Abstract:[Objective] To investigate the clinical outcomes of minimally invasive plate osteosynthesis (MIPO) with a large distractor for type II and III Pilon fractures. [Methods] A retrospective study was done on 48 patients who underwent surgical treatment for type II and III Pilon fractures in our hospital from March 2017 to April 2020. According to the consequence of preoperative doctor-patient commu- nication, 28 patients were treated with MIPO using a large distractor (the distractor group) , while the remaining 20 patients were treated with conventional open reduction and internal fixation (ORIF) (the conventional group). The perioperative, follow- up and imaging docu- ments were compared between the two groups. [Results] All patients in both groups had operation completed successfully. The distractor group proved significantly superior to the conventional group in terms of operative time, intraoperative blood loss, fluoroscopy times and in- cision length (P＜0.05) , but there was no significant difference in incision healing grade and hospital stay between the two groups (P＞0.05) . At the latest follow up lasted for more than 12 months, the VAS scores significantly decreased (P＜0.05) , while the AOFAS score and ROM significantly increased in both groups compared with those preoperatively (P＜0.05) . However, there were no statistical significances in the above items between the two groups at any corresponding time point (P＞0.05) . Radiographically, there was no significant difference in frac- ture reduction quality between the two groups according to Burwell-Charnley's criteria (P＞0.05) . In addition, there was no significant dif- ference in fracture healing time on images between the two groups (P＞0.05) . [Conclusion] The MIPO with a large distractor for Pilon frac- ture has the advantages of short operation time, small incision, less intraoperative fluoroscopy and less blood loss.

Abstract:[Objective] To compare the effects of oral versus intravenous tranexamic acid (TXA) on reducing bleeding in unicompart- mental knee arthroplasty (UKA) . [Methods] From June 2020 to June 2021, a total of 61 patients who were undergoing UKA for medial knee osteoarthritis in our hospital were enrolled into this study, and were divided into two groups by random number table method. Of them, 30 patients received oral TXA (the oral group) , while the other 31 patients had TXA intravenously in UKA (intravenous group) . The data re- garding to clinical outcome in perioperative period and blood tests were compared between the two groups. [Results] All the patients had op- erations completed smoothly with no serious complications during operation. There were no significant differences in terms of operative time, total incision length, intraoperative blood loss, postoperative drainage volume, total blood loss, dominant blood loss, hidden blood loss, blood transfusion rate, time to resume walking, incidence of symptomatic thrombosis, incision healing, hospital stay, hospitalization cost and incidence of complications between the two groups (P＞0.05) . The hemoglobin (Hb) was significantly decreased in both groups from 1 to 3 days after surgery (P＜0.05) . Likewise, the hematocrit (Hct) also declined from 1 to 3 days postoperatively, which proved statistically sig- nificant in the in the oral group (P＜0.05) , whereas not statistically significant in the intravenous group (P＞0.05) . There was no statistical significance in HB and Hct between 2 groups at any corresponding time points (P＞0.05) . In terms of ultrasound examination, there was no significant difference in the incidence of intramuscular venous thrombosis postoperatively between 2 groups (P＞0.05) . [Conclusion] Both oral administration and intravenous administration of TAX have similar effects on perioperative blood loss, transfusion rate and incidence of venous thrombosis in UKA.

Abstract:[Objective] To investigate the mid-term clinical outcomes of medial patellofemoral ligament (MPFL) reconstruction for re- current patellar dislocation (RPD) accompanied with femoral trochlear dysplasia (FTD) . [Methods] A retrospective study was conducted on 22 patients (26 knees) who received double-bundle MPFL reconstruction for RPD accompanied with FTD from January 2013 to December 2016 in our hospital. According to Dejour classification preoperatively, 10 patients were fall in the mild FTD group, while the remaining 12 patients were in the severe FTD group. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups were operated on successfully without serious complications. There were no significant differences in operative time, incision length, intraoperative blood loss, fluoroscopy times and hospital stay between the two groups (P＞0.05) . The follow-up period lasted for (5.23±0.86) years on an average. There was no significant difference in the time to resume complete weight-bearing activity be- tween 2 groups (P＞0.05) . The VAS scores decreased significantly (P＜0.05) , while Kujala score, Lysholm score and Tegner score were sig- nificantly increased in both groups over time (P＜0.05) . At any corresponding time points, there was no statistically significant difference in the above scores between the two groups (P＞0.05) . Radiographically, no significant changes in TT-TG, lateral trochlear inclination, trochle- ar facet asymmetry, trochlear depth and Caton-Deschamps index were found in both groups at the latest follow-up compared with those pre- operatively (P＞0.05) . [Conclusion] MPFL reconstruction does achieve satisfactory mid-term clinical outcomes for RPD, which is not im- pacted remarkably by FTD.

