Abstract:[Objective] To search the risk factors of nerve injury during correction surgery with osteotomy for spinal deformity. [Methods] A retrospective study was conducted on 312 patients who received osteotomy and instrumented correction with intraoperative neurophysiological monitoring (IONM) for spinal deformities in our department from January 2016 to December 2021. The factors related to nerve injury were screened by univariate comparison and multifactorial logistic regression analysis. [Results] IONM abnormalities occurred in 26 of 312 patients, accounting for 8.3%, while postoperative nerve injury occurred in 11 cases (3.5%). In term of univariate comparison, the IONM abnormal group proved significantly greater than the normal group in terms of the proportion of preoperative MRI spinal cord abnormalities [Yes/No, (5/21) vs (7/279), P=0.017], the proportion of preoperative CT spinal canal abnormalities [Yes/No, (8/18) vs (25/261), P= 0.029], and the proportion of Cobb angle ＞110° [cases (%), 19 (73.1) vs 31(10.8), P=0.011], flexibility＜ 10% [Cases (%), 20 (76.9) vs 29 (10.1), P＜0.001), osteotomy grade [≤2/≥3, (4/22) vs (193/93), P=0.005] and operation time [(262.4±27.3) min vs (215.6±30.3) min, P= 0.019]. However, there were no significant differences in age, sex, BMI, previous spinal surgery history, preoperative main curvature angle, correction rate, and intraoperative blood loss between the two groups (P＞0.05). As results of multi-factor logistic regression analysis, the poor preoperative flexibility (OR=9.824, P＜0.001), large preoperative Cobb angle (OR=6.751, P=0.004), preoperative abnormal spinal canal CT (OR=3.343, P=0.017), preoperative abnormal spinal cord MRI (OR=3.117, P=0.021), high grade of osteotomy (OR=2.897, P=0.026) and long operation time (OR=1.043, P=0.031) were independent risk factors for IONM abnormality and nerve injury complications during corrective surgery for spinal deformities. [Conclusion] Corrective surgery is an effective method for the treatment of severe spinal deformity, while the risk of nerve injury should be highly alert during surgery. It is very important to carefully evaluate spinal cord and spinal canal abnormalities by preoperative MRI and preoperative CT three-dimensional reconstruction. Minimizing osteotomy extent and operation time during surgery will be beneficial to avoid or reduce nerve injury during corrective surgery for spinal deformities.

Abstract:[Objective] To explore the predictive factors of clinical recovery in cervical unilateral open-door laminoplasty (UODL) for the cervical ossification of the posterior longitudinal ligament (C-OPLL). [Methods] A retrospective analysis was conducted on 316 patients who underwent UODL for C-OPLL in our department from January 2013 to January 2021. The posterior compression score of spinal cord (PCS) created by us was used to evaluate MRI images before surgery. Univariate omparison and multiple stepwise regression analysis were used to evaluate the factors related to clinical recovery. [Results] All patients had UODL performed successfully without serious nerve injury, infection and other complications. The mean follow-up time of patients was of (53.7±23.3) months. According to the recovery rate of JOA score 2 years after surgery, 160 patients with J0A score recovery rate ≥50% were considered as good recovery group (the GR), while other 156 patients with JOA score recovery rate ＜50% were considered as poor recovery group (the PR). The GR group proved a significantly shorter duration of the disease [(20.3±7.6) months vs (29.2±8.7) months, P＜0.001], significantly lower incidence of high signal on MRI preoperatively [yes/no, (36/124) vs (70/86), P＜0.001], whereas significantly higher PCS score [(10.7±3.4) vs (5.7±2.6), P＜0.001] than the PR group. However, there were no significant differences in terms of age, gender composition, body mass index (BMI), previous hypertension, diabetes, smoking and stroke histories, preoperative C_2~7 Cobb angle, C_2~7 SVA, T1 slope, K-line, number of vertebra involved in ossification, ossification occupying rate, ossification thickness, and postoperative rehabilitation training ratio between the two groups (P＞0.05). As result of multiple linear stepwise regression, the equation was as follows: Y=7.395-0.306×disease course +5.832× preoperative PCS score, which meaned long disease course (B=-0.306, P＜0.001), while low preoperative PCS score (B=5,832, P＜0.001) were the main factors related to poor postoperative recovery. [Conclusion] Long disease course is a risk factor for poor postoperative recovery, while high preoperative PCS score is a positive factor for good postoperative recovery.

