Abstract:In the past ten years, many scholars in China, adhering to innovative spirit of the pioneers of Chinese microsurgery, have made huge breakthroughs and progresses in terms of hand microsurgery and replantation, research and application of new theories and tech- nologies of skin flaps, super microsurgical techniques, treatment of severe limb trauma, basic and reconstruction research of peripheral nerve injury, treatment of osteonecrosis, nonunion and bone defect, combination of new materials and microsurgery technology, and other specialties, such as maxillofacial surgery and craniocerebral neurosurgery. This paper focuses on the domestic research progresses of micro- surgery, closely follows the international frontiers of microsurgery, and briefly reviews the most advanced treatment concepts and advanced technologies of micro-reconstructive orthopaedics in the past ten years.

Abstract:[Objective] To compare the clinical efficacy of intramedullary nailing (IMN) versus minimally invasive percutaneous plate osteosynthesis (MIPPO) for humeral shaft fractures in the adult. [Methods] A retrospective study was done on 59 adult patients who re- ceived surgical treatment for humeral shaft fractures in our hospitals from January 1, 2016 to January 1, 2021. According to preoperative doctor- patient communication, 26 patients underwent IMN, while the remaining 33 patients had MIPPO used. The documents regarding perioperative period, follow-up and radiographs were compared between the two groups. [Results] All the patients in both groups had opera- tion performed successfully without radial nerve or musculocutaneous nerve paralysis after operation. There were no significant differences in terms of operation time, intraoperative blood loss, incision healing grade and hospital stay between the two groups (P>0.05) , however, the incision length was significantlly longer, and the number of intraoperative fluoroscopy and posteoerative drainage volume were significantly lower in MIPPO group than those in IMN group (P<0.05) . All patients in the two groups were followed up for more than 12 months. During the follow-up, revision surgery for fracture nonunion happened in 4 cases of the IMN group, while 0 case of the MIPPO group, which was statistically significant (P=0.035) . In addition, revision operation was performed for subacromial impingement in 5 cases of the IMN group, while 0 case of the MIPPO group, and the difference was statistically significant (P=0.013) . Shoulder lifting ROM and UCLA shoulder score significantly improved in both groups over time (P<0.05) . The MIPPO group proved significantly superior to the IMN group in terms of shoulder lifting ROM and UCLA shoulder score at all corresponding time points postoperatively (P<0.05) , however, there was no signifi- cant difference in elbow ROM and MEPS scores between the two groups (P>0.05) . Radiographically, there was no significant difference in fracture reduction quality after operation between the two groups (P>0.05) . However, the MIPPO group got fracture healing on images sig- nificantly earlier than the IMN group (P<0.05) . [Conclusion] In this study MIPPO achieves considerably better clinical outcome than the IMN in the treatment of adult humeral shaft fractures.

Abstract:[Objective] To investigate the clinical effect of ultrasound-guided closed reduction and fixation with modified mini-exter- nal fixator for unstable distal radius fractures in children. [Methods] From March 2017 to December 2020, 55 children with unstable frac- tures of the distal radius were enrolled in this study. According to doctor-patient communication results, 29 patients were treated with ultra- sound-guided closed reduction and fixation with modified mini-external fixator (the ultrasound group) , while the remaining 26 children were treated with traditional external fixator under fluoroscopy (the fluoroscopy group) . The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had operation performed smoothly. The ultrasound group proved significantly superior to the fluoroscopy group in terms of operation time, imaging exposure times, intraoperative blood loss and hospital stay (P<0.05) . In addition, the WB-faces pain scores in the ultrasound group were significantly lower than those in the fluoroscopy group at 1day and 3 days postoperatively (P<0.05) . All patients in both groups were followed up for (18.53±4.24) months on average, with no signifi- cant differences in the time to remove external fixator and the time to resume full weight-bearing activity between the two groups (P>0.05) . Compared with those 3 months after surgery, the extension-flexion range of motion (ROM) and ulnar -radial deviation ROM significantly in- creased in both groups (P<0.05) , the Gartland-Werlay scores also improved in both groups at the last follow-up whereas without statistical- ly significant differences (P>0.05) . However, there were no significant differences in the abovesaid indexes between the two groups at any corresponding time points (P>0.05) . Radiographically, there was no significant difference in fracture reduction quality between the two groups (P>0.05) . The PT, RI and RL in both groups were significantly improved after operation (P<0.05) , whereas no significant differenc- es in the above imaging parameters were noticed between the two groups at corresponding time points (P>0.05) . [Conclusion] The ultra- sound-guided closed reduction and fixation with modified mini-external fixator does achieve considerably better clinical outcomes over the fluoroscopic closed reduction and conventional external fixator for distal radial unstable fractures in children.