Abstract:[Objective] To explore the relationship between synovial cytokines, including ghrelin and interleukin-1β (IL-1β), and the prognosis of arthroscopic repair for rotator cuff tear (RCT) . [Methods] A total of 80 patients who underwent arthroscopic repair for RCT in the hospital were prospectively enrolled into this study from June 2019 to June 2020. Based on Neer score at 6 months postoperatively, the patients were divided into the good outcome group and poor outcome group. The preoperative factors impacted on the prognosis were searched by using univariate comparison and binary multivariate logistic regression. In addition, ROC analysis was performed on the preop- erative synovia cytokines and the outcomes. [Results] At the latest follow-up, 58 patients were divided into the good group, while the re- maining 22 patients fall in the poor group. The good group had significantly higher preoperative synovial ghrelin, while significantly lower synovial IL-1β than the poor group (P＜0.05) . The Neer scores at the latest follow-up in 80 patients was significantly positively correlated with preoperative synovial fluid ghrelin (P＜0.05) , whereas significantly negatively correlated with preoperative synovial fluid IL- 1β (P＜ 0.05) . As results of the binary multivariate logistic regression analysis, preoperative high expression of synovial ghrelin was a protective fac- tor for poor clinical outcome (OR=0.276, P＜0.05) , whereas the high expression of IL-1β was a risk factor for poor clinical outcome (OR= 1.142, P＜0.05) . In addition, the ROC analysis showed that preoperative synovial ghrelin, IL-1β detected individually and the combination had significant value of predicting poor clinical outcome. [Conclusion] The preoperative synovial cytokines might be meaningful indicators for judging the prognosis of RCT arthroscopic treatment.

Abstract:

[Objective] To investigate the early evolution process of hip development in premature newborn and infants. [Methods] A prospective study was conducted on 4102 neonates who were born in Yangzhou Maternal and Child Health Hospital from January 2019 to June 2021. Graf hip ultrasound was conducted at 1, 7, 42 and 90 days after birth to observe the early development and conversion of the hip. [Results] According to the diagnostic criteria of premature neonate, 393 cases were of the premature, accounting for 9.58%, whereas 3709 cases were of the normal term neonates, accounting for 90.42%. The premature had significantly lower body weight (P<0.05) , and sig- nificantly higher ratios of multiple births, maternal hypertension and placenta previa than the mature (P<0.05) . At the 1 and 7 days after birth, the premature group had significantly higher proportion of Graf type I hip than the mature group (P<0.05), whereas which became not statistically significant between the two groups at 42 and 90 days after birth (P>0.05) . With the increase of postnatal age, the α angle signif- icantly increased (P<0.05) , while the β angle significantly decreased in both groups (P<0.05) . At all matching time point after birth, the premature group had significantly greater α angle, while significantly less β angle than mature group (P<0.05) . Among the 393 preterm in- fants, 32 were of early preterm (28~31 w) , 64 were intermediate preterm (32~33 w) , and 297 were late preterm (34~36 w) . At 1 and 7 days after birth, late preterm group had significantly lower proportion of Graf type I hip than the early preterm group and the intermediate pre- term group (P<0.05) , whereas which turned to be not statistically significant at 42 days after birth in Graf grades of the hip among the three groups (P>0.05) . [Conclusion] The preterm neonates have higher proportion of Graf type I hip than the matures, additionally, 42 days after birth is a reasonable time for the first screening of preterm neonates.