Abstract:[Objective] To explore the risk factors related to adjacent segment degeneration (ASD) after percutaneous kyphoplasty (PKP). [Methods] A total of 162 patients who received PKP in our hospital from January 2020 to September 2021 were included in this study. They were divided into a ASD group and a non-ASD group based on whether adjacent segment degeneration happened 2 years after the primary PKP. Multivariate logistic regression analyses were conducted to identify the risk factors for degeneration. A predictive model was constructed using logistic regression, and the predictive performance was evaluated using ROC curves. [Results] Among 162 patients, 25 cases (15.4%) experienced ASD 2 years after PKP surgery. As for univariate comparison, the ASD cohort proved significantly greater than the non-ASD group in terms of age [(73.0±6.6) years vs (67.9±7.9) years, P=0.003], proportion of smoking history [yes/no, (17/8) vs (62/75), P=0.036], proportion of previous ASD before surgery [yes/no, (9/16) vs (24/113), P=0.035], amount of bone cement injected [(4.1±1.0) ml vs (3.1±0.9) ml, P＜0.001], proportion of bone cement leakage [yes/no, (10/15) vs (23/114), P=0.008], Cobb angle immediately after surgery, [(11.5±2.7)° vs (9.8 ± 2.1)] and recovery rate of vertebral height [(12.0±2.6)% vs (8.2 ± 2.3)%, P＜0.001], whereas the former had significantly lower preoperative BMD than the latter [T value, (-3.2±0.8) vs (-2.6±0.5), P＜0.001]. As results of multivariate logistic regression analysis, more amount of bone cement injected (OR=2.653, P=0.044), higher vertebral height recovery rate (OR=2.045, P＜0.001), and older age (OR= 1.199, P=0.016) were the independent risk factors for ASD, while the greater BMD (OR=0.279, P=0.035) was a protective factor. The ROC areas under curve (AUCs) predicting ASD by independent factor were of 0.804 by age, 0.753 by BMD , 0.761 with bone cement volume injected, and 0.878 by vertebral height recovery rate, in contrast, of 0.960 by the prediction equation. [Conclusion]Advanced age, low bone density, large amount of bone cement injection, and excessive recovery of vertebral height are risk factors for ASD after PKP surgery, which should be highly valued and treated accordingly in clinical practice.

Abstract:[Objective] To establish a multivariate linear equation to predict the acetabular component diameter (external diameter) of used in total hip arthroplasty (THA). [Methods] A total of 182 patients (182 hip patients) who underwent THA in our hospital from March 2019 to November 2022 were included in this study. Pearson correlation analysis was performed on in outer diameter of acetabular component and physiological measurement parameters of patients. Multiple linear regression equations were established with the outer diameter of acetabular prosthesis as the dependent variable, while the physiological parameters of patients as the independent variable. The accuracy of the predicted acetabular outer diameter obtained by substituting the data from the validation cohort into the multivariate linear equation was compared with the actual acetabular outer diameter. [Results] Pearson correlation analysis showed that the acetabular outer diameter was significantly positive correlated to the body height (r=0.653, P＜0.001), body weight (r=0.627, P＜0.001), foot length (r=0.633, P＜0.001), but no significant correlation with age (P＞0.05). The prediction equation obtained by multiple linear regression was as follows: Y (outer diameter of acetabular component, mm) =20.702+0.465× foot length (cm) + 0.090 × height (cm) + 0.086× body weight (kg). The accuracy of the equation was 70.9% in predicting the prosthesis within difference in one size and 90.9% in predicting the prosthesis within difference in two sizes. [Conclusion] The anthropometric data can accurately predict the outer diameter of acetabular component in THA.

