time points (P>0.05) . [Conclusion] On the basis of first metatarsophalangeal fusion, both Weil osteotomy and metatarsophalangeal release of the 2~5 toes can achieve satisfactory clinical results for rheumatoid forefoot deformities. In comparison, the osteotomy group has better grip strength than the release group.

Abstract:Osteonecrosis of the femoral head (ONFH) is a common refractory orthopedic disease, and its pathogenesis is still not com- pletely clear. In recent years, more and more evidences have linked the occurrence and development of ONFH with the abnormal polariza- tion of macrophages. The persistent activation of classical activated / pro-inflammatory macrophages (M1) and the failure of polarization to anti-inflammatory macrophages (M2) mediate the chronic inflammation of necrotic bone tissue, leading to the continuous destruction of bone tissue and the obstacle of regeneration and repair, and finally induce bone necrosis. In this process, several signal pathways play important regulatory roles. In this review, we summarize available findings in the researches of macrophage polarization in ONFH, focusing on the rela- tionship between abnormal polarization of macrophage and ONFH, as well as the regulatory roles of related signal pathways.

Abstract:Periprosthetic infection and osteolysis caused by infection are the most severe clinical challenges after total hip arthroplasty. As the first line of defense against infection, macrophages can not only play an anti-infection role through phagocytosis, polarization and oth- er ways, but also secrete a variety of active factors to promote the osteogenic differentiation of bone marrow mesenchymal stem cells and real- ize bone integration. Therefore, in order to simultaneously prevent infection and promote osseointegration after hip arthroplasty, the immune regulation mechanism of macrophages at the prosthesis-bone interface has received extensive attention. This paper reviews the phenotypic transformation, anti-infection and osteogenesis of macrophages in the process of biomaterial implantation, which can provide a theoretical basis for the development of multifunctional prosthesis involving macrophage immune regulation.

Abstract:Tantalum metal is increasingly used in daily life, and it is also known as "biophilic" metal due to its excellent biological in- ertness and biocompatibility. Pure tantalum has been used in orthopaedics for over 80 years. Because the elastic modulus of pure tantalum differs greatly from that of bone tissue, it is not conducive to bone healing. Porous tantalum is an metal structure that resembles human can- cellous bone in appearance, with low elastic modulus close to that of subchondral and cancellous bone, which enables better load transfer and minimizes stress shielding phenomena. With highest coefficient of friction among biomaterials, the porous tantalum cage had sufficient- ly initial stability even without screw fixation. This article reviews the application of porous tantalum fusion cage in the anterior cervical spine, and provides a reference for clinicians to better choose the appropriate cage.

Abstract:[Objective] To investigate the effects of curcumin on pain and cartilage degeneration of knee osteoarthritis (KOA) in rat. [Methods] Thirty male Sprague-Dawley rats were randomly divided into 3 groups with 10 rats in each group. Ten animals in the sham group received capsulotomy only, while the remaining 20 rats had anterior cruciate ligament resected to establish the KOA rat model. Ten rats in the curcumin group was given curcumin (50 mg/kg) intraperitoneally, while the other 20 animals in the sham and model groups were given the same amount of normal saline once a day for 8 weeks. Eight weeks after modeling, pain response was evaluated, histological observation and scoring were conducted. In addition, ELESIA assay was used for synovial Il-1 β, TNF-α and McP-1, while Western blot assay was con- ducted for MMP-1, MMP-13, Aggrecan and Collagen II of cartilage. [Results] The model group had significantly lower mechanical with- drawal threshold (MWT) and thermal withdrawal latency (TWL) (P<0.05) , while significantly higher Osteoarthritis Research Society Interna- tional (OARSI) histological score than the sham group (P<0.05) . However, the curcumin group got significantly reversed variation in terms of MWT, TWL and OARSI scores compared with those in the model group (P<0.05) . As results of ELESIA assay, the model group had signifi- cantly higher synovial Il-1 β, TNF-α and MCP-1 than the sham group (P<0.05) , whereas which were significantly reversed in the curcumin group (P<0.05) . In term of Western blot assay, the model group had significant increases in MMP-1 and MMP-13, whereas significant de- creases in aggrecan and collagen II compared with the sham group (P<0.05) . Compared with model group, the curcumin group got signifi- cantly decreased MMP-1 and MMP-13 (P<0.05) , while significantly increased aggrecan and collagen II (P<0.05) . [Conclusion] The cur- cumin does considerably reduce hyperalgesia and cartilage degeneration in the KOA rats, which may be related to reducing IL-1β, TNF-α and McP-1 and restoring the balance of cartilage metabolism.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of autogenous grafting of iliac bone block with periosteum for Hepple stage V osteochondral lesions of the talus (OLT) by medial malleolus osteotomy approach. [Methods] From Janu- ary 2018 to December 2019, 26 patients received the abovesaid surgical treatment for Hepple stage V OLT. After three-plane osteotomy of the medial malleolus, involving the horizontal plane, sagittal plane and coronal plane, were conducted by using a mini oscillating saw, the OLT was exposed, and debrided to form a regular bone hole. A bone block with intact periosteum was harvested from the iliac and trimmed to meet the receipt site in shape, and embedded into the bone hole in the recipient area. Finally, the medial malleolus was reduced and fixed with 3 cannulated screws perpendicular to the osteotomy surface respectively. [Results] Twenty-six patients were successfully operated on without serious complications and were followed up for 24 months. At last follow-up, the VAS and AOFAS scores, as well as extension-flexion range of motion of the ankle significantly improved compared with those before operation (P<0.05) . In addition, the CT showed good healing between osteochondral lesion and osteotomy surfaces at the latest follow up. [Conclusion] The three-plane osteotomy technique does effec- tively expose the OLT, while autogenous grafting of iliac bone block with periosteum achieves sound clinical outcomes in mid-term for OLT.