Abstract:[Objective] To compare the short- and medium-term clinical outcomes of anterior cruciate ligament (ACL) reconstruction with remnant preservation by suture anchor versus conventional ACL reconstruction without remnant preservation. [Methods] A retrospec- tive study was conducted on 51 patients who underwent arthroscopic ACL reconstruction from March 2019 to March 2021. According to pre- operative doctor-patient communication and intraoperative arthroscopic findings of ACL remnant, 25 patients received ACL reconstruction combined with remnant preservation (RP) by suture anchor tightening, while the other 26 patients had the conventional (CV) ACL recon- struction performed only due to poor remnant quality. The perioperative period, follow-up and imaging results were compared between the two groups. [Results] All the 51 patients underwent corresponding surgical procedures successfully without vascular or nerve injury. Al- though the RP group consumed significantly longer operation time than the CV group (P＜0.05) , the former returned postoperative ambula- tion significantly earlier than the latter (P＜0.05) . All the patients in both groups were followed up for (13.35±1.18) months on an average, and the RP group resumed full weight-bearing activity significantly earlier than the CV group (P＜0.05) . The pivot shift test and Lachman test significantly improved (P＜0.05) , while the Lysholm and IKDC 2000 scores significantly increased in both groups over time (P＜0.05) , regardless of no significant change in passive angle regeneration of the knee (P＞0.05) . At 3 months after operation, the RP group proved significantly superior to the CV group in terms of Lysholm and IKDC 2000 scores, as well as passive angle regeneration test (P＞0.05) , whereas which became not statistically significant at 6 months and 12 months after operation (P＞0.05) . Radiographically, there was no sig- nificant difference in the excellent rate of femoral and tibial tunnel location between the two groups (P＞0.05) . At 3 months after operation the RP group was significantly superior to the CV group in term of bone tunnel enlargement (P＜0.05) , but there was no significant differ- ence in bone tunnel enlargement and Kellgren- Lawrence grade between the two groups at 6 months and 12 months after operation (P＞ 0.05) . [Conclusion] Compared with the conventional ACL reconstruction, the remnant-preserving ACL reconstruction does achieve better knee function and proprioceptive recovery in short-term.

Abstract:[Objective] To compare the clinical outcomes of all anterior 2 portals in figure-4 position versus conventional 3 portals for location of tibial tunnel in arthroscopic posterior cruciate ligament (PCL) reconstruction. [Methods] A retrospective study was conducted on a total of 83 patients who received arthroscopic PCL reconstruction in our hospital from April 2018 to December 2020. According to the re- sults of preoperative doctor-patient communication, 29 patients had the tibial tunnel located by the 2-portal technique, while the remaining 54 patients were by the conventional 3-portal technique. The documents regarding to perioperative period, follow-up and radiographs were compared between the two groups. [Results] All the patients in both groups had PCL reconstructed successfully without serious complica- tions, such as neurovascular injuries. The 2-portal group proved significantly superior to the 3-portal group in terms of operation time, total incision length and intraoperative blood loss (P<0.05) , although there was no significant difference in the times of fluoroscopy, postopera- tive walking time, incision healing and hospital stay between the two groups (P>0.05) . In addition, there was no a significant difference in the time to return to full weight-bearing activity between the two groups (P>0.05) . The VAS, Lysholm, and IKDC scores improved signifi- cantly (P<0.05) , whereas knee extension-flexion range of motion (ROM) remained unchanged over time in both groups (P>0.05) . The pos- terior stability revealed by posterior drawer test at 90° of knee flexion significantly improved in both groups at 6 months postoperatively and the latest follow-up compared with those preoperatively (P<0.05) . However, there were no significant differences in VAS, Lysholm, and IK- DC scores, as well as knee ROM and consequence of posterior drawer test between the two groups at the corresponding time points (P> 0.05) . Radiographically, there were no significant differences in sagittal, coronal and axial position data of the internal opening of the tibial tunnel between the two groups (P>0.05) . The Kellgren-Lawrence grade for osteoarthritis remained unchange over time in the two groups (P>0.05) . [Conclusion] There is no significant difference in the location of the tibial tunnel between all anterior 2-portal technique in fig- ure-4 position and conventional 3-portal method in posterior cruciate ligament reconstruction. By contrast, the former has considerably less iatrogenic trauma than the latter.

