Abstract:[Objective] To investigate the clinical outcomes of arthroscopic repair with remnant preservation and perpendicular micro- fracture as bone marrow stimulation for acute rotator cuff tear. [Methods] A retrospective study was done on 64 patients who received ar- throscopic double-row repair for acute rotator cuff tear in our hospital from May 2018 to May 2020. According to doctor-patient communi- cation, 32 patients had the rotator cuff repaired in condition of remnant preservation and perpendicular microfracture as bone marrow stimu- lation (the modified group), while the other 32 patients were repaired by traditional bone bed fresh technique (the traditional group). The perioperative, follow-up and imaging results were compared between the two groups. [Results] All patients in both groups had correspond- ing surgical procedures performed successfully, and there were no statistically significant differences in operation time, intraoperative blood loss, incision healing, active activity time and hospital stay between the two groups (P＞0.05). All of them were followed up for (31.9±3.4) months in a mean, and there was no significant difference in time to resume full weight-bearing activity between the two groups (P＞0.05). The VAS, Constant-Murley, UCLA and ASES scores, as well as shoulder forward flexion, upward lifting, abduction upward lifting range of motions (ROMs) in both groups were significantly improved at the last follow-up compared with those preoperatively (P＜0.05), which proved not statistically significant between the two groups at any time points accordingly (P＞0.05). With regard of imaging, tendon integrity was significantly improved in both groups at the last follow-up compared with that pre-surgery (P＜0.05), while the acromiohumeral dis- tance (AHD), the extents of tendon fat infiltration and the tendon atrophy remained unchanged in both groups (P＞0.05). By the latest followup, the modified group was significantly superior to the traditional group in terms of tendon integrity [I/II/III/IV/V, (20/11/0/0/1) vs (15/9/0/ 5/3), P=0.042] and retear rate (3.1% vs 25.0%, P=0.026). [Conclusion] Arthroscopic repair of acute rotator cuff tears with remnant preser-vation and bone marrow stimulation by perpendicular microfracture does relieve pain, enhance shoulder function score, improve shoulder motion, and achieve good clinical consequences, which may provide a new choice for clinicians in the treatment of acute rotator cuff tears.

Abstract:[Objective] To analyze the risk factors of postoperative blood transfusion of femoral intertrochanteric fracture in the elderly, and an established prediction equation was verified. [Methods] A retrospective study was done on 358 elderly patients who received surgi- cal treatment for femoral intertrochanteric fractures in our hospital from December 2016 to December 2021. The patients were divided into transfusion group and non-transfusion group according to whether postoperative blood transfusion occurred. The univariate comparisons and multi-factor binary logistic regression analysis were conducted to search the relative factors, and then a prediction model was estab- lished with its efficiency evaluated. [Results] Among the 358 patients, 168 (46.9%) received postoperative blood transfusion. In term of uni- variate comparison, the transfusion group were significantly older in age [(80.7±8.5) years vs (76.6±8.7) years, P＜0.001], lower BMI [(20.7± 3.3) kg/m² vs (21.5±3.7) kg/m² , P=0.015], higher prevalence of hypertension [(105/63) vs (93/97), P=0.010], and more severe fracture types [A1/A2/A3, (40/93/35) vs (80/83/27), P＜0.001], longer operation time [(122.9±56.6) min vs (101.4±30.5) min, P＜0.001], more intraopera- tive blood loss [(258.3±218.9) ml vs (130.5±94.9) ml, P＜0.001], lower preoperative Hb [(93.1±14.8) g/L vs (111.6±14.2) g/L, P＜0.001], and lower preoperative Alb [(34.7±8.2) g/L vs (36.8±4.5) g/L, P=0.002] than the non-transfusion group, and all abovesaid were statistically sig- nificant between the two groups. As results of logistic regression analysis, the age (OR=1.053, P=0.007), operation time (OR=1.008, P= 0.025), intraoperative blood loss (OR=1.007, P＜0.001) were the independent risk factors for postoperative transfusion, while the BMI (OR= 0.900, P=0.025) and preoperative hemoglobin (OR=0.904, P＜0.001) were the independent protective factor. Based on the logistic regres- sion results, a prediction equation was established, which proved area under curve (AUC) of 0.894, 95%CI 0.862~0.927，with cutoff of 0.578, the sensitivity of 74.4%, and the specificity of 88.4% by the ROC analysis. [Conclusion] The advanced age, longer operation time,more intraoperative bleeding, lower BMI and lower hemoglobin are independent risk factors for postoperative blood transfusion. The predic- tion model of postoperative blood transfusion might be helpful to judge the risk of transfusion and prevent it in advance.