Abstract:[Objective] To evaluate clinical outcomes of percutaneous kyphoplasty (PKP) through bilateral pedicle inferior approaches for severe osteoporotic vertebral compression fractures (OVCF) . [Methods] From January to December 2020, 48 patients received PKP through bilateral pedicle inferior approaches for severe OVCF with extent of vertebral compression more than 67%. [Results] All patients were successfully operated by general anesthesia without serious intraoperative complications, whereas with single-segment operation time of (64.58±137.06) minutes, the number of fluoroscopies of (21.68±6.12) times, and the amount of bone cement injected of (3.79±1.06) ml. Bone cement leakage was found in 7 patients (14.58%) , including 3 cases of intervertebral leakage (6.25%) and 4 cases of paraspinal leak- age (8.33%) , all of which had no clinical symptoms. Both VAS and ODI scores decreased significantly over time (P＜0.05) . Radiographical- ly, anterior vertebral height, middle vertebral height and local kyphosis Cobb angle significantly improved after PKP compared with those preoperatively (P＜0.05) . [Conclusion] The PKP through bilateral pedicle inferior edge approaches does establish safe working channels with conventional instruments, and has excellent efficacy for severe OVCF.

Abstract:[Objective] To explore the reasons for revision of upper cervical instrumented fusion, and to evaluate the clinical efficacy of revision surgery. [Methods] A retrospective study was performed on 16 patients who underwent revision surgery for failed upper cervical fu- sion in our department from 2017 to 2021. The reasons for revision, as well as the clinical and imaging consequences of revision surgery were evaluated. [Results] The reason for revision surgery proved improper reduction of atlantoaxial dislocation in 5 cases, nonunion of bone graft in 5 cases, incomplete decompression in 3 cases, tumor recurrence in 2 cases and infection in 1 case. All the 16 patients had revision surgery performed smoothly, with operation time of (216.25±23.34) min, the intraoperative blood loss of (406.25±103.08) ml, and the good incision healing. Except one patient who suffered from tumor patient was lost to follow-up, all the patients were followed up for (31.35±8.98) months on a mean. The JOA scores increased significantly (P＜005) , and ASIA grade for neurological function improved significantly over time (P＜ 005) . Radiographically, the head- neck alignment was significantly improved (P＜0.05) , ADI decreased significantly (P＜0.05) , whereas SAC significantly increased after revision surgery compared with those preoperatively (P＜0.05) . [Conclusion] The factors related to revi- sion of upper cervical fusion influence each other in many cases. Reasonable formulation of revision surgical plan and accurate operation do still achieve satisfactory clinical outcomes.

Abstract:[Objective] To investigate the clinical efficacy of one-stage hip replacement and hip preservation for bilateral femoral head necrosis with different heal collapse. [Methods] From October 2018 to June 2019, 28 patients underwent one-stage hip replacement for the severe collapse side and hip preservation by neck-head fenestration and bone grafting for the slight collapse side for bilateral femoral head necrosis in our hospital. The perioperative period, follow-up and imaging data of both sides were compared. [Results] All patients had opera- tion completed successfully. The VAS scores decreased significantly (P＜0.05) , while the hip flexor-extension range of motion (ROM) , inter- nal-external rotation ROM and Harris scores significantly increased on both sides over time (P＜0.05) . Although there was no significant dif- ference in VAS scores and Harris scores between the two sides at 6 months after surgery and the latest follow-up (P＞0.05) , the replacement side was significantly superior to the preservation side in terms of flexor-extension ROM and the internal-external rotation ROM postopera- tively (P＜0.05) . Radiographically, the perpendicular distance between ischial tuberosity connecting line and the tip of the lesser trochanter (PDIT) and femoral offset (FO) significantly increased in the hip replacement side (P＜0.05) at the latest follow-up, while which remained un- changed in the preservation side postoperatively compared with those preoperatively (P＞0.05) . There were no significant differences in PDIT and FO between the two sides at the latest follow-up (P＞0.05) . [Conclusion] One-stage hip replacement and hip preservation in the treat- ment of bilateral femoral head necrosis with different head collapse does achieve the comparable clinical outcomes on both side, which might delay or even avoid joint replacement on the side with slight head collapes.