Abstract:[Objective] To compare the clinical outcomes of arthroscopic reconstruction of the posterior cruciate ligament (PCL) through posterior double portals versus a single portal. [Methods] A retrospective study was performed on 74 patients who received ar- throscopic PCL reconstruction in our hospital between January 2018 and October 2019. According to the results of preoperative doctor-pa- tient communication, 36 patients had PCL reconstructed by double anterior portals combined with double posterior portal (the DP group) , while the remaining 38 patients were by double anterior portals combined with a single posterior portal (the SP group) . The documents re- garding perioperative period, follow-up and images were compared between the two groups. [Results] All the 74 patients had PCL recon- struction performed successfully without nerve or vascular injury. The DP group proved significantly superior to the SP group in terms of op- eration time and intraoperative fluoroscopy times (P＜0.05) , although there were no significant differences in total incision length, intraoper- ative blood loss, postoperative walking time, wound healing and hospital stay (P＞0.05) . All patients were followed up for more than 18 months, without a significant difference in the time of full weight-bearing activity between the two groups (P＞0.05) . The VAS, Lysholm, IK- DC scores, as well as knee extension-flexor range of motion (ROM) and posterior drawer test significantly improved in both groups over time (P＜0.05) . At 6 months and last follow-up, the DP group proved significantly superior to the SP group in terms of Lysholm and IKDC scores, regardless of the fact that there were no significant differences in VAS score, ROM, and posterior drawer test between them (P＞ 0.05) . Regarding imaging evaluation, the DP group was also better than the SP group in terms of coronal tibial tunnel deviation, the percent- age of slope tunnel position, and the vertical tibial tunnel deviation, whereas which were not statistically significant (P＞0.05) . The tibia pos- terior displacement distance measured at 90° flexion stress X-rays significantly reduced in both groups at 6 months after operation and at the last follow-up compared with those preoperatively (P＜0.05) , which was of no significant difference at any corresponding time points be- tween the two groups (P＞0.05) . [Conclusion] Arthroscopic PCL reconstruction through double posterior portals takes advantages of shorten- ing operation time, declining intraoperative fluoroscopy times and improving postoperative functional recovery over that through a single posterior portal.

Abstract:[Objective] To evaluate the clinical outcomes of locking-plate internal fixation with or without coracoclavicular ligament re- pair for Neer type II distal clavicular fractures by a meta- analysis. [Methods] The relevant literatures of the CNKI, Wanfang, VIP, SinoMed, Pubmed, Embase, Cochrane Library and Web of Science were searched. Subsequently, the data were extracted and a meta-analy- sis was conducted by using Review Manager 5.3 software. [Results] A total of 385 patients were enrolled involving 10 studies, including 191 patients in the unrepaired group and 194 patients in the repaired group. As results of the meta-analysis, the repair group had signifi- cantly longer operation time (MD=8.23, 95%CI 3.81~12.66, P＜0.001) , significantly larger amount of intraoperative blood loss (MD=18.81, 95%CI 13.79~23.83, P＜0.001) , whereas significantly higher Constant-Murley score (MD=7.92, 95%CI 3.53~12.30, P＜0.001) , and signif- icantly less postoperative coracoclavicular distance (MD=1.06, 95%CI 0.41~1.72, P＜0.001) than the non- repair group. However, there were no significant differences in UCLA score, DASH score, fracture healing time, and incidence of postoperative complications between the two groups (P＞0.05) . [Conclusion] The coracoclavicular ligament repair combined with locking- plate internal fixation does achieve considerably better clinical outcomes than the counterpart without coracoclavicular ligament repair for Neer type II distal clavicular frac- tures in terms of Constant-Murley score and coracoclavicular interval postoperatively, regardless of longer operation time and more intraop- erative blood loss.

Abstract:Multi-segmental lumbar disc herniation (msLDH) is a degenerative disease of more than two or three levels of lumbar disc, involving multiple nerve roots, and the best treatment for it remains controversial. Recently, percutaneous endoscopic lumbar discectomy (PELD) has been used for the treatment of msLDH, but the indications and efficacy of PELD remain unclear. In this paper, the clinical litera- ture on PELD used in the treatment of msLDH was summarized to provide a reference for the clinician.