Abstract:[Objective] To compare the clinical outcomes of two anchor techniques in arthroscopic repair of the anterior talofibular liga- ment (ATFL) for chronic lateral ankle instability (CLAI). [Methods] A retrospective study was performed on 88 patients who underwent ar- throscopic repair of ATFL with anchors for CIAI in our hospital from January 2018 to January 2021. According to the doctor-patient com- munication preoperatively, 49 patients received repair with the knotless anchor, while the other 39 patients were with the knotted anchor. The perioperative, follow-up and imaging data of the two groups were compared. [Results] Although there were no significant differences in operation time, intraoperative blood loss, incision length, walking time and hospital stay between the two groups (P＞0.05), the knotless group got significantly lower incidence of foreign body reaction than the knoted group (0% vs 33.3%, P＜0.001). All patients were followed for more than 24 months, and there was no statistically significant difference in the time to regain full weight bearing between the two groups (P＞0.05). Compared with those preoperatively, the ankle dorsal extension-plantar flexion range of motion (ROM), Karlson-Peterson score and AOFAS score significantly increased (P＜0.05), while the varus-valgus ROM and VAS scores significantly reduced (P＜0.05), and the anterior drawer test significantly improved in both groups at the latest follow-up (P＜0.05). However, there were no statistically signifi- cant differences in the above indexes between the two groups at any time points accordingly (P＞0.05). Regarding imaging, the talar tilt (TT) under inversion stress and anterior displacement (AD) under anterior drawer stress significantly reduced in both groups at the last followup compared with those preoperatively (P＜0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P＞0.05). [Conclusion] Both kinds of anchor used in arthroscopic repair of ATFL for the CLAI do restore stability and achieve good clinical consequences. In contrast, the knotless anchor has less the early foreign body reaction than the knotted counterpart.

Abstract:[Objective] To evaluate the clinical efficacy of ultrasound guided closed reduction and internal fixation with elastic intra- medullary nail for forearm fractures in children. [Methods] A retrospective study was performed on 60 children who received closed reduc- tion and percutaneous elastic intramedullary nail fixation for forearm fractures from September 2019 to July 2021. According to the preoper- ative doctor-patient communication, 30 children had operation performed under ultrasound guidance, while other 30 children were under fluoroscopy guidance. The perioperative, follow- up and imaging data of the two groups were compared. [Results] All children in both groups were operated on smoothly, with no neurovascular injury and other serious complications during the operation. The ultrasound group proved significantly superior to the fluoroscopy group in terms of operation time [(23.4±3.6) min vs (31.9±3.5) min, P＜0.05], intraoperative blood loss [(4.5±2.7) ml vs (6.7±4.5) ml, P＜0.05], intraoperative fluoroscopy times [(3.2±1.5) times vs (10.4±2.1) times, P＜0.05], the hospi- tal stay [(3.2±1.5) days vs (4.2±1.0) days, P＜0.05], external fixation removal time [(28.0±5.3) days vs (32.3±3.2) days, P＜0.05], despite insig- nificant differences in incision length and incision healing grade between two groups (P＞0.05). In addition, the ultrasound group got signifi- cantly higher success rate of initial closed reduction than the fluoroscopy group (96.7% vs 70.0%, P＜0.05). Postoperative pain VAS scores significantly declined in both groups over time (P＜0.05), which was not significant between the two groups at any corresponding time points (P＞0.05). Regarding the data of follow-up, there was no significant difference in the time to resume full weight-bearing activity between the two groups (P＞0.05). The DASH score, forearm rotation ROM, elbow extension ROM and wrist extension ROM significantly improved in both groups at 12 months after surgery compared with those 3 months postoperatively (P＜0.05), whereas which were not statistically signifi-cant between the two groups at any time points accordingly (P＞0.05). In terms of imaging, there were no significant differences in the quali- ty of fracture reduction and healing time between the two groups (P＞0.05). [Conclusion] The ultrasonic guided closed reduction and percu- taneous elastic intramedullary pin fixation for forearm fracture in children does reduce radiation injury, improve the success rate of initial closed reduction and shorten the operation time.