Abstract:[Objective] To explore the safety and effectiveness of 3D printed guider assisted pedicle screw placement in corrective oste- otomies for kyphotic deformity secondary to ankylosing spondylitis (AS) . [Methods] A retrospective analysis was performed on 70 patients who underwent surgical correction for kyphotic deformity secondary to AS in our hospital from June 2014 to December 2019. According to the preoperative doctor-patient communication results, 38 patients received corrective osteotomies with 3D printed guiders assisted pedicle screw placements (the 3D group) , while the other 32 patients underwent surgical procedures with pedicle screw placement with the conven- tional freehand technique (the freehand group) . The documentations regarding to perioperative conditions, follow-up indicators and imag- ing results were compared between the two groups. [Results] All the patients in both groups had operation performed successfully without serious complications. The 3D group proved significantly superior to the freehand group in terms of operation time, intraoperative blood loss, postoperative drainage, intraoperative X-ray frequency and hospital stay (P＜0.05) . Although no complications, such as deep infection and symptomatic thrombosis, occurred in the two groups, incision hematoma was noted in 1 case of the 3D group and 2 cases of the free- hand group, while nerve root injury was seen in only 1 case of the freehand group, all of which were subsided after corresponding treatment. All patients were followed up for 12~43 months, with an average of (22.47±5.84) months. The 3D group resumed walking and full weightbearing activity significantly earlier than the freehand group (P＜0.05) . The body height, sitting height and JOA scores significantly in- creased in both groups (P＜0.05) , whereas the VAS and ODI scores significantly decreased in both groups at the latest follow-up compared with those before operation (P＜0.05) . At the latest follow-up, the 3D group was significantly superior to the freehand group in abovemen- tioned items (P＜0.05) . Radiographically, the 3D group got significantly better accuracy of screw placement than the freehand group (P＜ 0.05) . The sagittal kyphotic Cobb angle and the sagittal C7PL deviation significantly reduced in both groups postoperatively compared with those preoperatively (P＜0.05) , which proved significantly better in the 3D group than the freehand group at the last follow-up (P＜0.05) .[Conclusion] Application of 3D printed guider in corrective osteotomies for kyphotic deformity secondary to AS does significantly improve the efficiency and accuracy of screw placement, and improve the clinical results.

Abstract:[Objective] To investigate the causes and outcomes of revision surgery within 10 days secondary to primary lumbar instru- mented fusion. [Methods] From January 2015 to August 2020, 1412 patients who underwent lumbar fixation fusion were reviewed. Among them, 26 patients underwent revision surgery in 10 days after the primary operation. The reasons for revision were recorded, and the pa- tients were divided into two groups according to whether nerve symptom deteriorated. The general condition, surgical data, VAS, JOA and ODI scores of the revised patients were compared. [Results] Among 1412 patients who underwent lumbar instrumented fusion, 26 patients (1.84%) received revision surgery within 10 days, including 11 males and 14 females aged ranged from 40 to 80 years, with an average of 58.58±8.33 years. In term of revision reasons, screw misplacement occurred in 11 cases (42.31%) , decompression incomplete in 5 cases (19.23%) , postoperative infection in 4 cases (15.38%), displacement of the fusion cage in 2 cases (7.69%) and poor wound healing in 4 cas- es (15.38%) . Among the 26 patients, 18 cases (69.23%) showed aggravation of nerve damage (the AND group) , mainly due to screw mis- placement and incomplete decompression, while 8 cases (30.77%) had no aggravation of nerve damage (the non-AND group) . The non- AND group proved significantly higher accuracy of screw placement in primary surgery than the AND group (P＜0.05) . The VAS, ODI and JOA scores varied in curve manner over time in both groups, which were statistically significant (P＜0.05) . At the latest follow-up, the non- AND group proved significantly superior to the AND group in terms of VAS, JOA scores and ODI scores (P＜0.05) . With regard to correla- tion analysis, there were no correlations between the time elapsed from primary to revision surgeries and the clinical VAS, ODI and JOA scores at the latest follow-up (P＞0.05) . [Conclusion] The screw misplacement and incomplete decompression are the main causes of early revision surgery, while aggravation of nerve damage after lumbar instrumented fusion has worse prognosis than other complications. Accu- rate screw placement and adequate intraoperative decompression are important to reduce the rate of early revision and the incidence of post- operative nerve injury complications.