Abstract:Endogenous neural stem cells (ENSCs) can differentiate into astrocytes, neurons and oligodendrocytes after spinal cord inju- ry (SCI) , and play an important role in nerve regeneration. The key to endogenous therapy is to induce its differentiation into specific nerve cells. In recent years, more and more ENSCs induction methods have been developed and applied to promote the formation of new neurons and oligodendrocytes to reduce the hindering effect of glial scar on repair. This paper reviews the recent progress of ENSCs in SCI repair.

Abstract:Hip arthroplasty has become a common surgical procedure in joint surgery for the treatment of fractures involving the hip, moderate to severe osteoarthritis, bone tumors, congenital dysplasia and so on. With the continuous maturation of hip replacement tech- nique and improvement of prosthetic materials, the stability of the artificial joint has improved greatly, whereas wear of the prosthesis is de- creasing. However, postoperative complications such as wear and loosening of the prosthesis are inevitable due to the relative movement be- tween prosthetic components and electrolysis and degeneration of the materials, as well as the improper placement of the prosthesis. Liner separation is an extremely rare postoperative complication, and research on the mechanism of occurrence, diagnosis and treatment of liner separation is even rarer, with its diagnosis mainly focused on X-ray. This article reports a case of a patient with a separated liner that is not easily diagnosed definitively, with a review of relevant literature about this catastrophic complication.

Abstract:Developmental dysplasia of the hip (DDH) is one of the most common congenital malformations, with extensive anatomical abnormalities of the hip, characterized by mild or incomplete formation of the acetabulum, leading to secondary deformities of the proximal femur and non-recoverable dislocation of the hip, which is a major cause of hip osteoarthritis in adults. Although some genetic and environ- mental factors have been considered related to the DDH, the definite pathogenic gene and pathogenesis of DDH remain unclear. Active clin- ical studies began in the 1950s, involving Graf static ultrasound and Harcker dynamic ultrasound to provide a further understanding of DDH, while genetic research began in the early 2000 s. In this paper, we conducted a PubMed MeSH search for "developmental hip dyspla- sia" / " congenital " / " genetics " / " genes "to review the research and progress of DDH susceptibility genes.

Abstract:[Objective] To explore the biomechanical difference of human tibial fracture under static loading and impact loading. [Methods] Twenty fresh human tibia specimens were randomly divided into two groups, with 10 tibia in each group, 5 of the left side and 5 of the right side. Static axial loading and dynamic impact axial loading were applied respectively to measure the mechanical parameters. [Results] As result of static test, the yield load, yield displacement, ultimate load and ultimate displacement of the left tibia were significant- ly higher than those of the right tibia (P＜0.05) . However, in the dynamic impact group, 10 specimens were tested at impact velocity of 2.5 m/s, impact height of 32 cm, and drop weight of 40 kg, and the results showed that there were no significant differences in acceleration, im- pacting extreme load, dynamic deformation and load time pulse width between the left and right tibia specimens in dynamic impact test (P＞ 0.05) . In term of comparison of two loading state, the dynamic impacting loading had significantly greater ultimate load than the static load- ing (P＜0.05) , similarly, the dynamic impacting loading got significantly greater displacement than the static loading (P＜0.05) . [Conclusion] Compared with the static axial loading, the dynamic impact loading has significantly greater ultimate load and ultimate displacement of tibia specimens.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopic figure 8 double-row knot- less anchors for massive rotator cuff tears. [Methods] A total of 24 patients received abovementioned arthroscopic repair of massive rotator cuff tears. Firstly, two anchor on the internal row were placed on proper position on the conjunction of lateral cartilage border and rotator cuff foot print after arthroscopic debridement. Furthermore, the free ends of the eight sutures were crossed through the torn rotator cuff ten- don by a suture hook or a thread crosser without tying. Moreover, the 8 sutures were pull to reduce the end of torn rotator cuff to the original foot print and fastened on the outer humeral greater tuberosity by two knotless anchors to cover the torn rotator cuff evenly. [Results] All the 24 patients underwent endoscopic repair successfully, with no serious complications. With time of follow-up lasted for 12~36 months, the VAS, UCLA and Constant-Murley scores significantly improved compared with preoperative scores (P＜0.05) . Radiographs showed no sig- nificant narrowing or degenerative changes in the subacromial and glenohumeral spaces. [Conclusion] The arthroscopic figure 8 doublerow knotless anchors for massive rotator cuff tears do significantly improve shoulder joint function, and get satisfactory clinical outcomes in short-term.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopic repair of medial patellofemo- ral ligament (MPFL) torn on patellar attachment secondary to acute patellar dislocation (APD) . [Methods] From May 2015 to September 2019, 30 patients with MPFL torn on patellar attachment secondary to APD received aforesaid arthroscopic repair. Two suture anchors were inserted on the medial edge of the patella, and then lumbar puncture needles punctured percutaneously, to pass through the femoral side MP- FL parallelly to the joint cavity. After that, the sutures attached on anchors were introduced out the skin on the medial side by loops through the lumbar puncture needles. Under arthroscopic vision, the sutures were tightened, and the patella track was evaluated, lateral retinacular release was added if necessary. As proper patella track achieved, the sutures were tied at last. [Results] All patients were successfully operat- ed on without serious complications such as nerve and vascular injury, and followed up for (26.10±9.70) months on average. By the time of the latest follow-up, all the patients got normal range of motion of the knee with no recurrent patellar dislocation and stiffness or dysfunction of the knee. The Lysholm score, patellar tilt angle (PTA) and patellofemoral congruence angle (CA) improved significantly in the latest fol- low-up compared with those preoperatively (P＜0.05) . [Conclusion] This arthroscopic repair of MPFL torn on patellar attachment secondary to acute patellar dislocation does restore the patellofemoral stability and function, and is an effective treatment.

