Abstract:[Objective] To investigate the clinical outcomes of extended proximal femoral nail anti-rotation (PFNA) with or without cerclages for femoral intertrochanteric and subtrochanteric fractures. [Methods] A retrospective study was done on 26 patients who received open reduction and internal fixation (ORIF) for femoral intertrochanteric and subtrochanteric fractures in our department from February 2018 to June 2020. According to the surgeon-patient discussion preoperatively, 13 patients had the fractures fixed by extended PFNA alone (non-cerclage group), while other 13 patients were fixed by extended PFNA combined with steel wire cerclages (cerclage group). The documents of perioperative period, follow-up and images were compared between the two groups. [Results] All patients in both groups had corresponding surgical procedures performed successfully. Although the non-cerclage group consumed significantly less total incision length [(8.4±1.7) cm vs (12.3±2.9) cm, P＜0.001], intraoperative fluoroscopy times [(49.2±21.5) times vs (62.6±15.3) times, P＜0.001] than the cerclage group, the cerclage group resumed partial weight bearing activity significantly earlier than the non-cerclage group [(29.0±7.2) days vs (59.7±14.8) days, P＜0.001]. The VAS and Harris scores, as well as hip extension-flexion range of motion (ROM) and internal-external rotation ROM significantly improved over time in both groups (P＜0.05). The cerclage group proved significantly superior to the non-cerclage group in terms of VAS score [(5.6±0.7) vs (7.3 ±1.0), P＜0.001], Harris score [(64.7±8.3) vs (53.1±9.6), P＜0.001], hip flexion-extension ROM [(83.2±18.9)° vs (54.7±22.3)°, P＜0.001], and internal-external rotation ROM [(46.4±13.7)° vs (35.8±15.1)°, P=0.017] 1 month postoperatively, as well as Harris score [(82.9±7.6) vs (69.5±10.3), P＜0.001] 6 months postoperatively. Regarding imaging, the cerclage group proved significantly superior to the non-cerclage group in fracture reduction quality based on Baumgaertner's criteria [excellent/good/ poor, (11/2/0) vs (3/4/6), P=0.002]. Compared with those preoperatively, the femoral shaft-neck angle (FSNA) and bilateral femur length discrepancy (BFLD) was significantly improved in both groups 1 week after operation and at the last follow-up (P＜0.05). The cerclage group proved significantly better than the non-cerclage group in terms of FSNA [(125.8±7.7)° vs (117.4±12.3)°, P=0.047] and BFLD [(3.0±2.1) mm vs (4.8±3.4) mm, P=0.049] at the latest follow-up, regardless of insignificant difference in fracture healing between the two groups (P＞ 0.05). [Conclusion] The extended PFNA combined with wire cerclages is considerably better in clinical consequences over the extended PFNA alone for treatment of femoral intertrochanteric and subtrochanteric fractures.

Abstract:[Objective] To compare the clinical consequences of external frame fixation of Tile type B pelvic fractures with or without pubic ramus pining. [Methods] A retrospective research was performed on 42 patients who were treated with external fixators for Tile type B pelvic fractures from January 2019 to April 2022. According to the results of preoperative patient-patient discussion, 22 patients received external frame with iliac crest and pubic ramus pining (PRP group), while the other 20 patients underwent external fixator with iliac crest pining alone (non-PRP group). The perioperative, follow-up and imaging documents of the two groups were compared. [Results] All the patients in both groups were operated smoothly, with no vascular, nerve injury and other complications. The PRP group was significantly greater than the non-PRP group in terms of operation time [(36.8±5.8) min vs (24.5±5.1) min, P＜0.001], the total length of incision [(6.1± 0.6) cm vs (4.1±0.5) cm, P＜0.001], intraoperative blood loss [(27.9±7.2) ml vs (17.1±6.8) ml, P＜0.001] and intraoperative fluoroscopy times [(9.1±1.8) times vs (6.6±1.6) times, P＜0.001], but the former proved significantly superior to the latter in terms of the time to resume walking [(22.8±2.4) days vs (41.9±3.8) days, P＜0.001], hospital stay [(12.2±1.8) days vs (19.4±2.8) days, P＜0.001] and the time recover full weight-bearing activity [(45.7±6.6) days vs (60.7±9.4) days, P＜0.001]. The VAS scores, hip flexion-extension range of motion (ROM), internal and external rotation ROM and Majeed scores were significantly improved in both groups with postoperative time (P＜0.05). The PRP group was significantly better than the non-PRP group regarding VAS score [(2.8±1.1) vs (4.2±1.7), P=0.004], hip extension-flexion ROM [(147.8±13.3)° vs (139.5±11.9)°, P=0.038], the internal-external rotation ROM [(69.8±8.4)° vs (64.2±6.2)°, P=0.020] and Majeed scores [(76.1±9.3) vs (65.2±7.0), P＜0.001] one month after operation. With respect of imaging, there were no statistically significant differences in fracture reduction quality and fracture healing time between the two groups (P＞0.05). [Conclusion] The clinical effect of external fixator with both iliac and pubic ramus pining is considerably better than that with iliac pining only for Tile type B pelvic fractures.

Abstract:[Objective] To investigate the correlation between lower limb alignment parameters and the extent of meniscal medial extrusion (MME) in knee osteoarthritis (KOA). [Methods] A total of 307 patients with KOA treated in our hospital from 2022 to 2023 were included in this study. Univariate comparison and Pearson correlation analysis were used to analyze the relationship between MME and lower limb alignment, while ROC curve analysis was used to evaluate the predictive value of lower limb alignment parameters for MME degree. [Results] As results of MME measured on MRI, 307 knees were divided into two groups. Of them, 212 knees with MME＞0.3 cm were marked as the severe group, accounting for 69.1%, while othor 95 knees with MME≤0.3 cm were as the mild group, accounting for 30.9%. In term of univariate comparison, the severe group proved significantly greater than the mild group regarding to AMA [(6.9±1.0)° vs (5.9± 0.8), P＜0.001], JLCA [(5.4±1.3)° vs (2.9±1.1)°, P＜0.001], mLDFA [(88.1±2.8)° vs (83.5±4.2)°, P＜0.001], while the former significantly less than the latter in MPTA [(86.1±3.0)° vs (86.6±3.1)°, P=0.005], mHKA [(1.6±0.8)° vs (2.9±1.9)°, P＜0.001]. In term of pairwise correlation, the MME was positively correlated with AMA, JLCA and mLDFA (P＜0.05), while was significantly negatively correlated with FTA, MPTA and mHKA (P＜0.05). ROC analysis indicated that AMA, JLCA and mLDFA with values higher than 6.33°, 3.55 ° and 86.34° predicted MME≥0.3 cm got the area under cuve (AUC) of 0.807, 0.954 and 0.791 respectively. [Conclusion] AMA, JLCA and mLDFA are closely related to the degree of MME in KOA, and can be used as important parameters to evaluate the severity of MME.

Abstract:[Objective] To investigate the survival and risk factors of death after surgical treatment for intertrochanteric fracture of femur in the elderly over 90 years. [Methods] A retrospective study was done on 172 patients elder over 90 years who received surgical treatment for femoral intertrochanteric fractures in our hospital from January 2016 to March 2023. All patients were treated with proximal femoral nail anti-rotation or hip hemiarthroplasty. In addition to the Kaplan-Meier survival analysis and Cox proportional risk regression used, univariate comparison were conducted to analyze the difference between the death and survival. [Results] The follow-up period was lasted for 1~87 months, and the mortality was of 27 cases (15.7%), 53 cases (30.8%) and 102 cases (59.3%) at 6 months, 12 months and 24 months, respectively. In terms of univariate comparison of whether survival at 6 months after surgery, the death group proved significantly greater BMI [(19.7±3.6) kg/m² vs (21.2±3.7) kg/m² , P=0.049], significantly severe American Society of Anesthesiologists (ASA) classification [II/III/IV/V, (2/10/15/0) vs (23/82/39/1), P=0.031] and significantly lower preoperative Hb level [(92.4±16.6) g/L vs (100.1±18.2) g/L, P=0.043] than the survival group. As consequences of multivariate Cox regression, the severe ASA grade (HR=5.295, P＜0.001) and complex fracture type (HR=2.264, P=0.013) were the independent risk factors for death after surgical treatment for femoral intertrochanteric fractures in elderly, whereas the female (HR=0.290, P=0.003) and high preoperative Hb (HR=0.983, P=0.037) were the protective factors. [Conclusion] The postoperative mortality is higher in the elderly over 90 years with femoral intertrochanteric fractures, especially within 24 months. Meanwhile, light BMI, severe ASA stage and complex fracture classification are risk factors for postoperative death of elderly postoperatively for femoral intertrochanteric fractures.

Abstract:[Objective] To explore the clinical value of using 3D printed guide to assist sacroiliac screw fixation in the treatment of pelvic posterior ring injury. [Method] A retrospective analysis was conducted on the clinical data of 45 patients with pelvic posterior ring injury admitted to the trauma orthopedic ward center of our hospital from January 2020 to February 2023. Based on preoperative doctor-patient communication results, 21 patients were assisted with 3D guide, while 24 patients were treated with screw placement by freehand technique. The perioperative, follow-up, and imaging data were compared between the two groups. [Results] The 3D group proved significantly superior to the freehand group in terms of surgical time [(84.8±2.6) min vs (113.3±2.2) min, P＜0.001], screw insertion time [(40.9±0.4) min vs (65.3±1.6) min, P＜0.001], number of screw adjustments [(0.8±0.7) times vs (4.0±0.9) times, P＜0.001], and X-ray exposure time [(35.2± 0.8) s vs (77.3±1.4) s, P＜0.001]. The average follow-up period lasted for (24.1±7.5) months, and the 3D group resumed full weight-bearing activity significantly earlier than the freehand group [(85.6±2.7) days vs (95.1±0.6) days, P=0.046]. Compared with those one month after surgery, both groups of patients showed significant improvements in VAS score, hip extension and flexion, internal-external rotation ROM, and Majeed score at the last follow-up (P＜0.05). The 3D group proved significantly better than the freehand group in terms of VAS score [(2.6±0.3) vs (3.7±0.2), P=0.042], hip extension flexion ROM [(121.2±1.1)° vs (103.2±1.6)°, P=0.046], hip internal and external rotation ROM [(78.0±0.5)° vs (55.5±0.9)°, P＜0.001], and Majeed score [(36.5±2.3) vs (26.8±0.3), P＜0.001] 1 month postoperatively, whereas the differences in aforesaid items became not significant between the two groups since then (P＞0.05). Radiographically, the 3D group was also significantly better than the freehand group in terms of accuracy of screw placement [cases (%)] [excellent/good/poor, 19 (90.4) / 1 (4.8) / 1 (4.8) vs 14 (58.3) / 7 (29.2) / 3 (12.5), P＜0.001], fracture reduction quality [excellent/good/poor, 18 (85.7) / 2 (9.5) / 1 (4.8) vs 11 (45.8) / 9 (37.5) / 4 (16.7), P＜0.001], and fracture healing time [＜10 weeks / 10~16 weeks / ≥ 16 weeks, 17 (80.9) / 3 (14.3) / 1 (4.8) vs 11 (45.8) / 10 (41.7) / 3 (12.5), P＜0.001]. [Conclusion] The 3D printed guide assisted sacroiliac screw fixation for pelvic posterior ring fractures has minimal damage and can achieve better early treatment outcomes.

Abstract:Steroid -induced osteonecrosis of the femoral head (SONFH) is a metabolic disease caused by the extensive use of glucocorticoid. The pathogenesis of SONFH is still not completely clear, yet there are various hypotheses. Studies have shown that the inflammatory reaction of macrophages may be one of the important factors to impel the development of SONFH. The TLR4/NF-κB inflammatory signaling pathway can be activated by excessive glucocorticoid in the short-term or long term, resulting in the activation of NF-κB, which changes the original structural state of NF-κB, and then transmits to the nuclear promoter gene expression to release a large number of inflammatory mediators, such as TNF-α, Il-1β, IL-6, etc. They inhibits osteoblast differentiation and bone formation, induces osteoblast apoptosis, at the same time, enhances osteoclast differentiation, increases bone resorption and destroys bone homeostasis, eventually leading to collapse and necrosis of femoral head. This article reviews the possible mechanism of TLR4/NF-ΚB signaling pathway in the progression of SONFH, providing a reference for the prevention and treatment of SONFH.

Abstract:Tendon injury, a common clinical disease, usually has scar tissue formed in natural healing with improper functional recovery, which seriously affects the motor function and quality of life of patients due to the poor healing ability of tendon itself. Although the existing treatment methods have achieved some results, they still cannot completely restore the original structure and function of the injured tendon. In recent years, exosomes derived from mesenchymal stem cells have been widely used as a new means in the field of tissue repair and regeneration, however, there are few studies on the treatment of tendon injury by mesenchymal stem cell exosomes, and the specific mechanism is not fully understood. In this review, the research progresses of different mesenchymal stem cell derived exosomes on tendon injury repair and related tissue engineering techniques were reviewed, providing theoretical support for the clinical treatment and applied research of tendon injury.

Abstract:Paget's disease of bone is a non-inflammatory metabolic bone disease characterized by abnormal bone remodeling, mainly manifested as bone pain, bone enlargement, bone deformity and fracture. This disease is extremely rare in China, and the main causes of its formation are still unclear. Most of the literatures believe that its occurrence is related to genetic factors and environmental factors. At present, there are no clear diagnostic criteria, which mainly rely on elevated blood alkaline phosphatase and characteristic imaging changes. In this paper, a case of Paget's disease of bone was reported, who was definitively diagnosed by combining with immunohistochemistry. By reviewing the literature, the pathogenesis, diagnosis and treatment of the malformed osteitis were mainly introduced in order to provide reference for the research, diagnosis and treatment of Paget's disease of bone.

Abstract:Os acromiale is a nonunion bone mass formed by the failure of fusion of the acromial ossification center during development, with overall incidence of 7%, and mainly manifests as acromial pain and limited active movement of the shoulder. Several treatments are currently in use, although the best choice remains controversial. Due to the low incidence and the fact that some patients have no obvious symptoms, accurate physical examination, imaging screening and individualized treatment plans are very important for early recovery of motor function. This article reviews the diagnosis and treatment of os acromiale from the aspects of pathology and pathogenesis, symptoms and signs, imaging manifestations, differential diagnosis, conservative and surgical treatment, and expounds the advantages and disadvantages of various treatment methods, in order to provide reference for the individualized and precise diagnosis and treatment of os acromiale.

Abstract:[Objective] To screen potential biomarkers associated with chondrocyte senescence in osteoarthritis (OA) by using bioinformatics analytics to provide a theoretical basis for unraveling the mechanisms of OA and exploring new therapeutic approaches. [Methods] The OA cartilage tissue datasets were downloaded from the Gene Expression Omnibus (GEO), and we used RStudio software to screen the deferentially expressed genes (DEGs) and perform enrichment analysis. Then, the DEGs were intersected with the SenMayo senescence gene set obtained to screen Hub genes, which were validated and identified. Finally, we used the miRNet online platform and Cytoscape software to construct the competitive endogenous RNA (ceRNA) network. [Results] A total of 272 DEGs were obtained from data sets GSE169077 and GSE114007 after difference analysis and intersection. The GO analysis showed that DEGs were mainly concentrated in extracellular matrix organization， extracellular structure organization, etc. The KEGG analysis showed that DEGs were mainly enriched in the PI3K-Akt signaling pathway, focal adhesion, etc. IGF1 and MMP2 were identified as the Hub genes. We constructed the ceRNA networks and screened out 3 groups of RNA regulatory pathways: KCNQ1OT1/XIST-hsa-mir-16-5p-IGF1, KCNQ1OT1/XIST-hsa-mir-424- 5p-MMP2, KCNQ1OT1/XIST-hsa-mir-377-3p-IGF1/MMP2. [Conclusion] IGF1 and MMP2 can act as the Hub genes of chondrocyte senescence in OA. KCNQ1OT1/XIST-hsa-mir-16-5p-IGF1, KCNQ1OT1/XIST-hsa-mir-424-5p-MMP2, KCNQ1OT1/XIST-hsa-mir377-3p-IGF1/MMP2 might be potential RNA regulatory pathways to regulate the chondrocyte Senescence of OA.

Abstract:[Objective] To introduce the surgical techniques and preliminary clinical results of intra-articular osteotomy for old tibial plateau fractures. [Methods] A total of 15 patients underwent intraarticular osteotomy for old intraarticular fracture of the tibial plateau. As the original fracture line was identified if the fracture was not healed, an osteotome was inserted through the original fracture line, and the fracture block was split and the intra-articular osteotomy was performed. If the fracture was healed, two parallel Kirschner pins were inserted at the most obvious point of the deformity, and the intra-articular osteotomy was performed along the Kirschner pins. The osteotome was inserted to the subchondral bone and pry to restore the height of the tibial plateau, and bone grafts were implanted in the bone defect area to support, finally plate fixation was conducted. [Results] All the patients were operated successfully without complications such as vascular and nerve injury, while with operation time of (119.1±26.3) min. All the osteotomy were healed with a mean clinical healing time of (19.3± 3.1) weeks. At the last follow-up, Lysholm's knee joint score was of (89.9±4.6), with the excellent and good rate of 93.3%. There were no complications such as loosening of internal fixation, fracture and loss of correction. [Conclusion] This intraarticular osteotomy does effectively restore the congruity of the articular surface of the tibial plateau and reconstruct the alignment of the lower extremity, and has a good effect for old intraarticular fracture of the tibial plateau.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of volar plate fixation of long segment comminuted Galeazzi's fractures without severing pronator quadratus. [Methods] From December 2018 to February 2022, 14 patients with long segment comminent type II Galeazzi's fracture were treated with abovesaid minimally invasive surgery. As an incision between the flexor carpi radialis and the radial artery was made 3.0 cm proximal to the transverse carpal line, the flexor carpi radialis was freed and retracted to the ulnar side, while the radial artery was retracted to the radialis side to reveal the pronator muscle. A periosteal stripper was attached beneath the pronator quadratus to peel off the muscle for establishing a "musculoskeletal tunnel”. A volarr locking plate in appropriate size was percutaneously inserted by three-point location. As fractures reduced properly, screws were placed respectively to fix the fractures. [Results] All patients successfully completed the operation with the average operation time of (75.1±15.0) min, and the average intraoperative blood loss of (38.2±30.3) ml. All of them were followed up for an average of (24.6±10.9) months, and the Mayo score was recorded 6 months after surgery as pain score of (23.6±2.3), satisfaction score of (23.9±2.1), range of motion score of (17.1±4.1), grip strength score of (23.6±3.5), and bone healing achieved in all patients. [Conclusion] The palmar plate fixation of long segment comminuted Galeazzi's fractures without severing pronator quadratus has advantages of less trauma, accurate internal fixation and rapid functional recovery of affected limb.

Abstract:[Objective] To evaluate the reliability and effectiveness of combined high tibial osteotomy (HTO) and distal femoral osteotomy (DFO) in the correction of complex knee varus in adolescents. [Methods] From July 2015 to June 2022, 10 patients (12 knees) underwent combined DFO and HTO osteotomy. The clinical and imaging documents were evaluated. [Results] All the patients had operation performed successfully without complications, such as vascular and nerve injury during the operation. All the 10 patients were followed up with an average of (21.9±10.3) months, with walking time of (36.9±18.2) days. Compared with those preoperatively, the HSS score [(86.6±5.1), (97.2±1.2), P＜0.001] and Lysholm score [(77.5±15.3), (95.7±2.7), P＜0.001] significantly increased, whereas VAS scores [(4.2±1.2), (0.7± 0.3), P＜0.001] significantly decreased at the last follow-up. As for imaging, the proximal medial tibial angle (MPTA) [(72.3±6.6)°, (85.2± 1.9)° , P＜0.001], mechanical lateral distal femoral angle (mLDFA) [(78.2 ± 5.3)° , (87.4 ± 0.9)° , P＜0.001], and femorotibial angle (FTA) [(182.8±4.4)°, (176.6±2.1)°, P＜0.001] significantly improved, additionally, the leg length discrepancy (LLD) [(24.6±6.8) mm, (11.9±4.3) mm, P＜0.001], and the mechanical axis deviation [(30.9±11.3) mm, (10.4±3.8) mm, P＜0.001] significantly declined. [Conclusion] Combined DFO and HTO osteotomy do effectively correct the varus deformity of the knee, and increase the length of the affected limb, achieve satisfactory short-term consequence.

Abstract:[Objective] To explore the effect of insert placement sequence in posterior-stabilized total knee arthroplasty (PS-TKA). [Methods] From January 2021 to October 2021, a total 93 patients who were undergoing initial unilateral PS-TKA in our hospital were randomly divided into two groups. Of them, 47 knees had the insert placed firstly, while other 46 knee group had insert placed secondarily. The documents regarding to perioperative period and images of the two groups were compared. [Results] The firstly group proved significantly shorter operation time than the secondarily group [(49.1±3.8) min vs (55.3±4.2) min, P＜0.001], althogh there were no significant differences in incision length, intraoperative blood loss, postoperative walking time and incision healing between the two groups (P＞0.05). The VAS, HSS scores and knee ROM significantly improved in both groups at discharge compared with those preoperatively (P＜0.05). At discharge, the firstly group was significantly better than the secondarily group in term of HSS score [(75.3±5.9) vs (72.2±5.6), P=0.011]. With respect of imaging, the postoperative Hip-knee ankle angle (HKA), medial proximal tibial angle (MPTA) and mechanical lateral distal femoral angle (mLDFA) significantly increased in both groups compared with those preoperatively (P＜0.05). Despite of insignificant differences in the above imaging indexes between the two groups before operation (P＞0.05), the firstly group got significantly greater mLDFA than the secondarily group postoperatively [(91.1±1.1)° vs (90.6±1.3)°, P=0.011]. [Conclusion] In PS-TKA, the insert placed firstly does reduce the operation steps and shorten the operation time, which is conducive to the recovery of joint function in this study.

Abstract:[Objective] To investigate the clinical effect of ropivacaine concentration used in lumbar plexus block during total hip arthroplasty (THA). [Methods] From January 2022 to August 2023, 100 patients undergoing initial unilateral THA under general anesthesia combined with lumbar plexus block were included in this study. The patients were randomly divided into three groups by coin tossing method, and received lumbar plexus block before operation. Among them, 32 patients received 0.25% ropivacaine, 34 patients received 0.30% ropivacaine, and 34 patients received 0.35% ropivacaine. The documents regarding perioperative period were compared among the three groups. [Results] There were no significant differences in operation time, intraoperative blood loss, recovery time, extubation time and getting out of bed time among the three groups (P＞0.05). The 0.25% group had mean arterial pressure (mmHg) [(98.8±1.2), (96.4±3.4), (90.4± 4.8), (84.8±2.5), P=0.208] and heart rate (b/min) [(78.5±6.0), (77.4±6.9), (74.7±7.3), (75.2±6.3), P=0.076] remained unchanged significantly during different time points intraoperatively, whereas the 0.30% group and 0.35% group got significant changes in mean arterial pressure and heart rate (P＜0.05). However, there was no significant difference in the incidence of adverse reactions among the three groups (P＞0.05). In terms of postoperative pain, there were no statistically significant differences in postoperative VAS score, time of first additional analgesia, number of analgesic pump compression, and frequency of vasoactive drug use among the three groups (P＞0.05). [Conclusion] Low concentration of ropivacaine is more stable in hemodynamic treatment of lumbar plexus block during THA, which is not significantly different in analgesic effect compared with higher concentration of ropivacaine.

Abstract:[Objective] To investigate the value of enhanced recovery after surgery (ERAS) protocol used in the perioperative period of pedicle screw fixation of thoracolumbar fractures. [Methods] From April 2019 to June 2023, 80 patients who received pedicle screw fixation of thoracolumbar fractures were included in this study and randomly divided into two groups by coin tossing. Of them, 40 patients received ERAS care, while the other 40 received conventional care. The documents regarding perioperative period and postoperative pain were compared between them. [Results] All patients in both groups had fracture fixed with pedicle screw successfully without serious complications. There was no significant difference in operation time and intraoperative blood loss between the two groups (P＜0.05), however, the ERAS group was significantly superior to the conventional groups in terms of the exhaust time [(19.4±5.6) hours vs (24.2±6.7) hours, P＜ 0.001], bed rest time [(22.5±6.2) hours vs (27.1±7.8) hours, P=0.005], hospital stay [(6.6±2.0) days vs (7.8±2.5) days, P=0.020], and the total incidence of complications (5.0% vs 22.5%, P=0.023). Regarding pain, the ERAS group was marked significantly lower VAS scores 2 hours, 1 day and 3 days postoperatively than the conventional group (P＜0.05), whereas which became not significantly different between the two groups 5 days after surgery (P＞0.05). In addition, the ERAS group was also significantly better than the conventional group in terms of time of first analgesia given [(7.4±2.8) hours vs (10.6±3.3) hours, P＜0.001] and the number of PCA compressed [(4.6±1.4) times vs (6.0±1.8) times, P＜0.001]. [Conclusion] ERAS care in the perioperative period of pedicle screw fixation of thoracolumbar fractures can promote early recovery and reduce early postoperative pain.

Abstract:[Objective] To evaluate the clinical efficacy of repair of old Achilles tendon injury with tendon autografts. [Methods] A retrospective study was conducted on 7 patients who had old Achilles tendon rupture repaired by tendon autografts from July 2016 to October 2021. The documents regarding to perioperative period and follow-up were evaluated. [Results] All patients had Achilles tendon repaired smoothly with operation time of (106.4±13.6) min, intraoperative blood loss of (35.3±12.3) ml, tendon defect of the broken end of (5.1±2.1) cm, and hospital stay of (11.6±1.3) days. All patients got incision healed in stage I and followed up for (46.1±19.6) months. As time went from the point preoperatively, 6 months postoperatively to the latest follow-up, the VAS score significantly reduced [(2.9±0.9), (1.7±0.8), (0.6±0.5), P＜0.001], whereas AOFAS score [(57.4±10.0), (81.1±4.5), (95.1±4.0), P＜0.001], ankle ROM [(27.4±3.0)°, (50.3±3.3)°, (56.6± 3.5)°, P＜0.001], ATRS score [(41.1±5.8), (71.6±4.4), (93.3±4.2), P＜0.001] significantly increased, and triceps muscle strength [case, III/IV/ V (7/0/0), (0/2/5), (0/0/7), P＜0.001] improved significantly. [Conclusion] For the old Achilles tendon rupture, repair with tendon autografts, such as peroneus longus or semitendinosus, can still achieve satisfactory clinical consequence.

Abstract:[Objective] To provide reference for the design of domestic knee femoral prosthesis by CT measurement of the anatomical and morphological parameters of the distal femoral osteotomy surface of the knee in normal Chinese people. [Methods] From March 2022 to October 2022, 187 normal ethnic Han Chinese, including 94 males and 93 females, underwent CT three-dimensional reconstruction of the knee. The mediolateral diameter (ML), anteroposterior diameter (AP), medial condyle width (MCW), lateral condyle width (LCW), width of intercondylar fossa (WICF), and height of intercondylar fossa (HICF) were measured, in addition, the ML/AP ratio were calculated. The gender differences and correlations of each parameter were searched. [Results] The males were measured significantly greater anatomical data of the distal femur than females (P＜0.05). Although there was no significant correlation between MCW and WICF (r=0.087, P=0.236), LCW and WICF (r=0.052, P=0.478), HICF and ML/AP (r=0.023, P=0.757), significantly positive correlations among other measurements were noted (P＜0.05). The ML/AP of distal femur was negatively correlated with AP (P＜0.05), in other word, the ML/AP decreased with the increase of AP. At the same AP value, the male had significantly greater ML/AP than the female (P＜0.05). [Conclusion] Chinese men and women have considerable differences in size and shape of distal femoral osteotomy. ML/AP should be considered as a reference in designing femur prostheses with gender differences.

Abstract: