Abstract:[Objective] To compare the clinical efficacy of arthroscopic release combined with manual release versus manual release only under anesthesia for advanced joint stiffness following total knee arthroplasty (TKA). [Methods] A retrospective study was performed on 40 patients who received release for advanced knee stiffness after TKA from January 2017 to August 2021. According to doctor-patient communication, 19 patients received arthroscopic release combined with manual release (the combined group), while the other 21 patients received manual release alone. The documents regarding perioperative period, follow- up and images were compared between the two groups. [Results] All patients in both groups were operated smoothly. Although the combined group consumed significantly longer operative time [(65.4±12.4)min vs (27.7±5.3)min, P＜0.05] than the manual group, the former got significantly greater maximum knee flexion [(105.4± 12.8)° vs (97.4±11.6)°, P＜0.05] and knee extension [(0.8±1.9)° vs (3.7±2.5)°, P＜0.05] than the latter intraoperatively. All patients were fol- lowed up for a mean of (26.7±6.9) months, and there was no significant difference in the time to resume full weight-bearing activity between the two groups (P＞0.05). The VAS score for pain decreased significantly (P＜0.05), while the KSS clinical and functional scores, HSS score as well as knee extension-flexion range of motion (ROM) increased significantly in both groups over time (P＜0.05). There was no significant difference in the above indexes between the two groups before surgery (P＜0.05), but the combined group proved significantly superior to the manual group in terms of HSS score [(79.8±5.1) vs (74.2±4.3), P＜0.05], KSS clinical score [(88.6±3.4) vs (83.9±3.2), P＜0.05], KSS function score [(85.7±3.5) vs (82.1±3.3), P＜0.05], and knee ROM [(93.4±6.5)° vs (87.2±6.3)°, P＜0.05] at the latest follow-up. Radiographically, fem- orotibial angle (FTA), states of prosthesis loosening, and ectopic ossification remained unchanged over time in both groups (P＞0.05), which were not significantly different between the two groups at any corresponding time points (P＞0.05). [Conclusion] The arthroscopic release combined with manual release does effectively improve the knee range of motion with good clinical efficacy and low complications for the knee stiffness following TKA.

Abstract:[Objective] To compare the clinical outcomes of percutaneous endoscopic interlaminar discectomy (PEID) with the Delta en- doscopy versus the counterpart through the Quadrant channel for large L₅S₁ disc herniation in young adults. [Methods] A retrospective study was performed on 62 young patients who underwent minimally invasive surgery for the giant L₅S₁ disc herniation in our department from Janu- ary 2018 to December 2020. According to the results of preoperative doctor-patient communication, 27 patients received the endoscopic dis- cectomy (ED), while the other 35 patients underwent the channel discectomy (CD). The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All the patients in both groups had operation performed successfully without serious complications. Although the ED group consumed significantly longer operative time than the CD group [(123.1±13.7)min vs (112.1±13.3), P=0.002], the for- mer proved significantly superior to the latter in terms of intraoperative blood loss [(15.6±3.1)ml vs (38.1±6.2)ml, P＜0.001], total incision length [(1.1±0.3)cm vs (2.3±0.4)cm, P＜0.001], postoperative walking time [(1.5±0.9)days vs (2.5±1.4)days, P＜0.001] and hospital stay [(6.1± 1.4)days vs (8.4±1.7)days, P＜0.001]. All of them were followed up for 12 to 36 months, with a mean of (24.08±5.17) months, the patients in the ED group resumed full weight-bearing activity significantly earlier than those in the CD group [(88.2±1.2)days vs (90.2±1.4)days, P＜ 0.001]. The VAS scores for lumbago and leg pain, as well as ODI scores significantly decreased over time in both groups (P＜0.05). The VAS and ODI scores were not statistically significant between the two groups preoperatively (P＞0.05). The ED group was significantly superior to the CD group in terms of VAS score for low back pain [(3.0±0.9) vs (3.3±1.0), P=0.028], VAS score for leg pain [(3.0±0.8) vs (3.5±0.9), P= 0.032] and ODI score [(20.7±4.0) vs (23.0±3.5), P=0.019] at discharge from hospital, whereas which became not statistically significant be- tween the two groups at the last follow-up (P＞0.05). Imaging, intervertebral height and lumbar lordosis angle (L₅S₁ Cobb angle) were not sig-nificantly changed over time (P＞0.05), however, the spinal canal area was significantly enlarged in both groups postoperatively compared with those preoperatively (P＜0.05). There were no statistically significant differences in intervertebral height, spinal canal area and lumbar lordosis angle between the two groups at any time points accordingly (P＞0.05). [Conclusion] Compared with the Quadrant channel counter- part, Delta endoscopic discectomy is less invasive and more beneficial to early recovery for giant L₅S₁ disc herniation in young adult.

Abstract:[Objective] To compare the clinical outcomes of total knee arthroplasty (TKA) assisted by computer assisted surgery (CAS) versus portable accelerometer-based navigation device (PAD). [Methods] A retrospective study was performed on 30 patients who under- went navigation-assisted TKA in our hospital from November 2018 to August 2021. According to doctor-patient communication, 12 patients had CAS used, while the remaining 18 patients had PAD applied. The documents of perioperative period, follow-up and imaging measur- ments were compared between the two groups. [Results] All the patients had TKA performed successfully with no significant differences in terms of operation time, cumulative blood loss on the third day after operation, and length of hospital stay between the two groups (P＞0.05). All of them in both groups were followed up for more than 12 months. Compared with that preoperatively, the VAS scores significantly de- creased (P＜0.05), while the HSS scores significantly increased at the latest follow-up in both groups (P＜0.05), which proved not significantly different between the two groups at any corresponding time points (P＞0.05). Radiographically, the hip-knee-ankle angle (HKAA) signifi- cantly decreased in CAS group and PAD group postoperatively compared with that preoperatively (P＜0.05). The preoperative and postopera- tive HKAA in both groups were not significantly different (P＞0.05). The mechanical medial proximal tibial angle (mMPTA) significantly in- creased in both groups postoperatively compared with that preoperatively (P＜0.05), which proved not significantly different between the two groups at any matching time points (P＞0.05). The mechanical lateral femoral angle (mLDFA) was significantly increased in the CAS group (P＜0.05), whereas which was of no change in the PAD group postoperatively compared with that preoperatively (P＞0.05). At any correspond- ing time points, there was no significant difference in mLDFA between the two groups (P＞0.05). [Conclusion] There were no significant dif- ferences between CAS and PAD used for assistance in TKA in terms of perioperative conditions, accuracy of lower extremity alignment and clinical efficacy. Therefore, both CAS and PAD can be selected flexibly according to the concrete situation.

Abstract:[Objective] To evaluate the clinical efficacy of bone marrow mesenchymal stem cells (BMSCs) combined with platelet-rich plasma (PRP) augmented arthroscopic rotator cuff repair. [Methods] A retrospective study was conducted on 160 patients who underwent arthroscopic rotator cuff repair for rotator cuff tear in our department from July 2019 to October 2021. Among them, 80 patients in the su- ture group received arthroscopic rotator cuff repair only, while the remaining 80 patients in the combined group received arthroscopic rota- tor cuff repair combined with local injection of BMSCs and PRP. The perioperative period, follow-up and imaging data were compared be- tween the two groups. [Results] All patients in both groups had operation done successfully without serious complications. There were no significant differences in operation time, total incision length, intraoperative blood loss, postoperative active motion time, incision healing and hospital stay between the two groups (P＞0.05), whereas the VAS scores in both groups were significantly decreased over time in the ear- ly stage after operation (P＜0.05). All of them were followed up for (13.6±0.8) months on an average. Compared with those preoperatively, the forward flexion, abduction and internal-external rotation range of motions (ROMs) significantly reduced in both groups 3 months after operation (P＜0.05), while the UCLA score was significantly increased (P＜0.05), whereas which all significantly increased at the last followup (P＜0.05). However, there was no significant difference in the above items between the two groups at any corresponding time points (P＞ 0.05). Radiographically, the acromiohumeral interval (AHI) and Sugaya MRI classification significantly improved postoperatively compared with those before surgery (P＜0.05). Although there were no significant differences between the two groups before and 3 months after surgery (P＞0.05), the combined group proved significantly superior to the suture group in AHI and MRI classification at the latest follow-up (P＜ 0.05). At the last interview, the rate of rotator cuff re-rupture was 32.5% (26/80) in the suture group, while 15.0% (12/80) in the combined group. [Conclusion] The BMSCs and PRP do significantly improve postoperative healing of rotator cuff tear and reduce the chance of re- tear.

Abstract:[Objective] To evaluate the clinical outcomes of percutaneous transforaminal endoscopic discectomy (PTED) combined with platelet-rich plasma (PRP) for discogenic low back pain (DLBP). [Methods] A total of 36 patients with DLBP were randomly divided into PRP group and non-PRP group with 18 cases in each group. The PRP group was treated with PTED combined with intradiscal injec- tion of PRP, while the non-PRP group received PTED only. The perioperative, follow-up and imaging documents were compared between the two groups. [Results] All patients in both groups had corresponding surgical procedures performed smoothly without significant differ- ences in terms of operation time, intraoperative fluoroscopy times, intraoperative blood loss and hospital stay between the two groups (P＜ 0.05), without serious adverse reactions and complications in both groups. All of them were followed up for more than 12 months, and the PRP group resumed full weight-bearing activity significantly earlier than the non-PRP group (P＜0.05). The VAS score for pain and ODI score significantly decreased (P＜0.05), while JOA score significantly increased in both groups over time (P＜0.05), which was not significant- ly different between the two groups before surgery and 3 months after surgery (P＞0.05), while in the PRP group proved significantly superi- or to those in the non-PRP group at 12 months postoperatively (P＜0.05). With respect of imaging, the PRP group also proved significantly superior to the non-PRP group in terms of the disc height and Pfirrmann grades of involved intervertebral space 12 months postoperatively (P＜0.05). [Conclusion] PTED combined with PRP is a safe and effective method for the treatment of DLBP, which can effectively relieve pain and might delay intervertebral disc degeneration to a certain extent.

Abstract:[Objective] To understand the current research status, research hotspot and future development trend of internal fixation treatment of femoral neck fracture in the world by bibliometric and visual analysis. [Methods] The literature was analyzed and visualized by using VOSviewer software and CiteSpace software through the literature retrieval of Web of Science database. [Results] A total of 1355 literatures were included, and the literatures related to internal fixation of femoral neck fracture showed an increasing trend in the past de- cade, among which China, the United States and Canada maintained the leading position in this field. The research hotspots mainly focused on the limited element analysis, biomechanical analysis, femoral neck system, medial support plate and other aspects. [Conclusion] By us- ing bibliometrics method, the global research status and hotspot of internal fixation of femoral neck fracture can be more clearly and intui- tively understood.

Abstract:Limb salvage surgery is more and more popularly used to treat malignant tumors of bone, in order to preserve limb function as much as possible. The bone defect secondary to tumor resection is usually reconstructed by prostheses or bioactive materials. In recent years, replantation of liquid nitrogen treated tumor-bearing bone has become a widely used biological reconstruction technique due to its advantag- es of simple operation, complete inactivation and high bone healing rate. At present, the technology is widely applied in Japan and Europe and America, while seldomly used in China. This article reviews the progress of bone defect reconstruction by replantation of liquid-nitrogen treated tumor-bearing bone in limb salvage surgeries for bone malignant tumors.

Abstract:Total hip arthroplasty (THA) is a surgical technique for treating femoral bone necrosis, hip dysfunction, osteoarthritis and other diseases, and the most of the patients are elderly. In the case of THA, elderly patients frequently experience increased sensitivity to the outside world as a result of excessive pain perception during joint prosthesis adaptation. This condition is known as postoperative kine- siophobia, which increases the risk of disability and degrades the quality of life. Clinical staff now lacks knowledge about and attention to ki- nesiophobia, making it difficult for them to recognize it and create timely solutions. This article reviews the concept, causes, adverse effects, influencing factors, measurement tools, and interventions of kinesiophobia in elderly patients who undergo THA to provide a reference for clinical workers.

Abstract:[Objective] To explore whether adiponectin has an effect on the proliferation and hypertrophy of articular process chondro- cytes in patients with idiopathic scoliosis (IS). [Methods] Plasma adiponectin levels in IS patients and normal subjects were detected by ELISA. Primary chondrocytes of the articular process were isolated from IS patients and normal subjects, and the expressions of adiponectin and its receptor AdipoR1, chondrocyte marker Col Ⅱ and hypertrophy marker ColX were detected by western blotting. Subsequently, the chondrocytes of IS group were stimulated by different concentrations of adiponectin, and the expression of related proteins was detected. [Results] The IS group was measured significantly higher plasma adiponectin than the normal group [(19.3±11.5)μg/ml vs (9.5±8.4)μg/ml, P＜0.05], including the females [(19.3±11.5)μg/ml vs (11.9±8.8)μg/ml, P＜0.05] and the males [(9.3±4.5)μg/ml vs (3.7±3.3)μg/ml, P＜0.05]. In addition, the chondrocytes harvested from IS patients were significantly higher than those of normal control in terms of protein expression of adiponectin [(1.4±0.3) vs (1.0±0.1), P＜0.05], AdipoR1 [(1.3±0.3) vs (1.0±0.2), P＜0.05] and Col Ⅱ [(1.8±0.7) vs (1.0±0.7), P＜0.05], whereas the former had significantly lower Col X than the latter [(0.2±0.1) vs (1.0±0.8), P＜0.05]. The protein expression of Adipo Q and Adi- poR1 in chondrocytes of the IS group increased in a concentration-dependent manner after stimulation with different concentrations of adi- ponectin (P＜0.05), the protein levels of Col Ⅱ and anti-apoptotic factor Bcl2 also significantly increased (P＜0.05), while the protein levels of ColX and Bax significantly decreased (P＜0.05). [Conclusion] Increased adiponectin levels in plasma might promote the proliferation of chondrocytes and inhibit the hypertrophy process in IS patients by upregulating AdipoR1, Bcl2 and Col Ⅱ, and downregulating Bax and Col X.

Abstract:[Objective] To investigate the biomechanical properties of NICE knot fixation for mid-shaft clavicle fracture. [Methods] A total of 60 human clavicle specimens were randomly divided into 4 groups. The mid-shaft clavicle fracture models (OTA /AO type 15-A2) were made with an oscillating saw. After that, the fracture was fixed with lag screw, 2-0 suture NICE knot, 1-0 suture NICE knot and 1# su- ture NICE knot, respectively. Failure load, maximum displacement and yield stiffness of fracture models were measured by Instron biome- chanical machine. [Results] There were no significant differences between the lag screw group and 1 # suture NICE knot group in terms of failure load [(98.4±0.7)N vs (99.0±1.7)N, P＞0.05], the maximal displacement [(10.1±0.4)mm vs (10.0±0.4)mm, P＜0.05] and yield stiffness [(24.4±0.4)N/mm vs (24.5±0.5)N/mm, P＞0.05]. However, the lag screw proved significantly superior to 2-0 suture NICE group and 1-0 su- ture NICE group in terms of the failure load [(99.0±1.7)N vs (45.2±0.5)N and (64.8±0.7)N, P＜0.05], the maximal displacement [(10.0±0.4) mm vs (9.4±0.6)mm and (5.6±0.5)mm, P＜0.05] and yield stiffness [(24.5±0.5)N/mm vs (5.0±0.3)N/mm and (12.5±0.3)N/mm, P＜0.05]. In ad- dition, the 1-0 suture group was significantly superior to the 2-0 suture NICE group regarding failure load [(64.8±0.7)N vs (45.2±0.5)N, P＜ 0.05] and yield stiffness [(12.5±0.3)N/mm vs (5.0±0.3)N/mm, P＜0.05], despite that the former had significantly less maximum displacement than the latter [(5.6±0.5)mm vs (9.4±0.6)mm, P＜0.05]. [Conclusion] The biomechanical performance of NICE knot with 1# suture for fixa- tion of mid-shaft clavicle fractures is comparable to that of lag screw fixation.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of closed reduction and internal fixation with elastic intramedullary nail rocker technique for the treatment of distal radius metaphyseal junction fractures in children. [Methods] A total of 28 children with distal radius metaphyseal junction fractures were treated with closed reduction and internal fixation using elastic in- tramedullary nail rocker technique. Under fluoroscopy, the "safe zone" of the proximal radius was located and marked with Kirschner wire or hemostatic forceps. A incision was made over the zone center to expose to the radius. An intramedullary nail selected in proper size and bended in shape was inserted into medullary cavity through an opening, and with controlling the handle of the nail to complete the coronal reduction of the fracture at the distal end. If there was still rotational displacement of the fracture, the "rolling pin" technique was used to correct it. [Results] All the 28 children were successfully operated on without serious complications, and followed up for 6 to 18 months, with an average of (8.4±4.6) months. At the latest follow-up, range of motion, grip strength, and local pain were significantly improved in all children. The modified Mayo scores ranged from 80 to 100, with an average of (92.6±7.9) at the latest follow up. The clinical results were marked as excellent in 20 cases and good in 8 cases, with the excellent and good rate of 100%. [Conclusion] The closed reduction and in- ternal fixation with elastic intramedullary nail rocker technique is minimally invasive, simple, safe for the treatment of distal radius metaph- yseal junction fractures in children.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of lateral locking plate and antero-posteri- or lag screws for fixation of collapsed fractures of the anterolateral tibial plateau. [Methods] A total of 26 patients received abovesaid surgi- cal procedures for Schatzker type Ⅱ tibial plateau fractures. Before operation, Mimics software was used to determine the position, direc- tion and length of the locking plate and antero-posterior lag screws in the digital model of the proximal tibia on the healthy side. After an anterolateral incision was made to explore the proximal tibia, the fractures were reduced and fixed with the lateral locking titanium plate se- lected according to the preoperative measurement with Mimics software on the contralateral proximal tibia, while two antero-posterior lag screws in appropriate lengths were implanted in the sagittal direction. [Results] The operation lasted for (72.6±4.3) min, associated with in- traoperative blood loss of (85.7±6.5) ml. All the patients resumed complete knee extension-flexion range of motion with significantly im- proved HSS score 1 year after operation (P＜0.05). Radiographically, the depth of articular surface collapse significantly reduced (P＜0.05), while the Rasmussen radiology score significantly increased postoperatively compared with those preoperatively (P＜0.05). All patients got fracture healing in 12~18 weeks postoperatively. The CT images showed good fracture reduction without articular surface collapse 1 year af- ter operation. [Conclusion] The lateral locking plate and antero-posterior lag screws plateau do achieve satisfactory clinical outcomes for collapsed fractures of the anterolateral tibial plateau, which might avoid secondary articular surface collapse.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of the one-stage posterior osteotomy for the correction of congenital kyphosis due to anterior segmentation failure. [Methods] From 2006 to 2017, 13 children with pure Winter-II con- genital kyphosis underwent one-stage posterior Schwab osteotomies combined with internal fixation. The osteotomy mode was determined ac- cording to the age, kyphotic site and lesion range of the children. Smith-Petersen Osteotomy (SPO) in 1 case, Ponte osteotomy combined with VCRs in 1 case, pedicle subtraction osteotomy (PSO) in 5 cases, bone-disc-bone osteotomy (BDBO) in 4 cases, vertebral column resection (VCR) in 1 case, and VCRs in 1 case were performed correspondingly. Braces were worn after surgery to maintain the correction effect. [Re- sults] All the 13 children had corresponding surgical operations performed smoothly without serious complications. The patients who had neurological symptoms were improved after operation. At the latest follow-up lasted for (66.4±33.5) months the Cobb angle of the main curve significantly decreased (P＜0.05), and the thoracic kyphosis (TK), lumbar lordosis (LL) significantly improved (P＜0.05), whereas the T1-pel- vic angle (TPA) remained unchanged compared with those preoperatively (P＞0.05). [Conclusion] One-stage posterior osteotomy is an effec- tive surgical method for Winter type II congenital kyphosis with a benefit of controlling progression of the deformity.

Abstract:[Objective] To compare the clinical outcomes of direct anterior approach (DAA) versus posterolateral approach (PLA) for to- tal hip arthroplasty (THA) in the treatment of osteoporotic femoral neck fractures. [Methods] From January 2019 to December 2021, a total of 68 patients received THA for osteoporotic femoral neck fractures in our hospital. According to doctor-patient communication, 33 patients had THA performed through DAA, while the other 35 patients were through PLA. The clinical data of the two groups were compared. [Re- sults] All patients in both groups had THA performed successfully without intraoperative death or other serious intraoperative complica- tions. Although the DDA group consumed significantly longer operation time than the PLA group [(106.8±14.0)min vs (91.2±12.0)min, P＜ 0.001], the DAA group proved significantly superior to the PLA group in terms of incision length [(11.9±1.8)cm vs (14.8±2.2)cm, P＜0.001], intraoperative blood loss [(172.2±25.9)ml vs (212.0±33.7)ml, P＜0.001], postoperative walking time [(26.2±8.3)hours vs (44.4±11.8)hours, P＜ 0.001] and hospital stay [(6.8±0.6)days vs (9.8±1.3)days, P＜0.001]. In addition the DAA group was marked significantly lower VAS scors for pain [(4.1±0.7) vs (5.5±1.0), P＜0.001], whereas significantly higher Harris score [(73.9±6.5) vs (64.8±5.9), P＜0.001] than the PLA group 3 days postoperatively. All patients were followed up for more than 6 months, the VAS scores decreased significantly (P＜0.05), while Harris score increased significantly over time in both groups (P＜0.05), which proved not significantly different between the two groups at 3 and 6 months after surgery (P＞0.05). [Conclusion] The DAA for THA in the treatment of osteoporotic femoral neck fractures takes the advantages of less injury and faster early postoperative recovery over the PLA.

Abstract:[Objective] To evaluate the therapeutic outcomes of kinesiology taping (KT) combined with core stability training (CST) for chronic lateral ankle instability (CLAI). [Methods] From October 2014 to December 2020, 50 patients with CLAI were divided into two groups according to random number table method. Of them, 25 patients receive KT and CST on the base of routine exercise (the KT-CST group), while the other 25 patients received the routine exercise only (the routine group). The clinical and test data of the two groups were compared. [Results] The KT-CST group proved significantly superior to the routine group in terms of VAS score [(2.1±1.4) vs (3.0±1.0), P＜ 0.05] and FADI score [(101.0±18.0) vs (88.0±13.9), P＜0.05] after treatment. In addition, the KT -CST group was also significantly better than the routine group in terms of AF/W [(1.1±0.3)Nm/kg vs (0.8±0.5)Nm/kg, P＜0.05], AE/W [(0.6±0.2)Nm/kg vs (0.4±0.2)Nm/kg, P＜0.05], YBT [(95.2±14.3) vs (88.0±15.7), P＜0.05]. [Conclusion] The kinesiology taping combined with core stability training does effectively in- crease the muscle strength around the ankle, thereby increasing ankle stability and function with improved balance capacity for chronic an- kle instability.

Abstract:[Objective] To investigate the clinical significance of percutaneous repair with Tightrope for distal tibiofibular syndesmosis instability diagnosed by ankle arthroscopy. [Methods] From November 2017 to March 2020, 41 patients received percutaneous Tightrope repair for distal tibiofibular syndesmosis instability that was found under ankle arthroscopy. The clinical and imaging documents were evalu- ated. [Results] All the 41 patients had operation completed with incisions healed in stage I, whereas without complication such as incision infection, neurovascular injury and lower limb deeper venous thrombosis. All patients were followed up for 24~52 months, with an average follow-up time of (35.4±7.7) months. During the follow-up, none of the 41 patients had complications such as incision infection, neurovas- cular injury, venous thrombosis of lower limbs and revision surgery. With time elapsed in points preoperatively, 6 months postoperatively, 12 months postoperatively and the latest follow- up, the VAS score significantly reduced [(4.4±2.8), (2.6±1.8), (1.8±1.6), (1.4±1.5), P＜ 0.001], while the AOFAS score [(60.9±28.6), (73.4±13.9), (82.2±14.0), (85.0±10.0), P＜0.001] and SF-36 score [(89.5±12.1), (98.8±12.9), (106.8±12.0), (112.2±13.4), P＜0.001] significantly increased, however, the ankle plantar flexion-dorsal extension range of motion (ROM) and pronation-supination ROM remained unchanged (P＞0.05). By the last follow-up, 39 patients regained the pre-injury exercise level, ac- counting for 95.1%. In terms of imaging, medial clear space (MCS), tibiofibular clear space (TFCS), tibiofibular overlap (TFO) was not signif- icantly changed (P＞0.05). [Conclusion] The ankle arthroscopic examination is efficient tool to find distal tibiofibular syndesmosis instabili- ty, while percutaneous Tightrope repair of distal tibiofibular syndesmosis instability does achieve satisfactory clinical outcomes in this study.

Abstract:[Objective] To investigate the clinical outcomes of mini plate combined with countersunk screws and Kirschner wire for Dubberley type B capitellum fractures. [Methods] A retrospective study was done on 13 patients who received surgical treatment for Dub- berley type B capitellum fractures in our hospital from March 2016 to August 2019. All patients underwent open reduction and internal fixa- tion with mini plate combined countersunk screws and Kirshner wires through lateral approach. The clinical and imaging consequences were observed. [Results] All the patients had operation completed successfully without serious iatrogenic injuries, and followed up for (17.5±2.7) months on an average with time to resume full weight activity of the affected limb of (15.3±1.6) weeks. The VAS score decreased significantly (P＜0.05), whereas elbow extension-flexion ROM and MEPS scores significantly increased in all the 13 patients (P＜0.05). Post- operative images showed anatomical reduction in 12 cases, and displacement less than 2 mm without angulation or rotation in one case. At latest follow-up, all patients achieved fracture healing without further displacement of bone fragment, whereas 2 patients had mild osteoar- thritis, and one patient had heterotopic ossification. [Conclusion] Mini plate combined with countersunk screw and Kirschner wires does ef- fectively fix Dubberley type B humeral capitellum fracture.

Abstract:[Objective] To investigate the clinical results of unilateral percutaneous vertebroplasty (PVP) in the treatment of L₅ osteopo- rotic compression fracture (OVCF). [Methods] From November 2018 to July 2022, 47 patients with L₅-OVCF were treated with unilateral PVP with puncture skin entry point about 2cm away the outer edge of the L₄ pedicle projection, while bone entry point at the outer upper edge of the L₅ pedicle. The clinical and imaging data were evaluated. [Results] All the 47 patients were successfully operated on with the operation time of 14~50 min, the injection volume of bone cement of 3.5~10 ml. Bone cement leakage occurred in 11 cases, whereas which not led any complications, such as nerve injury. With time of follow-up lasted for 2 to 26 months (before surgery, at discharge and at last fol- low-up), the VAS score [(7.1±1.0), (1.7±0.8), (0.9±0.6), P＜0.001] and ODI scores [(67.6±16.6), (16.9±8.6), (10.2±4.7), P＜0.001] signifi- cantly reduced. At the last follow-up, the clinical results were marked as excellent in 19 cases, good in 22 cases, fair in 6 cases, with the ex- cellent and good rate of 87.23% based on the modified MacNab criteria. Radiographically, postoperative radiographs showed that bone ce- ment was distributed across the midline of the vertebral body in all of them. Compared with that preoperatively, the anterior height of verte- bral body significantly increased postoperatively [(2.1±0.4)cm, (2.7 ±0.3)cm, P＜0.001]. [Conclusion] This technique of PVP does achieve satisfactory clinical outcomes in short term for L₅-OVCF.

Abstract:[Objective] To evaluate the clinical efficacy of a novel inflatable spine support (ISS) for treatment of thoracolumbar com- pression fractures (TLCF). [Methods] A total of 50 patients who received non-operative treatment for TLCF in our hospital were enrolled in- to this study from January 2018 to December 2019. Based on doctor-patient communication, 26 patients received ISS therapy, while the re- maining 24 patients underwent the conventional pad therapy. Clinical and imaging data were compared between the two groups. [Results] The ISS group resumed ambulation significantly earlier than the conventional group [(60.8±4.1)days vs (63.9±3.3)days, P=0.012]. The VAS and ODI scores decreased significantly over time in both groups (P＜0.05). The ISS group was marked significantly lower VAS score [(3.5± 0.7) vs (4.1±0.8), P=0.008] and ODI scores [(29.5±2.6) vs (32.1±2.2), P＜0.001] than the conventional group. Radiographically, lumbar lordo- sis and anterior vertebral height ratio increased significantly (P＜0.05), while the local kyphotic angle decreased significantly over time in both groups (P＜0.05). The ISS group proved significantly superior to the conventional group in terms of lumbar lordosis [(47.3±1.0)° vs (45.3±0.9)°, P＜0.001], local kyphotic angle [(10.5±0.7)° vs (12.0±0.4)°, P＜0.001] and anterior vertebral height ratio [(93.1±1.9)% vs (88.1± 2.4)%, P＜0.001] 3 weeks after treatment. [Conclusion] The new inflatable spine support does maintain fracture reduction more effectively, improve the comfort of treatment and improve the therapeutic outcomes over the conventional pad therapy.

Abstract:[Objective] To evaluate the clinical outcomes of metacarpal condylar locking plate for fixation of zone I. fracture of the fifth metatarsal. [Methods] A retrospective study was done on 19 patients who received metacarpal condylar locking plate for fixation of zone I. fracture of the fifth metatarsal from June 2017 to June 2020. The clinical and imaging consequences were evaluated. [Results] All patients had operation performed smoothly with the operation time of (51.6±9.7)min, incision length of (3.7±0.8)cm, and intraoperative blood loss of (15.5±2.4)ml. The patients were followed up for (10.9±2.8) months on a mean, and resumed full weight- bearing activities in (10.2±2.4) weeks. Compared with those preoperatively, the VAS score at 6 months after surgery and the last follow-up significantly decreased [(2.5± 1.2), (1.7±1.2), (1.0±0.6), P＜0.05], while the AOFAS score significantly increased [(74.2±7.8), (83.2±8.3), (92.1±8.5), P＜0.05]. Among the 19 patients, the quality of fracture reduction was excellent in 16 cases and good in 3 cases, and all patients got fractures healed in 6 months. [Conclusion] Metacarpal condylar locking plate used for fixation of zone I fracture of the fifth metatarsal base is stable and achieves satisfac- tory clinical outcome.

Abstract:[Objective] To compare the clinical efficacy of two approaches for open reduction and internal fixation (ORIF) of trimalleolar fractures. [Methods] From December 2014 to December 2020, 32 patients received ORIF of trimalleolar fractures, including 17 patients with posterior malleolus exposed by posterolateral approach (lateral group) and 15 patients with posterior malleolus exposed by posteromedi- al approach (medial group). The perioperative and follow-up documents were compared between the two groups. [Results] Anatomic reduc- tion was achieved in all patients of both groups, without complications such as nerve and blood vessel injury. There were no significant differ- ences in operation time, intraoperative blood loss and wound healing between the two groups (P＞0.05). The incision length for exposing poste- rior malleolus was significantly longer in the lateral group than in the medial group (P＜0.05). All patients in both groups were followed up for more than 1 year, without a significant differences in the time to resume full- weight activity, as well as AOFAS score and ankle ROM be- tween the two groups at latest follow-up (P＞0.05). [Conclusion] Both approaches can expose the posterior malleolus effectively in open re- duction and internal fixation of trimalleolar fractures, which should be selected based on the concrete condition of the posterior malleolus fractures.