Abstract:[Objective] To evaluate the clinical outcomes of abduction push-top manipulation (APT) versus hand-pull and foot-push manipulation (HPFP) for reduction of anterior shoulder dislocation. [Methods] From May 2017 to November 2021, 126 patients with anteri- or dislocation of shoulder joint were treated with manual reduction. Of them, 57 patients received APT, while the remaining 69 patients un- derwent HPFP. The clinical consequences were evaluated and compared between the two groups. [Results] The success rates of reduction at the first time was 89.5 % in the APT group, whereas 85.5 % in the HPFP group, which was not statistically significant (P>0.05) . Howev- er, the APT group proved significantly superior to the HPFP group in term of ASES score immediately after reduction (P<0.05) , despite of the fact that no a significant difference in term of VAS score was noticed between the two groups (P>0.05) . As time went during the follow up lasted for more than 12 weeks, the VAS and ASES scores significantly improved in both groups (P<0.05) , whereas which were not statis- tically significant between the two groups at any matching time points (P>0.05) . None re- dislocation was found in anyone of the both groups during the follow-up. [Conclusion] Although the success rate of reduction at the first time is similar between the two manipulations, the APT achieves better shoulder function recovery immediately after reduction than the conventional HPFP maneuver.

Abstract:[Objective] To explore the clinical outcomes of anterior-posterior placement of cannulated lag screw for internal fixation of posterior malleolus fracture fragment in ankle injuries. [Methods] From June 2015 to September 2020, a total of 53 patients, including 24 males and 29 females, received anterior-posterior placement of cannulated lag screw for internal fixation of posterior malleolus fracture frag- ment complicated in ankle injuries in our hospital. The clinical and imaging results were evaluated. [Results] All the patients had operation performed smoothly with operation time of (87.23±9.50) min, and intraoperative blood loss of (105.25±21.60) ml, and then resumed full weight-bearing activity in (2.08±0.78) months on an average postoperatively. As time went during the follow up lasted for a mean of (13.57± 4.08) months, the VAS scores significantly decreased (P＜0.05) , while AOFAS scores and ankle dorsal extension- plantar flexion range of motion (ROM) significantly increased (P＜0.05) . Radiographically, postoperative images showed satisfactory fracture reduction achieved in all the patients, with significantly declined displacement distance of articular surface compared with that before surgery (P＜0.05) . Accord- ing to Burwell-Charnley criteria, 47 patients were marked as anatomic fracture reduction, while the remaining 6 patients as acceptable re- duction. By the time of last follow-up, all patients got fracture union with the joint degeneration of grade 0 in 45 cases, grade 1 in 5 cases, and grade 2 in 3 cases in term of Kellgren-Lawrence classification. [Conclusion] This anterior and posterior placement of cannulated screws does firmly fix the posterior malleolus fracture fragment in ankle injuries, which minimizes the iatrogenic trauma and is beneficial to postoperative recovery.