Abstract:[Objective] To explore the design and surgical outcomes of 3D printed prosthetic reconstruction after en bloc resection of pri- mary malignant bone tumor in the extremities. [Methods] A total of 14 patients received en bloc resection and 3D printed prosthetic recon- struction of primary malignant long bone tumors on the shaft, including 10 cases of osteosarcoma, 2 cases of Ewing sarcoma and 2 cases of un- differentiated pleomorphic sarcoma in Enneking stage IIB. [Results] All the patients had the surgical procedures performed successfully without perioperative death, while with the operation time of (162.33±72.06) min, the intraoperative blood loss of (1 521.42±638.42) ml, the incision length of (20.50±5.69) cm, the time to take out stitches of (14.00±2.44) days, and the hospital stay of (19.00±2.10) days. All patients were followed up for (23.70±16.92) months an an average. Compared with that 3 months after operation, the VAS score significantly de- creased at 6 months after operation and at the last follow-up with statistical significances (P<0.05) . However, the MSTS 93 score for limb function and survival states remained unchanged significantly with time of the follow-up (P>0.05) . During the follow-up, 5 patients had pul- monary metastasis, 3 of them died of multiple metastasis and 2 survived with tumor, accounting for 35.71%, whereas the remaining 9 patients survived without tumor, accounting for 64.29%. [Conclusion] This individualized 3D printed prosthetic reconstruction is a sound choice for massive bone defect secondary to en bloc resection of primary malignant bone tumor on the shaft in the extremities.

Abstract:[Objective] To explore the clinical outcomes of microscope-assisted bilateral decompression via unilateral approach for de- generative lumbar stenosis. [Methods] A retrospective study was conducted on 40 consecutive patients who underwent microscope-assisted bilateral decompression and fusion via unilateral approach for single-segment degenerative lumbar stenosis from June 2018 to March 2019. The perioperative documents were collected, whereas the visual analogue scale (VAS) for leg pain, Oswestry disability index (ODI) score and modified Macnab criteria were used for evaluation of the clinical consequences. [Results] All the patients had operation performed smoothly without change of surgical plan, with operation time of (181.33±20.21) mins, and blood loss of (167.81±37.41) ml. Of them, 3 pa- tients got cerebrospinal fluid leakage due to dural sac tear, and 1 got nerve root outer membrane tear, which were not repaired during the op- eration without adverse consequences. Both the VAS and ODI scores decreased significantly over time (P＜0.05) . At the latest follow-up, the excellent and good rate of clinical outcomes were of 92.5% (37/40) based on the modified Macnab’s criteria. [Conclusion] The micro- scope-assisted bilateral decompression via unilateral approach is effective for degenerative lumbar stenosis with characteristic of minimally invasive surgery.

Abstract:[Objective] To investigate the clinical efficiency of unilateral biportal endoscopic (UBE) discectomy and annulus fibrosus su- ture for huge lumbar disc prolapse. [Methods] A retrospective study was performed on 31 patients who received UBE and annulus fibrosus suture for huge lumbar disc prolapse from September 2019 to September 2021. The perioperative period, follow-up and imaging data were evaluated. [Results] All the patients had operations performed successfully, and followed up for (13.74±5.23) months on an average. The VAS and ODI scores decreased significantly (P<0.05) , while the JOA score significantly increased over time (P<0.05) . At the latest followup, the clinical outcome was graded as excellent in 23 cases, good in 5 cases, fair in 3 cases according to the modified MacNab criteria, with the excellent and good rate of 90.32%. Radiographically, spinal canal area significantly increased (P<0.05) ; the intervertebral space height decreased, but which was not statistically significant (P>0.05) ; the Pfirrmann classification for disc degeneration significantly improved at 3 months postoperatively and latest follow-up compared with those preoperatively (P<0.05) . [Conclusion] The UBE discectomy and annulus fibrosus suture does effectively treat huge lumbar disc prolapse with satisfactory clinical results.

Abstract:[Objective] To provide imaging data for accurate puncture in percutaneous transforaminal endoscopic discectomy (PTED, TESSYSTM technique) for prolapsed lumbar disc herniation (LDH) . [Methods] A total of 78 patients who were undergoing PTED for pro- lapsed LDH were enrolled in this study from July 2014 to September 2021. Preoperative images were used to measure the width of interverte- bral foramen, safe horizontal distance, horizontal angle and head tilt angle during puncture. In addition, the imaging data were used to guide the puncture in real operation, and verified by the precise, efficiency and safety of the operation based on whether the expected puncture tar- get was reached. [Results] There was no significant difference in the width of intervertebral foramen among different prolapse extents (P＞ 0.05) , whereas which were of statistically significant difference among different levels in the same prolapse extent (P＜0.05) . The foraminal width was significantly ranked up- down as L_3/4＞L_4/5＞L₅S₁. However, there were no significant differences in the safe horizontal angle, the body surface distance between puncture point and spinous process in the same segment with different prolapse extents and in different seg- ments with the same prolapse extents (P＞0.05) . Applying the abovementioned imaging data as guide, all the patients achieved accurate tar- geted puncture point and had operation completed successfully. [Conclusion] The preoperative image measurement data are beneficial to develop personalized puncture planning and guide safe and accurate puncture during surgery.