Abstract:[Objective] To evaluated the clinical outcomes of double- bundle reconstruction of coracoclavicular ligament with Rigid- loop for type III acromioclavicular dislocation. [Methods] A retrospective study was conducted on 48 patients who received surgical treat- ment for Rockwood III acromioclavicular dislocation in our hospital from June 2019 to June 2020. According to preoperative doctor-patient communication, 22 patients received hook plate fixation, while the remaining 26 patients underwent double-bundle reconstruction of cora- coclavicular ligament with Rigidloop. Perioperative period, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had corresponding surgical procedures performed successfully, without a significant difference in the operation time between the two groups (P＞0.05). The reconstructed group proved significantly superior to the hook plate group in terms of the total length of incision [(4.3±0.5) cm vs (7.0±0.8) cm, P＜0.05], intraoperative blood loss [(62.0±15.8) ml vs (97.1±26.5) ml, P＜0.05] and hospital stay [(11.1±2.3) days vs (14.3±2.9) days, P＜0.05]. The VAS scores significantly decreased in both groups (P＜0.05), the CRP was significant- ly increased (P＜0.05), whereas the IL-6 remained unchanged in both group over time in the early stage postoperatively (P＞0.05), which in the reconstructed group were significantly better than the hook plate group at all time point accordingly during the early stage (P＜0.05). All patients were followed up for (22.2±2.5) months on an average, with no a significant difference in the time to return to full weight-bearing activities between the two groups (P＞0.05). The UCLA score, shoulder abduction-lifting, forward flexion-lifting, internal rotation and exter- nal rotation range of motions (ROMs) were significantly increased in both groups over time (P＜0.05). At the latest follow-up the reconstruct- ed group was significantly superior to the hook plate group regarding UCLA score [(32.5±3.7) vs (29.1±3.1), P=0.002], abduction-lifting ROM [(151.4±10.4)° vs (135.6±12.4)°, P＜0.001], internal rotation ROM [(62.9±13.0)° vs (52.1±11.4)°, P=0.004] and external rotation ROM [(66.6±9.4)° vs (57.0±9.4)°, P=0.001]. Radiographically, the coracoclavicular distance (CC) and the acromioclavicular distance (AC) de- creased significantly 3 months after surgery compared with those preoperatively results (P＜0.05), whereas which proved not statistically sig- nificant between the two groups at any corresponding time points (P＞0.05). [Conclusion] The double-bundle reconstruction of coracoclavic- ular ligament with Rigidloop for type III acromioclavicular dislocation has the advantages of less trauma, faster postoperative recovery, less postoperative pain, lower postoperative inflammation reaction, and better joint function over the hook plate fixation.

Abstract:[Objective] To compare the clinical outcomes of two tenodesis techniques for ruptured long head of biceps tendons (LHBT) in arthroscopic repairing rotator cuff repair. [Methods] A retrospective study was performed on 72 patients who underwent arthroscopic treatment for rotator cuff tear complicated with LHBT rupture in our hospital from January 2015 to March 2020. After arthroscopic repairing rotator cuff tear, 37 patients had the LHBT fixed by interference screw (IS), while the remaining 35 patients had LHBT fixed by suture an- chor (SA). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both group had opera- tion performed smoothly without serious complications. The IS group proved significantly superior to the SA group in terms of operative time [(61.4±2.5) min vs (70.2±2.6) min, P＜0.001]. As time went during the follow-up lasted for (16.4±1.5) months, the VAS scores decreased sig- nificantly (P＜0.05), while the ASES score increased significantly in both groups (P＜0.05). At the latest follow-up, the IS group proved sig- nificantly superior to the SA group in ASES score [(13.3±0.2) vs (12.1±0.2), P＜0.001], despite of the fact that there was no significant differ- ence in VAS score between the two groups (P＞0.05), and there was no significant difference in the time to resume full weight-bearing activi- ty between the two groups (P＞0.05). Radiographically, the coracohumeral distance (CHD) increased significantly (P＜0.05), whereas the cor- acoid overlap (CO) decreased significantly in both groups over time (P＜0.05). There were no significant differences in CHD and CO be- tween the two groups at corresponding time points (P＞0.05). [Conclusion] Compared with suture anchor, the interference screw used for te- nodesis of ruptured LHBT does shorten the operation time, reduce postoperative drainage, and is conducive to functional recovery for rota- tor cuff tear complicated with LHBT rupture.

Abstract:[Objective] To compare the clinical efficacy of Tight-rope combined with Nice knot reinforcement versus anatomical lock- ing plate in the treatment of Neer type IIb distal clavicular fractures. [Methods] A retrospective study was performed on 58 patients who re- ceived surgical treatment for Neer type IIb distal clavicular fractures in our department from January 2017 to December 2020. According to the results of doctor-patient communication, 27 patients underwent Tight-rope combined with Nice knot (TR group), while the other 31 pa- tients received anatomic locking plate for fixation of the distal clavicular fracture (plate group). The perioperative, follow-up and imaging data were compared between the two groups. [Results] The TR group proved significantly superior to the plate group in terms of operation time [(71.4±31.8) min vs (85.2±27.0) min, P＜0.05], the total length of incision [(3.6±1.3) cm vs (10.1±2.0) cm, P＜0.05], intraoperative bleeding [(24.4±19.4) ml vs (96.7±43.3) ml, P＜0.05], hospital stay [(10.8±3.7) days vs (13.4±5.5) days, P＜0.05] and time to return active ac- tivity [(28.5±4.2) days vs (34.5±3.9) days, P＜0.05]. All of them in both groups were followed up for more than 24 months, and TR group re- sumed full weight-bearing activity significantly earlier than the plate group [(19.0±1.5) weeks vs (21.3±2.5) weeks, P＜0.05]. The ConstantMurley scores, abduction-lifting, forward flexion upward lifting, and internal-external rotation range of motion (ROM) of the shoulder in- creased significantly over time in both groups (P＜0.05). Although there was no significant difference in the above items between the two groups before surgery (P＞0.05), the TR group proved significantly superior to the plate group in terms of Constant-Murley score [(80.7±4.4) vs (78.3±4.5), P＜0.05], abduction-lifting ROM [(121.9±9.0)° vs (112.7±8.4)°, P＜0.05], forward flexion upward lifting ROM [(128.5±6.8)° vs (119.4± 8.0)°, P＜0.05] and the internal-external rotation ROM [(115.9±5.5)° vs (112.1± 5.7)°, P＜0.05] 3 months postoperatively. Radio-graphically, the TR group was significantly better than the plate group in fracture reduction quality [excellent/good/poor, (21/7/0) vs (1/17/ 2), P＜0.05] and postoperative coracoclavicular distance (CCD) at the last follow-up [(9.4±1.8) mm vs (11.9±1.4) mm, P＜0.05], regardless of that there was no significant difference in fracture healing time between the two groups (P＞0.05). [Conclusion] Both surgical methods have obtained good clinical efficacy in the treatment of Neer type IIb distal clavicular fractures, while Tight-rope combined with Nice knot rein- forcement takes less trauma, and better pain relief and shoulder function over the plate fixation.

Abstract: [Objective] To compare the clinical efficacy of transforaminal endoscopy (TE) versus interlaminar endoscopy (IE) used in excision of apophyseal fragments with oscillating bur for lumbar posterior ring apophysis fracture. [Methods] From April 2016 to May 2019, a total of 41 patients received endoscopic excision of apophyseal fragments with oscillating bur for lumbar posterior ring apophysis fracture. According to the results of preoperative doctor-patient communication, 18 patients were treated with TE, while the other 23 pa- tients were with IE for excision of apophyseal fragments by oscillating bur. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had corresponding surgical procedures performed successfully without dural tear, nerve injury and other complications. The TE group had significantly greater number of intraoperative fluoroscopy than the IE group [(5.1±0.1) times vs (1.0±0.1) times, P＜0.05], despite statistically insignificant differences in operative time, total incision length, intraopera- tive blood loss, ambulation time and hospital stay between the two groups (P＞0.05). With time of the follow-up lasted for more than 12 months, the VAS and ODI scores in both groups were significantly reduced (P＜0.05), which were not significantly different between the two groups at any time points accordingly (P＞0.05). Radiographically, the spinal canal sagittal diameter was significantly enlarged (P＜0.05), whereas the intervertebral height remained unchanged in both groups 12 months after surgery compared with those preoperatively (P＞0.05), in addition, there was no significant difference in the above image indexes between the two groups at any time points accordingly (P＞0.05). [Conclusion] Both endoscopic excisions of apophyseal fragments with oscillating bur are safe, effective and minimally invasive methods for lumbar posterior ring apophysis fracture, with similar clinical outcomes.

Abstract:[Objective] To compare the clinical outcomes of mono- segment (MS) pedicle screw fixation versus short- segment (SS) counterpart for minor thoracolumbar fracture. [Methods] A total of 62 patients admitted our department from January 2019 to July 2021 for minor thoracolumbar fractures were randomly divided into 2 groups. Of them, 32 patients received MS fixation of the injured vertebra with the upper or lower vertebra according to the fracture location, while the other 30 patients underwent SS pedicle screw fixation of the upper and lower vertebrae over the injured vertebrae. The document regarding to perioperative period, follow-up and images were compared be- tween the two groups. [Results] All patients in both groups had corresponding surgical procedures performed successfully without serious complications. The MS group proved significantly superior to the SS group in terms of operation time [(39.6±21.5) min vs (54.4±26.9) min, P＜0.05], length of incision [(8.6±2.4) cm vs (11.3±3.9) cm, P＜0.05], intraoperative blood loss [(79.2±53.2) ml vs (112.6±63.7) ml, P＜0.05] and postoperative walking time [(3.3±2.3) days vs (5.7±3.5) days, P＜0.05]. All patients in both groups were followed up for (16.3±4.5) months in a mean, and the MS group resumed full weight-bearing activity significantly earlier than the SS group [(28.5±11.2) days vs (40.1± 24.4) days, P＜0.05]. The VAS, ODI and JOA scores were significantly improved over time in both groups (P＜0.05). Although there was no significant difference in the above indexes between the two groups before surgery (P＞0.05), the MS group was significantly better than the SS group in VAS score 1 week after surgery [(2.4±1.5) vs (3.9±1.8), P＜0.05], and ODI score at the last follow-up [(10.9±2.4) vs (13.5±3.9), P＜0.05]. Regarding imaging, the anterior vertebral height (AVH), posterior vertebral height (PVH) and local kyphotic Cobb angle signifi- cantly improved at 1 week after surgery and at the last follow-up compared with those preoperatively (P＜0.05). There was no significant dif- ference in the above imaging indexes between the two groups before surgery (P＞0.05), whereas the MS group was significantly superior to the SS group in terms of AVH 1 week postoperatively [(98.4±12.2)% vs (91.7 ±10.2)%, P＜0.05], AVH at the last follow-up [(95.1±9.4)% vs (87.1±10.6)%, P＜0.05] and kyphotic Cobb angle [(2.3±5.8)° vs (5.9±7.4)°, P＜0.05]. [Conclusion] The mono-segment pedicle screw fixa- tion of minor thoracolumbar fracture has the advantages of small incision, less operation time and less intraoperative bleeding, and does achieve good stability and therapeutic effect over the traditional short-segment fixation.

Abstract:[Objective] To compare the clinical outcomes of different reduction heights with a self-developed reductor before percuta- neous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). [Methods] A total of 86 patients with single-segment OVCF admitted to our hospital from January 2020 to December 2021 were randomly divided into 3 groups. All patients underwent PVP af- ter fracture reduction in supine position with the self-developed reductor. Of them, 30 patients in the low reduction (LR) group received re- duction with the reductor height of 7~9 cm, 29 patients in the middle reduction (MR) group were with the height of 10~12 cm, while the re- maining 27 patients in the high reduction (HR) group were with the height of 13~15 cm. The perioperative period, follow-up and imaging data of the three groups were compared. [Results] The LR group had significantly less amount of bone cement injected in PVP than the MR and HR groups [(3.4±0.9) ml vs (4.1±0.9) ml vs (3.9±1.0) ml, P=0.015], although there was no a significant difference in bone cement leak- age rate among the three groups (P＞0.05). With time of follow-up lasted for more than 12 months, the VAS and ODI scores significantly de- creased in the three groups (P＜0.05). Nevertheless, there were no significant differences in terms of VAS scores between the three groups preoperatively to 6 months postoperatively (P＜0.05), and ODI scores at any time points accordingly (P＜0.05), the LR group proved signifi- cantly higher VAS scores than the MR and HR groups at the latest follow-up [(1.4±0.9) vs (0.9±0.7) vs (0.9±0.8), P=0.020]. Regarding to imaging, the new-onset or recurrent fractures during follow-up were found in 2 cases (6.7%) in the LR group, 3 cases (10.3%) in the MR group, and 6 cases (22.2%) in the HR group, whereas which was not statistically significant (P＞0.05). Compared with those preoperatively, the anterior vertebral height and local kyphotic Cobb angle significantly improved in all the three groups postoperatively (P＜0.05). There were no significant differences in anterior vertebral height and local kyphotic Cobb angle among the three groups before surgery (P＞0.05), whereas the LR group proved significantly inferior to the MR and HR groups in abovementioned items at all corresponding time points after surgery (P＜0.05). However, there were no significant differences in the anterior vertebral height and the local kyphotic Cobb Angle between the MR and HR groups postoperatively (P＞0.05). [Conclusion] PVP after fracture reduction in different heights does effectively relieve pain and improve postoperative quality of life for OVCF. By comparison, the reduction height in more than 10cm does better restore the an- terior vertebral height of the fractured vertebra and improve the kyphosis.

Abstract:[Objective] To systematically evaluate the clinical efficacy of 4 cannulated screws (4CS) versus 3 cannulated screws (3CS) in the treatment of femoral neck fractures. [Methods] The PubMed, CNKI, Cochrane library, Wanfang, VIP, Embase, CBM and ChiCTR da- tabase were searched to collect the literature on the comparison of 4CS and 3CS internal fixations for treatment of femoral neck fractures with retrieval time from the establishment of the database to January 2023. The quality assessment and data extraction were completed inde- pendently by two researchers, and meta-analysis was performed using RevMan 5.3 software. [Results] A total of 5 literatures with 436 pa- tients were included, involving 216 patients in the 4CS group and 220 patients in the 3CS group. As results of the meta-analysis, the 4CS group was significantly greater than the 3CS group in terms of the operative time (MD=0.93, 95%CI 0.27~1.58, P＜0.001), intraoperative blood loss (MD=0.59, 95%CI 0.09~1.08, P=0.02), intraoperative fluoroscopy (MD=6.53, 95%CI 5.41~7.64, P＜0.001). However, the 4CS group proved significantly superior to the 3CS group in terms of Harris score 6 months postoperatively (MD=5.07, 95%CI 1.77~8.37, P= 0.003), fracture healing time (MD=-0.35, 95%CI -0.59~0.11, P=0.004), and fracture nonunion rate (OR=0.3, 95%CI 0.11~0.84, P=0.02), femoral head necrosis rate (OR=0.52, 95%CI 0.26~1.03, P=0.06) and screw loosening rate (OR=0.33, 95%CI 0.13~0.83, P=0.02). There were no significant differences in incision length, postoperative walking time and hospital stay between the two groups (P＞0.05). [Conclusion] The 4CS has the advantages of short fracture healing time, low incidence of fracture nonunion, high Harris score 6 months after sur- gery, low loosening rate, and significant better clinical outcomes over the 3CS in the treatment of femoral neck fracture. However, 4CS re- quires longer operation time, more intraoperative bleeding and more intraoperative fluoroscopy than 3CS.

Abstract:The repair of bone defects has always been an important problem to be solved in clinic. At present, the bone repair materi- als used in clinical practice include allogeneic bone, autogenous bone, artificial bone and so on. The bone allograft has risk of immunologi- cal rejection and graft-versus-host reaction, while the artificial bone is expensive and has weak osteogenic effect, the bone autograft is limit- ed in source with morbidity of the donor site. All the shortcomings of the abovementioned materials impacted their application for bone re- pair in clinical setting. In recent years, lithium and related biomaterials have attracted wide attention in the field of bone repair due to their good biocompatibility and osteogenic potential. This article reviews the role and mechanism of lithium and related biomedical materials such as hydrogels, biological scaffolds and nano-coatings used in repairing bone defects, in order to provide a new vision for the study of bone repair.

Abstract:Postoperative relapse of lumbar disc herniation (rLDH) might compress nerves and cause failed back surgery syndrome (FBSS). Because the blood supply to the annulus is mainly from the small vessels of the peripheral segmental artery branches and the forma- tion of annulus scar takes 3~6 months, the new scar formed around the rupture has low strength-resistance capacity. As the pressure in the intervertebral disc increases rapidly, the residual nucleus pulposus will protrude again from the scar. On the other hand, the inflammatory factors released from the spinal canal into intervertebral disc through the annulus fibrosus rupture, and further aggravates the degeneration of the intervertebral disc. Fibrous ring repair can promote the healing of broken annulus fibrosus, significantly enhance the hardness of scar, reduce the re-protrusion rate of nucleus pulposus, and reduce the possibility of postoperative revision. With the popularity of the con- cept of minimally invasive spine surgery, the way of fibrous annulus repair has gradually changed from open laminae fenestration surgery to endoscopic minimally invasive surgery. Therefore, this paper reviews the different surgical procedures for annular fibrosus repair.

Abstract:Diametaphyseal (DMP) fracture of distal radius is a special fracture type in children. Different from metaphyseal fracture, its diagnostic criteria and treatment methods have not reached a consensus. DMP fracture is prone to re-displacement, nonunion and other complications, so it should be emphasized. In this paper, the diagnostic criteria, anatomical characteristics, treatment methods and compli- cations of DMP fracture of distal radius in children were summarized and analyzed by reviewing the relevant literatures, not only to improve its clinical recognition and provide basis for selecting proper treating methods, but also to promote final outcome and reduce complications.

Abstract:[Objective] To explore the effect of two Chinese herbal preparations, the Yougui and Buyi on bone metabolism and bone biomechanics in the osteoporosis model of rats. [Methods] A total of 48 Wistar female rats were randomly divided into the sham group, mod- el group, Yougui group and Buyi group, with 12 rats in each group. The rats in the sham group had the fat around the ovaries resected only without ovariectomy, while all those in the remaining groups underwent ovariectomy. Two weeks after surgery, all animals were given intra- gastrically once a day for 12 weeks, the Yougui group and Buyi group received corresponding TCM preparations with dosage of 0.875 ml / 100 g/once time, respectively, whereas the sham group and model group were given 0.9% normal saline in the equal volume. After another 12 weeks, urine within 24 h and blood were collected for bone metabolism assay, and the left femur was taken for bone density and bone bio- mechanics tests. [Results] The model group was significantly higher than the sham group in terms of urine Ca/Cr [(0.6±0.3) vs (0.4± 0.1), P＜ 0.05] and urine P/Cr [(0.7±0.2) vs (0.5±0.1), P＜0.05]. However, the Buyi group proved significantly superior to the Yougui group and model group in terms of Ca/Cr [(0.3±0.1) vs (0.5±0.2) vs (0.4±0.1), P＜0.05] and P/Cr [(0.3±0.2) vs (0.6±0.3) vs (0.5± 0.1), P＜0.05]. The model group was significantly higher in term of ALP level [(193.4±9.2) U/L vs (128.6±10.4) U/L vs (110.4±9.8) U/L vs (128.9±8.5) U/L, P＜0.05], whereas significantly lower in PINP [(186.5±20.3) pg/ml vs (238.9±18.6) pg/ml vs (235.9±18.6) pg/ml vs (207.6±21.1) pg/ml, P＜0.05] and BMP-2 [(10.5±0.1) pg/ml vs (15.8±0.2) pg/ml vs (15.7±0.3) pg/ml vs (13.2±0.4) pg/ml, P＜0.05] than the sham group, Buyi group and Yougui group. The Buyi group had significantly lower ALP level, while significantly higher PINP and BMP- 2 than the model group and Yougui group (P＜0.05), whereas without significant differences with the sham group (P＞0.05). Moreover, the Buyi group proved significantly superi- or to the model group and Yougui group in terms of bone mineral density, maximum load and maximum displacement (P＜0.05), without sig-nificant differences with the sham group (P＞0.05). [Conclusion] In this study, the Buyi preparation of Chinese herbal does presents the ef- fect of anti-osteoporosis.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcome of medial patellar fascia strip transfer combined with suture enhancement and medial tightening for patella dislocation in children. [Methods] From March 2020 to September 2022, 15 children received abovementioned surgical procedures for patella. After arthroscopy was performed to remove the blood clot, carti- lage fragments and the hyperplastic synovial tissue, a 4 cm longitudinal incision was made along the medial edge of the patella. A fascia strip 1cm in width was cut longitudinally along the medial edge of the patella. The proximal attachment of the fascia bundle was kept intact, while the distal end was freed and sutured with stitches. Then, the fascia bundle was led subcutaneously to the medial femoral epicondyle and fixed with sutures anchors. The fascia defect on the medial patella was closed with tight sutured. [Results] All the 15 patients were suc- cessfully operated on, and followed up for 2 to 30 months. No patellar re-dislocation or subluxation occurred in anyone of them during the follow-up period. The Lysholm score increased from (59.9±9.3) before surgery to (91.7±4.5) at the last follow-up with a statistical signifi- cance (P＜0.05). In addition, the patellar tilt angle (PTA) measured on CT significantly decreased from (30.5±8.9)° preoperatively to (7.0± 2.9)° at the latest follow-up (P＜0.05). [Conclusion] The medial patellar fascia strip transfer combined with suture enhancement and medial tightening is simple and feasible treatment for patella dislocation in children with satisfactory initial outcome, while the long-term efficacy needs to be further observed.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopic repair of acetabular labrum tear from the peripheral to central compartments. [Methods] The patient was placed in supine position on the fracture table after general an- esthesia, with the affected low limb in the internal rotation, hip flexion of 10° and abduction of 25°. The body surface markers were made on the front and lateral sides of the hip with the assistance of "C" arm fluoroscopy. A blunt trocar was inserted through the anterolateral portal, and as a tough tissue was felt, the trocar was moved from one side to other side to separate the tissues around the capsule, then inner trocar was pulled out and the arthroscope replaced. As the hip anterior capsule was exposed under arthroscope, “Y” shaped capsulotomy was done with a plasma cutter introduced from the anterior portal to reveal the anterolateral aspect of the hip joint, and the peripheral compart- ment was examined. Pulling the affected limb, the central compartment was exposed. Finally, the acetabular labrum injuries were evaluated and repaired with suture anchors. [Results] All patients were operated on smoothly without serious complications during the operation, and were followed up from 24 to 96 months. Compared with those preoperatively, the VAS score for pain [(6.7±1.2), (2.1±0.7), P＜0.001] and Harris score [(52.8±6.4), (86.9±4.7), P＜0.001] significantly improved at the latest follow-up. During the follow-up period, no revision or secondary surgery was performed in anyone of the patients. [Conclusion] This arthroscopic repair of acetabular labrum tear from the periph- eral to central compartments is feasible technique with shortened traction time, does achieve satisfactory preliminary clinical consequences.

Abstract:[Objective] To introduce the surgical techniques and preliminary clinical results of electromagnetic navigation guided per- cutaneous pedicle screw for fixation of thoracolumbar burst fractures. [Methods] From January 2020 to January 2022, a total of 30 patients received electromagnetic navigation guided percutaneous pedicle screw for single-segment thoracolumbar burst fractures. After general an- esthesia, the patients were placed in the prone position, and the magnetic field generator, locator and navigation bridge were placed respec- tively. After the C-arm fluoroscopic image was successfully matched with the electromagnetic navigation system, the pedicle screws were percutaneously placed under the guidance of electromagnetic navigation, following by fastened with the bilateral rods that introduced percu- taneously to finish the fixation. [Results] All the patients were successfully operated on without nerve or vascular injury, and followed up for (12.1±2.3) months on a mean. The VAS scores [(0.3±0.1), (6.3±0.3), P＜0.05] and ODI scores [(3.2±0.6), (40.3± 0.8), P＜0.05] significantly reduced postoperatively compared with those preoperatively. In addition, the local kyphotic Cobb angle [(6.4±0.9)° , (23.4±1.6)°, P＜0.05], and compression ratio of the injured vertebra [(3.4±0.5)%, (30.5±2.5)%, P＜0.05] significantly declined at the latest follow-up compared with those preoperatively. During the follow-up period, no broken screw, broken rod, internal fixation loosening and other adverse imaging finding was noted in anyone of them. [Conclusion] This electromagnetic navigation guided percutaneous pedicle screw for thoracolumbar burst fracture does effectively restore vertebral height, significantly reduce symptoms, decrease radiation exposure, and resume spinal stabil- ity well.

Abstract:[Objective] To introduce the surgical technique and preliminary results of osteochondral autografting combined with plate- let-rich plasma in the treatment of talus cartilage defect. [Methods] A total of 8 patients received the abovementioned surgical treatment for talus cartilage defect. Preoperative osteochondral autograft transplantation plan was developed. The worn cartilage surface of the talus was exposed and debrided through the anterolateral approach. Based on the aera of cartilage defect, 1 to 3 circular bone slots were made on the recipient site. Osteochondral grafts, which harvested from the non-weight-bearing cartilage surface of the lateral femoral condyle con- sistent with the shape and size of the recipient bone slots, were packed into the bone slots in the talus cartilage defect aera to keep smooth with the articular surface, and then the incision was closed in layers. Finally, platelet rich plasma (PRP) prepared with autogenous blood was injected into the affected joint. [Result] All the 8 patients had operation performed successfully without serious complications, and fol- lowed up for (24.5±4.4) months in a mean. Compared with those preoperatively, the pain VAS score significantly decreased [(7.3±1.0), (1.0± 0.3), P＜0.05]. AOFAS ankle and hindfoot score increased significantly at the latest follow-up [(43.3±4.4), (87.6±5.7), P＜0.05]. The salvage rate of the ankle was 100% 24 months after surgery. [Results] The osteochondral autograft transplantation combined with platelet-rich plas- ma for the treatment of talus cartilage defect is feasible and does achieve satisfactory clinical consequences.

Abstract:[Objective] To explore the cause and prevention of complications of total hip arthroplasty (THA) through the direct anterior approach (DAA) under traction for femoral neck fracture in elderly. [Methods] A retrospective study was conducted on 358 elderly patients who received DAA-THA under traction from January 2018 to June 2021. The complications were summarized and their causes were ana- lyzed. [Results] Complications occurred in 63 cases of the 358 patients, with a total incidence of 17.6%. The incidence of complications in descending order was: lateral femoral cutaneous nerve injury (8.1%) ＞ leg length discrepancy (LLD) (3.4%) ＞ incision effusion (2.8%) ＞ an- kle pain (1.7%) and periprosthetic fracture (1.7%). [Conclusion] DAA-THA under traction for femoral neck fracture does has some compli- cations, such as LLD, incision effusion, ankle pain, periprosthetic fracture and femoral lateral cutaneous nerve injury. Fully grasping the pa- tient's condition, improving the surgical technique and paying attention to postoperative rehabilitation might reduce the occurrence of com- plications.

Abstract:[Objective] To analyze the correlation between the hospital cost structure and the total cost in insured orthopedic patients to provide a theoretical basis for reasonably controlling the hospital cost of orthopedic patients, ensuring the safety of medical insurance fund and restricting the unreasonable growth of medical cost. [Methods] A total of 7 773 orthopedic patients in a hospital from 2019 to 2022 were included into this study. According to the classification of the cost structure, the total hospitalization cost of orthopedic patients was divided into 6 categories. The gray correlation analysis was conducted for the 6 evaluation items, and the correlation between the six evaluation items and the average cost was studied by taking the average cost of per time as the "reference value". [Results] From 2019 to 2022, the average hospitalization cost of insured orthopedic patients showed a trend of increase first and then decrease, but the overall trend was increasing, and the proportion of increase was the largest in 2020. The trend of the proportion of drugs was the same as the average cost of hospitaliza- tion, but the proportion of consumables was on the contrary, showing an upward trend. In term of grey correlation analysis, medical expenses had the highest correlation before the diagnosis classification-based payment. After the new medical insurance payment, the consumables cost had the highest correlation, followed by medical and administrative costs. [Conclusion] The focus of medical insurance supervision on hospital expenses of orthopedic patients should be on the high-value consumables, followed by rational drug use and reasonable charges. At the same time, we should pay attention to the value of orthopedic nursing staff and improve the enthusiasm of medical staff in diagnosis and treatment. At the hospital level, we should pay attention to and gradually explore and promote the reform of diagnosis intervention packet pay- ment methods, and improve the level of hospital fine management.

Abstract:[Objective] To observe the clinical consequences of orientational muscle group guided training (OMGGT) in the early reha- bilitation of total hip arthroplasty (THA). [Methods] A total of 60 patients who were undergoing THA in our hospital from October 2021 to October 2022 were enrolled into this study and randomly divided into the two groups. Of them, 30 patients in the training group received OMGGT, while other 30 patients in the conventional group received the conventional rehabilitation training after surgery. The clinical data were compared between the two groups. [Results] All patients in both groups had THA performed successfully without serious complica- tions. The VAS for pain, Harris scores, hip range of motion (ROM) and performance-oriented mobility assessment (POMA) improved signifi- cantly over time in both groups (P＜0.05). One month postoperatively, the training group proved significantly superior to the conventional group in terms of VAS score [(0.9±0.7) vs (3.3±0.9), P＜0.001], Harris score [(81.8±5.8) vs (67.2±4.3), P＜0.001], hip ROM [(94.6±9.9) vs (77.2±7.4), P＜0.001] and POMA score [(25.3±1.4) vs (21.5±1.1), P＜0.001]. [Conclusion] The orientational muscle group guided training does improve hip function recovery after total hip arthroplasty, increase the hip muscle strength and balance ability, improve the patient's ambulation adaptability.

Abstract:[Objective] To summarize the characteristics of lumbar disc herniation in armed police officers and soldiers, investigate the clinical efficacy of CT guided endoscopic discectomy (CTED). [Methods] A retrospective study was conducted on 92 armed police officers and soldiers who underwent CTED for lumbar disc herniation in our hospital from June 2010 to December 2020. Clinical and imaging data were evaluated. [Results] All the 92 patients were successfully operated on, with average operation time of (63.5±19.7) min, average num- ber of intraoperative CT scans of (7.8±1.7) times and average follow-up time of (52.3±38.3) months. With time preoperatively, at discharge and the latest follow-up, the VAS score [(7.4±0.9), (1.6±0.7), (1.1±0.3), P＜0.05] and ODI scores [(74.5±11.7), (18.6±3.0), (14.4±1.3), P＜ 0.05] significantly reduced, while JOA score significantly increased [(9.0±3.2), (26.1±2.3), (28.0±1.2), P＜0.05]. Radiographically, com- pared with those preoperatively, the height of the vertebral space at the involved level significantly decreased [(9.1±1.3) mm, (8.6±1.3) mm, (8.0±1.2) mm, P＜0.05], whereas the lumbar lordotic angle significantly increased [(22.3±4.6)°, (27.7±4.9)°, (27.0±3.6)°, P＜0.05] postopera- tively. [Conclusion] The CTED used in the treatment of lumbar disc herniation in armed police officers and soldiers has the advantages of minimally invasive surgery, accurate location, high safety, quick recovery and good curative outcome.

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