Abstract:[Objective] To investigate the clinical outcomes of arthroscopic repair with single row anchors for large rotator cuff tears. [Methods] A total of 24 patients underwent arthroscopic repair with single row metal anchors for large rotator cuff tears 3 to 5 cm in size from January 2019 to June 2020. The perioperative and follow-up documents were evaluated. [Results] All the patients were operated on smoothly without intraoperative neurovascular injuries, whereas with operation time of (68.22 ± 16.67) min, intraoperative blood loss of (15.09±4.27) ml, implant used of (2.94±0.23) anchors, and well incision healing. Of them, 22 patients were followed up for (18.87±4.99) months, with the time to resume full weight bearing activity of (3.83±1.02) months. The VAS and UCLA scores significantly improved at the latest follow up compared with those preoperatively (P＜0.05) . All the patients recovered well in term of shoulder function without night pain. MRI showed excellent rotator cuff healing without pullout of the anchor in all the patients, except 2 patients who were found retear of the rotator cuff. [Conclusion] Arthroscopic repair with single row anchors for large rotator cuff tear has the advantages of simplifying opera- tion, shortening operation time, satisfactory outcome, decreasing financial cost and declining the learning curve.

Abstract:[Objective] To evaluate the accuracy of knee space rotary compression test by compared with traditional physical examina- tion. [Methods] A total of 150 patients (163 knees) who underwent arthroscopic knee surgery from February 2020 to June 2021 were en- rolled in this study. As the results of arthroscopy were used as the final diagnostic criteria, the sensitivity and accuracy of the joint space ro- tary compression test, joint space tenderness test, passive hyperextension and flexion test, McMurray test and Apley grinding test were com- pared in the diagnosis of meniscus injury. [Results] Among the 5 physical examination tests, the rotary compression test with sensitivity (93.75%) , negative predictive value (75.76%) and accuracy (88.96%) proved significantly superior to the other 4 examination test sensitivi- ty (P＜0.05) . The sensitivity of rotary compression test in term of different meniscus parts, was of 90.48% for the anterior horn and anterior junction, 95.74% for the body, 87.69% for the posterior horn and posterior junction, and 93.75% for compound tear with more than 2 inju- ries simultaneously. [Conclusion] The knee space rotary compression test has high sensitivity and accuracy in the diagnosis of meniscus in- jury.

Abstract:[Objective] To observe regenerative capacity of the residual peroneus longus tendon secondary to anterior half tendon har- vested by magnetic resonance image. [Methods] A total of 19 patients had anterior half peroneus longus tendon harvested for single-bundle anterior cruciate ligament reconstruction. Magnetic resonance examinations were performed regularly before operation, the next day after op- eration, 1 month, 3 months, 1 year and 2 years after operation to obtain their magnetic resonance imaging data. The Dicom format images ob- tained were imported into RadiAnt DICOM Viewer software, and the tendon points were located using the software to obtain axial images at 2cm to the distal and proximal ends of the tendon harvested, and the cross- sectional area of the peroneus longus tendon was measured, Compared with the cross-sectional area of peroneus longus tendon at the same level before operation, its regeneration was analyzed. [Results] All the patients remained good continuity of the residual peroneus longus tendon without rupture on MRIs. At 3 months after opera- tion, the residual ligament harvested at the proximal end regenerated rapidly, up to 85% of the original cross sectional area, while which at the distal end was also thickened. At 1 year after operation, the proximal and distal ends of the tendon harvested were thickened significant- ly, exceeding the preoperative level, and basically recovered to the preoperative level at 2 years after operation. [Conclusion] The residual peroneus longus tendon has a strong regenerative capacity, therefor the anterior half of the tendon is suitable tendon autograft for clinical needs.

Abstract:[Objective] To evaluate the significance of enhanced recovery after surgery (ERAS) applied by a team integrated with sur- geon, nurse and rehabilitator in perioperative period of total knee arthroplasty (TKA) for rheumatoid arthritis. [Methods] From November 2019 to September 2021, 84 patients received TKA for rheumatoid arthritis, and were divided into two groups by random number table method. The ERAS was used in 42 cases, while conventional treatment was used in the other 42 cases. The early clinical and laboratory da- ta were compared between the two groups. [Results] The ERAS group prove sifnificanlty superior to the conventional group in terms of the time of getting out of bed and hospital stay (P<0.001) . The ERAS group was significantly superior to the conventional group in terms of HSS scores at 2 weeks, 6 weeks and 6 months after surgery (P<0.05) , VAS scores at 2 and 6 weeks postoperatively (P<0.05) . In terms of blood testing, the ERAS group had significantly lower levels of D-D, FIB, ESR and CRP at 1 and 3 days postoperatively. [Conclusion] The integrated ERAS does significantly relieve perioperative pain, accelerate knee functional recovery, improve clinical coagulation and inflam- mation markers, and shorten hospitalization time in TKA for rheumatoid arthritis.