Abstract:[Objective] To compare diagnostic efficacy of three foreign diagnostic criteria for periprosthetic joint infection (PJI), includ-ing the European Bone and Joint Infection Society (EBJIS 2021), the International Consensus Meeting (ICM 2018) and Infectious DiseasesSociety of America (IDSA 2013) in the Chinese population. [Methods] A retrospective study was conducted on 140 patients who receivedtreatment for PJI in The Fourth Medical Center of the PLA General Hospital from January 2017 to November 2019. The data related to PJI di-agnosed respectively according to three foreign diagnostic criteria was collected. The documents of patients who met all three diagnostic crite-ria and those who met part of the diagnostic criteria were compared and analyzed. [Results] Among the 140 patients, 135 patients (96.4%)met the criteria of IDSA2013, 127 patients (90.7%) met the criteria of ICM2018, and 133 patients (95.0%) met the criteria of EBJIS2021,and there was no statistically significant difference in diagnostic efficacy among the three criteria (P＞0.05). Of them, 122 cases (87.1%) metall the three diagnostic criteria, whereas 18 cases (12.9%) met one or two of the diagnostic criteria. The patients meeting all the three criteriaproved significantly higher than those meeting ≤2 criteria in terms of local sinus [cases, No/Yes, (79/43) vs (18/0), P=0.002], intraoperativepus [cases, No/Yes, (85/37) vs (17/1), P=0.027], ratio of positive culture in different sites [cases, No/Yes, (38/84) vs (18/0), P＜0.001]. In addi-tion, the former had significantly higher CRP [mg/dl, M (P25, P75), 1.95 (0.55, 3.81) vs 0.95 (0.1, 2.58), P=0.030] and the joint fluid leuko-cyte count [cells/μl, M (P25, P75), 11 970 (2 126.5, 24 900) vs 300 (32, 5 498), P=0.021] than the latter. [Conclusion] PJI diagnostic criteriaof EBJIS2021 have similar diagnostic efficacy to those of IDSA2013 and ICM2018. However, the three diagnostic criteria are different in thediagnosis of PJI with mild systemic inflammatory response or local symptoms.

Abstract:[Objective] To explore the predictive value of neutrophils/lymphocytes ratio (NLR) and C-reactive protein (CRP)/albumin(ALB) ratio (CRP/ALB) for postoperative infection of spinal surgery. [Methods] A total of 145 patients who underwent surgery for spinal dis-eases in our hospital from October 2018 to May 2022 were included into this study, with data collected. According to whether infection oc-curred within 7 days after operation, 127 cases were fall into the uninfected group, while other 18 cases were in the infected group. Univari-ate comparison and binary multi-factor logistic regression analysis were used to analyze the related factors of infection. In addition, receiveroperating characteristic curve (ROC) was used to evaluate the predictive value of NLR and CRP/ALB ratio for postoperative infection. [Results] There was no significant difference in sex, body mass index (BMI) and surgical site between the two groups (P＞0.05), but infectedgroup proved significantly greater than the uninfected group in terms of age [(67.2±5.8) years vs (58.3±4.6) years, P＜0.001], the operationtime [(189.4±22.7) min vs (167.3±23.1) min, P＜0.001], blood transfusion ratio [Yes/No, (12/6) vs (52/75), P=0.040], internal fixation ratio[Yes/No, (10/8) vs (29/98), P=0.003], postoperative NLR [(7.5±2.0) vs (4.7±1.3), P＜0.001] and CRP/ALB [(3.5±0.6) vs (2.4±0.4), P＜0.001].As results of logistic regression analysis, the older age (OR=3.651, P=0.001), internal fixation (OR=2.362, P=0.003), CRP/ALB ratio (OR=2.324, P=0.002), elevated postoperative NLR (OR=1.681, P=0.011), longer operation time (OR=1.584, P=0.043), intraoperative blood trans-fusion (OR=1.333, P=0.003) were independent risk factors for postoperative infection. Regarding to ROC analysis, the areas under the ROCcurve for predicting postoperative infection by NLR and CRP/ALB ratio alone, as well as combination of the two were of 0.857 (95% CI0.785~0.934), 0.956 (95%CI 0.898~1.000) and 0.982 (95%CI 0.912~1.000), respectively. [Conclusion] The NLR and CRP/ALB ratios are