Abstract:Delirium is a common perioperative complication in elderly patients with femoral neck fractures, which is currently be- lieved due to multiple factors and closely related to adverse outcomes. Many clinical evidences have showed that benzodiazepines induces delirium by non- specific activation of GABAA receptors, however, the perioperative delirium induced by benzodiazepines in elderly pa- tients with femoral neck fractures has not been paid enough attention. In order to provide a reference for perioperative management of elder- ly patients with femoral neck fractures, this paper reviews the pathophysiological mechanism of delirium, the relationship between benzodi- azepines and delirium, the causes of delirium in elderly patients with femoral neck fractures and prevention strategies.

Abstract:[Objective] To explore the impacts of methylene blue (MB) , a cationic dyes usually used as tracer agent for periprosthetic joint infection, on the culture results of different bacteria in vitro. [Methods] Eight standard bacterial strains were prepared in vitro, includ- ing staphylococcus aureus (SAU) , staphylococcus epidermidis (SEP) , staphylococcus hominis (SHO) , escherichia coli (ECO) , klebsiella pneumoniae (KPN) , bacterial suspensions of acinetobacter baumannii (ABA) , streptococcus pyogenes (SPY) and candida albicans (CAL) , for simulation of bacterial culture of synovial fluid. The bacterial suspensions of all the standard bacterial strains were diluted 50 times and divided into three groups with 5 samples in each group, and then treated with 0.1%MB and 0.05%MB and 0.45% sterile saline, respective- ly. The colony count was compared among the 3 groups. [Results] The colony counts of SHO and ABA strains were ranked from low to high in sequence of 0.1%MB group ＜0.05% MB group ＜ saline group, with a statistically significant difference (P＜0.05) . However, there were no significant differences in colony counts in terms of SEP, ECO, KPN, SPY and CAL among the 3 groups (P＞0.05) . As results of Spear- man correlation analysis, the MB concentration was significantly negatively correlated with SHO and ABA colony counts (P＜0.05) , whereas which had no correlation with colony counts of SAU, SEP, ECO, KPN, SPY and CAL (P＞0.05). [Conclusion] The MB has dose-dependent inhibitory effect on SHO and ABA, but has no effect on the other 6 bacterial strains.

Abstract:

[Objective] To investigate the difference of gut microbiota between knee osteoarthritis (KOA) and normal control in rabbits. [Methods] A total of 20 Japanese white rabbits were randomly divided into 2 groups, of them, 12 animals were injected 2% papain solution intraarticularly to prepare KOA model, while the other 8 rabbits were injected normal saline intraarticularly as normal control. Fecal sam- ples were collected and detected by 16S rRNA gene targeted sequencing technology to analyze the diversity and distribution of gut microbio- ta in their feces. [Results] The KOA group had a total of 20 188 species (ASV/OTU) , while the control group was of 14 029 species (ASV/ OTU) . The fecal flora in KOA group was significantly more abundant than that in the control group in levels of phylum and genus (P< 0.05) , but there were no statistical significant differences in the levels of class, order, family and specie between the two groups (P>0.05) . The KOA group had the greatest number of firmicutes and bacteroides at phylum level, and ruminococcus and spironella flutter at genus lev- el, with an obvious marker species of proteus. The gut microbiota was closely related to metabolic pathways, especially carbohydrate metab- olism, amino acid metabolism, cofactor and vitamin metabolism. [Conclusion] There are some differences in gut microbiota between KOA group and control group, and proteus is the marker species.

Abstract:[Objective] To investigate the effects of inorganic polyphosphate (Poly P) on the proliferation and energy metabolism of ten- don stem cells in vitro. [Methods] Rat tendon stem cells were isolated and cultured, their surface molecules were identified by flow cytome- try, and then treated with 0 mmol/L, 0.5 mmol/L, and 1.0 mmol/L Poly P. The Ckk-8, cell cycle and ATP energy assays were performed. In addition, the immunofluorescence and western blot assays were used to detect the expression of type I collagen. [Results] The flow cytome- try showed that ＞ 95% of the isolated cells expressed CD44 and CD90.1, but almost no CD45 and CD106. In term of Ckk-8 assay, the OD values of in all groups increased significantly over time (P＜0.05) , which increased significantly in Poly P concentration-dependent manner, with statistically significant differences among the three groups from 4 to 24 hours (P＜0.05) . The flow cytometry revealed that Poly P in- creased the percentage of G2+S phase and promoted cell proliferation in dosage-dependent manner with a statistically significant differenc- es (P＜0.05) . In terms of ATP detection, the ATP detection in the three Poly P groups increased significantly over time (P＜0.05) , which sig- nificantly increased in Poly P concentration-dependent manner with statistically significant differences among the three groups from 4 to 24 hours (P＜0.05) . Regarding to type I collagen presentation, the immunofluorescence staining showed that the fluorescence intensity of type I collagen increased significantly with the increase of Poly P concentrations, additionally, Western blot analysis showed that the expression of type I collagen in 0.5 mmol/L and 1.0 mmol/L Poly P group was significantly increased compared with that in 0 mmol/L Poly P group (P＜ 0.05) . [Conclusion] Poly P does promote the proliferation of rat tendon stem cells by up-regulating the expression of type I collagen and ATP production in vitro.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of intramedullary nailing via infrapatellar approach in lateral position for fixation of tibial shaft fractures. [Methods] From June 2015 to September 2019, a total of 103 patients un- derwent closed reduction and internal fixation for tibial shaft fracture. The patient was placed in lateral decubitus, and the affected knee was positioned in 90 degrees of flexion. Under axial traction, the fractures were closely reduced manually. An infrapatellar incision was made, and then the patellar tendon was split longitudinally to expose the proximal tibia. As a guide pin was inserted into the medullary cavi- ty from the proximal tibia, reaming was conducted and a main nail in proper size was inserted following the guide pin. After satisfactory frac- tures reduction and proper position verified fluoroscopically, the guide pin was removed, and interlocking screws were placed distally and proximally. [Results] All patients were successfully operated on without serious complications such as vascular and nerve injury, whereas with intraoperative fluoroscopy of (10.80±2.43) times, successful guide pin placement in the first time in 84 cases (81.55%) , operation time of (72.98±14.21) min. The patients got clinical fracture healing in (14.03±5.98) weeks, with LEFS score of (77.19±2.39) 12 months after op- eration. Of them, 17 case had anterior knee pain and 5 had malunion, whereas none of deep infection and fracture nonunion was noted at the latest follow up. [Conclusion] Intramedullary nailing via infrapatellar approach in lateral position for tibial shaft fractures is a comfort- able position with advantages of convenience to intraoperative fluoroscopy, shortening operation time and reducing number of assistants.

Abstract:[Objective] To compare the clinical outcomes of interlocking versus parallel cannulated screws for internal fixation of Gar- den type I and II femoral neck fractures. [Methods] A retrospective study was done on 26 patients who received closed reduction and inter- nal fixation for Garden type I and II femoral neck fractures from January 2015 to December 2016 in our department. Of them, 12 patients had 3 cannulated screws placed interlocking each other (the interlocking group), while the remaining 14 patients had 3 cannulated screws inserted parallelly (the parallel group) . The clinical and imaging data were compared between the two groups. [Results] All patients in both groups had operation completed successfully without serious complications. There were no significant differences in operative time and in- traoperative fluoroscopy times between the two groups (P＞0.05) . All patients were followed up for more than 12 months. The interlocking group proved significantly superior to the parallel group in terms of time to resume full weight-bearing activity and Harris score at the last follow-up (P＜0.05) . Radiographically, the interlocking group had significantly less femoral length loss, femoral head offset loss, femoral neck shortening and screw withdrawal than the parallel group at 12 months postoperatively (P＜0.05) . [Conclusion] The cannulated screws placed in interlocking manner for internal fixation of Garden type I and II femoral neck fractures do effectively control femoral neck shorten- ing, reduce screw withdrawal, and improve hip function recovery.