Abstract:[Objective] To explore the risk factors for failure of proximal femoral nail anti-rotation (PFNA), establish a scoring system for postoperative stability of PFNA, and explore its predictive value. [Methods] A total of 164 patients who received PFNA for femoral inter- trochanteric fractures in our hospital from January 2019 to January 2022 were included in this study. According to the follow-up results, the patients were divided into successful group and failure group. Univariate comparison and binary regression analysis were used to search the risk factors of PFNA failure. A scoring system was established according to the risk factors, its value for predicting PFNA failure was an- alyzed using receiver operating curve (ROC). [Results] Of the 164 patients, 38 patients were confirmed as PFNA failure, counting for 23.2%. As consequences of univariate comparison, the failure group was significantly inferior to the successful group in terms of that the lat- eral wall integrity [n, complete/incomplete; (12/25) vs (93/33), P＜0.05], calcar referenced tip-apex distance (Cal-TAD) [n, ＜25 mm /≥25 mm; (9/29) vs (83/43), P＜0.05], spiral blade position [n, good/poor; (13/25) vs (111/15), P＜0.05], fracture classification [n, complete/danger- ous/broken; (5/12/21) vs (98/17/11), P＜0.05], reduction quality [n, excellent/good/poor; (4/12/22) vs (81/29/16), P＜0.05], cortical support [n, positive/neutral/negative; (4/11/23) vs (82/29/15), P＜0.05]. Based on logistic regression analysis, poor lateral wall integrity (OR=12.118, P= 0.007), greater Cal-TAD (OR=18.995, P=0.003), poor spiral blade position (OR=20.603, P=0.003), and poor fracture classification (OR= 14.71, P=0.014), negative medial cortical support (OR=16.068, P=0.01) and poor reduction quality (OR=45.598, P=0.001) were indepen- dent risk factors for PFNA failure. According to the logistic regression, a scoring system was created, and ROC analysis showed that the crit- ical value for predicting fixed failure of this scoring system was 6.5, the area under the curve (AUC) was 0.934, and the sensitivity and speci- ficity were 94.7% and 73.0%. [Conclusion] Poor lateral wall integrity, poor spiral blade position, poor fracture classification, negative medi- al cortical support, and poor reduction quality are risk factors for PFNA failure. The scoring system established on this basis might have clinical significance for predicting PFNA failure in some extent.

Abstract:[Objective] To evaluate the clinical efficacy of supercapsular approach (SC) for hemiarthroplasty (HA) in the treatment of unstable femoral intertrochanteric fractures in the elderly. [Methods] A retrospective study was conducted on 50 patients who received hemiarthroplasty for unstable femoral intertrochanteric fractures in our department from April 2017 to March 2020. Based on doctor-pa- tient communication, 25 patients had HA performed though the SC approach, while other 25 patients were through the posterolateral ap- proach (PL). The perioperative, follow-up and imaging data of the two groups were compared. [Results] The SC group was significantly su- perior to the PL group in terms of operation time [(60.5±8.5) min vs (74.0±6.5) min, P＜0.05], incision length [(8.2±0.5) cm vs (12.1±1.1) cm, P＜0.05], intraoperative blood loss [(200.8±29.7) ml vs (297.2 ±23.0) ml, P＜0.05], the ambulation time [(1.8±0.7) days vs (3.2±0.8) days, P＜ 0.05] and hospital stay [(9.6±1.4) days vs (11.7±2.0) days, P＜0.05]. All patients were followed up for more than 12 months, and the SC group returned to full weight-bearing activity significantly earlier than the PL group [(5.6±1.0) weeks vs (6.8±1.2) weeks, P＜0.05]. The Har- ris score, hip extension-flexion ROM, and internal-external rotation ROM significantly increased in both groups at the last follow-up com- pared with those preoperatively (P＜0.05). By the time of the last follow-up, the SC group was significantly better than the PL group in terms of Harris score [(79.4±2.6) vs (73.9±3.3), P＜0.05], hip extension-flexion ROM [(97.0±5.0)° vs (93.2±4.3)°, P＜0.05], internal-external rota- tion ROM [(57.6±5.9)° vs (52.2±5.7)°, P＜0.05]. Regarding image, the leg length discrepancy (LLD) decreased significantly over time in both groups (P＜0.05). However, there were no significant differences in LLD, quality of fracture reduction and prosthetic position between the two groups at any time points accordingly (P＞0.05), no hip dislocation or prosthesis loosening occurred in anyone of both groups. [Conclu- sion] The SC approach used in HA has the advantages of minimally invasive surgery, shorter operation time, less intraoperative bleeding, less postoperative pain and faster recovery over the PL approach for the treatment of unstable femoral intertrochanteric fracture in the elderly.