Abstract:[Objective] To compare the clinical outcomes of two kinds of traditional Chinese medicine (TCM) therapy for adolescent lumbar disc herniation (ALDH). [Methods] A total of 104 ALDH patients who underwent non-surgical treatment in our hospital from February 2020 to March 2022 were included into this study, and divided into two groups by random number table method. Of them, 52 patients were treated by Pingji method, including optimal traction, TCM fumigation, manual release and holistic spinal manipulation, while the other 52 patients received conventional treatment, involving optimal traction, TCM fumigation and conventional manual treatment. Clinical and imaging data were compared between the two groups. [Results] The Pingji group got clinical cure significantly earlier than conventional group [(253.2±26.8) d vs (272.6±29.5) d, P＜0.001]. The follow-up period was of (15.3±3.7) months on an average, and lower back pain and leg pain VAS scores, as well as the ODI score in both groups were significantly decreased at the last follow-up compared with those before treatment (P＜0.05). At the last follow-up, the Pingji group was significantly superior to the conventional group in terms of lower back pain VAS [(1.5±0.3) vs (2.6±0.5), P＜0.001], leg pain VAS score [(1.8±0.4) vs (2.9±0.6), P＜0.001] and ODI score [(8.2±1.7) vs (13.6±2.5), P＜0.001]. As for imaging evaluation, the spinal canal occupation rate, T1-pelvic angle (TPA), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis (TK) were significantly improved at the latest follow-up compared with those before treatment. At the last follow-up, the Pingji group also was significantly better than the conventional group in terms of canal occupying rate [(2.0±0.3)% vs (3.5±0.6)%, P＜0.001], TPA [(15.3±2.4)° vs (18.6±3.5)°, P＜0.001], PT [(14.2±1.8)° vs (16.7±2.5)°, P＜0.001], SS [(29.4±6.1)° vs (25.8±4.9)°, P＜0.001], LL [(37.6±6.7)° vs (30.5±5.3)°, P＜0.001], TK [(25.9±5.8)° vs (20.3±4.6)°, P＜0.001]. [Conclusion] The Pingji therapy is effective in the treatment of AL-DH patients, which can improve the function, reduce back pain and leg pain, and regain the spinopelvic sagittal balance.

Abstract:[Objective] To compare the clinical efficacy of percutaneous endoscopic lumbar interbody fusion with large channel (PE-LIF) versus open posterior lumbar interbody fusion (PLIF) for single-level and low-grade lumbar spondylolisthesis. [Methods] A retrospective study was conducted on 56 patients who received lumbar fusion for the single-level and low-grade lumbar spondylolisthesis in our hospital from January 2020 to February 2023. According to preoperative dock-patient communication, 27 patients underwent PELIF, while other 29 patients received PLIF. The perioperative, follow-up and imaging data were compared between the two groups. [Results] The PELIF group proved significantly superior to the PLIF group in terms of total incision length [(8.3±1.5) cm vs (10.2±2.2) cm, P＜0.001], intraoperative blood loss [(151.9±99.5) ml vs (303.5±117.2) ml, P＜0.001], time to return walking [(2.2±0.9) days vs (3.3±0.9) days, P＜0.001], hospitalization [5.9±1.8) days vs (8.6±2.3) days, P＜0.001], despite of the fact that the former was significantly inferior to the latter in terms of operative time [(178.3±32.5) min vs (134.5±27.4) min, P＜0.001] and intraoperative fluoroscopy times [(34.3±7.1) times vs (12.0±4.0) times, P＜ 0.001]. There was no significant difference in intraoperative complication rate and incision healing grade between the two groups (P＞0.05). As time went on during follow-up period lasted for (16.3±2.6) months, VAS score for leg pain, VAS score for back pain, ODI score and JOA score significantly improved in both groups (P＜0.05). The PELIF group had significantly lower lumbago VAS score than the PLIF group 3 days postoperatively [(2.6±1.9) vs (4.0±1.8), P=0.005], whereas there were no significant differences in the leg pain VAS score, ODI and JOA scores between the two groups at any time points accordingly (P＞0.05). As for imaging, the lumbar lordosis angle, intervertebral space height, slipping rate and spinal canal area significantly improved in both groups after surgery compared with those preoperatively (P＜0.05), while which were not statistically different between the two groups at any corresponding time points (P＞0.05). [Conclusion] Both PELIF and open PLIF can achieve satisfactory efficacy in the treatment of low-grade lumbar spondylolisthesis, but PELIF has the advantages of less trauma and quick recovery in early stage after operation over the PLIF.

Abstract:[Objective] To compare the clinical outcomes of double loop plate combined with compression screw (DLP) versus clavicular hook plate (HP) in the treatment of Neer type IIB distal clavicular fractures. [Methods] A retrospective study was done on 61 patients who received surgical treatment for Neer type IIB distal clavicular fractures from January 2020 to December 2022. According to the preoperative doctor-patient communication, 30 cases were treated with DLP, while the remaining 31 patients were treated with the HP. The perioperative period, followup and imaging data were compared between the two groups. [Results] The DLP group proved significantly superior to the HP group in terms of incision length [(4.5±0.4) cm vs (7.7±0.6) cm, P＜0.001], intraoperative blood loss [(46.7±6.9) ml vs (66.9±8.8) ml, P＜0.001] and active activity time [(25.4±1.5) days vs (30.0±1.8) days, P＜0.001], despite of the fact that the former consumed significantly longer operative time than the latter [(69.5±7.8) min vs (62.7±7.7) min, P＜0.001]. In addition, the DLP group regained full weight bearing activitysignifi-cantly earlier than HP group [(84.1±5.7) days vs (87.3±6.1) days, P=0.039]. As time went on, VAS scores were significantly decreased (P＜ 0.05), whereas Constant-Murley scores, abduction-uplifting, forward flexion-uplifting and internal and external rotation range of motion (ROMs) of the shoulder significantly increased in both groups (P＜0.05). The DLP group proved significantly better than the HP group in abovesaid items at 3 months postoperatively and the last follow-up (P＜0.05). As for imaging, fracture reduction quality in the DLP group was also significantly better than that in the HP group [excellent/good/poor, (19/10/1) vs (9/20/2), P=0.027]. The postoperative coracoclavavicular distance (CCD) in both groups significantly reduced compared with that preoperatively (P＜0.05), which in the DLP group was significantly smaller than that of in the HP group 3 months after the operation and the last follow-up (P＜0.05). However, there was no significant difference in fracture healing time between the two groups (P＞0.05). [Conclusion] Compared with traditional clavicular hook plate in the treatment of Neer type IIB distal clavicular fractures, double loops plate combined with compression screw has the advantages of minimally invasive surgery, less influence on postoperative joint function and fewer complications, and more satisfactory clinical consequences.

Abstract:[Objective] To investigate the factors related to pigmentation of cutaneous neurotrophic vascular flap for repair of soft tissue defect. [Methods] A retrospective study was conducted on 185 patients who received cutaneous neurotrophic vascular flap in emergency for repair of soft tissue defect in our hospital from January 2013 to February 2022. They were divided into pigmentation group and non-pigmentation group according to whether pigmentation occurred 3 months after the skin flap operation. Univariate comparison and multivariate logistic regression were used to analyze the factors related to the pigmentation. [Results] Among the 185 patients, 36 patients were confirmed as pigmented, accounting for 19.5%; while the raining 149 cases were non-pigmented, accounting for 80.5%. As result of univariate comparison, the pigmented group proved significantly higher ratio than the non-pigmented group in terms of smoking [Y/N, (24/12) vs (67/82), P= 0.019], diabetes [Y/N, (15/21) vs (25/124), P=0.010], hypertension [Y/N, (18/18) vs (28/121), P＜0.001], early vascular crisis [Y/N, (14/22) vs (5/144), P＜0.001], and the former had significantly greater time interval between injury and operation [(8.5±2.4) h vs (7.1±3.1) h, P=0.019]. However, the pigmented group was significantly lower than the non-pigmented group in ratios of vascular anastomosis [Y/N, (4/32) vs (75/ 74), P＜0.001] and early flap survival [Y/N, (24/12) vs (145/4), P＜0.001]. Regarding to logistic regression analysis, the early vascular crisis (OR=20.228, P=0.042), hypertension (OR=7.727, P＜0.001), smoking (OR=4.129, P=0.010), diabetes (OR=4.121, P=0.012) were independent risk factors for skin flap pigmentation, while vascular anastomosis (OR=0.080, P=0.001) was of protective factors. [Conclusion] Skin flap pigmentation is more likely to occur in patients with smoking, hypertension, diabetes and early postoperative vascular crisis, while vascular anastomosis can reduce the occurrence of pigmentation.

Abstract:Sarcopenia is a common metabolic disease closely related to age in elderly patients. The current research on sarcopenia is not thorough, but it related to poor prognosis of spinal surgery has been confirmed. It may be due to that sarcopenia have a certain degree of impact on the relevant treatment plan, preoperative planning and perioperative management of spinal surgery. Sarcopenia has recently been a hot topic of research, with a large number of reports on the development of sarcopenia, the impact of sarcopenia on spinal surgery prognosis, and drug, nutritional, and exercise therapy interventions for sarcopenia. This article will provide a review of the previous works, focusing on summarizing the research progress on the relationship between sarcopenia and spinal surgery, providing ideas for the research and clinical diagnosis and treatment of sarcopenia in spinal surgery, and preparing for related clinical research in the future.

Abstract:Spina cord injury (SCI) disrupts the signal transmission of the central nerve circuit of the spinal cord, resulting in permanent movement, sensory loss and autonomic dysfunction. However, most of the neural circuits located at the upper and lower lesion remain anatomically intact, and these circuits can transmit descending motor signals through spinal cord relay circuits. Therefore, reconstruction of the relayed neural circuit has become one of the most promising therapeutic strategies. Among them, neuroregulatory technique can reconstruct the spinal cord trunk neural circuit by using the residual brain, brainstem and spinal cord neurons, and improve the neurological dysfunction after SCI. In order to understand the latest progress of neuroregulatory techniques in the reconstruction of relayed neural circuits after SCI, this paper reviews the reconstruction of relayed neural circuits in the cerebral cortex, brainstem and spinal cord after SCI, and further discusses the potential mechanism and significance of the neural regulation of relevant neural circuits after SCI.

Abstract:With the update of minimally invasive spinal concepts and technologies, unilateral biportal endoscopy technology (UBE) had been favored by spinal surgeons due to its unique advantages of achieving bilateral decompression through a unilateral approach. It was widely used in the treatment of lumbar degenerative diseases, such as lumbar disc herniation, lumbar spinal stenosis, and lumbar spondylolisthesis, achieving good clinical results. This article provided a review of relevant literature on this field.

Abstract:[Objective] To explore the role and mechanism of receptor activator of nuclear factor-κB ligand (RANKL) in bone metastasis of breast cancer. [Methods] The MDA-MB-231, BT549 and MCF-7 breast cancer cells were cultured in vitro, with the final concentration of 200ng/ml RANKL (RANKL group), or the same volume of double distilled water (control, Ctrl group). Transwell, single-cell calcium imaging (SCCI), PCR, and western blot assays were performed. The bone marrow stem cells (BMSCs) of mice were isolated, and cultured with the supernatant of breast cancer cells, which contained RANKL. TRAP, ALP and von Kossa staining were performed. [Results] The relative migration cell numbers of RANKL added MDA-MB-231 cells [(1.7±0.1) vs (1.0±0.1), P=0.002] and BT549 cells [(1.6±0.1) vs (1.0±0.1), P= 0.027] were significantly higher than those in the Ctrl group. The RANKL-200 group showed significantly higher levels of MCF-7 [positive/ total (%), 58/127 (45.7) vs 3/118 (2.5), P＜0.001] and BT549 cells [positive/total (%), 51/224 (22.8) vs 31/228 (13.6), P=0.011] compared to the Ctrl group. PCR detection showed that E-cadherin in MDA-MB-231 cells of the RANKL-200 group was significantly lower than that in the Ctrl group, while the expression levels of N-cadherin and vimentin in the former were significantly higher than those in the latter. Western blot showed that the relative expression levels of N-cadherin were in the following order: RANKL-500 group＞RANKL-200 group＞Ctrl group (P＜0.05), whereas the expression levels of E-cadherin protein were in the order of RANKL- 500 group＜RANKL- 200 group＜Ctrl group. In the in vitro experiment of mouse bone marrow cells, the number of TRAP stained positive cells in the group containing RANKL supernatant was significantly higher than that in the Ctrl group [(451.3±15.0) vs (174.3±9.2), P＜0.001], while there was no statistically significant difference between ALP staining and Von Kossa staining (P＞0.05). [Conclusion] RANKL induced calcium signaling is mediated by NF- κ B pathway, enhances the EMT process of breast cancer cells and promotes bone metastasis of breast cancer.

Abstract:[Objective] To investigate the effect of bone marrow mesenchymal stem cells (BMSCs) composied with nano-polyaiticglycolic acid (PLGA) frame on repairing femoral cartilage defect in rats. [Methods] BMSCs were obtained from the bone marrow cavity of the tibia and femur of rats, cultured and passed through, and then cultured on the nano-PLGA scaffold frame, and the graft was observed under electron microscope. Eighteen SD rats were operated on both hind limbs to create cartilage defect on the distal femur, and the defect on the right side was filled with BMSC-PLGA composited material (the graft group), whereas the defect on the left side left not further treated [the blank control (BC) group]. Gross and histological observation and scoring, as well as optical density values measured in toluidine blue staining and immunohistochemical staining were compared between the two groups. [Results] BMSCs grew in a unique spiral shape, the PLGA frame showed fiber interwoven network structure under electron microscope, and BMSCs grew well on the PLGA frame. At 1 and 3 months after implantation, the graft group proved significantly superior to the BC group in terms of gross observation scores [(8.1±0.8) vs (1.7±0.8), P＜ 0.001; (10.3±1.2) vs (3.8±1.5), P＜0.001], histological score [(11.6±1.0) vs (4.0±0.9), P＜0.001; (15.5±1.0) vs (4.8±0.8), P＜0.001], toluidine blue staining OD value [(0.2±0.0) vs (0.1±0.0), P＜0.001; (0.4±0.0) vs (0.1± 0.0), P＜0.001], in addition, immunohistochemical II collagen detection OD value [(0.4±0.0) vs (0.1±0.0), P＜0.001] 3 months postoperatively. [Conclusion] BMSCs -PLGA composition does effectively repair cartilage defects in rats in this study, demonstrating a potential tissue engineering modification method for the treatment of cartilage defects.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcomes of Zhang's tension-reduced sutures for high-tension incision secondary to open reduction and internal fixation (ORIF) of Pilon fracture. [Methods] A total of 11 patients had incisions closed by this tension-reduced suture following ORIF of Pilon fractures from 2019 to 2022. The enter points of the suture were separated on both sides of the incision, with distance from the incision edge about 1cm. The starting point and the ending point were located at both ends, about 1cm away from the incision. At one end of the incision, the needle was vertically inserted into the subcutaneous tissue, dermis and epidermis in order to exit the needle; at the same point, the needle was vertically inserted into the skin surface in order to penetrate the epidermis, dermis and subcutaneous tissue, and the skin surface to form a depression at the puncture point after moderately tightening the skin tissue, and was continuously stitched to the other end of the incision, and the subcutaneous knot was tied at the end. [Results] This Zhang's tension-reduce suture can close the high-tension after ORIF of Pilon fracture in one-stage, and can effectively reduce the complication of the incision.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcomes of arthroscopic superior fulcrum reconstruction (SFR) for irreparable massive rotator cuff tears (IMRCT). [Methods] From January 2020 to June 2022, 18 patients underwent arthroscopic SFR for IMRCT. The rotator cuff stumps and bursa tissue were examined and debrided firstly, and the long head biceps tendon was cut or fixed according to the concrete situation. The ipsilateral peroneus longus tendon was harvested 13~15 cm in length and 2~3 mm in diameter. The tendon was divided into two bundles and braided with sutures. Bone tunnels were established on the glenoid side and the head side of the humerus respectively, and the tendons were introduced through the bone tunnel by PDS suture. Finally, the tendons were knotted on the lateral end of the proximal humerus. [Results] All the 18 patients had arthroscopic surgery completed successfully without serious complications, such as nerve and vascular injury, and followed up from 12 to 24 months. Compared with those preoperatively, the VAS [(7.2± 1.2), (0.5±0.5), P＜0.001], CMS [(21.1±3.0), (80.3±2.7), P＜0.001], UCLA [(5.9±1.2), (31.4±1.3), P＜0.001] and ASES scores [(34.1±6.0), (85.3±3.8), P＜0.001] improved significantly at the latest follow-up. Radiographically, the acromiohumeral distance (AHD) significantly increased postoperatively compared with that preoperatively [(0.5±0.1) cm, (0.9±0.1) cm, P＜0.001], and the graft remained in good appearance on images. [Conclusion] The arthroscopic superior fulcrum reconstruction is feasible with a reliable short-term clinical consequence for the huge irreparable rotator cuff tear.

