Abstract:[Objective] To explore the significance of retinol binding protein-4 (RBP4) for diagnosis of nontraumatic osteonecrosis of fem- oral head (NONFH) . [Methods] A total of 70 patients who were diagnosed of NONFH in Department of Hip Surgery, People's Hospital of Linyi City from August 2021 to December 2021 were selected as the necrosis group, while other 62 healthy subjects matched in age with the necrosis group in the same period were selected as the normal group. The serum RBP4 concentration of the two groups of subjects was detected by en- zyme-linked immunosorbent assay. The general data of the two groups were compared. The serum RBP4 level in the necrosis group was com- pared according to different factors, including etiology, ARCO stage, unilateral or bilateral hips involved and the femoral head uncollapsed or collapsed. The correlations between RBP4 and clinical parameters were searched, and ROC curve was drawn to analyze the diagnostic value of serum RBP4 for NONFH. [Results] The level of serum RBP4 in the necrotic group was significantly lower than that in the normal group (P＜ 0.05) . In the necrosis group, the level of serum RBP4 was significantly lower in patients with femoral head collapse than that in those without femoral head collapse (P＜0.05) , significantly lower in the patients with bilateral femoral head involved than in those with unilateral necrosis (P＜0.05) . There were significant differences in serum RBP4 levels among different ARCO stages (P＜0.05) , the higher stage the lower serum RBP4. In terms of correlation analysis, serum RBP4 level was negatively correlated with VAS score and ARCO stage (P＜0.05) , while was weakly positively correlated with Harris score (P＜0.05) . In term of ROC analysis, serum RBP4 level was used for diagnosis of femoral head ne- crosis and collapse with the sensitivity of 64.3%, specificity of 96.8% and area under curve (AUC) of 0.895. [Conclusion] As progress of NONFH, the serum RBP4 is prone to decline. Therefore, the serum RBP4 is a potential serum marker for the diagnosis of NONFH.

Abstract:[Objective] To explore the significance of serum Bax/Bcl-2 expression in non-traumatic osteonecrosis of the femoral head (NONFH) . [Methods] A total of 75 patients with NONFH and 67 healthy subjects were included in the study from March 2021 to July 2021. The serum Bax/Bcl-2 were detected by enzyme linked immunosorbent assay (ELISA) . The data were compared between the NONFH pa- tients and normal subjects. In addition, the patients were divided into different groups according to different factors, and the Bax/Bcl-2 lev- els were compared among different groups. The correlation between the serum assays and clinical data was searched, and ROC curve analy- sis was performed on Bax/Bcl-2 and whether osteonecrosis of the femoral head happened. [Results] The NONFH patients had significantly higher serum Bax and Bax/Bcl-2 than the normal controls [(2.8±1.9) vs (1.4±0.7) , P＜0.05] . Of the NONFH patients, there was no significant difference in Bax/Bcl-2 among different etiological subgroups (P＞0.05) , however, the bilateral affected had significantly higher Bax/Bcl-2 than the unilateral affected (P＜0.05) , the patients with femoral head collapsed had significantly higher Bax and Bax/Bcl-2 than those with- out femoral head collapsed (P＜0.05) . As ARCO classification progressed, the Bax and Bax/Bcl-2 upgraded significantly (P＜0.05) . In terms of correlations, the levels of Bax and Bax/Bcl-2 was positively correlated with ARCO stage and VAS score (P＜0.05) , whereas negatively cor- related with Harris score (P＜0.05) . Furthermore, the ROC curve analysis showed that the area under the curve (AUC) of Bax/Bcl-2 for the predication of NONFH was of 0.844. [Conclusion] The level of serum Bax/Bcl-2 is related to the severity of NONFH, and may be used as a potential index for clinical judgment of NONFH.