Abstract:[Objective] To evaluate the clinical efficacy of percutaneous vertebroplasty (PVP) combined with augmented pedicle screw(APS) for stage III Kummell disease. [Methods] A retrospective analysis was performed on 76 patients who underwent surgical treatment forstage III Kummell disease without neurological symptoms during March 2019 to August 2021 in our hospital. According to doctor-patientcommunication, 32 cases were treated with simple PVP (the PVP group), 21 cases underwent PVP combined pedicle screw (the PVP-PSgroup), and 23 cases received PVP combined with augmented pedicle screw (the PVP-APS group). Perioperative, follow-up and imaging da-ta of the three groups were compared. [Results] The PVP group was significantly less than the PVP-PS and PVP-APS groups in terms of op-erative time, intraoperative fluoroscopy times, puncture adjustment times, bone cement injection amount, intraoperative blood loss, walkingtime and hospital stay (P＜0.05). As time went during the follow-up period lasted for more than 1 year, the VAS and ODI scores significantlydecreased in all the 3 groups (P＜0.05). At the last follow-up, PVP-PS and PVP-APS groups proved significantly superior to the PVP groupin terms of VAS [(2.7±0.6) vs (2.4±0.6) vs (3.3±0.4), P＜0.001] and ODI scores [(22.6±4.3) vs (25.0±4.8) vs (30.1±5.8), P＜0.001]. As for imag-ing, the PVP-PS and PVP-APS groups were significantly better than the PVP group in terms of sagittal index (SI) [(88.4±3.6)% vs (93.2±3.7)% vs (46.2±3.6)%, P＜0.001], local kyphotic Cobb angle [(17.6±4.2)° vs (10.7±3.5)° vs (27.6±4.6)°, P＜0.001], and spinal stenosis rate[(14.4±3.6)% vs (9.1±3.2)% vs (25.2±4.8)%, P＜0.001]. Moreover, the PVP-APS group was significantly better than PVP-PS group regardingabovesaid parameters (P＜0.05). [Conclusion] The PVP-APS do effectively restore the height of the diseased vertebra, correct kyphotic defor-mity and improve spinal stenosis, and achieve satisfactory short-term clinical outcome for stage III Kummell's disease without neurologicalsymptoms, while the long-term efficacy remains to be followed up further.

Abstract:[Objective] To compare the short-term clinical outcomes of fixed-bearing unicompartmental knee arthroplasty (FB-UKA)verus mobile bearing unicompartmental knee arthroplasty (MB-UKA) for medial knee osteoarthritis. [Methods] A retrospective study wasconducted on 98 patients who received UKA for medial knee osteoarthritis from January 2020 to February 2023. According to the results ofdoctor-patient communication, 43 underwent FB-UKA with Zimmer prosthesis, while other 55 patients were treated with MB-UKA by usingOxford prosthesis. The data of perioperative period, follow-up and images were compared between the two groups. [Results] All patients inboth groups had UKA performed successfully without statistically significant differences in operation time, incision length, intraoperativeblood loss, ambulation time, incision healing grade, hospital stay and hospital cost between the two groups (P＞0.05). All of them in bothgroups were followed up for (12.7±4.8) months in an average, and there was no significant difference in the time to regain full weight-bearingactivities between the two groups (P＞0.05). The VAS and WOMAC scores significantly decreased (P＜0.05), while HSS score, forgotten jointscore (FJS) and knee extension-flexion ROM significantly increased in both groups at the latest follow-up compared with those preoperative-ly (P＜0.05). At the last follow-up, the MB group was significantly better than the FB group in terms of FJS [(85.5±3.5) vs (84.1±2.7), P=0.032], and knee extension-flexion ROM [(125.4±3.5)° vs (123.7±4.2)°, P=0.031]. As for imaging, HKAA and JICA were significantly im-proved in both groups after surgery (P＜0.05), while TPVA remained unchanged significantly (P＞0.05). At corresponding time points, therewere no significant differences in the above imaging items between the two groups (P＞0.05). [Conclusion] For medial knee osteoarthritis,the MB-UKA has better forgotten joint score regarding to short-term clinical consequence over the FB-UKA.

Abstract:[Objective] To explore the factors related to the clinical outcome of expansive open-door laminoplasty (ELAP) for treatmentof multilevel cervical spondylotic myelopathy. [Methods] From July 2020 to June 2023, 196 patients were treated with ELAP for multilevelcervical spondylotic myelopathy. Univariate comparison and binary multifactor logistic regression analysis were used to analyze the factorsrelated to the recovery rate of neurological function. [Results] Of them, 149 cases (76.0%) got excellent recovery of nerve function with recov-ery rate of ≥50% (the good group), whereas the remaining 47 cases (24.0%) got recovery rate ＜50% (the poor group). In term of univariatecomparison, the poor group proved significantly greater than the good group regarding to age [(62.2±8.8) years vs (56.3±10.2) years, P＜0.001], BMI [(27.0±2.9) kg/m² vs (24.3±2.8) kg/m², P＜0.001], hypertension ratio [cases (%), 24 (51.1) vs 32 (21.5), P＜0.001], coronary heartdisease [cases (%), 11 (23.4) vs 8 (5.4), P＜0.001], smoking [y/n, (23/24) vs (37/112), P=0.002], and duration of disease [(14.9±15.1) monthsvs (10.3±10.8) months, P=0.022]. As results of multivariate logistic regression, smoking (OR=6.406, P＜0.001), hypertension (OR=5.204, P=0.005), BMI (OR=1.396, P＜0.001), age (OR=1.075, P=0.034) were independent risk factors for poor neurological recovery after ELAP treat-ment in multi-segmental CSM. JOA score before surgery (OR=0.465, P＜0.01) and C2~7 Cobb angle 1 month after surgery (OR=0.841, P＜0.05) were protective factors for postoperative neurological recovery. [Conclusion] Age, BMI, history of hypertension, and smoking are inde-pendent risk factors for poor neurological recovery after ELAP treatment in multi-segmental CSM, while preoperative JOA score and C2~7Cobb angle 1 month after surgery are protective factors for nerve recovery.

Abstract:[Objective] To compare the clinical outcomes of posterior-anterior lag screw versus buttress plate for fixation of Haraguchitype I posterior malleolus fractures. [Methods] A retrospective analysis was performed on 80 patients who received open reduction and in-ternal fixation (ORIF) for Haraguchi type I posterior malleolus fractures from June 2020 to September 2022. According to the doctor-pa-tient communication, 38 case had the posterior malleolus fractures fixed with the posterior-anterior lag screw (the screw group), while other42 cases were fixed with buttress plate (the plate group), with the combined lateral and medial malleolar fractures treated simultaneously.The perioperative, follow-up and imaging data of the two groups were compared. [Results] The screw group was significantly less than theplate group in terms of operative time [(69.5±4.6) min vs (90.2±6.4) min, P＜0.001], total incision length [(9.0±2.3) cm vs (10.3±2.6) cm, P=0.021] and intraoperative blood loss [(104.8±20.5) ml vs (116.0±21.3) ml, P=0.019], although the former resumed postoperative walking sig-nificantly later than the latter [(64.8±3.7) days vs (60.0±4.0) days, P=0.019]. There was no statistically significant difference in time to re-gain the full weight-bearing activity between the two groups (P＞0.05). Compared with those 3 months after surgery, the VAS, AOFASscores and dorsal-plantar flexion ROM in both groups were significantly improved at the last follow-up (P＜0.05). The screw group got sig-nificantly lower AOFAS score than the plate group 3 months after surgery [(83.6±4.9) vs (86.0±5.5), P=0.044], whereas there were no signifi-cant differences in VAS score and ankle-dorsal-plantar flexion ROM between the two groups (P＞0.05). At the last follow-up, there was nosignificant difference between the two groups in terms of any items abovementioned (P＞0.05). As for imaging, there were no significant dif-ferences in the quality of fracture reduction and healing time between the two groups (P＞0.05). [Conclusion] Both posterior-anterior lagscrew and buttress plate achieve comparable clinical consequences for fixation of Haraguchi type I posterior malleolus fractures. By compar-ison, the screw has shorter operation time and less intraoperative bleeding, but longer time to resume walking.

Abstract:[Objective] To evaluate the clinical efficacy of percutaneous endoscopic interlaminar discectomy (PEID) versus percutane-ous endoscopic transforaminal discectomy (PETD) for calcified lumbar disc herniation (cLDH). [Methods] PubMed, Web of science, EMS-CO, CNKI and Wanfang and VIP databases from January 1973 to February 2023 were searched to collect literatures on the comparison ofPETD and PEID in the treatment of cLDH. A meta-analysis was performed with Revman 5.4 software. [Results] A total of 2 English litera-tures and 1 Chinese literatures were included in this study, involving a total of 161 patients, 72 treated with PEID and 89 with PETD. As re-sults of the meta-analysis, the leg pain VAS scores [PEID group, (MD=6.58, 95%CI 4.65~8.51, P＜0.001); PETD group, (MD=6.40, 95%CI4.72~8.07, P＜0.001)], and ODI score [PEID group, (MD=53.39, 95% CI 50~56.78, P＜0.001); PETD group (MD=52.34, 95% CI 48.73~55.96, P＜0.001)] were significantly improved at the latest follow-up compared with those preoperatively. However, there were no significantdifferences in VAS, ODI score, modified score and postoperative complication rate between the two groups at the last follow-up (P＞0.05).[Conclusion] Both PEID and PETD can effectively treat calcified lumbar disc herniation, and there is no significant difference in efficacyand complication rate between PEID and PETD.

Abstract:With the increase of age, intervertebral disc degeneration (IVDD) is an important cause of low back pain, which brings ahuge economic burden to society. Many intrinsic factors, such as inflammation, oxidative stress, mitochondrial dysfunction, telomere shorten-ing, DNA damage, nutrient deprivation and epigenetic changes, etc, and extrinsic factors, including acute disc injury, excessive mechanicalloading and long-term smoking, etc, have been shown to promote the aging of disc cells. In this paper, we summarized the relevant researchprogress of intervertebral disc cells and summarized the effects of some anti-aging interventions in delaying the disc cell aging in recentyears, including senescent cell clearance, anti-inflammatory, antioxidant stress, telomerase transduction, growth factor supply and cell cycleblocking inhibitors, etc. These measures provide a new treatment strategy for delaying IVDD.

Abstract:Congenital scoliosis is a congenital spinal deformity caused by abnormal embryonic development of the spine, while hemiver-tebrae resection is the main treatment. In recent years, hemivertebrae resection has changed in terms of operation stage, surgical approachand fusion mode. For this reason, the evolution of hemivertebrae resection, the combination of pedicle screw internal fixation techniques, rel-evant new techniques and concepts, as well as common causes of failure and improvement plans for hemivertebrae resection are described inthis paper, and the research progress of hemivertebrae resection in the treatment of congenital scoliosis (CS) is also reviewed.

Abstract:With the rapid development of cutting-edge science and technology such as computer vision and deep learning, joint replace-ment robotic surgical system has significant advantages in terms of stability and accuracy compared with traditional joint replacement surgi-cal techniques, effectively improving the surgical treatment effect. With the continuous iteration and update of the joint replacement roboticsurgical system, and the combination of virtual reality, artificial intelligence and other emerging technologies, powerful preoperative plan-ning and intelligent operation functions have been generated. There are many kinds of joint replacement robotic surgical systems on the mar-ket today. This paper reviews the latest application status and future development trend of joint replacement robotic surgical systems, ex-pounds the advantages and limitations of joint replacement robotic surgical systems in clinical application, and puts forward solutions. It pro-vides reference for the future research and development of robotic surgical system for joint replacement.

Abstract:The cause of spinal disease is complex, while spinal operation is difficult with high risk of serious complication. The patientin the process of diagnosis and treatment will have different degrees of psychological and physiological changes, anxiety is more common andeasy to be ignored. It has been reported that anxiety is related to the prognosis of patients and impacts the diagnosis and treatment process. Inthis paper, the causes of anxiety, the assessment tools of anxiety, the harm of anxiety to the perioperative period, as well the management andtreatment strategies of anxiety were reviewed to provide new ideas and methods for further research about the influence of anxiety on the peri-operative spinal surgery.

Abstract:[Objective] To investigate the effects of different concentrations of astragalus polysaccharide on osteoporosis induced by reti-noic acid in rats. [Methods] Fifty SD rats were randomly divided into control group, model group, low-dose group, medium-dose group andhigh-dose group, with 10 rats in each group. Except the control group, the other groups were given 70 mg/kg retinoic acid continuous intra-gastrically for 18 days, and the control group was given equal volume distilled water. After that, astragalus polysaccharide was given intragas-trically, 100 mg/kg in the low dose group, 200 mg/kg in medium dose group and 400 mg/kg in high dose group, whereas equal volume of dis-tilled water was given in the control group and model group. At 30 days after administration, gross measurement, BMD and biomechanicaltests were performed on the left femur of rats. Serum concentrations of TNF-α and TGF-β1 and bone homogenate protein were measured.[Results] The femur weight in descending order was control group＞high dose group＞medium dose group＞low dose group＞model group [(1.1±0.2) g vs (1.0±0.1) g vs (0.9±0.2) g vs (0.8±0.1) g vs (0.6±0.0) g, P＜0.001], with no significant difference in bone weight between control groupand high-dose group (P＞0.05). BMD was ranked as control group＞high dose group＞medium dose group＞low dose group＞model group[(252.5±21.2) mg/cm2 vs (232.7±21.4) mg/cm2 vs (190.6±31.2) mg/cm2 vs (158.1±13.1) mg/cm2 vs (119.9±12.2) mg/cm2, P＜0.001], and therewas no significant difference in BMD between the control group and the high-dose group (P＞0.05). The order of maximum load in mechani-cal test was the same as above, with statistically significant differences among groups (P＜0.05). The order of serum TNF-α detection was ofcontrol group＜high dose group＜medium dose group＜low dose group＜model group, with statistically significant differences among them (P＜0.05). The order of serum TGF-β1 was of high dose group＞control group＞medium dose group＞low dose group＞model group, with statisticallysignificant differences (P＜0.05). Bone homogenate measured BMP-2/β-actin and P-ERK /ERK were as follows: control group＞high dosegroup ＞ medium dose group＞low dose group＞model group, with statistical significances (P＜0.05). [Conclusion] Astragalus polysaccharidecan improve the osteoporosis induced by retinoic acid in rats, and its mechanism may be the activation of the downstream MAPK/ERK signal-ing pathway.

Abstract:[Objective] To investigate the relationship of the Janus kinase-signal transducer and activator of transcription (JAK-STAT)signaling pathway with the pathogenesis of steroid-induced osteonecrosis of femoral head. [Methods] In vivo experiment, 36 Sprague-Daw-ley (SD) rats were randomly divided into three groups with 12 animals in each group, including the blank control group, model group and in-tervention group, which were treated with corresponding drugs respectively. The femoral head was harvest for HE and TUNEL staining 28days later. In vitro test, osteoblasts were separated from the skull of a young rat and divided into three groups as in vivo test. After correspond-ing treatments were given in vitro, the expression levels of ALP and JAK-STAT pathway related protein, such as JAK2 and p-STAT3, wereassessed. [Results] In vivo test, the rates of empty bone crypts revealed by HE stain was ranked up-down as follows: the model group ＞ theintervention group ＞ the control group, with a statistically significant difference [(38.9±1.3)% vs (18.9±0.9)% vs (3.2±0.6)%, P＜0.001], like-ly, the apoptosis rates showed by TUNEL stain was of the model group ＞ the intervention group ＞ the control group, with a statistically signifi-cant different [(42.2±2.7)% vs (16.1±1.3)% vs (6.2 ±1.1)%, P＜0.001]. In vitro test, apoptosis rate by TUNEL staining was ranked as: the mod-el group ＞ the intervention group ＞ the control group and the difference was statistically significant [(42.3±3.5)% vs (18.2±1.6)% vs (10.2±1.3)%, P＜0.001], whereas the ALP activity was ranked from low to high as: the model group ＜ the intervention group ＜ the control group witha statistically significant difference [(53.6±7.7) IU vs (79.2±6.5) IU vs (92.4±4.4) IU, P=0.037]. In addition, JAK-STAT-related marker pro-tein expression in model group was significantly higher than that in the control group and the intervention group, including p-JAK2 [(1.6±0.2) vs (1.0±0.1) vs (1.3±0.3), P＜0.05] and p-STAT [(1.4± 0.2) vs (1.0±0.1) vs (1.2±0.3), P＜0.05]. [Conclusion] The JAK-STAT signalingpathway specific inhibitor AG490 does inhibit steroid-induced cell apoptosis, its mechanism may be related to the inhibition of p-JAK2 andp-STAT protein expression.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcomes of posterior atlantoaxial anti-rotationscrew rod fixation for atlantoaxial dislocation. [Methods] From June 2018 to June 2022, 16 patients underwent abovesaid surgical proce-dures for reversible atlantoaxial dislocation. As posterior midline incision was performed under general anesthesia, the pedicle screws or par-tial transpedicle screws were placed on the C1, while pedicle screws or laminar screws were placed on the C2. Subsequently, the pre-curvedanti-rotation rods were installed to construct the atlanto-axial anti-rotation screw rod system for lifting, reducing and fixing C1~C2. Finally il-iac autogenous bone graft was implanted for C1~C2 fusion. After operation, the atlantoaxial reduction, fusion, and neurological function wereevaluated in regular intervals. [Results] All the 16 patients had the operation completed successfully with no complications, such as nerveand vascular injury. The patients got symptoms improved significantly after surgery, with satisfactory atlantoaxial reduction on images. TheADI decreased from (5.7±1.3) mm before surgery to (1.7±0.7) mm one week after surgery, whereas the JOA score increased from (13.7±1.1)before surgery to (16.3±0.9) one week after surgery. At the latest follow-up lasted from 3 to 24 months, all patients achieved atlanto-axialbony fusion. [Conclusion] The posterior atlantoaxial instrumented fusion with this anti-rotation screw-rod system for atlantoaxial disloca-tion does achieve satisfactory short-term clinical consequence with an advantage of more convenient surgical operation. However, furthercomparison with the conventional atlantoaxial screw system is needed to verify its advantages.

Abstract:[Objective] To explore the safety and clinical efficacy of unilateral biportal endoscopy (UBE) in the treatment of multileveldegenerative lumbar disease ( MDLD). [Methods] Twenty nine patients who received surgical decompression with UBE for MDLD from July2020 to June 2022 were retrospectively analyzed. The clinical and imaging data were evaluated. [Results] All the 29 patients successfullycompleted the operation, with the average operation time of (178.6±26.5) min, the average intraoperative fluoroscopy times of (10.9±2.9). Interm of complication, dural tear happened in 2 cases, transient lower limb numbness in 2 cases, and epidural hematoma in 1 case, which notled serious consequence in anyone of them. The follow-up period lasted for (19.3±6.3) months in average. As time went from the point beforesurgery, to 7 days, 3 months and 12 months postoperatively, the VAS score for pain [(6.6±1.5), (3.2±0.5), (2.1±0.6), (1.7±0.5), P＜0.001], ODIscore [(58.6±11.2), (33.5±4.6), (22.8±3.8), (17.5±2.2), P＜0.001], JOA score [(15.6±2.4), (19.6±2.0), (21.2±2.2), (24.7±2.5), P＜0.001] signifi-cantly improved. At 12 months after operation, the excellent and good rate was of 86.2%, according to the modified MacNab criteria. In termsof imaging, there was a significant increase in spinal canal area at 12 months after surgery compared with that preoperatively [(58.3±9.6)mm2, (118.4±14.2) mm2, P＜0.001]. The retention rate of facet joints was more than 60% in all levels. [Conclusion] The UBE used in thetreatment of MDLD does achieve satisfactory clinical outcomes, with a benefit to maintain the stability of lumbar spine by preserving morefacet joints, is a safe and effective operation.

Abstract:[Objective] To compare clinical outcomes of percutaneous Kambin's triangle approach lumbar interbody fusion (PKLIF)versus minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative lumbar spondylolisthesis (DLS). [Methods] Aretrospective study was conducted on 32 patients who had DLS treated surgically in our hospital from March 2023 to March 2024. Accord-ing to preoperative doctor-patient communication, 15 patients received PKLIF with self-developed instruments, while other 17 patients re-ceived routine MIS-TLIF. Clinical and imaging data of the two groups were compared. [Results] All patients had the corresponding surgicalprocedures performed successfully without serious complications such as nerve injury and death, and were followed up in a mean of (6.0±1.8) months. The PKLIF group proved significantly superior to the MIS-TLIF group in terms of intraoperative blood loss [ (82.7±9.6) ml vs(165.3±25.3) ml, P＜0.001], postoperative ambulation time [(1.9±0.7) days vs (3.1±0.6) days, P＜0.001], hospital stay [(8.3±2.2) days vs(11.7±2.6) days, P＜0.001], back pain VAS score one day postoperatively [(1.8±0.7) vs (2.9±0.7), P＜0.001] and ODI score 2 weeks after op-eration [(31.2±3.0) vs (40.6±5.8), P＜0.001]. However, the PKLIF group was significantly greater than the MIS-TLIF group regarding intra-operative fluoroscopy times [(17.7±1.7) times vs (5.1±1.0) times, P＜0.001] and operation time [(134.0±12.4) min vs (115.9±13.7) min, P＜0.001]. [Conclusion] PKLIF does relieve clinical symptoms of DLS, with the advantages of less intraoperative blood loss, early ambulation,and shortened hospitalization, whereas disadvantages of more intraoperative fluoroscopy times and longer operation time compared with theMIS-TLIF.

Abstract:[Objective] To evaluate the clinical outcomes of unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF) for recurrent lumbar disc herniation (RLDH). [Methods] A retrospective study was conducted on 38 patients who had RLDHtreated surgically in our hospitals from January 2022 to December 2023. Based on preoperative doctor-patient communication, 18 patientsunderwent UBE-TLIF, while other 20 patients received posterior lumbar interbody fusion (PLIF). Clinical and imaging data were evaluatedand compared between the two groups. [Results] All patients in both groups were operated on successfully without neurological injury andother complications. The UBE-TLIF group proved significantly superior to the PLIF group in terms of operative time [(138.3±15.4) min vs(154.8±14.6) min, P=0.002], intraoperative blood loss [(186.1±41.0) ml vs (230.5±55.8) ml, P=0.009], the ambulation time [(2.4±0.6) daysvs (5.9±1.0) days, P＜0.001], hospital stay [(8.1±2.3) days vs (12.4±2.9) days, P＜0.001]. All patients in both groups were followed up for amean of (5.42±1.10) months. The UBE-TLIF group proved significantly better than the PLIF group regarding to back pain VAS score [(2.2±0.7) vs (3.1±0.8), P=0.002], ODI score [(36.7±3.4) vs (57.0±3.9), P＜0.001] and JOA scores [(11.2±2.4) vs (9.2±2.5), P=0.018] 1 day aftersurgery, whereas which became not statistically significant between the two groups at the latest follow-up (P＞0.05). [Conclusion] TheUBE-TLIF achieves better early functional recovery, with the advantages of shorter operation time, less intraoperative blood loss, earlierambulation time and shorter hospital stay over the PLIF.

Abstract:[Objective] To investigate the clinical and MRI features of ganglion cysts around the flexor hallucis longus tendon. [Meth-ods] From December 2018 to December 2021, 19 patients who suffered flexor longus tendon sheath cyst were retrospectively analyzed, in-cluding 12 males and 7 females, 8 cases on the left side and 11 cases on the right side. All patients were examined by MRI, including sagittalT1WI, sagittal and coronal PDWI and transverse T2WI. The observation data were evaluated, involving the location and range of cyst, the sig-nal characteristics of the cyst and articular cartilage degeneration. [Results] Of the 19 patient, 8 (42.1%) had the cyst found superior to themalleolar canal with longitudinal diameter from 4 to 8 cm, while 6 (31.6%) were distal to the malleolar canal with longitudinal diameter from2 to 6 cm, and 5 (26.3%) had the cyst around the metatarsophalangeal joint with longitudinal diameter from 2.5 to 3.4 cm. In term of MRIcharacteristics, the cyst presents a smooth border mass around the joint, with low or moderate signal on T1WI, whereas high signal on T2WIand PDWI. In addition, 15 of them got significant adjacent joint degeneration, including 11 of periarticular osteophytes, 9 of subchondral os-teosclerosis, and 4 of metaphyseal bone marrow edema. Furthermore, 13 patients had articular cartilage degeneration involving a total of 67articular cartilage surfaces, according to the Recht criteria, 5 articular cartilage surfaces of grade I, 18 of grade II, and the rest articular carti-lage surfaces of grade III or IV changes. [Conclusion] MRI could show the range, anatomic relationship and joint degeneration around theganglion cysts, and provide help for clinical treatment.