Abstract:[Objective] To evaluate the efficacy of valgus osteotomy for the treatment of Pauwels type III old femoral neck fracture in children. [Methods] From 2016 to 2021, 4 patients with Pauwels TYPE III old femoral neck fracture were treated with valgus osteotomy of proximal femur with internal fixation by locking compression pediatric hip plate (LCP-PHP) . The clinical and imaging documents were summarized. [Results] All the 4 patients were successfully operated on with operation time of (161.25 ± 51.05) min, incision length of (10.75±2.98) cm, intraoperative blood loss of (192.50±86.94) ml, and primary healing of the incision. All patients had unilateral spica cast as external fixation for 6 weeks after surgery. The patients resumed actively affected limb motion without weight bearing one month after the cast removed, and then full weight-bearing activity 3 months later. All the patients were followed up for 9~23 months, with an average of (18.50±6.45) months. During the follow-up, there was no reinjury or revision surgery in anyone of them. The VAS score significantly de- creased (P＜0.05) , while Harris score and hip flexion-extension range of motion (ROM) significantly increased at the latest follow up com- pared with those preoperatively (P＜0.05) . At the latest follow up, all the 4 patients recovered normal walking without obvious claudication, whereas with normal squatting activities, and resumed normal daily life activity and sports capacity. [Conclusion] Valgus osteotomy is an ef- fective treatment for old femoral neck fracture in children.

Abstract:[Objective] To evaluate the clinical outcomes of total hip arthroplasty (THA) in the treatment of failed intramedullary fixa- tion for femoral intertrochanteric fractures. [Methods] A retrospective study was conducted on 21 patients (21 hips) who underwent THA in our department for failed proximal femoral nail anti-rotation (PFNA) fixation of femoral intertrochanteric fractures from June 2014 to De- cember 2019. The perioperative and follow-up documents were summarized. [Results] All the patients were operated on smoothly without serious complications, such as vascular and nerve damage during the operation, whereas with operation time of (153.53±12.45) min, intraop- erative blood loss of (400.52±45.97) ml, blood transfusion of (250.65±66.82) ml, and well incision healing. As time went during the followup period lasted for (20.70±6.90) months on average, both the Harris and SF-12 scores increased significantly (P＜0.05) . No serious late complications, such as periprosthetic fracture, periprosthetic joint infection, as well as aseptic loosening, periprosthetic osteolysis and het- erotopic ossification seen on images were noticed in anyone of them to the latest follow up. [Conclusion] THA is effective treatment to save joint function and improve the quality of life for failed PFNA fixation of intertrochanteric fractures.

Abstract:[Objective] To explore the clinical outcomes of the anterior locking plate for internal fixation of acetabular fractures involv- ing quadrilateral area. [Methods] A retrospective study was done on 32 patients who received open reduction and internal fixation (ORIF) for acetabular fractures involving quadrilateral area in our hospital from January 2017 to December 2020. Based on Letournel-Judet classi- fication, 6 patients were of anterior wall combined with posterior semi-transverse fractures, 7 were of transverse fractures, 12 were of dou- ble-column fractures and 7 of T-shaped fractures. All patients had fractures fixed with anterior locking plate combined with the reconstruc- tion plate through the lateral rectus approach. The clinical and radiographic documents were summarized. [Results] All patients had ORIF performed smoothly without iatrogenic injury to blood vessels and nerves, and followed up for 12~41 months, with an average of (25.84± 10.95) months. The patients resumed full-weight bearing activity in (11.93±3.62) weeks on average, and got significant increases of hip flex- ion-extension and internal-external rotation range of motions (ROM) over time. According to Merled' Aubigné-Postel criteria, the clinical outcomes were marked as excellent in 22, good in 6, fair in 3 and poor in 1, with excellent and good rate of 87.50% (28/32) . In term of Mat- ta criteria, anatomic reduction achieved in 23 cases (71.88%) , satisfactory reduction was in 7 cases (21.88%) and unsatisfactory reduction was in 2 cases (6.25%) , with total satisfactory rate of 93.75% (30/32) . To the latest follow up, all the patients got fracture healing without adverse imaging findings, such as heterotrophic ossification, femoral head necrosis and implant loosening. [Conclusion] The anterior lock- ing plate for internal fixation of acetabular fractures involving the quadrilateral area is reliable technique to achieve satisfactory clinical out- comes.

