Abstract:[Objective] To compare the clinical efficacy of Intertan Nail (IN) versus Proximal Femoral Nail Anti-rotation (PFNA) in thetreatment of unstable intertrochanteric femur fracture (IFF) in the elderly. [Methods] A total of 114 elderly patients with unstable IFF weretreated by operation from January 2019 to December 2021. The patients were divided into 58 cases in the IN group and 56 cases in the PF-NA group by random number method. Perioperative, follow-up and imaging data were compared between the two groups. [Results] The PF-NA group proved significantly superior to the IN group in terms of operation time [(45.3±8.0 min) vs (49.6±7.9) min, P＜0.05], the total inci-sion length [(4.5±1.2) cm vs (5.0±1.3) cm, P＜0.05], blood loss [(81.7±10.3) ml vs (127.6±20.0) ml, P＜0.05], intraoperative fluoroscopy times[(11.7±2.4) times vs (13.0±2.2) times, P＜0.05], ambulation time [(6.5±1.2) days vs (7.6±1.4) days, P＜0.05], incision healing time [(12.0±2.3) days vs (13.4±3.1) days, P＜0.05] and hospital stay [(5.9±0.9) days vs (7.1±1.3) days, P＜0.05], despite of insignificant difference in clini-cal fracture healing time between the two groups (P＞0.05). Compared with those 6 months after surgery, the Harris score, hip extension-flex-ion ROM and internal-external rotation ROM significantly increased in both groups at 12 months after surgery (P＜0.05), whereas whichwere not statistically significant between the two groups at any time points accordingly (P＞0.05). Radiographically, there were no significantdifferences in the quality of fracture reduction and fracture healing between the two groups (P＞0.05). In addition, there were no statisticallysignificant differences in shaft-neck angle and anteversion between the two groups at any time points accordingly (P＞0.05). However, theIN group had significantly less tip-apex distance (TAD) than the PFNA group at the last follow-up [(23.4±2.5) mm vs (25.2±2.8) mm, P＜0.05]. [Conclusion] Both IN and PFNA used for internal fixation of unstable IFF do restore hip function and promote fracture healing in the elderly. By comparison, the PFNA is more suitable for elderly patients with poor tolerance due to less intraoperative blood loss, fluoroscopytimes, short operation time and hospital stay, while IN takes better biomechanical advantages.

Abstract:[Objective] To evaluate the clinical efficiency of 3D printing-assisted high tibial osteotomy (HTO) in the treatment of varusknee osteoarthritis (KOA). [Methods] A retrospective study was performed on 94 patients who received HTO for varus KOA treated from Jan-uary 2018 to June 2019. According to doctor-patient communication, 47 patients received 3D printing-assisted HTO, while the other 47 pa-tients received traditional freehand HTO. The perioperative, follow-up and imaging data of the two groups were compared. [Results] The 3Dgroup proved significantly superior to the freehand group in terms of operative time [(58.8±5.0) min vs (65.8±5.4) min, P＜0.001] and intraop-erative fluoroscopic frequency [(2.1±0.9) times vs (7.5±1.6) times, P＜0.001]. All the patients in both groups were followed up for more than24 months. The flexion-extension range of motion (ROM), VAS, WOMAC, and HSS scores significantly improved over time in both groups(P＜0.05). The 3D group was significantly better than the freehand group regarding to flexion-extension ROM [(96.8±5.8)° vs (88.7±5.2)°, P＜0.001], VAS sore [(5.7±1.1) vs (6.6±1.4), P＜0.001], WOMAC score [(28.7±3.9) vs (34.8±4.0), P＜0.001] and HSS score [(58.5±7.0) vs (53.3±6.9), P＜0.001] 6 months postoperatively. Radiographically, the femorotibial angle (FTA), medial proximal tibial angle (MPTA), and Kellgren-Lawrence (K-L) scale for osteoarthritis of the medial compartment significantly improved in both groups at the latest follow-up comparedwith those before surgery (P＜0.05), however, the posterior tibial slope (PTS) and K-L scale of the lateral compartment remained unchangedin both of them between the two time points (P＞0.05). In addition, there were no significant differences in FTA, MPTA, PTS, and K-L scalesbetween the two groups at any time points accordingly (P＞0.05). [Conclusion] The 3D print-assisted HTO does bolster accuracy of the oste-otomy, enhance surgical efficiency and improve the clinical outcomes for treatment of varus KOA.