Abstract:[Objective] To compare the effects of high tibial osteotomy (HTO) , unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) on coagulation fibrinolytic system and clinical outcomes for knee osteoarthritis (KOA) . [Methods] A retrospective study was conducted on 99 patients who received surgical treatment for medial KOA in our hospital from January 2015 to December 2018. According to preoperative doctor-patient communication, 34 patients received HTO, 33 patients underwent UKA, and 32 patients were treat- ed with TKA. The documents regarding to coagulation-fibrinolytic system and clinical consequences were compared. [Results] Compared with those preoperatively, the PT, APTT, FDP and D-D significantly increased in all the three groups 1 day after operation (P<0.05) , and then returned to the preoperative level at 7 days after operation (P>0.05) . At 1 day after operation, PT, APTT, FDP and D-D were ranked from low to high in the following order: UKA group < HTO group HTO group > TKA group, with statistically significant differences (P<0.05) , whereas which became not statistically significant among the three groups at 2 years after operation (P>0.05) . [Conclusion] The three surgical procedures for treatment of medial compartment KOA is comparable in the middle and long-term outcomes, however, the UKA is better than HTO and TKA in short-term outcomes with little impact on the coagulation system.

Abstract:[Objective] To compare the clinical outcomes of percutaneous endoscopic-assisted transforaminal lumbar interbody fusion (TLIF) versus traditional open counterpart for single-segment lumbar spondylolisthesis. [Methods] A retrospective study was performed on 64 patients who received TLIF for single-level moderate lumbar spondylolisthesis in our hospital from July 2019 to June 2021. According to preoperative doctor-patient communication, 32 cases received endoscope-assisted TLIF (the endoscopic group) , while the other 32 cases re- ceived traditional open TLIF (the open group) . The perioperative period, follow-up and imaging data were compared between the two groups. [Results] The endoscopic group proved significantly superior to the open group in terms of operation time, total incision length, intraoperative blood loss and postoperative hospital stay (P＜0.05) , despite of the fact that the endoscopic group took significantly more frequency of intraop- erative fluoroscopy than the open group (P＜0.05) . Postoperative early complications were 1/32 (3.1%) in the endoscopic group, while 8/32 (25.0%) in the open group, which was statistically significant (P=0.031) . All the 64 patients were followed up for more than 12 months. The ODI scores decreased significantly (P＜0.05) , while JOA score increased significantly in both groups over time (P＜0.05) . Although there were no significant differences in ODI and JOA scores between the two groups before operation (P＜0.05) , the endoscopic group was significantly su- perior to the open group in the ODI and JOA scores at 6 months and 12 months after operation (P＜0.05) . Radiographically, the slippage angle and slippage rate measured on X-ray films significantly reduced in both groups postoperatively compared with those preoperatively (P＜0.05) , which were not significantly different between the two groups at any corresponding time points (P＞0.05) . At the latest follow-up, all patients in both groups got solid intervertebral fusion without loosening of internal fixators. [Conclusion] This percutaneous endoscope- assisted TLIF does reduce surgical trauma and improve clinical outcomes in the treatment of single-level mild-to-moderate lumbar spondylolisthesis.

Abstract:[Objective] To evaluate the clinical efficacy of debridement combined with vacuum-assisted closure (VAC) for limb wound. [Methods] A retrospective study was performed on 64 patients who received surgical treatment of limb wound in our hospital from October 2017 to November 2019. According to the consequence of preoperative doctor-patient communication, 32 patients were treated with debride- ment combined with VAC (the VAC group) , while the remaining 32 patients were treated with debridement combined with conventional dressing change (the conventional group) . The documents regarding to perioperative period, follow-up and laboratory tests were compared between the two groups. [Results] All patients in both groups had the two-stage operations performed successfully without serious complica- tions. The VAC group consumed slight longer operation time in the first stage than the conventional group, but without a statistically signifi- cant difference between them (P＞0.05) . The VAC group proved significantly superior to the conventional group in terms of number of dress- ing change, exudation grade, granulation grade, interval between two operations, time of the second operation, wound healing and hospital stay (P＜0.05) . In addition, the VAC group resumed full weight-bearing activity significantly earlier than the conventional group (P＜0.05) . The VAS scores, local scar, and adjacent joint function improved significantly over time in both groups (P＜0.05) , which in the VAC group was significantly superior to the conventional group at 3 months postoperatively (P＜0.05) , whereas became not statistically significant be- tween the two groups at 6 and 12 months postoperatively (P＞0.05) . With respect of laboratory tests, the WBC, NEU, CRP, and ESR de- creased significantly over time in both groups (P＜0.05) , which in the VAC group were significantly better than those in conventional group before the second stage operation (P＜0.05) . [Conclusion] The VAC has advantages of shortening recovery time of limb wound, reducing the risk of infection and the incidence of complications over the conventional dressing change.

Abstract:[Objective] To compare the clinical efficacy of four different treatments for diffuse pigmented villonodular synovitis (PVNS) of the knee. [Methods] From January 2010 to December 2019, 52 patients with diffuse PVNS of the knee were retrospectively analyzed. Ac- cording to preoperative doctor-patient communication, 8 patients were treated with arthroscopic synovectomy (AS) , 22 patients underwent AS combined with radiotherapy (ASRT) , 5 patients underwent AS combined with posterior open synovectomy (ASPO) , while the remaining 17 patients were treated with AS combined with posterior open synovectomy and radiotherapy (APRT) . The perioperative, follow-up and im- aging data were compared among the four groups. [Results] The AS group and ASRT group proved significantly superior to the ASPO group and APRT group in terms of operation time, total incision length, postoperative drainage volume, postoperative walking time and hospital stay (P＜0.05) . All patients were followed up for 25~118 months, with an average of (59.8±20.2) months. The AS and ASRT groups returned to full weight-bearing activity significantly earlier than the ASPO and APRT groups (P＜0.05) . At last follow-up, the VAS scores significant- ly decreased (P＜0.05) , while the Ogilvie-Harris score significantly increased in all the 4 groups compared with those preoperatively (P＜ 0.05) . At the corresponding time points, there was no significant difference in VAS score among the four groups (P＞0.05) . At the last followup, the Ogilvie-Harris scores were ranked from high to low ASRT ＞ APRT ＞ AS ＞ ASPO, which was statistically significant (P＜0.05) . In term of MRI assessment, joint effusion was significantly reduced in all four groups at last follow-up compared with those preoperatively (P＜ 0.05) . The recurrence rate of PVNS was ranked up-down as follows: ASPO group 3/5 (60.0%) ＞ AS group 3/8 (37.5%) ＞ APRT group 1/17 (5.9%) ＞ ASRT group 1/22 (4.6%) , which was statistically significant (P＜0.05) . [Conclusion] For diffuse PVNS of the knee, arthroscopic surgery is recommended if it involves intraarticularly only, while arthroscopic combined with posterior open synovectomy is recommended if it involves intraarticularly and extraarticularly. Both of them can reduce the recurrence rate by combined with postoperative adjuvant lowdose radiotherapy.

Abstract:[Objective] To compare the clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) under local anesthe- sia (LA) versus general anesthesia (GA) . [Methods] Literatures published before March 2022 regarding to clinical comparison of PELD un- der LA versus GA were searched from CNKI, Wanfang, VIP, EMBASE, PubMed, CBM and the Cochrane Library. A meta-analysis of out- come measures was performed using Stata/SE 12.0 software. [Results] A total of 9 studies were included into this study, involving 796 pa- tients, including 388 patients in the LA group and 408 patients in the GA group. As results of the meta-analysis, the LA group proved sig- nificantly superior to the GA group in terms of hospital stay (WMD=-1.39, 95%CI: -2.72~0.06, P＜0.05) , hospitalization cost (WMD=-5 278.27, 95%CI: -7 668.84~-2 887.70, P＜0.05) , and incidence of postoperative complications (RR=0.30, 95%CI: 0.11-0.85, P＜0.05) . However, there were no significant differences between the two groups in terms of operation time, postoperative VAS score, and postopera- tive Oswestry disability index (P＞0.05) . [Conclusion] The PELD under local anesthesia is significantly better than that under general an- esthesia in terms of hospital stay, treatment cost and incidence of postoperative complications, and the former has no obvious disadvantage in terms of safety.

Abstract:High tibial osteotomy, a classic knee-preserving surgery for medial compartment osteoarthritis of the knee, plays an impor- tant role in young patients with knee osteoarthritis who need high-function activities. Although high tibial osteotomy can effectively im- prove clinical symptoms, restore knee function and prolong service life, the clinical results and the related factors still remain unpredict- able. It is of great significance to study and clarify these influencing factors for individualized treatment of medial knee compartment osteo- arthritis and to improve the postoperative clinical efficacy. This article will review the factors related to the clinical outcome of high tibial os- teotomy, in order to help the decision making in clinical setting.

Abstract:Kümmell’s disease, a complex spinal disease, is often characterized by progressive kyphosis and intractable low back pain, which seriously impacts the quality of life in the elderly. As the conservative treatments of Kümmell’s disease are not satisfied at present, the percutaneous kyphoplasty or percutaneous vertebroplasty is preferred to this disease with obvious pain without neurological symptoms, de- spite of the risk of bone cement displacement postoperatively. However, the treatment for that complicated spinal cord compression is contro- versial, including open surgery and minimally invasive surgery. The treatments of Kümmell’s disease should be varied according to different stages. This paper reviews the reseach progress in the treatment of Kümmell’s disease.

Abstract:Shoulder dislocation complicated with rotator cuff tear is a common combined shoulder injury. However, the accompanied partial or complete rotator cuff tear might be ignored in the initial reduction of shoulder dislocation in emergency. Proper management of the rotator cuff injury secondary to dislocation is of great significance to prevent recurrent dislocation and persistent pain symptoms. In cases of persistent pain, loss of function, or nerve damage, the rotator cuff needs to be evaluated cautiously, and surgical repair should be considered if necessary. This paper reports 3 cases of shoulder dislocation complicated with rotator cuff injury, and discusses the pitfalls in the diagno- sis and treatment of shoulder dislocation combined with rotator cuff injury by a literature review.

Abstract:Glucocorticoid is one of the main causes leading to non-traumatic femoral head necrosis, a refractory disease in clinical prac- tice, which remains not clear completely in pathogenesis mechanism. Previous several hypotheses for explaining the mechanisms, such as im- paired blood supply, endothelial injury, coagulation disorders, thrombosis, abnormal lipid metabolism and cell apoptosis, were thought to play important roles. In recent years, small non-coding RNAs and genetic susceptibility have been found to be related to the mechanism of femoral head necrosis, with increasing numbers of signaling pathways and cytokines revealed in the disease. It is hoped that we can reverse the pathogenesis of the femoral head by intervening in one or more of the interacting processes in the disease. This paper mainly summarized the pathophysiological mechanism of ONFH caused by corticosteroid to provide a theoretical reference for future research and clinical treat- ment of steroid-induced femoral head necrosis.

Abstract:Anterior shoulder dislocation is the most common dislocation in clinical setting, which in most cases can be treated well by manual reduction. However, anterior shoulder dislocation complicated with greater tuberosity fracture and neurovascular injuries has rarely been reported. We report a case of a 79-year-old female patient who had glenohumeral dislocation accompanied with greater tuberosity fracture and brachial plexus injury caused by a fall. After closed reduction of the shoulder dislocation, the pain did not relieve, subsequent- ly, an arthroscopic debridement, double-row anchor fixation of greater tuberosity fracture were conducted. In addition, this paper also re- views the literature on injury mechanism, diagnosis, and treatment of the complicated shoulder injuries to provide reference for clinicians.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of reduction and fixation of posterior cruci- ate ligament (PCL) tibial avulsion fractures under arthroscope with a self-developed double-tunnel guider. [Methods] From January 2014 to December 2020, 32 patients with PCL avulsion fracture were reduced and fixed arthroscopically with the self-developed double-tunnel guider. After arthroscopic debridement, the top part of double-tunnel guider was inserted into the posterior compartment through the antero- medial portal, pressed on the fracture block to reduce and fix it temporarily. Two guide tubes were placed on distal end of the guider on the anteromedial tibia, and then two Kirschner wires were inserted following the guide tubes to establish two bone tunnels adjacent to the frac- ture block. Maintaining fracture reduction, the 2 Kirschner wires were removed, and then two-bundle high-strength Ethicon sutures were in- troduced by epidural needles under the arthroscope to cross fracture block, which were pulled out through the bone tunnels to the anteromedi- al tibial, then tightened and fixed. [Results] All 32 patients had the arthroscopic procedures performed successfully with time to establish two bone tunnels of (3.6±0.4) min, whereas without neurovascular injury and other complications. Lysholm score increased significantly from (28.7±7.8) preoperatively to (94.0±2.4) at latest follow-up (P＜0.001) . At the latest follow-up, all patients got the stable knee with normal flexion-extension range of motion, while negative posterior drawer test, and good fracture healing by X-ray film and CT examination. [Conclusion]For arthroscopic reduction and fixation of PCL tibial avulsion fractures, this self-developed double-tunnel guider allows establish- ing two bone tunnels at a time with high precision, and significantly improve the operation efficiency.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of unilateral open-door laminoplasty com- bined with total spinous process resection by ultrasound osteotome for cervical spondylotic myelopathy. [Methods] From January 2020 to December 2021, 30 patients received aforesaid surgical treatment for cervical spondylotic myelopathy. As diluted epinephrine saline solu- tion was injected around the incision, a posterior midline incision was made to expose the spinous process and lamina by dissecting bilateral paraspinous muscles from C₃ to C₆. An ultrasonic osteotome was used to make grooves with a thin intact inner plate along the junction of the lamina and lateral mass on the axial side, whereas full layer resection on the decompression side (the symptomatic side) . Lifting the lamina one by one to widen and decompress the spinal canal, and then the corresponding open-door segments were fixed with Z-shaped titanium plates in appropriate size to maintain the lamina opening. Subsequently, C3~C6 spinous process were totally removed from the base by ultra- sonic osteotome to facilitate reattachment of paraspinous muscles without dead space. [Results] All the patients had operation performed successfully without serious complications. The VAS score was improved from (3.6±0.9) before operation to (1.2±0.6) at the last follow-up, while JOA score was improved from (8.5±1.2) preoperatively to (15.0±0.9) at the latest follow-up, which all were statistically significant (P＜ 0.05) . During the follow-up period, none of implant loosening and fracture, nor “re-closing” phenomenon were noted in anyone of the 30 patients. [Conclusion] Total resection of spinous processes of C3~C6 might reduce the stress shielding on the neck muscles, and this bilater- al basically symmetrical construct is more conducive to the reattachment of muscles.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of thoracolumbar canal reconstruction with lamina complex re-implantation fixed by laminar screws. [Methods] A total of 17 patients underwent abovesaid surgical treatment after re- section of introspinal tumors in our hospital. The entire autologous spinous process-lamina complex was completely removed to expose canal before the resection of the tumor. The entire autologous spinous process-lamina complex was reimplanted to restore corresponding spinal structure, and were fixed by laminar screws. [Results] All patients had operation performed smoothly without serious complications, and fol- lowed up 12~18 months. At the latest follow-up, all the patients got significant improvement in symptoms, without displacement and col- lapse of re-implanted spinous process-lamina complex. [Conclusion] Thoracolumbar canal reconstruction with autologous spinous processlamina complex re-implantation fixed by laminar screw is simple and feasible technique with unique advantages and does achieve satisfacto- ry clinical outcomes in short term.

Abstract:[Objective] To compare the perioperative clinical and laboratory test outcomes of total knee arthroplasty (TKA) for rheuma- toid arthritis (RA) and osteoarthritis (OA) . [Methods] From March 2019 to September 2019, 115 patients who underwent unilateral TKA for RA or OA in our hospital, and had complete perioperative clinical and laboratory data were included in this study. The clinical and laborato- ry data of the two groups were compared. [Results] All patients in both groups were successfully operated on, without serious complications. Although there was no significant difference in operation time and incision length between the two groups (P＞0.05) , the RA group had signif- icantly greater intraoperative blood loss than the OA group (P＜0.05) . The RA group was marked significantly higher VAS score than the OA group at 3 days after operation (P＜0.05) . In terms of laboratory test, the D-dimer (DD) and fibrinogen (FIB) in both groups increased at 3 days after operation compared with those before operation, whereas which was not statistically significant (P＞0.05) , by contrast, the erythro- cyte sedimentation rate (ESR) and C-reactive protein (CRP) significantly increased in both groups (P＜0.05) . The RA group had significantly higher preoperative DD and FIB than the OA group (P＜0.05) , nevertheless which became not statistically significant between the two groups 3 days after operation (P＞0.05) . However, the RA group had significantly higher ESR and CRP than the OA group preoperatively and 3 days postoperatively (P＜0.05) . [Conclusion] TKA does effectively treat both RA and OA. In contrast, the RA has significantly greater intraopera- tive blood loss than the OA, which might be related to the significantly higher inflammatory marker in the RA over the OA.

Abstract:[Objective] To explore the clinical consequences of double mini plates for internal fixation of ulnar and radial shaft frac- tures. [Methods] A retrospective study was done on 16 patients who received open reduction and internal fixation (ORIF) of ulnar and radial shaft fractures with double mini plate (the metacarpal plate) in our department from March 2019 to March 2021. The clinical and radiograph- ic documents were evaluated. [Results] All the patients had ORIF completed successfully, with no serious intraoperative complications, and followed up for a mean of (19.4±3.2) months. The supernation and pronation range of motions (ROMs) significantly increased, additionally, the DASH score, Grace and Eversmann scale significantly improved at 6 months compared with those at 3 months postoperatively (P＜0.05) , with excellent rate of 100% in term of Grace and Eversmann scale at 6 months. By the time of the latest follow up, fracture healing achieved in all the patients without implant loosening or breaking. [Conclusion] The double metacarpal plates are feasible and effective for internal fixation of ulnar and radial shaft fractures, with advantages of less occupation and minimizing intervention of local blood supply.

Abstract:[Objective] To investigate the clinical efficacy of debridement and instrumented fusion of affected vertebrae through the pos- terior approach for single- segment brucellar spondylitis. [Methods] A retrospective study was performed on 21 patients who underwent abovementioned surgical treatment for single-segment brucellar spondylitis from November 2016 to December 2019. [Results] All the pa- tients had operation conducted successfully without serious complications. As time went in the follow-up lasted for (18.8±3.4) months, the VAS and ODI scores decreased significantly (P＜0.05) , while JOA score increased significantly (P＜0.05) . In term of pathological biopsy, a large number of monocytes, lymphocytes and other inflammatory cells were found in the lesion area by HE staining in the 21 patients, which was consistent with brucellosis. In addition, Gimesa staining found brucellosis bacillus. The ESR, CRP and local kyphotic Cobb angle were significantly decreased (P＜0.05) , while the intervertebral space height significantly increased postoperatively compared with those preopera- tively (P＜0.05) . At the latest follow-up, imaging showed that all patients obtained bone fusion, without implant loosening or fracture. [Conclusion] The debridement and instrumented fusion of affected vertebrae through the posterior approach are safe and effective treatment for single-segment lumbar brucellar spondylitis.