Abstract:[Objective] To evaluate the clinical outcome of a single ilioinguinal approach for open reduction and internal fixation (OR- IF) for acetabular double column and posterior wall fractures with the posterior wall fracture untreated. [Methods] From May 2016 to Janu- ary 2021, 30 patients, including 17 males and 13 females aged 22-76 years, received ORIF through a single ilioinguinal approach, involv- ing plate fixation of the anterior column and lag screw fixation of the posterior column, whereas the posterior wall fracture untreated for the acetabular double column and posterior wall fractures. The clinical and imaging results were evaluated. [Results] All the 30 patients were successfully operated on without serious complications, whereas achieved clinical fracture union with significant improvement in terms of the VAS score, hip extension ROM, hip internal and external rotation ROM, Harris score, and Merle-d 'Aubigne-Postel score at the latest follow-up compared with those at 3 months postoperatively (P＜0.05) . Radiographically, all the patients got or maintained concentric hip alignment, satisfactory reduction of fracture, proper position of anterior and posterior column implants, with no protrusion of acetabulum. The Matta grade for fracture reduction and Tonnis scale for hip degeneration remained unchanged at the latest follow-up compared with those 3 months postoperatively (P＞0.05) . [Conclusion] This single ilioinguinal approach for reduction and internal fixation with posterior wall fracture untreated achieves good clinical results for acetabular double column and posterior wall fractures

Abstract:[Objective] To investigate the clinical characteristics of lumbar disc herniation (LDH) in the elderly, and the outcome of open decompression combined with discectomy. [Methods] From December 1995 to December 2005, a total of 60 patients who were over 60 years of age and suffered from LDH were enrolled in this study. A single underling disease was noted in 50.00% (30/60) , while multiple comorbidities were found in 41.66% (25/60) . Open decompression combined with discectomy was performed in all patients with bony struc- ture preserved as much as possible if decompression sufficient. [Results] All patients were successfully operated on without death and neu- rovascular injuries. Of them, 56 cases (93.33%) were complicated with lumbar spinal stenosis. After operation, 8 patients (13.33%) present- ed delirium and other mental abnormalities, which were recovered within 4 days after corresponding treatment. During follow-up lasted for 6 months to 8 years, 4 patients died of a disease unrelated to the surgery. The VAS and ODI scores decreased significantly (P＜0.05) , while JOA score increased significantly over time (P＜0.05) . At the latest follow- up, 47 patients were completely painless and recovered their pre-disease ability of life, whereas 9 patients had discomfort in some extent during activities with quality of life under the pre-disease lev- el. [Conclusion] The clinical manifestations of LDH in the elderly are not typical, most of them are complicated with underling diseases, and local spinal canal stenosis or spinal deformity. Open decompression combined with discectomy does achieve satisfactory clinical results for the scenarios.

Abstract:[Objective] To analyze the changes of neck extensor muscle (NEM) and cervical sagittal parameters secondary to posterior unilateral open- door laminoplasty, and to explore the correlation between postoperative NEM atrophy and cervical sagittal parameters. [Methods] A total of 128 patients underwent posterior cervical unilateral open-door laminoplasty in our hospital from January 2015 to July 2019. Imaging examinations were performed before surgery, 1 week after surgery, 1 year after surgery and 2 years after surgery to measure the C2~7 Cobb angle, C2~7 SVA and T1S, additionally the SEA/VBA and DEA/VBA, which presented the abundance of NEM, as well as the fat content of the NEM. Correlation analysis was conducted between the sagittal plan parameters and the NEM measurements. [Results] The C2~7 SVA, C2~7 Cobb angle, T1S, as well as SEA/VBA, DEA/VBA and NEM fat content had curve variations over time, which were statistical- ly significant among time points (P＜0.05) . As consequences of Spearman analysis, the SEA/VBA and DEA/VBA were significantly positive- ly correlated with C2~7 Cobb angle and C2-7 SVA (P＜0.05) , whereas the NEM fat content was significantly negatively correlated with the C2~7 Cobb angle (P＜0.05) , and the fat content of C7/T1 NEM was positively correlated with T1S (P＜0.05) . [Conclusion] The cervical spine pres- ents a trend of lordosis after posterior unilateral open-door laminoplasty, and NEM atrophy is correlated with the changes of cervical sagit- tal parameters.