Abstract:[Objective] To explore the choice of surgical methods and the influence on prognosis of hyperextension tibial plateau frac- tures. [Methods] A retrospective study was done on 53 patients who received open reduction and internal fixation (ORIF) for tibial plateau fractures in our hospital from January 2016 to January 2021. According to Firoozabadi's criteria, 19 patients fall in hyperextension (HE) group, while other 34 patients were in the non-hyperextension (NHE) group. The documents regarding to perioperative period, follow-up and imaging were compared between the two groups. [Results] The HE group proved significantly greater than the NHE group in terms of overall incidence of combined injury (63.1% vs 23.4%, P＜0.05), operation time [(141.3±19.7) min vs (107.6±15.4) min, P＜0.05], incision length [(19.6±4.1) cm vs (15.4±3.4) cm, P＜0.05] and intraoperative blood loss [(228.3±33.9) ml vs (163.4±24.1) ml, P＜0.05], despite of in- significant differences in intraoperative fluoroscopy times, ambulation time, incision healing grade and hospital stay between the two groups (P＞0.05). The mean follow-up time was of (14.3±1.1) months, and there was no significant difference in time to resume full weight-bearing activity between the two groups (P＞0.05). Both KSS clinical score and KSS functional score were significantly increased in both groups over time (P＜0.05), of which the KSS functional score in HE group was significantly lower than that of NHE group 2 months after surgery [(50.4± 5.4) vs (54.7±5.8), P＜0.05]. Radiographically, the joint congruity significantly improved (P＜0.05), while MPTA significantly increased post- operatively compared with those preoperatively (P＜0.05). However, there were no significant differences in joint congruity, fracture healing time and MPTA between the two groups any time points accordingly (P＞0.05). The PTS in HE group were significantly smaller than that in the NHE group preoperatively (P＜0.05), while became not statistically significant between the two groups postoperatively (P＞0.05). [Con- clusion] Hyperextension tibial plateau fracture is often associated with other structural injuries, and the surgical treatment is much more complicated with poor prognosis compared with the non-hyperextension counterpart.

Abstract:[Objective] To compare the clinical efficacy of vesselplasty (VP) with or without manual reduction for osteoporotic verte- bral compression fracture (OVCF). [Methods] A retrospective study was done on 65 patients who underwent VP for OVCF in our hospital from July 2020 to April 2022. According to doctor-patient communication, 31 patients had manual reduction conducted, followed by the VP (the reduction group), while the other 34 patients underwent VP without manual reduction before surgery (the non- reduction group). The documents regarding to perioperative period, follow-up and images were compared between the two groups. [Results] All patients were successfully operated on without serious complications. The reduction group proved significantly superior to the non- reduction group in terms of operation time [(31.4±6.7) min vs (38.9±13.0) min, P=0.006] and the bone cement leakage rate (22.6% vs 58.8%, P=0.003), al- though there were no significant differences in intraoperative fluoroscopy times, bone cement injection amount, postoperative ambulation time, hospital stay and hospitalization cost between the two groups (P＞0.05). All patients were followed up for more than 1 year, and there was no significant difference in the time to resume full weight-bearing activities between the two groups (P＞0.05). The VAS and ODI scores decreased significantly over time in both groups (P＜0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P＞0.05). With regard of imaging, the local kyphotic Cobb angle and anterior vertebral height were significantly im- proved in both groups at the latest follow-up compared with those preoperatively (P＜0.05), however, there were no statistically significant differences in the local kyphotic Cobb angle and anterior vertebral height between the two groups at any corresponding time points (P＞ 0.05). [Conclusion] The VP combined with manual reduction does better reduce the chance of bone cement leakage, and shorten the opera- tive time in the treatment of osteoporotic vertebral compression fractures.