Abstract:[Objective] To compare the clinical outcomes of femoral neck system (FNS) versus traditional 3 cannulated compressionscrews (CCS) for femoral neck fractures in the young and middle-aged. [Methods] A retrospective study was done on 94 patients who re-ceived internal fixation for femoral neck fractures from November 2019 to June 2020. According to doctor-patient communication, 46 pa-tients had fractures fixed with FNS while the remaining 48 patients were treated with CCS. The perioperative, follow-up and imagingdocumants were compared between the two groups. [Results] All patients in both groups had operation finished successfully without any se-rious complications, such as neurovascular injury. The FSN group proved significantly superior to the CCS group in terms of operation time,intraoperative blood loss, intraoperative fluoroscopy and hospital stay (P＜0.05). All of them in both groups were followed up for (15.5±1.6)months on an average, and the FNS group returned to full weight-bearing activity significantly earlier than the CCS group (P＜0.05). TheHarris score, hip extension-flexion range of motion (ROM) and internal-external rotation ROM significantly increased (P＜0.05), while theVAS score significantly decreased in both groups over time (P＜0.05), which in the FNS group were significantly better than the CCS groupone month after surgery (P＜0.05), and became not statistically significant between the two groups at 6 months after surgery and the latest fol-low-up (P＞0.05). Radiographically, Garden alignment index significantly improved in both groups postoperatively compared with that be-fore operation (P＜0.05), which proved not significantly different between the two groups at any time points accordingly (P＞0.05). At 6months and the latest follow-up, femoral neck shortening in the FNS group was significantly less than those in the CCS group (P＜0.05), al-though there was no significant difference in fracture healing time between the two groups (P＞0.05). At the time points accordingly, the fixa-tion stability in FNS group were significantly better than that in CCS group (P＜0.05). With time postoperatively hip degeneration in some extent was noted in both groups, but which was not significantly different in term of Tonnis classification between the two groups at any cor-responding time points (P＞0.05). [Conclusion] Compared with traditional CCS internal fixation, FNS is less invasive, more stable, and getsbetter hip function recovery after surgery.

Abstract:[Objective] To compare the clinical efficacy of Tianji Orthopedics robot-assisted sacroiliac cannulated screw fixation ver-sus traditional freehand counterpart for posterior pelvic ring injury. [Methods] A retrospective study was done on a total of 74 patients whounderwent surgical treatment for the posterior pelvic ring injury from March 2019 to March 2021. According to preoperative doctor-patientcommunication, the surgical techniques used of percutaneous sacroiliac cannulated screw placement was selected, including 16 patients inthe robotic-assistance in the early-stage (RAE) group, 16 cases in the robotic-assistance in the late-stage group (RAL), and 42 cases inthe traditional group. Perioperative, follow-up and imaging data were compared among the three groups. [Results] All patients in the threegroups were successfully operated on without serious complications. Compared with that in the traditional group, the RAE group consumedsignificantly longer time for screw placement, while the RAL group took significantly shorter time with statistically significant differenceamong the 3 groups [(78.6±4.8) min vs (66.4±7.1) min vs (70.3±6.5) min, P＜0.001]. In addition, the RAE group and RAL group proved sig-nificantly superior to the traditional group in terms of intraoperative blood loss [(14.8±2.4) ml vs (13.7±1.7) ml vs (18.5±2.9) ml, P＜0.001],intraoperative fluoroscopy times [(10.4±1.3) times vs (9.5±0.7) times vs (12.5±1.4) times, P＜0.001] and the number of screw setting adjust-ments [(0.6±0.6) times vs (0.3±0.5) times vs (1.1±0.7) times, P＜0.001]. However, there were no significant differences in incision healinggrade, postoperative ambulation time and hospital stay among the three groups (P＞0.05). All patients were followed up for more than 12months, and the RAE group and RAL group resumed full weight-bearing activities significantly earlier than the traditional group [(90.5±4.8) days vs (89.1±6.0) days vs (95.8±6.4) days, P＜0.001]. The VAS score for pain decreased significantly, while Majeed scores increased significantly in all the 3 groups over time (P＜0.05). and the RAE group and RAL group were significantly better than the traditional groupin Majeed scores 3 months after surgery [(85.4±5.2) vs (85.7±3.9) vs (80.5±6.1), P＜0.001]. Regarding imaging, the RAE group and RALgroup were significantly better than the traditional group in term of accuracy of screw placement [excellent/good/poor, (14/2/0) vs (15/1/0) vs(28/13/1), P=0.048], but there was no statistically significant difference in Matta grade of fracture reduction among the three groups (P＞0.05). By the last follow-up, all patients in the 3 groups got fractures healed without loosening of internal fixation implants. [Conclusion]The Tianji robot assisted percutaneous sacroiliac cannulated screw internal fixation has the advantages of high accuracy, safety and mini-mally invasive surgery despite of a learning curve.

Abstract:[Objective] To compare the clinical efficacy of percutaneous screw-rod system versus plate in the treatment of unstable pel-vic ring fractures. [Methods] A retrospective study was conducted on 57 patients who underwent open reduction and internal fixation (OR-IF) for Tile type C pelvic fractures in our department from January 2016 to December 2020. After the ORIF for the posterior ring had beenperformed, 30 patients had the anterior ring fixed with screw-rod system, while the other 27 patients were with plate. The perioperative, fol-low-up and imaging documents were compared between the two groups. [Results] All the patients in both groups were operated on success-fully without nerve and vascular injury and other serious complications. The screw-rod group proved significantly superior to the plategroup in terms of operation time [(59.1±12.2) min vs (77.2±18.3) min, P＜0.05], total incision length [(15.4±3.2) cm vs (27.5±4.3) cm, P＜0.05] and intraoperative blood loss [(75.2±15.3) ml vs (350.4±50.6) ml, P＜0.05], nevertheless there were no significant differences in thenumber of intraoperative fluoroscopy, incision healing grade and hospitalf stay between the two groups (P＞0.05). The early complicationswere 3.3% (1/30) in the screw-rod group, whereas 18.5% (5/27) in the plate group, which was not statistically significant (P=0.091). All pa-tients were followed up for more than 12 months, and the screw-rod group resumed full weight-bearing activity significantly earlier than theplate group [(92.6±11.2) days vs (107.4±12.1) days, P＜0.05]. The VAS scores for pain decreased significantly (P＜0.05), while the Majeedscore increased significantly over time in both groups (P＜0.05). The screw-rod group was significantly better than the plate group in term ofMajeed score at 3 months [(77.5±5.6) vs (71.8±3.6), P＜0.05] and 6 months [(88.7±3.6) vs (82.5±1.6), P＜0.05]. Radiographically, there wereno significant differences in reduction quality according to Matta's criteria and internal fixation position between the two groups at any timepoints accordingly (P＞0.05). However, the screw-rod group got fracture healing on images significantly earlier than that of plate group (P＜0.05). [Conclusion] The percutaneous screw-rod system used for the anterior ring fixation in Tile type C pelvic fractures has advantages ofshortening operation time, minimizing surgical trauma, reducing bleeding, enhancing fracture healing of the pelvis over the traditional platefixation.

Abstract:[Objective] To explore the factors related to hip dislocation in children with spastic cerebral palsy. [Methods] A total of235 children with spastic cerebral palsy (470 hips) admitted to our hospital from January 2014 to December 2021 were included in thisstudy, including 172 males and 63 females, aged (8.3±3.2) years. The patients were divided into two groups according to whether the hipwas dislocated. Univariate comparison and multi-factor logistic regression analysis were used to explore the factors related to dislocation ofthe hip in children with spastic cerebral palsy, additionally, simple correlations between clinical and imaging indicators were searched. [Re-sults] Of the 235 children, 73 cases were definitively diagnosed of dislocation, accounting for 31.1%. In term of univariate comparison, thedislocation group proved significantly younger than the non-dislocation group [(7.6±3.2) years vs (8.6±3.3) years, P=0.048], the former hadsignificantly poor GMFCS grade than the latter [GMFCS I/II/lIII/IV/V, (5/23/25/20/0) vs (42/56/46/18/0), P=0.001], whereas the dislocationgroup had significantly greater migration percentage of femoral head (MP) [(43.7±14.1)% vs (25.0±5.7)%, P=0.001], head-shaft angle(HAS) [(164.3±8.1)° vs (160.9±8.5)°, P=0.010], and acetabular index (AI) [(32.1±9.5)° vs (21.9±7.4)°, P=0.001] than the non-dislocationgroup. As results of logistic regression analysis, the AI (OR=1.131, 95%CI 1.080~1.184, P=0.001), HSA (OR=1.076, 95%CI 1.027~1.128,P=0.002), and GMFCS (OR=1.478, 95%CI 1.029~2.121, P=0.003) were independent risk factors for dislocation. Regarding simple correla-tion analyses, the age proved significantly negative correlation with MP (r=-0.187, P=0.004), HSA (r=-0.287, P＜0.001), NSA (r=-0.306,P＜0.001) and AI (r=-0.264, P＜0.001), whereas the GMFCS was significantly positive correlation with MP (r=0.375, P＜0.001), HSA (r=0.192, P=0.003), NSA (r=0.235, P＜0.001), AI (r=0.355, P＜0.001). [Conclusion] In children with spastic cerebral palsy, the decline ofgross motor function and the developmental deformity of proximal femur and acetabulum are closely related to the occurrence of hip disloca-tion.

Abstract:[Objective] To compare the clinical efficacy of 3D printed patient-specific instruments (PSI) versus conventional instru-ments (CI) in total knee arthroplasty (TKA). [Methods] A retrospective study was conducted on 100 patients who received primary unilater-al TKA from January 2019 to December 2021. According to preoperative doctor-patient communication, 47 patients had TKA performedwith PIS, while the other 53 patients were treated with CI. The perioperative, follow-up and imaging data of the two groups were compared.[Results] Although the PSI group consumed significantly longer operation time [(80.0±12.7) min vs (66.1±12.3) min, P＜0.05], and signifi-cantly higher hospital expense [(5.0±1.0) ten thousand yuan vs (4.2±0.5) ten thousand yuan, P＜0.05] than the CI group, the former provedsignificantly superior to the latter in terms of incision length [(9.2±1.5) cm vs (14.0±2.6) cm, P＜0.05], intraoperative blood loss [(42.0±10.8)ml vs (50.1±12.8) ml, P＜0.05], postoperative drainage [(124.5±23.6) ml vs (154.3±20.7) ml, P＜0.05], postoperative walking time [(24.0±4.5)hours vs (28.3±5.6) hours, P＜0.05] and hospital stay [(6.8±2.6) days vs (9.0±3.0) days, P＜0.05]. The follow-up period lasted for (18.0±3.5)months on a mean, and the PSI group resumed full weight-bearing activities significantly earlier than the CI group [(20.6±2.8) days vs(25.0±3.0) days, P＜0.05]. The HSS score and knee extension-flexion ROM significantly increased, whereas the VAS and WOMAC scoressignificantly decreased in both groups over time (P＜0.05), which proved not statistically significant between the two groups at any timepoints accordingly (P＞0.05). Radiographically, the PSI group also proved significantly superior to the CI group in terms of FTA deviation[(1.0±0.3)° vs (2.2±0.7)°, P＜0.05], FFC deviation [(0.4±0.1)° vs (1.3±0.5)°, P＜0.05], FTC deviation [(0.2±0.0)° vs (1.2±0.3)°, P＜0.05], LFCdeviation [(4.0±0.9)° vs (8.8±1.3)°, P＜0.05] and LTC deviation [(0.5±0.1)° vs (0.9±0.3)°, P＜0.05]. [Conclusion] The TKA with 3D-printedpatient-specific instruments achieve similar consequence to conventional instruments. Although this personalized technique consumes rela-tively longer operation time, it has obvious advantages over the conventional technique in restoring the coronal alignment of lower extremity and reducing intraoperative blood loss.

Abstract:[Objective] To compare the clinical outcomes of total hip arthroplasty (THA) versus hip arthrodesis (HA) in the treatment ofadvanced hip tuberculosis. [Methods] A retrospective study was performed on 88 patients who received surgical treatment for advanced hiptuberculosis in our hospital from January 2017 to January 2019. According to the doctor-patient communication, 44 patients received onestageTHA, while the other 44 received HA. The documents regarding perioperative period, follow-up and auxiliary examination were com-pared between the two groups. [Results] All patients in both group had corresponding surgical procedures performed successfully withoutserious complications. The THA group proved significantly superior to the HA group in terms of operation time [(90.3±9.3) min vs (97.1±8.6) min, P＜0.05], intraoperative blood loss [(206.5±60.5) ml vs (231.5±54.3) ml, P＜0.05], hospital stay [(14.4±1.9) days vs (15.3±1.3) days,P＜0.05] and postoperative walking time [(8.4±1.3) days vs (9.1±1.2) days, P＜0.05]. The mean follow-up time lasted for (18.2±3.2) monthson an average, and there was no significant difference in the time to return to full weight-bearing activities between the two groups (P＞0.05). During the follow-up, local tuberculosis recurrence was noted in 2 cases of the THA group, while 3 cases in the HA group, whichwere cured after repeated debridement and regular anti-tuberculosis therapy. Compared with those preoperatively, the Harris scores in bothgroups improved significantly, while the flexion-extension and adduction-abduction range of motions (ROMs) in the THA group significant-ly increased (P＜0.05), whereas the ROMs in the HA group were lost at the last follow-up. At the latest follow-up, the THA group was signif-icantly better than the HA groups in terms of Harris score [(93.2±8.4) vs (85.6±7.4), P＜0.05], flexion-extension ROM [(102.9±9.6)° vs 0°,P＜0.05] and adduction-abduction ROM [(164.1±13.2)° vs 0°, P＜0.05]. Regarding auxiliary examination, the leg length discrepancy in bothgroups significantly decreased at the last follow-up compared with that before surgery (P＜0.05). At the corresponding time points, therewere no significant differences in auxiliary examination parameters between the two groups (P＞0.05). [Conclusion] Both one-stage THAand HA do effectively treat advanced hip tuberculosis. In contrast, the THA has less iatrogenic trauma and better functional recovery over the HA.

Abstract:Chronic lateral ankle instability (CLAI) is often secondary to acute ankle sprain, which is one of the most common problemsin ankle injury. About 30 percent of patients develop CLAI after failure of primary conservative treatments and need surgery. ModifiedBrostr?m anatomical repair techniques have traditionally been considered the gold standard for treating CLAI. However, many patients arenot suitable for direct repair of damaged ligaments in clinical practice, ligament reconstruction with grafts might be a better choice. Recon-structions are divided into anatomical and non-anatomical projects, and the choice of grafts mainly includes autograft and allograft. Thetechnique of lateral ankle ligament reconstruction has been developing in recent years. This article reviews CLAI for reconstruction of later-al ligament to provide basis for clinical treatment.

Abstract:Exosome, as an important component of paracellular secretion, are involved in the transport of biochemical substances suchas cytokines, mRNAs, miRNAs, and protein, and play an important role in intercellular communication through the transfer of genetic mate-rial. Non-coding RNA (ncRNA), mainly including microRNA, long-chain non-coding RNA and cyclic RNA, which can be selectively in-gested and delivered by the exosome to the receptor cells, thereby regulating the physiological activities and functions of the receptor cells.Fracture is a common traumatic consequence in humans, and its fracture healing process is driven by the early inflammatory response, ac-companied by a variety of biological activities, using the endogenous regeneration potential to restore the original bone structure. In recentyears, more and more attention has been paid to the regulatory mechanism of exosome ncRNA in fracture healing. By reviewing the researchresults in this field, we explored the detailed mechanism of exosome ncRNA in fracture healing.

Abstract:[Objective] To investigate the effects of paeonol on bone metabolism, involving nuclear faction-kappa B (NF-κB) / matrixmetalloproteinases-9 (MMP-9) signaling pathway, in osteoporotic fracture in rat. [Methods] A total of 52 SD female rats were randomly di-vided into the sham operation (SO) group, model group, calcitriol group and paeonol group, with 13 in each group. Except those in the SOgroup, all the rats underwent bilateral total ovariectomy (OVX), and all animals underwent operation to establish femur fracture with inter-nal fixation 10 weeks later. The sham operation group and model group were respectively given normal saline, while the calcitriol group wasgiven 0.05 μg/kg alfacalcitol, and the paeonol group was given 200 mg/kg paeonol intragastrically once a day for 12 weeks. The BMD andbone microCT were conducted, and serum makers, signaling pathway markers mRNA and protein expression were detected. [Results] At 12weeks after drug administration, the BMD [(0.31±0.06) g/cm² vs (0.26±0.06) g/cm² vs (0.25±0.05) g/cm² vs (0.19±0.04) g/cm², P＜0.001], thetrabecular number (Tb.N) [(5.5±0.6) mm^-1 vs (4.7±0.6) mm^-1 vs (4.5±0.5) mm^-1 vs (3.0±0.4) mm^-1, P＜0.001] and bone trabecular thickness(Tb.Th) [(78.5±5.4) μm vs (72.3±4.7) μm vs (70.8±5.0) μm vs (46.9±3.8) μm, P＜0.001] were ranked from high to low as follows: the SOgroup＞the paeonol group＞the calcitriol group＞the model group with statistically significant differences. In terms of serum detections, thePINP, BGP and ALP were ranked in descending order as the SO group＞the paeonol group＞the calcitriol group＞the model group with statisti-cally significant differences (P＜0.05), while the serum TNF-α, IL-6 and IL-8 were in the order from low to high: the SO group＜the paeonolgroup＜the calcitriol group＜the model group with statistically significant differences(P＜0.05). In terms of signaling pathway marker detec-tion, both the mRNA and protein expressions of NF-κB p65 and MMP ranked as follows: the SO group＜the paeonol group＜the calcitriolgroup＜the model group, which all were statistically significant (P＜0.05). [Conclusion] The paeonol does significantly improve bone mineraldensity, bone microCT measurement and serum bone metabolism markers, while down-regulate the expression of NF-κB/MMP9 signaling pathway markers in OP fractured rats in this study.

Abstract:[Objective] To investigate the characteristics and significance of variation in spinal-pelvic sagittal parameters of post-trau-matic thoracolumbar kyphosis (PTK) in elderly. [Methods] A retrospective study was conducted on 65 patients who visited our hospital forsingle-segment PTK patients from January 2018 to December 2020. In addition, 50 patients who visited our hospital for simple osteoporosis(OP) during the same period were used as the control. The spinal-pelvic sagittal parameters measured on X-ray films were analyzed to ex-plore the characteristics and relationship among them. [Results] The PTK group was measured significantly greater thoracic kyphosis (TK)[(40.1±10.1)° vs (34.0±11.8)°, P＜0.05], thoracolumbar kyphosis (TLK) [(38.1±10.8)° vs (19.1±6.6)°, P＜0.05] and pelvic tilt (PT) [(29.5±12.0)° vs (21.2 ±5.9)°, P＜0.05] and sagittal vertical axis (SVA) [(54.4±23.8) mm vs (26.4±18.3) mm, P＜0.05] than the OP group. However,the former had significantly less lumbar lordosis (LL) [(31.7±10.5)° vs (49.7±13.8)°, P＜0.05] and sacral slope (SS) [(20.9±6.4)° vs (30.3±8.3)°, P＜0.05] than the latter. The sagittal imbalance rate proved 53.9% in the PTK group, while 20.0% in the OP group, which was statisti-cally significant (P＜0.05). Regarding correlation analysis, TK was positively correlated with TLK and SVA (P＜0.05), whereas PI was posi-tively correlated with PT and SS (P＜0.05) in the PTK patients. [Conclusion] Elderly patients with PTK do have considerable variation inspinal-pelvic sagittal parameters, and are prone to sagittal imbalance, with forward shift of center of gravity and backward rotation of pelvis.

Abstract:[Objective] To investigate the effects of enhanced recovery after surgery (ERAS) management on deep vein thrombosis(DVT) in total knee arthroplasty (TKA). [Methods] A retrospective study was done on 307 patients who received primary TKA and under-went preoperative and postoperative lower limb vascular ultrasonography in our hospital from July 2016 to June 2018. According to the doc-tor-patient discussion, 88 cases were divided into ERAS group, while other 219 cases were in the routine group. The clinical results, coagu-lation test and ultrasound consequence of the two groups were compared. [Results] The ERAS groups proved significantly superior to theroutine group in terms of operative time [(107.0±19.4) min vs (134.9±20.7) min, P＜0.001] and postoperative ambulation time [(27.8±11.5)days vs (70.6±11.0) days, P＜0.001], occurrence of symptomatic thrombosis during hospitalization [non/calf/whole lower limb/cardiopulmo-nary, (86/2/0/0) vs (196/15/8/0), P=0.046], and the incidence of confirmed thrombotic events (9.1% vs 19.6%, P=0.025). With regard to co-agulation assay, ERAS group were significantly lower than the routine group in postoperative D-D [(3.2±1.7) mg/L vs (3.8±1.7) mg/L, P=0.008] and FIB [(4.9±1.9) g/L vs (5.6±2.3) g/L, P=0.011]. Regarding to ultrasound, the ERAS was also significantly better than the routinegroup in distribution of thrombus [none/ intermuscular/ small vein/ large vein/ pulmonary artery, (80/2/6/0/0) vs (176/10/20/13/0), P=0.045]during hospitalization. [Conclusion] Perioperative ERAS management can effectively reduce the occurrence of DVT in primary TKA andcontribute to the prevention of thrombosis.

Abstract:[Objective] To evaluate the clinical outcomes of Tinavi orthopedic robot assisted pedicle screw fixation with increasing ce-phalic tilting in the fractured segment for thoracolumbar fractures. [Methods] A retrospective study was performed on 60 patients who re-ceived percutaneous pedicle screw fixation for single-segment thoracolumbar fractures with upper endplate collapse in our hospital fromAugust 2018 to June 2021. According to preoperative doctor-patient communication, 25 patients received robot-assisted pedicle screwplacement with increasing cephalic tilting in the fractured segment, while the other 35 patients received routine fluoroscopy-guidancescrew placement. The clinical and imaging data of the two groups were compared. [Results] All patients had operations performed success-fully without serious complications. The robot group proved significantly superior to the routine group in terms of operative time [(90.8±3.4)min vs (93.6±4.5) min, P＜0.05] and intraoperative blood loss [(96.4±8.6) ml vs (115.7±23.6) ml, P＜0.05]. The VAS scores in both groupswere significantly decreased over time (P＜0.05), which were not significant different between the two groups at any time points accordingly(P＞0.05). Regarding imaging, the robot group was significantly better than the routine group in term of Gertzbein-Robbins scale of screw in-sertion accuracy [A/B/C, (138/2/0) vs (174/20/2), P＜0.05]. Compared with those preoperatively, the relative vertebral height and local ky-photic Cobb angle of injured vertebra significantly improved in both groups postoperatively (P＜0.05). The robot group was significantly bet-ter than the routine group regarding to the relative height of the injured vertebra [(27.0±2.2) mm vs (21.9±4.1) mm, P＜0.05] and local ky-photic Cobb angle [(7.8±2.1)° vs (10.2±2.6)°, P＜0.05] 3 months after surgery. [Conclusion] For thoracolumbar fracture with upper endplatecollapse, fractured-segment pedicle screw placement with increasing cephalic tilting under Tinavi orthopaedic robot does achieve betterclinical consequences.

Abstract:[Objective] To evaluate the application value of personalized puncture in percutaneous kyphoplasty (PKP) for osteoporoticvertebral fractures. [Methods] From January 2020 to January 2023, 162 patients with osteoporotic vertebral fractures of 276 vertebrae weretreated with personalized percutaneous kyphoplasty. The clinical effect was evaluated by VAS score and ODI scores, as well as the vertebralheight and local kyphotic Cobb Angle were measured on images. [Results] All patients were successfully operated on without serious com-plications. Although bone cement leakage occurred in 23 cases during the operation, including paravertebral leakage in 6 cases, interverte-bral leakage in 17 cases and no intraspinal leakage, no obvious clinical symptoms were presented in anyone of them. Compared with thosepreoperatively, the VAS scores [(8.6±0.8), (1.8±0.7), (1.7±0.9), P＜0.001] and ODI scores [(72.6±1.2), (28.4±2.3), (27.9±2.5), P＜0.001], aswell as anterior vertebral height [(15.4±1.3) mm, (19.3±2.5) mm, (18.9±2.9) mm, P＜0.001], middle vertebral body height [(17.2±1.4) mm,(21.3±3.1) mm, (20.8±3.4) mm, P＜0.001] and local kyphotic Cobb angle [(14.6±4.3)°, (9.4±3.8)°, (9.2±4.1)°, P＜0.001] significantly im-proved 1 day postoperatively and at the latest follow-up. [Conclusion] This individualized puncture in PKP is a safe and effective methodfor the treatment of osteoporotic vertebral fractures.

Abstract:[Objective] To evaluate the clinical outcome of cup-on-cup technique used in revision surgery for acetabular componentloosening with AAOS IIb acetabular bone defect. [Methods] A retrospective study was performed on 22 patients who underwent revisionhip arthroplasty by cup-on-cup technique in our hospital from February 2016 to April 2017. The clinical and radiological data were evalu-ated. [Results] All patients had the revision THA performed successfully, without vascular, nerve injury and other serious complications,and followed up for (5.3±1.1) years on an average. Compared with those preoperative, the Harris score [(45.5±10.3) vs (90.4±10.6), P＜0.05],hip flexion-extension range of motion (ROM) [(78.2±13.6)° vs (103.3±20.4)°, P＜0.05], hip internal-external rotation ROM [(26.1±10.7)° vs(46.6±17.9)°, P＜0.05], pain VAS score [(8.3±1.3) vs (3.1±0.4), P＜0.05], and the leg length discrepancy [(15.1±2.5) mm vs (4.4±1.6) mm, P＜0.05] improved significantly at the latest follow up. Radiographically, compared with those preoperatively, both the vertical deviation of thecenter of rotation (COR) [(47.2±10.5) mm vs (20.5±5.7) mm, P＜0.05], and the transvers deviation of COR [(15.5± 8.4) mm vs (4.8±3.5) mm,P＜0.05] significantly reduced at the latest follow-up. [Conclusion] The preliminary clinical consequence of cup-on-cup technique is satis-factory for AAOS IIb acetabular defect.

Abstract:[Objective] To evaluate the clinical outcomes of pedicle screw fixation combined with bone grafting into the affected verte-bral body for thoracolumbar fractures. [Methods] A retrospective study was conducted on 55 patients who were treated with the above surgi-cal methods for thoracolumbar fractures from January 2018 to June 2022. After fixation and reduction with pedicle screw-rod system, target-ed puncture aimed the "cavity" of injured vertebrae was performed with bone cement puncture needle, and bone graft was implanted intothe vertebral body through the needle. Clinical and imaging data of the patients were evaluated. [Results] All the 55 patients were operatedon smoothly, without complications, such as nerve injury, while with satisfactory position of pedicle screw placed revealed by intraoperativefluoroscopy, operation time of (82.6±13.8) min and intraoperation blood loss of (51.5±15.7) ml. All the patients were followed up for (18.8±8.7) months on an average. Compared with that preoperatively, the VAS score significantly decreased 3 days postoperatively and at the lat-est follow-up [(7.2±1.3), (2.0±1.3), (1.0±1.3), P＜0.001]. Radiographically, the vertebral body compression ratio [(42.6±9.6)%, (2.1±1.5)%,(3.2±0.9)%, P＜0.001] and local kyphotic Cobb angle [(24.1±5.5)°, (3.0±2.2)°, (3.2±2.1)°, P＜0.001] significantly reduced. At the last followup,all the injured vertebral body got bony healing without obvious loss of vertebral height, and no loosening or fracture of internal fixationdevices. [Conclusion] The pedicle screw fixation combined with bone grafting into the affected vertebral body for thoracolumbar fracturesdoes obtain more stable fracture reduction and fixation to avoid vertebral height loss.

Abstract:[Objective] To compare the clinical efficacy of modified Nice knots and loop plate (MNLP) versus hook plate (HP) for fixa-tion of acromioclavicular dislocation. [Methods] A retrospective study was done on 34 patients who received surgical treatment for Rock-wood type III or V acromioclavicular dislocation in our hospitals from January 2017 to January 2020. According to preoperative doctor-pa-tient communication, 18 patients underwent open reduction and fixation with MNLP, while the remaining 16 patients were with HP. Theperioperative period, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had correspondingsurgical procedures performed without nerve, vascular injury and other complications, without significant differences in terms of operationtime, intraoperative blood loss, hospital stay, incision length, incision healing grade between the two groups (P＞0.05), and followed up for(16.4±3.6) months on a mean. Compared with those preoperatively, the pain VAS, Constant and ASES scores in both groups were signifi-cantly improved 9 months after operation (P＜0.05). There was no significant difference in abovementioned items between the two groups be-fore operation (P＞0.05), the MNLP group proved significantly superior to the HP group in terms of VAS score [(1.1±0.8) vs (2.5±1.2), P＜0.001], Constant score [(87.1±2.7) vs (75.7±2.8), P＜0.001] and ASES scores [(83.8±3.7) vs (77.8±5.2), P＜0.001] 9 months postoperatively.Regarding to imaging, the acromioclavicular distance (ACD) and coracoclavicular distance (CCD) in both groups decreased significantly atthe last follow-up compared with those preoperatively (P＜0.05), whereas which were not significantly different between the two groups atany time points accordingly (P＞0.05). [Conclusion] The modified Nice knots and loop plate do achieve considerably better clinical conse-quences over the hook plate fixation for acute acromioclavicular dislocation.

Abstract:[Objective] To evaluate the clinical outcomes of open acromioplasty and osteoplasty of the humeral greater tuberosity com-bined with rotator cuff reattachment by double-row suture anchors for the subacromial impingement secondary to malunion of humeralgreater tuberosity fractures. [Methods] From June 2018 to October 2022, 17 patients received abovementioned surgical procedures for sub-acromial impingement secondary to malunion of humeral greater tuberosity fractures. The functional recovery of the affected shoulder wasevaluated. [Results] All the 17 patients were smoothly operated on with incision healing in the first-stage without infection, and were fol-lowed up for 6~12 months. Compared with those preoperatively, the VAS score [(7.5±1.1), (1.2±0.7), P＜0.001], UCLA score [(12.9±3.8),(30.9±2.2), P＜0.001], Constant-Murley score [(50.7±12.1), (95.1±9.4), P＜0.001] and lifting ROM [(94.9±12.1)°, (151.5±10.2)°, P＜0.001],as well as relative height of humerus head measured on images [(6.1±1.2) mm, (10.3±0.7) mm, P＜0.001] were significantly improved at thelatest follow-up, although there were no significant changes in subacromial space, acromial index, and acromial tilt angle (P＞0.05). [Con-clusion] The open acromioplasty and osteoplasty of the humeral greater tuberosity combined with rotator cuff reattachment by double-rowsuture anchors do effectively improve the mobility of the affected shoulder, with improvement of the relative height of the humerus head forsubacromial impingement secondary to malunion of humeral greater tuberosity fractures.