Abstract:[Objective] To investigate the preliminary clinical consequences of modified minimally invasive anterolateral (orthopa-dische chirurgie munchen, OCM) approach used for total hip arthroplasty (THA). [Methods] A retrospective study was done on 32 patients who had THA performed through the modified OCM approach from January 2021 to January 2023, including 12 males and 20 females with an average age of (74.3±12.5) years. The clinical and imaging data were evaluated. [Results] All patients were successfully operated with the average operation time of (46.1±13.4) min and the average intraoperative blood loss of (187.6±125.4) ml. With time of follow-up period lasted for (1.5±0.3) years in a mean, the VAS score [(7.8±1.8), (2.6±0.3), (1.4±0.3), P＜0.001] significantly reduced, while the Harris score [(42.5±3.8), (81.2±4.2), (86.8±3.1), P＜0.001], hip flexion-extension ROM [(86.3±7.2)°, (115.2±6.5)°, (130.3±7.1)°, P＜0.001] increased significantly. In term of imaging, all the 32 patients got prostheses in proper position, with no change in acetabular anteversion and acetabular abduction angle at the last follow-up compared with those 3 months after surgery. [Conclusion] This modified OCM approach for total hip arthroplasty has the advantages of short operation time, less blood loss, less complications with satisfactory clinical efficacy, and is a safe and effective surgical approach.

Abstract:[Objective] To investigate the effects of degenerative lumbar spinal stenosis (DLSS) involved segments on sagittal spinopelvic parameters. [Methods] A retrospective analysis was performed on 192 patients with DLSS admitted to our hospital from November 2019 to November 2021. According to the imaging, 72 cases had DLSS involved a single segment (SS), 63 cases involved double segments (DS), and 57 cases involved multiple segments (MS). The clinical and imaging data of the three groups were compared. [Results] There was no significant difference in lumbar VAS score, leg VAS score and ODI score among the three groups (P＞0.05), but the disease course was ranked down-up in a sequence of SS＜DS＜MS [(30.5±35.2) months vs (55.9±44.4) months vs (82.3±70.0) months, P＜0.001]. In term of imaging, the lumbar lordosis (LL) [(43.4±10.4)° vs (41.1±7.6)° vs (35.6±8.4)°, P＜0.001], thoracic kyphosis (TK) [(28.6±7.1)° vs (27.9±7.6)° vs (23.2±7.3)°, P＜0.001], sacral slope (SS) [(31.0±6.2)° vs (29.6±5.0)° vs (26.0±5.1)°, P＜0.001] were all ranked up-down as SS＞DS＞MS, whereas the pelvic tilt (PT) was ordered down-up as SS＜BS＜MS [(21.6±7.0)° vs (21.8±4.2)° vs (24.9±6.5)°, P=0.005]. [Conclusion] As the DLSS involved segment number increases, the lumbar lordosis, thoracic kyphosis and sacral inclination decrease, whereas the pelvic inclination increases.

Abstract:[Objective] To evaluate the outcomes of the targeted nursing in perioperative period of pedicle screw fixation of ankylosing spondylitis (AS) spinal fractures. [Methods] From January 2020 to July 2023, 40 patients underwent posterior long-segment pedicle screwrod system fixation for AS spinal fractures, with targeted nursing measures implemented in the perioperative period. The negative emotion scores and quality of life scores were compared between the admission and discharge. [Results] All the 40 patients were successfully operated without serious complications. Compared with those at admission, the self-rating depression scale (SDS) [(60.2±5.7), (48.2±4.1), P＜ 0.001] and self-rating anxiety scale (SAS) [(58.1±5.8), (48.7±3.1), P＜0.001] significantly decreased, while the generic quality of life inventory-74, GQOLI-74, including physical function [(60.1±6.2), (85.2±8.1), P＜0.001], the psychological function [(62.8±7.2), (88.3±9.2), P＜ 0.001], the social function [(61.5±8.1), (90.6±8.2), P＜0.001] and material life state [(65.2±7.7), (88.3±8.2), P＜0.001] significantly increased at discharge. [Conclusion] Surgical fixation of spinal fracture of AS with special nursing intervention in perioperative period can alleviate negative emotions and improve quality of life.