Abstract:[Objective] To compare the clinical efficacy between distal locked and unlocked intramedullary nailing in the treatment of femoral intertrochanteric fracture. [Method] The data bases, such as China National Knowledge Infrastructure (CNKI), Wanfang database, VIP database, China Biological Literature system (CBM), PubMed, Embase, and Cochrane library were searched for the comparison of clini- cal outcomes of distal locked versus unlocked intramedullary nailing in the treatment of intertrochanteric fracture from the creating to Octo- ber 2022. Literature screening, quality assessment, and data extraction were conducted to meet the inclusion and exclusion criteria, and Rev-Man 5.3 was used to perform the meta-analysis of parameters related to the consequences. [Results] A total of 9 studies were included with 1 977 patients treated with intramedullary nail fixation for femoral intertrochanteric fractures, including 830 cases in the distal locked group and 1 147 cases in the distal unlocked group. As results of the meta-analysis, the unlocked group proved significantly superior to the locked group in terms of operation time (MD=7.5, 95%CI 5.0~10.1, P＜0.001), intraoperative bleeding (MD=37.6, 95%CI 20.1~55.2, P＜ 0.001), fluoroscopy times (MD=6.8, 95%CI 4.4~9.2, P＜0.001） and total incision length (MD=2.5, 95%CI 2.1~2.9, P＜0.001), whereas the unlocked group had significantly lower incidence of postoperative thigh pain than the locked group (RR=4.7, 95%CI 2.4~9.2, P＜0.001). However, there was no significant difference in complications, such as delayed fracture healing, hip pain, wound infection, screw cutting, peri-implant fractures between the two groups (P＞0.05). In addition, there was no significant difference in Harris score between the two groups at the last follow-up (P＞0.05). [Conclusion] For femoral intertrochanteric fractures (31A1+A2), the distal unlocked intramedullary nails can ensure stable fixation, while reducing intraoperative injury and reducing the incidence of postoperative thigh pain.

Abstract:Osteoporosis is a common orthopedic disease with a high incidence in the elderly population. The vertebral compression fracture, also known as osteoporotic vertebral compression fracture (OVCF), occurs in daily activities due to decreased bone strength and in- creased bone fragility after osteoporosis. Percutaneous vertebroplasty (PVP) is an effective method for OVCF, but clinical studies have found that recurrent vertebral fractures might happened secondary to PVP, with increasing the pain and burden of patients. These phenome- na have attracted the attention of orthopedic clinicians, and more and more scholars have studied the causes and mechanisms of its occur- rence. In this paper, the epidemiology, temporal and spatial characteristics, and related risk factors of recurrent fractures after PVP for OVCF in recent years were reviewed, so as to provide references for clinical workers to reduce the probability of recurrent fractures after PVP.

Abstract:The recovery of joint function of patients after anterior cruciate ligament reconstruction depends on postoperative rehabilita- tion training, while home rehabilitation is the most cost-effective and long-term rehabilitation mode under the current situation of limited medical resources. However, home rehabilitation is affected by many factors. This paper reviews the current situation, influencing factors, intervention strategies and limitations of home rehabilitation for anterior cruciate ligament reconstruction, in order to provide a reference for the controllable factors and intervention programs of patients' home rehabilitation.

Abstract:Reverse engineering (RE) is an important part of the manufacturing of personalized orthoses, which including reconstruct- ing 3D model of the involved area according to the measured data, the orthoses are designed by computer aided design (CAD) method, and then made by rapid prototyping technology (RP). The 3D printing personalized orthoses are currently popular interdisciplinary research in ‘medical-engineering’, which with advantages of suitable, light weight, customized structure can be helpful for functional recovery. In re- cent years, in order to accelerate the application, the research on the efficiency, cost and comfort of personalized orthoses manufacturing has been increasing year by year. Therefore, this article focuses on the RE method, and summarizes the research on related technology im- provement of manufacturing process from optical scanning, CAD modeling, hollow-carved design to RP.

Abstract:Periprosthetic fractures after total knee arthroplasty (TKA) have become a common complication, a challenging orthopedic problem. Periprosthetic fractures of the proximal tibia are less common than the distal femoral and patellar fractures, the tibial tubercle frac- tures combined with patellar tendon injuries are even rarer in clinical practice, which are rarely described in the medical literature, and their diagnosis and treatment remain a challenge. This paper describes a 74-year-old female with Felix type IV-A fracture of the right tibi- al tubercle with patellar tendon injury caused by a fall 4 years after TKA for right knee osteoarthritis. The fracture was fixed with an suturebridge, and the patellar tendon was reconstructed with semitendinous tendon transfer. The patient achieved full active knee extension with- out knee extension retardation 10 months after the revision surgery. In addition, relative literatures were reviewed in this article.

Abstract:[Objective] To introduce the surgical techniques and preliminary clinical results of percutaneous bone grafting and pedicle screw fixation for severe Kümmell's disease. [Methods] From June 2019 to June 2021, 14 patients received the abovementioned surgical pro- cedures for severe Kümmell's disease. After general anesthesia, the location of screw insertion points under fluoroscopy with body surface marks in prone position were conducted, and manual reduction of the fracture by traction and compression, the pedicle screws were placed percutaneously. The screw in the injured vertebra on one side was temporally removed, then a channel was inserted into the fissure of the fractured vertebrae over the screw tract and granular bone autografts were implanted through the channel followed by reinserting the pedicle screw. After that, the same operation was performed on the opposite side. Finally, the pedicle screw-rod system was fastened to finish the fix- ation. [Results] All patients had operations performed smoothly without serious complications with operation time of (112.6±28.2) min, and intraoperative blood loss of (131.4±77.6) ml. With time preoperatively, 1 week postoperatively and the latest follow-up, the VAS [(7.1±0.8), (3.1±0.6), (1.6±0.6), P＜0.001] and ODI scores [(75.4±4.1), (30.9±3.7), (16.0±3.5), P＜0.001] significantly decreased. In term of radiograph, all the patients had the implants in good position, with significantly improved local kyphotic Cobb angle [(29.1±4.4)°, (12.8±3.8)°, (13.6± 3.2)°, P＜0.001] and anterior vertebral height [(11.8±4.0) mm, (20.1±1.5) mm, (19.6±1.2) mm, P＜0.001] postoperatively compared with those preoperatively. [Conclusion] The percutaneous bone grafting and pedicle screw fixation are minimally invasive and technically feasible, and do effectively relieve pain, correct kyphotic deformity and restore vertebral height for severe Kümmell's disease.

Abstract:[Objective] To introduce the surgical techniques and preliminary clinical results of femoral neck system (FNS) for internal fixation of femoral neck fracture under retractor traction and C-arm 3D image monitoring in middle-aged and young adults. [Methods] A total of 21 young and middle-aged patients underwent abovesaid surgical treatment for femoral neck fractures. The patient was placed in oblique lateral position with the affected side elevated 40° with beanbag. The pin in supracondylar of the fractured side was inserted, and a fracture retractor frame was installed. As longitudinally traction was applied with adduction and internal rotation, the fracture was reduced properly under C-arm 3D image monitoring, a longitudinal incision 3 cm in length was made at the greater trochanteric of the femur to ex- pose the proximal femur. As the guide was placed on the lateral aspect the femur, guide pins were inserted. Finally, the FNS was installed to fix the fracture following the guide pins with the screw tips 5mm below the femoral head cartilage surface under image monitoring, and then the incision was closed in layers. [Results] All patients were successfully operated on with operation time of (54.2±11.3) min, intraoperative blood loss of (197.5±18.3) ml, and fluoroscopy time of (65.1±3.2) seconds. All the patients were followed up for (14.5±4.2) months, got prop- er fracture reduction with Garden index grade I in 16 cases and grade II in 5 cases, got fracture healing in (3.5±1.5) months and were marked in Harris score at the last follow-up of (84.5±4.2). [Conclusion] The FNS used for internal fixation of femoral neck fracture under retractor traction and C-arm 3D image monitoring has advantages of improving the reduction, enhancing fixation stability and accuracy, and achieves satisfactory hip function recovery.

Abstract:[Objective] To investigate the clinical outcomes of distraction by Ilizarov frame combined with selective tibial nerve constric- tion in the treatment of spastic talipes equinovarus. [Methods] A total of 37 patients (48 feet) with cerebral palsy spastic talipes equinovarus received limited soft tissue release, selective tibia nerve constriction followed by gradual distraction with Ilizarov frame in our hospital from January 2015 to December 2019, including 32 feet of Dimeglio grade III and 16 feet of grade IV. The clinical and imaging documents were evaluated. [Results] All patients had the operations performed successfully without neurovascular injury, with operation time of (96.9±14.2) min, intraoperative blood loss of (39.7±10.4) ml, partial loading time of (6.7±0.9) days, adjustment time of external fixator of (8.0±1.1) weeks, full loading activity time of (9.9±1.7) weeks and external fixator carrying time of (12.2±1.0) weeks. Compared with those preoperatively, the ICFSG [(37.8±4.0), (8.7±6.4), P＜0.05] and MAS grade [3.0 (3.0~4.0), 1.0 (0~3.0), P＜0.05] significantly reduced, while the dorsal extensionplantar flexion of the ankle [(12.4±6.9)°, (33.7±10.4)°, P＜0.05] and AOFAS score [(42.1±7.7), (81.2±9.3), P＜0.05] significantly increased at the latest follow up lasted for (18.3±3.6) months. Regarding to imaging, compared with those preoperatively, the TC [(8.9±3.4)°, (30.0±6.1)°, P＜0.05], TF [(24.2±13.0)°, (2.6±6.7)°, P＜0.05] and LTC [(5.0±2.4)°, (34.8±7.3)°, P＜0.05] improved significantly at the latest follow-up. [Conclusion] The Ilizarov technique combined with selective tibial nerve constriction is effective and safe in the treatment of spastic talipes equinovarus caused by cerebral palsy.

Abstract:[Objective] To investigate the effect of esketamine on tourniquet injury in knee arthroplasty. [Methods] A total of 106 pa- tients who were undergoing knee arthroplasty under general anesthesia were included in the study. They were randomly divided into two groups, 53 patients received esketamine (the drug group), while other 53 patients not received esketamine (the non-drug group). The clinical and laboratory data of the two groups were compared. [Results] All patients in both groups were successfully operated on. The drug group had significantly lower mean artery pressure (MAP) than the non-drug group 60 min after torniquet applied [(109.7±8.3) mmHg vs (115.7± 9.5) mmHg, P＜0.001] and 10 min after torniquet released [(102.6±7.4) mmHg vs (99.3±6.9) mmHg, P=0.019]. At the corresponding time points, the drug group got significantly lower NRS score for pain than the non-drug group (P＜0.05). In addition, the drug group was mea- sured significantly greater femoral circumference than the non-drug group 7 days after operation [(42.7±5.4) cm vs (40.4±5.1) cm, P=0.026]. Regardless of insignificant difference in the incidence of nausea, vomiting and agitation between the two groups (P＞0.05), the drug group had significantly lower incidence of postoperative delirium than the non-drug group (1.9% vs 15.1%, P=0.031). In terms of laboratory test, al- though there were no statistically significant differences in IL-6, LA and MDA levels between the two groups before operation (P＞0.05). the drug group was tested significantly lower IL-6 [(407.3±26.7) pg/ml vs (432.5±28.7) pg/ml, P＜0.001], LA [(0.8±0.2) mmol/L vs (1.0±0.2) mmol/L, P＜0.001], and MDA [(4.4±0.6) μmol/L vs (4.8±0.6) μmol/L, P＜0.001] than the non-drug group 10 min after torniquet released. [Conclusion] Esketamine does inhibit tourniquet hypertension, relieve tourniquet pain and prevent quadriceps atrophy in knee arthroplasty in this study.

Abstract: