Abstract:[Objective] To compare the clinical efficacy of proximal femoral nail anti-rotation (PFNA) with or without lateral wall re- construction for femoral intertrochanteric fractures. [Methods] A retrospective study was conducted on 60 patients who received PFNA for femoral intertrochanteric fractures complicated with lateral wall fractures in our department from January 2017 to June 2021. According to the preoperative doctor-patient communication, 31 patients underwent PFNA and lateral wall reconstruction with a locking plate (the recon- struction group), while the other 29 patients received PFNA alone (the non-reconstruction group). The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All the patients were operated on smoothly without nerve and vascular injury. Al- though there were no significant differences in operation time, intraoperative blood loss, total incision length, intraoperative fluoroscopy times, success rate of the first nail placement, screw blade length, incision healing grade and hospital stay between the two groups (P＞0.05), the reconstruction group resumed ambulation significantly earlier than the non-reconstructed group [(14.1±1.8) days vs (18.5±2.9) days, P＜ 0.05]. All patients in both groups were followed up for an average of (19.0±4.3) months, and the reconstruction group returned to full weightbearing activity significantly earlier than the non-reconstructed group [(13.6±3.4) weeks vs (18.5±2.9) weeks, P＜0.05]. The Harris score, hip extension-flexion range of motion (ROM) and adduction- abduction ROM significantly increased in both groups with postoperative time (P＜0.05), which in the reconstruction group proved significantly better than those in the non-reconstructed group at all time points accord- ingly (P＜0.05). Radiologically, there was no significant difference in reduction quality between the two groups (P＞0.05). At the last followup, the reconstruction group was also significantly superior to the non- reconstruction group in terms of neck-shaft angle (NSA) [(127.3± 2.7)° vs (124.8±1.7)°, P＜0.05] and extent of femoral head-neck shortening [(4.1±0.7) mm vs (5.1±0.6) mm, P＜0.05]. [Conclusion] The lat- eral wall reconstruction in PFNA fixation of femoral intertrochanteric fractures does enhance the stability of fixation, facilitate the function-al recovery of hip joint and reduce complications in this study.

Abstract:[Objective] To compare the clinical efficacy of lower extremity axial distractor (LEAD) versus conventional traction table (CTT) assisted fracture reduction and intramedullary nailing in the treatment of Seinsheimer type Ⅴ femoral subtrochanteric fractures. [Methods] A retrospective study was performed on 49 patients who received fracture reduction and intramedullary nailing for Seinsheimer type Ⅴ femoral subtrochanteric fracture in our hospital from May 2012 to May 2021. According to preoperative doctor-patient communica- tion, LEAD reduction was used in 29 patients, while CTT reduction used in the remaining 20 patients. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] The LEAD group proved significantly superior to the CTT group in terms of traction device installation time [(4.0±1.1) min vs (14.0±3.6) min, P＜0.05], operation time [(134.4±33.3) min vs (196.6±103.0) min, P＜ 0.05], intraoperative blood loss [(231.0±109.7) ml vs (380.0±247.3) ml, P＜0.05], intraoperative fluoroscopy [(28.5±4.7) times vs (31.8±4.0) times, P＜0.05], nevertheless there were no significant differences in the total incision length, guide needle positioning times, closed-open reduction rate, incision healing grade, hospital stay, and walking time between the two groups (P＞0.05). All of them were followed up for (15.4±2.5) months on a mean, and there was no significant difference in the time to resume full weight-bearing activities between the two groups (P＜0.05). Compared with those 1 month after surgery, the Harris score, hip flexion-extension range of motion (ROM), and hip inter- nal-external rotation ROM significantly increased in both groups at the last follow-up (P＜0.05), which proved not significantly different be- tween the two groups at any time points accordingly (P＞0.05). In terms of imaging, there were no significant differences in the quality of fracture reduction or the imaging fracture healing time between the two groups (P＞0.05). [Conclusion] Compared with conventional traction table, the lower extremity axial distractor does shorten operation time, reduce intraoperative blood loss and reduce intraoperative fluorosco- py times considerably for intramedullary nailing Seinsheimer type Ⅴ femoral subtrochanteric fractures.

Abstract:[Objective] To investigate the clinical outcomes of proximal femoral nail anti-rotation (PFNA) placed through a modified small incision in the treatment of femoral intertrochanteric fractures in the elderly. [Methods] A total of 84 patients received PFNA for fem- oral intertrochanteric fractures in our hospital from January 2019 to January 2021. According to preoperative doctor-patient communica- tion, 44 patients had PFNA placed though the modified small incision (SI group), while the other 40 patients were treated with conventional incision (CI group). The documents regarding the perioperative period and follow- up and radiographs were compared between the two groups. [Results] All patients in both groups had PFNA performed successfully without serious intraoperative complications. The SI group was proved significantly superior to the CI group in terms of the total incision length [(5.3±1.3) cm vs (7.0±1.4) cm, P＜0.001], intraopera- tive blood loss [(88.3±19.2) ml vs (106.3±22.4) ml, P＜0.001], the times of fluoroscopy [(12.0±2.5) times vs (15.2±3.2) time, P＜0.001], but there were no statistically significant differences in operation time, postoperative ambulation time, hospital stay and incision healing grade between the two groups (P＞0.05). The follow-up period lasted for more than 12 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 decreased significantly (P＜0.05), while the Harris score, hip extension-flexion ROM and hip internal-external rotation ROM increased significantly in both groups over time (P＜0.05), where- as which were not statistically significant between the two groups at any time points accordingly after surgery (P＞0.05). Regarding to imag- ing, there were no significant differences in the reduction quality and healing time between the two groups (P＞0.05). The neck-shaft angle immediately postoperatively and at the last follow-up was significantly greater than that before surgery in both groups (P＜0.05). However, there was no significant difference in the neck-shaft angle between the two groups at any matching time points (P＞0.05). By the time of the last follow-up, all patients in both groups got fractures healed without internal fixation loosening and other adverse image changes. [Conclu- sion] This modified small incision used for placement of PFNA for femoral intertrochanteric fractures does reduce intraoperative trauma,and get the clinical results comparable to conventional incision.

Abstract:[Objective] To compare the clinical efficacy of femoral neck system (FNS) versus cannulated screws (CS) for fixation of fem- oral neck fracture. [Methods] A retrospective study was performed on 50 patients who received internal fixation for femoral neck fractures in our hospital from February 2020 to February 2021. According to preoperative doctor-patient communication, 25 patients had the frac- tures fixed by FNS, while the other 25 patients were by CS. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups were operated on successfully without serious complications. The FNS group proved signifi- cantly superior to the CS group in terms of operation time [(45.1±7.0) min vs (51.8±8.7) min, P＜0.05], intraoperative fluoroscopy times [(8.8± 1.8) vs (15.5±2.4), P＜0.05], guide pin placement times [(3.4±0.9) vs (8.8±1.5), P＜0.05] and postoperative walking time [(4.0±1.2) weeks vs (6.2±1.1) weeks, P＜0.05], despite of the fact that the former was significantly greater than the latter in terms of total incision length [(4.5± 0.5) cm vs (3.5±0.5) cm, P＜0.05] and intraoperative blood loss [(84.6±21.1) ml vs (43.2±8.7) ml, P＜0.05]. The FNS group resumed full weight-bearing activity significantly earlier than the CS group [(11.1±1.2) weeks vs (13.5±1.5) weeks, P＜0.05]. The Harris score, hip exten- sion-flexion ROM and hip internal- rotation rotation ROM significantly increased over time in both groups (P＜0.05). The FNS group was significantly better than the CS group in Harris score at 1 month, 3 months postoperatively and at the latest follow-up [(55.2±3.2) vs (46.8± 2.8), P＜0.05; (80.8±3.4) vs (78.4±1.9), P＜0.05; (89.8±2.6) vs (87.6±2.6), P＜0.05], although there were no significant differences in exten- sion-flexion ROM and internal rotation-external ROM between the two groups at any corresponding time points (P＞0.05). Regarding to im- aging, Garden alignment index significantly improved in both groups immediately after surgery and at the last follow-up compared with that before operation (P＜0.05). However, the neck-shaft angle and Tonnis classification for hip degeneration remained unchanged remarkably in both groups postoperatively (P＞0.05). There were no significant differences in the abovementioned image items between the two groups at any time points accordingly (P＞0.05). [Conclusion] The FNS has the advantages of short operation time, strong fixation stability and good hip function recovery over the CS in the treatment of femoral neck fractures.

Abstract:[Objective] To compare the clinical outcomes of the elastic stable intramedullary nail (ESIN) for fixation of length unstable tibial shaft fractures versus stable counterparts in children. [Methods] A retrospective study was conducted on 84 children who received ESIN for tibial shaft fractures in our hospital from January 2016 to November 2021. Among them, 32 children suffered from unstable frac- ture, while the remaining 52 children were of stable fracture. The perioperative, follow-up and imaging data were compared between the two groups. [Results] Although there were no significant differences in operation time, total incision length, intraoperative blood loss, inci- sion healing and hospital stay between the two groups (P＜0.05), the unstable group had significantly more intraoperative fluoroscopy than the stable group [(12.4±1.5) times vs (10.3±1.7) times, P＜0.05]. All patients in both groups were followed up for (13.3±2.3) months on a mean, and there was no a significant difference in the time to return full weight-bearing activity between the two groups (P＞0.05). The AO- FAS scores and ankle dorsal extension- plantar flexion ROM significantly increased in both groups over time postoperatively (P＜0.05), which proved not statistically significant between the two groups at any time points accordingly (P＞0.05). In addition, there was no a signifi- cant difference in Johner-Wruh scale between the two groups at the latest follow-up (P＞0.05), with normal gait and squat activity in all chil- dren in both groups. Radiographically, there were significant improvements in tibial alignment, leg length discrepancy (LLD) and tibial an- gulation in both groups postoperatively compared with those preoperatively (P＜0.05). The unstable group proved significantly inferior to the stable group in terms of tibial alignment [excellent/good/poor, (9/18/5) vs (33/18/1), P＜0.05], and LLD [(2.1±2.2) mm vs (0.7±1.3) mm, P＜ 0.05], despite that there was no statistical significance in tibia angulation between the two groups immediately postoperatively (P＞0.05).However, all differences in the above indexes became not statistically significant between the two groups at the latest follow-up (P＞0.05). There was no significant difference in fracture healing time on images between the two groups (P＞0.05). [Conclusion] ESIN, a safe and ef- fective for the length stable tibial shaft fractures in school-age children, is also suitable for the length unstable fractures. Although there is a greater possibility of postoperative shortening in length unstable fractures, the overgrowth can compensate for the final difference in lower limb length.

Abstract:[Objective] To compare the clinical outcomes of suture bridge fixation with single row anchors combined with bone tunnel (SR-BT) versus double rows of anchors (DR) for humeral greater trochanteric fractures. [Methods] A retrospective study was performed on 44 patients who received surgical treatment for humeral greater trochanteric fractures in our hospital from June 2017 to June 2021. Accord- ing to doctor-patient communication, 24 patients were treated with SR-BT, while the remaining 20 patients were with DR. The periopera- tive period, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had the operation ac- cordingly performed successfully with no complications such as neurovascular injury. Although there were no significant differences in terms of operation time, intraoperative blood loss, fluoroscopy times, active activity time, incision healing time and hospital stay between the two groups (P＞0.05), the SR-BT group had significantly longer incision, whereas significantly lower total hospital expenses than the DR group (P＜0.05). Compared with that preoperatively, the VAS score for pain in both groups significantly decreased 7 and 14 days after sur- gery (P＜0.05), which was not statistically significant between the two groups at any time points accordingly (P＞0.05). All patients were fol- lowed up for (18.1±3.9) months, without a significant difference in the time to return to full weight- bearing activities between the two groups (P＞0.05). The ASES score, forward flexion, abduction and external-internal rotation range of motion (ROM) significantly increased in both groups over time (P＜0.05), whereas which proved not significantly different between the two groups at any corresponding time points (P＜0.05). Radiographically, there were no significant differences in fracture block displacement and acromiohumeral interval (AHI) be- tween the two groups at any time points accordingly (P＞0.05). In addition, there was no significant difference in fracture healing time be- tween the two groups (P＞0.05). [Conclusion] Both single-row anchors combined with bone tunnel and double-row anchors are effective for internal fixation of humeral greater trochanteric fractures. By contrast, the single-row anchors combined with bone tunnel take benefit of re- ducing medical cost considerably over the double-row anchors.

Abstract:[Objective] To compare the clinical outcomes of three small-incisions suture repairs of acute closed Achilles tendon rup- ture. [Methods] A retrospective study was conducted on 98 patients who received small-incision repair for acute closed Achilles tendon rupture in our hospital from January 2016 to October 2021. According to the results of preoperative doctor-patient communication, 47 pa- tients were treated with 3-incision simple suture (3ISS), 28 patients were treated with 3-incision Bunnell suture (3IBS), while the remain- ing 23 patients were with the 6-incision Bunnell suture (6IBS). The perioperative period and follow-up data of the three groups were com- pared. [Results] There were no significant differences in operation time, intraoperative blood loss, postoperative walking time, incision heal- ing grade and hospital stay among the three groups (P＜0.05). The 3ISS and 3IBS had significantly shorter total incision length than the 6IBS group (P＜0.05). The 3ISS group resumed full weight- bearing activity significantly earlier than the 3IBS and 6IBS groups (P＜0.05). The VAS scores decreased significantly (P＜0.05), while AOFAS score, ATRS score and plantar-dorsal flexion range of motion (ROM) signifi- cantly increased in all the 3 groups over time (P＜0.05). Although there was no significant difference in the abovesaid items among the three groups a month after operation (P＞0.05), the 3ISS group proved significantly superior to the 3IBS and 6IBS group in terms of the AOFAS and ATRS scores (P＜0.05), whereas not in plantar-dorsal flexion ROM at 6 months postoperatively (P＞0.05). However, there was no signifi- cant difference in the abovementioned indexes among the three groups at the last follow-up (P＞0.05). During the follow-up, no complica- tions such as Achilles tendon re- rupture occurred in anyone of the three groups. [Conclusion] Although the 3 different suture methods have similar long-term clinical outcomes on acute closed Achilles tendon rupture, the 3-incision simple suture is more conducive to the early recovery of Achilles tendon function with smaller incision.

Abstract:[Objective] To compare the clinical outcomes of transoral (TO) versus transnasal (TN) intratracheal intubations under gener- al anesthesia for short-segment instrumented fusion of Hangman's fractures. [Methods] A retrospective study was performed on 37 patients who received posterior cervical pedicle screw fixation and fusion for Hangman's fractures in our hospital from January 2014 to June 2019. According to the results of preoperative doctor-patient communication, 24 patients underwent TO intubation, while the remaining 13 pa- tients received TN intubation. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All the 37 patients had operations performed successfully with no complications such as vascular nerve injury during the operation. The TO group proved significantly less laryngeal exposure time and intubation time than the TN group (P＜0.05), although there were no significant differ- ences in the success rate of catheterization on the first time, operation time, incision length, intraoperative blood loss, anesthesia- related complications, postoperative ambulation time, incision healing, and hospital stay between the two groups (P＞0.05). All of them in both groups were followed up for (16.2±6.7) months on a mean, and there was no significant difference in the time to return to full weight-bear- ing activities between the two groups (P＞0.05). The ASIA grade for neurological function, NDI and JOA scores improved significantly in both groups over time (P＜0.05), which were not significantly different between the two groups at any time points accordingly (P＞0.05). Re- garding image, there was no significant difference in screw placement accuracy between the two groups (P＞0.05). The cervical lordotic an- gle and C_2~3 slip ratio significantly improved in both groups at the latest follow-up compared with those preoperatively (P＜0.05), which were not found significantly different between the two groups at any corresponding time points (P＞0.05). [Conclusion] Posterior short-segment instrumented fusion does achieve satisfactory clinical outcomes for the treatment of unstable Hangman's fractures, and both transoral and transnasal intratracheal intubations under general anesthesia are safe and feasible.

Abstract:Intervertebral disc degeneration (IDD) is one of the main causes of lower back pain (LBP), while LBP caused by IDD is known as discogenic LBP. There are many factors that lead to IDD, this article focuses on the role of inflammatory factor regulation and neu- rovascular proliferation in the pathogenesis of disc-derived LBP, and reviews advances in cellular, growth factor, and gene biologic thera- pies for the treatment of IDD and discogenic LBP.

Abstract:Platelet-rich plasma (PRP) is a product of plasma with high-concentration of platelet extracted from animal or human whole blood by centrifugation or single collection of blood cells, and proves one of the promising drugs for regenerative medicine at present with clinical therapeutic value equivalent to the stem cells. Since Anitua discovered that PRP significantly promoted bone tissue repair in 1999, PRP has been widely used in orthopedic diseases because of its excellent properties. This article reviewed the research progress of PRP in the treatment of fracture in terms of the mechanism of PRP affecting bone biology and promoting bone healing.

Abstract:Tendon is a part of musculoskeletal system, which is the connective tissue that transfers strength from muscle to bone. After acute or chronic injury, the tendon is susceptible to adhesion and re-injury due to its unique nature. In addition to conventional physical therapy and surgical treatment, biotechnology as a novel and promising method is gradually applied in clinic. Exosomes are bilayer vesicles containing a variety of protein markers, DNA fragments and RNA. Recent studies have found that exosomes play anti-inflammatory, immu- nomodulatory and cellular repair roles in the treatment of tendinopathy. This paper reviewed the research progress of exosomes from differ- ent sources in tendon injury repair, and summarized the latest tissue engineering techniques related to clinical transformation in this field, aiming to provide certain references for subsequent studies.

Abstract:[Objective] To investigate the effects of lentivirus TAZ gene transfection on bone mineral density (BMD) and biomechanical characteristics of the femur neck in the ovariectomized rats. [Methods] A total of 90 6-month-old female SD rats were randomly divided in- to two groups, 25 underwent sham operation (SO) and 65 underwent bilateral ovariectomy (OVX). The BMD and femur mechanical proper- ties were tested in 6 animals in each group 3 weeks after OVX, while the remaining OVX animals were furtherly divided into 3 groups. After femoral neck was drilled, the TAZ group was injected with lentivirus TAZ, the Cherry group was injected with lentivirus Cherry, while the drilled group was not injected with any drug. In addition, the remaining animals in the SO group were used as normal controls. The BMD and biomechanics of the femoral neck were assessed again. [Results] The SO group had significantly higher BMD [(0.217±0.11) g/cm² vs (0.158±0.03) g/cm², P＜0.001], maximum load of the femoral neck [(108.6±6.1) N vs (83.3±5.8) N, P＜0.001] and stiffness [(338.8±11.1) N/ mm vs (226.4±12.9) N/mm , P＜0.001] than the OVX group 3 weeks after OVX. At 1, 2 and 3 months after in vivo transfection, the BMD, maximum load and stiffness of femoral neck in the four groups were all ranked from high to low as SO group＞TAZ＞Cherry Group＞ drilled group, with statistically significant overall differences among them (P＞0.05). Regarding to pairwise comparison, the TAZ group was signifi- cantly lower in terms of BMD, maximum load and stiffness of femoral neck than the SO group (P＜0.05), while significantly higher in BMD and maximum loading than Cherry group (P＜0.05) regardless of that the difference was not statistically significant in stiffness between them (P＞0.05). However, there were no significant differences in BMD, maximum load and stiffness between Cherry group and drilled group (P＜ 0.05). As time went after in vivo transfection, the TAZ group got significant increase of BMD, maximum load and stiffness (P＜0.05), where- as the Cherry group had significant decrease in BMD (P＜0.05), and no significant changes in maximum load and stiffness of femur (P＞0.05). The drilled group was of significant groove-like changes in BMD (P＜0.05), while significantly decline in the maximum load and stiff- ness of femur neck (P＜0.05). [Conclusion] The lentivirus-mediated TAZ gene transfection into OVX rats does significantly increase bone mineral density and enhance bone biomechanical strength.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of volar distal radius locking plate used for internal fixation of medial-end clavicular fractures. [Methods] From January 2011 to January 2022, 21 patients with medial-end clavicle fractures were treated with open reduction and internal fixation with volar distal radius locking plate. As a transverse incision was made along the long axis of the clavicle with the fracture ends as the center, the fracture ends were exposed and reduced. A volar distal radius locking plate in proper size was selected and shaped to meet the anatomy of medial-end clavicle. If the sternoclavicular was dislocated, the joint should be exposed at the same time. After the fractures were reduced properly, Kirscher wires were placed for temporary fixation, fol- lowed by permanent fixation with the plate and screws, in which the screws should be placed bi-cortically on the clavicular side, while unicortically in sternum side. [Results] All patients were operated on successfully without neurovascular injury, incision infection and other complications, and followed up for (12.8±2.6) months on an average. All patients got fractures healed with the average clinical fracture heal- ing time of (12.6±2.4) weeks. According to Rockwood criteria, 18 cases were excellent and 3 cases were good. [Conclusion] This volar dis- tal radius locking plate provides a good internal fixation implant for the treatment of medial-end clavicular fractures.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of retrograde transfer of medial foot perfora- tor flap to repair the defects of forefoot soft tissue. [Methods] Fourteen patients with the defects of forefoot soft tissue were treated with the retrograde transfer of medial foot perforator flap. The flap was cut from the medial side of the foot, and freed the pedicle with the perforating vessel branches at the metatarsal neck on the medial side of the first metatarsophalangeal joint, and separated under the deep fascia，only the blood vessel pedicle retained to connect the flap. After that, the flap was reversed to cover the soft tissue defect of the forefoot. [Results] All 14 patients got flaps survived completely, with skin grafts survived well on the donor site, and followed up for 9 months to 3 years. The surviving flaps were soft in texture without obvious swelling. During the follow up period, no flap trimming was performed in anyone of them, due to satisfactory appearance of the flaps with on impacting on shoe wearing. [Conclusion] This retrograde transfer of medial foot perforator flap to repair forefoot soft tissue defects is safe and reliable, with less injury to the foot donor area, does achieve the satisfactory appearance and good functional recovery of the affected foot after surgery.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcomes of a self-made double-pin rocker assist- ed closed reduction and anterograde intramedullary nail for femoral shaft fracture. [Methods] From January 2018 to March 2021, 13 patients received the above surgical treatment for femoral shaft fracture. As the proximal femoral medullar cavity was opened, a cannulated lever, the “gold finger” was inserted over the guide pin. Subsequently, two pin 3.0 mm in diameter were percutaneously placed in the appropriate posi- tion at the distal fragment of the fracture, and the self-made rocker was attached with the pins by tightening the end caps. Using the “gold finger” and rocker as the levers, the fracture was reduced, and maintained in reduced position easily under fluoroscopy, then the guide pins were passed through the fracture gap successful, followed by the main nail inserted and locked. [Results] All the patients had closed reduc- tion and anterograde intramedullary nail fixation performed successfully without serious postoperative complications, while with operation time of (100.4±12.8) min, intraoperative blood loss of (170.2±28.3) ml, and intraoperative fluoroscopy of (34.0±5.1) times. Clinical fracture healing time ranged from 12 weeks to 17 weeks with an average of (13.8±1.3) weeks. The VAS score significantly decreased from (3.5±1.0) at 3 days postoperatively to (0.4±0.7) at the latest follow-up (P＜0.001), while the KSS score significantly increased from (43.5±8.8) to (95.8± 2.6) at the final interview (P＜0.001). [Conclusion] This self-made double-pin rocker is beneficial to the closed reduction of femoral shaft fracture, therefore improve the efficiency of anterograde intramedullary nail fixation.

Abstract:[Objective] To investigate the surgical treatment and its clinical outcomes for ankle injuries accompanied by complete rup- ture of deltoid ligament (DL). [Methods] From January 2018 to December 2020, a total of 25 patients received surgical treatment for ankle injuries and DL complete fracture. After the fractures were reduced and fixed, and the inferior tibiofibular syndesmosis injury was repaired, the DL was repaired with two suture anchors if significant medial instability was proved. Clinical and imaging documents were evaluated. [Results] All patients were operated on successfully without serious complications, and followed-up time was (19.6±6.8) months on an aver- age. With time elapsed preoperatively, 6 months postoperatively and the latest follow-up, the VAS score for pain decreased significantly [(7.8±0.7), (2.0±0.6), (1.0±0.8), P＜0.05], while the AOSAF score [(53.0±7.2), (83.8±5.7), (93.0±2.9), P＜0.05] and ankle dorsal extensionplantar flexion ROM [(22.3±2.3)°, (44.1±4.8)°, (59.4±2.4)°, P＜0.05] increased significantly, and ankle inversion-eversion ROM significant- ly reduced [(37.9±1.9)°, (27.6±1.2)°, (28.1±1.4)°, P＜0.05]. In terms of imaging, postoperative radiographs showed satisfactory reduction of fractures in all patients with smooth articular surface. The medial clear space (MCS) significantly reduced postoperatively [(5.4±0.6) mm, (3.2±0.3) mm, (3.3±0.4) mm, P＜0.05], and no significant joint degeneration was noted in anyone of them at the latest follow-up. [Conclu- sion] DL repair with two suture anchors does restore ankle joint stability better for ankle injuries with obvious medial instability, which is conducive to early functional exercise and improve clinical consequences.

Abstract:[Objective] To investigate the clincal outcomes of unilateral biportal endoscopy (UBE) for lumbar spinal stenosis (LSS) with nocturnal pain (NP) as the main clinical manifestations. [Methods] A retrospective study was performed on 16 patients who received UBE for LSS with NP as the main manifestation in our hospital from September 2020 to December 2021. The clinical and imaging documents were evaluated. [Results] All the 16 patients had the UBE procedures performed successfully without serious complications, while with op- eration time of (68.2±7.6) min, total incision length of (2.5±0.5) cm, postoperative walking time of (2.3±0.5) days, and hospital stay of (6.8± 0.9) days. All of them were followed up for an average of (10.3±2.2) months. With time elapsed preoperatively, at dischange and the latest follow-up, theVAS score [(5.8±0.4), (3.6±0.5), (1.1±0.7), P＜0.05] and the ODI sleep score [(3.4±0.5), (2.4±0.5), (0.3±0.6), P＜0.05] signifi- cantly decreased. Radiographically, vertebral canal sagittal diameter [(9.9±0.5) mm, (17.6±1.2) mm, (17.4±1.2) mm, P＜0.05] and vertebral canal area [(0.9±0.1) cm² , (1.5±0.1) cm² , (1.5±0.1) cm² , P＜0.05] significantly increased. At the last follow-up, the consequence was marked as excellent in 13 cases, good in 2 cases and fair in 1 case with excellent and good rate of 93.8% according to the modified MacNab criteria. [Conclusion] This UBE does effectively relieve pain symptoms and improve sleep status for patients who have LSS with NP as the main manifestation.

Abstract:[Objective] To evaluate the clinical outcomes of open reduction and internal fixation (ORIF) with Kirschner wire for hamate body fracture. [Methods] A retrospective study was done on 23 patients who received ORIF with Kirschner wire for hamate body fracture in our hospital from January 2015 to December 2020. The documents regarding clinical and imaging results were evaluated. [Results] All pa- tients were operated on successfully with no serious complications such as neurovascular injuries. With time of follow-up lasted for (25.0± 14.0) months, the VAS and DASH scores decreased significantly (P＜0.05), whereas wrist extension-flexion range of motion (ROM) and ul- nar-radial deviation ROM increased significantly (P＜0.05). In addition, there was no significant difference in grip strength between the af- fected side and the healthy side at the latest follow-up (P＞0.05). In terms of imaging, the quality of fracture reduction assessed by postoper- ative radiographs was excellent in 12 cases, good in 3 cases, fair in 3 cases and poor in 5 cases. The patients got fracture healing from 6 to 12 weeks postoperatively on images without obvious signs of degeneration of wrist joint until the latest follow-up. [Conclusion] Open reduc- tion and internal fixation with Kirschner wire do better reduce the articular surface and repair the damaged tissue without increase of the in- fection risk for coronal fracture of the hamate body.

Abstract:[Objective] To evaluate the clinical significances of early recovery after surgery (ERAS) nursing in surgical treatment of tho- racolumbar fractures. [Methods] From May 2020 to May 2022, a total of 96 patients with thoracolumbar spine fracture admitted to our de- partment were divided into two groups according to random number table method. All patients in both group underwent surgical reduction, decompression and pedicle screw fixation. Of them, 47 patients received ERAS nursing, while other 45 patients received conventional nurs- ing. The perioperative data of the two groups were compared. [Results] All patients in both groups were operated on successfully without se- rious complications. Early postoperative complications were of 6.4% in the ERAS group, while 22.2% in the conventional group, which was statistically significant (P=0.001). The ERAS group proved significantly superior to the conventional group in terms of bowel function recov- ery time [(7.2±1.1) hours vs (10.4±2.3) hours, P＜0.001], time of the first fart [(9.5±2.2) hours vs (16.4±2.6) hours, P＜0.001], time of the first defecation [(25.6±4.9) hours vs (43.2±5.6) hours, P＜0.001], postoperative ambulation time [(3.1±0.6) days vs (5.3±1.1) days, P＜0.001] and hospital stay [(8.4±1.0) days vs (12.0±1.3) days, P＜0.001]. The VAS score for pain and general comfort questionnaire (GCQ) score were sig- nificantly improved in both groups over time (P＜0.05), which were not statistically significant between the two groups before operation (P＞ 0.05), whereas in the ERAS group were significantly better than those in the conventional group 1 to 7 days postoperatively (P＜0.05). [Con- clusion] ERAS nursing used in the perioperative period for thoracolumbar fractures does promote the recovery of intestinal function, re- lieve postoperative pain and improve comfort of the patients.