Abstract:[Objective] To investigate the clinical efficacy of robotic versus freehand lateral lumbar interbody fusion (LLIF) with poste-rior pedicle screw fixation for the treatment of lumbar degenerative diseases (LDD). [Methods] A retrospective study was conducted on 43patients who underwent LLID for LDDs in our hospital from January 2019 to January 2022. According to preoperative doctor-patient com-munication, 22 patients underwent robot-assisted single lateral position LLIF and pedicle screw fixation (the robot group), while other 21patients underwent traditional LLIF with changing position and freehand technique (the freehand group). The documents regarding to peri-operative period, follow-up and images were compared between the two groups. [Results] All patients in both groups had operation per-formed successfully. The robot group proved significantly superior to the freehand group in terms of operation time [(136.0±18.6) min vs(149.4±22.0) min, P=0.036], intraoperative blood loss [(124.9±16.5) ml vs (138.2±20.3) ml, P=0.023], intraoperative fluoroscopy times[(11.6±3.7) times vs (40.0±8.1) times, P＜0.001]. The mean follow-up time was of (11.3±3.8) months, and there was no significant differencein time to regain full weight-bearing activity between the two groups (P＞0.05). The VAS scores of low back pain and leg pain, as well asODI score significantly decreased over time in both groups (P＜0.05), which were not statistically significant between the two groups at anycorresponding time points (P＞0.05). As for imaging, there was no significant difference in the accuracy of pedicle screw placement betweenthe two groups (P＞0.05). Compared with those preoperatively results, the spinal canal area, sagittal diameter of lateral recess and lumbar lor-dosis angle significantly improved in both groups postoperatively (P＜0.05), whereas which were not statistically significant between the twogroups at any time points accordingly (P＞0.05). [Conclusion] Both robot-assisted and freehand lateral lumbar interbody fusion are effective

Abstract:[Objective] To investigate the current situation of surgical treatment decision of orthopaedic surgeons for thoracolumbarfracture among 50~65 years old patients in Jiangxi region. [Methods] A questionnaire survey was conducted among orthopedic surgeons inJiangxi province. The questionnaire included the basic information of the survey subjects, the basis for surgical decision making, the selec-tion of internal fixation methods and the postoperative management of thoracolumbar fracture in patients aged from 50 to 65 years. [Results]A total of 319 questionnaires were collected, including 114 from secondary hospitals and 205 from tertiary hospitals. Among the survey sub-jects, 79 were junior professional titles, 117 were intermediate, and 123 were senior. The proportion of preoperative bone mineral density(BMD) examination by physicians in tertiary hospitals was significantly higher than that in secondary hospitals [cases (%), 149 (72.7) vs 68(59.6), P=0.017]. Junior physicians selected infection indexes [cases (%), 44 (55.7) vs 86 (73.5) vs 99 (80.5), P＜0.001], tumor indexes [cas-es (%), 7 (8.9) vs 46 (39.3) vs 71 (57.7), P＜0.001] and BMD examination [cases (%), 25 (31.6) vs 89 (76.1) vs 103 (83.7), P＜0.001] were sig-nificantly lower than those with middle and senior professional titles. The proportion of orthopedic surgeons in tertiary hospitals choosingBMD as the basis for surgical decision-making was significantly higher than that in secondary hospitals [cases (%), 157 (76.6) vs 72 (63.2),P=0.011]. The proportion of minimally invasive screw fixation in junior professional titles was significantly lower than those with the middleand senior professional titles (P＜0.001). For the patients with injured vertebrae protruding into the spinal canal but no neurological symp-toms, the proportion of decompression was significantly decreased with the increase of professional rank (P＜0.001). The junior professionaltitles who chose not to do intravertebral bone grafting was significantly higher than the middle and senior professional titles (P＜0.001). Theproportion of ambulation immediately after drainage tube removal after internal fixation in tertiary hospitals was significantly higher than that in secondary hospitals [cases (%), 119 (58.0) vs 53 (46.5), P=0.012]. The junior professional titles who chose to stay in bed for morethan 1 month after internal fixation was significantly higher than those with middle and senior professional titles [cases (%), 12 (15.2) vs 3(2.6) vs 4 (3.3), P＜0.001]. [Conclusion] There is a great difference in surgical decision making among orthopedic surgeons in Jiangxi regionfor thoracolumbar fracture in patients aged 50~65 years, and there is a lack of standard basis for surgical decision making.

Abstract:[Objective] To compare the clinical efficacy of Multiloc intramedullary nail fixation of proximal humerus fractures (PHF)with or without medial column supporting reconstruction in the elderly. [Methods] A retrospective study was done on 84 elderly patientswho receive Multiloc intramedullary nail fixation for PHF in our hospital from January 2020 to August 2022. According to doctor-patientcommunication, 44 patients underwent the fixation with medial column supporting reconstruction (the reconstruction group), while the other40 patients underwent Multiloc intramedullary nail fixation alone (the non-reconstruction group). The perioperative period, follow-up andimaging parameters were compared between the two groups. [Results] Although the reconstruction group consumed significantly longer op-erative time than the non-reconstruction group [(90.7±9.0) min vs (85.0±8.5) min, P=0.004], the former was significantly superior to the lat-ter in terms of time to regain initiative activity [(5.5±1.3) days vs (6.4±1.5) days, P=0.004] and the hospital stay [(7.5±1.4) days vs (8.6±2.0)days, P=0.004]. There were no significant differences in the total incision length, intraoperative blood loss, postoperative drainage volumeand incision healing grade between the two groups (P＞0.05). The mean follow-up time was of (16.0±2.5) months, while the reconstructiongroup resumed full weight-bearing activities significantly earlier than the non-reconstructed group [(82.6±9.8) days vs (115.0±17.4) days,P＜0.001]. The VAS, ASES, Constant-Murley scores were significantly improved in both groups over time (P＜0.05), in which the reconstruc-tion group was significantly better than the non-reconstruction group at all time point accordingly (P＜0.05). In addition, the reconstructiongroup was also significantly better than the non-reconstruction group in forward flexion uplifting and abduction uplifting range of motions(ROMs) at 3 months after surgery (P＜0.05), but which became not significant different between the two groups at 12 months after surgery(P＞0.05). Regarding imaging, there were no significant differences in fracture reduction quality, fracture healing time and humeral neck-shaft angle (HNSA) immediately after surgery or at the last follow-up between the two groups (P＞0.05). [Conclusion] Medial column supporting reconstruction combined with Multiloc intramedullary nail fixation is safe and effective in the treatment of elderly PHF, which isconducive to functional recovery and improvement of shoulder joint motion.

Abstract:[Objective] To explore the clinical outcomes of preformed elastic intramedullary nail (ESIN) fixation for distal radius diaph-yseal metaphyseal junction fracture (DRDMJ) in children. [Methods] A retrospective analysis was conducted on 80 children who receivedsurgical treatment for DRDMJ in our hospital from January 2020 to September 2022. According to doctor-patient communication, 40 casesunderwent retrograde ESIN preformed accoding to 3D CT reconstruction (the preformed group), while other 40 cases underwent convention-al retrograde ESIN fixation (the non-preformed group). The documents regarding perioperative period, follow-up, and images were com-pared between two groups. [Results] There was no statistically significant difference in surgical time, incision length, intraoperative fluoros-copy frequency, intraoperative bleeding, incision healing grade, active activity time, and hospitalization time between the two groups (P＞0.05). All children in both groups were followed up for (15.0 ± 3.5) months in a mean, and there was no statistically significant difference intime to resume full weight-bearing activity between the two groups (P＞0.05). The MEPS score and Cooney wrist score significantly in-creased in both groups (P＜0.05) over time, which proved not statistically significant between the two groups at any time points accordingly(P＞0.05). The preformed group had significantly lower incidence of postoperative fracture displacement during follow-up than the non-pre-formed group [4/40 (10.0%) vs 11/40 (27.5%), P=0.045]. As for imaging, compared with those before surgery, the palmar tilt (PT), radial in-clination (RI), and radial length (RL) in both groups significantly increased 4 weeks postoperatively and at the last follow-up (P＜0.05). At 4weeks after surgery and the last follow-up, the preformed group proved significantly superior to the non-preformed group in terms of PT[(8.9±2.4)° vs (7.6±2.1)°, P=0.012; (11.3±2.0)° vs (10.4±1.8)°, P=0.038] and RL [(7.6±2.1) mm vs (6.5±2.0) mm, P=0.019; (9.6±1.7) mm vs(8.8±1.8) mm, P=0.044]. [Conclusion] The preformed retrograde ESIN fixation for pediatric DRDMJ does improve postoperative fracture re-duction, and is of great significance in reducing the incidence of secondary fracture displacement.

Abstract:[Objective] To investigate the effect of vertebral body edema extent on clinical outcomes of percutaneous pedicle screw fixa-tion (PPSF) for thoracolumbar fracture. [Methods] A retrospective study was done on 141 patients who received PPSF for thoracolumbarfracture treated from February 2018 to May 2021. [Results] According to the vertebral body edema extent in preoperative MRI images, thepatients were divided into three groups, including 55 cases in mild group, 52 cases in moderate group and 34 cases in severe group. Therewere no statistically significant differences in operation duration, intraoperative fluoroscopy times, total incision length, intraoperative bloodloss, success rate of first screw placement, incision healing grade, postoperative walking time and length of hospital stay among three groups(P＞0.05). The mean follow-up time was (18.5±2.4) months, and there was no significant difference in time to resume full weight-bearing ac-tivity among the three groups (P＞0.05). The VAS, ODI and JOA scores were significantly improved over time in all three groups (P＜0.05),whereas which were not statistically significant among the three groups at any time points accordingly (P＞0.05). As for images, there wereno significant differences in anterior vertebral compression rate (AVCR) and local kyphotic Cobb angle (KA) among the three groups beforeand immediately after surgery (P＞0.05), but all with statistically significant differences at the preoperative and the latest follow-up. [Conclusion] The severe vertebral body edema preoperatively might lead to delayed kyphosis deformity in long term after PPSF.

Abstract:With rise and rapid development of proteomics technology, this technology provides an overall and comprehensive under-standing of various physiological and pathological changes in the body from the perspective of protein level due to its advantages of rapidscreening and identification of specific biomarkers of diseases. At present, proteomics technology has been widely used in the medical field.This article reviews the current status of its application in related spinal diseases, including intervertebral disc degeneration (IDD), spinalcord injury focused on the pathogenesis and repair mechanism, as well as spinal ligament ossification and hypertrophy, cervical spondylosis(CS), ankylosing spondylitis (AS), scoliosis, spinal tuberculosis (STB), neural tube defects (NTDs) biomarker screening and pathogenesis re-search.

Abstract:Spinal cord injury (SCI) cause motor and sensory dysfunction. Due to high disability and fatality, it brings huge economicburden to patients and society. Hair follicle-associated pluripotent stem cells (HAPSCs) originated from hair follicle prominences had multi-ple potential for differentiation and expressed specific markers of embryonic neural crest stem cells. It is a new potential cell for SCI celltransplantation therapy. Previous studies have shown that the transplantation of these cells can significantly restore the motor and sensoryfunctions of spinal cord injury in animal models. The combination of cell, drug and tissue engineering can enhance its therapeutic effect. Inthis paper, we reviewed the progress of HAPSCs research in spinal cord injury in recent years, aiming to clarify the current research statusand future research direction of HAPSCs.

Abstract:Atlantoaxial dislocation (AAD) is one of special disorders in the spine and spinal cord. Radiographs are characterized bycervical hyper-extension or hyper-flexion positions in which X-rays reveal widening of the atlantodental interval (ADI) or narrowing of thespace available for the cord (SAC). With the deepening of research on upper cervical surgery, the clinical diagnosis and treatment of AADhave made considerable progress. However, the anatomical structure of atlantoaxial vertebrae is complex, with the possibility of neurologi-cal, vascular and bone structural variation. A full understanding of the patient's condition and imaging characteristics is helpful to developpersonalized diagnosis and treatment plans for patients. In this paper, the pathogenesis, diagnosis, non-surgical treatment and surgical treat-ment of AAD were reviewed to provide a reference for clinical diagnosis and treatment of AAD.

Abstract:[Objective] To investigate the effects of ionizing radiation on aging and aging-related secretion phenotype expression of ratannulus fibrosus cells. [Methods] Six mature SD rats were selected to harvest lumbar intervertebral disc annulus fibrosus cells. The annu-lus fibrosus cells cultured under the same conditions were randomly divided into two groups, which received ionizing X-ray radiation indose of 0 Gy and 15 Gy respectively. The senescence-associated secretory phenotype (SASP) was assayed to determine the senescence ofannulus fibrosus cells. [Results] After being treated with 15 Gy ionizing radiation, the annulus fibrosus cells showed typical characteristicsof aging morphology, and the positive staining percentage of annulus fibrosus cells was 77% by SA-β-Gal assay. The CCK-8 test showedthat the OD value in the non-irradiated group increased gradually (P＜0.05), but there was no statistical significance in the comparison of OD values in the irradiated group (P＞0.05). Both IF and PCR tests showed that aging related genes in the radiation group, including P16[(5.2±0.3) vs (1.0±0.1), P＜0.001], P21 [(12.9±0.5) vs (1.0±0.1), P＜0.001] were significantly higher than those in the non-radiation group,whereas the expression of SASP in the radiation group including Col-1 [(1.6±0.1) vs (1.0±0.1), P=0.004], Col-2 [(7.0±0.4) vs (1.0±0.1), P＜0.001], IL-6 [(7.9±0.2) vs (1.0±0.1), P＜0.001], IL-8 [(1.8±0.1) vs (1.0±0.1), P＜0.001], matrix metalloproteinase (MMP)-1 [(39.2±0.6) vs(1.0±0.1), P＜0.001] and MMP-3 [(4.5±0.3) vs (1.0±0.1), P＜0.001] were significantly higher than those in the non-radiation group. [Conclu-sion] Ionizing radiation can induce senescence of rat intervertebral disc annulus cells, and the expression of senescence related secretionphenotype is significantly increased.

Abstract:[Objective] To investigate the effect of lateral wall reconstruction on postoperative stability of femoral intertrochanteric frac-tures. [Methods] One elderly female volunteer was selected to obtain the femoral CT data. Medical 3D software was used to construct themodel of intertrochanteric fracture and proximal femoral nail anti-rotation (PFNA) with intact lateral wall (the intact group), lateral wall de-fect (defect group), and lateral wall reconstructed by plate (reconstruction group). Boundary conditions and constraint conditions were set,and different loads were applied to the femoral head to analyze Von Mises stress, displacement and strain of the femor-PFNA system. [Results] The displacement femor-PFNA system was slightly larger in the intact group and defect group than that of reconstruction group,whereas which were not statistically significant between any two of the three groups (P＞0.05). The Von Mises stress was not significantly dif-ferent in the mean maximum stress between any two of the three model groups under different stress loads (P＞0.05). The maximum mainstrain was ranked in the order of reconstruction group ＞ intact group ＞ defect group, which in the reconstructed group was significantly high-er than that of the defect group [(30.3±15.1)×10-3 vs (22.5±12.1)×10-3, P＜0.001], while there was no significant difference between the re-constructed group and the defect group in the mean maximum PFNA strain (P＞0.05). [Conclusion] Lateral wall reconstruction can improvethe overall stability of the femor-PFNA system, reduce the stress distribution of the femor-PFNA system, and increase the strain distribu-tion of the proximal femur.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical effect of 3D printed guider assisted open reductionand internal fixation (ORIF) of complex acetabular fractures through a single anterior approach. [Methods] From February 2022 to Septem-ber 2023, 15 patients with complex acetabular fractures were treated by abovementioned surgical procedure. Before surgery, E-3D digitalmedical modeling and design system software was used to reconstruct the pelvis model based on the patient's CT data. After image process-ing, the acetabular fractures were reduced in the pelvis model, and a 1∶1 personalized 3D printed guider for the posterior column screwplacement was designed, made and verified. In the real operation, the acetabular complex fractures were reduced and fixed under assistanceof the guider through a single anterior approach. [Results] All the 15 patients had ORIF performed successfully with the average operationtime of (103.2±11.2) min, with no vascular, nerve injury and other serious complications during the operation. Postoperative radiographsand CT indicated that the anterior and posterior column of fractured acetabulum were well reduced with the posterior column lag screwswell positioned. The follow-up time lasted from 6 months to 12 months, and the fractures were all healed at the last follow-up. The modifiedMerle D' Aubigne and Postel scores were (16.9±1.5), and excellence and good rate of the clinical outcome was of 86.7%. [Conclusion] The3D printed guider assisted ORIF of complex acetabular fractures through a single anterior approach can achieve satisfactory reduction andfixation, and is a safe and reliable surgical technique.

Abstract:[Objective] To introduce the surgical technique and preliminary consequence of arthroscopic debridement and bone graft-ing, combined with dorsal percutaneous screw fixation for old scaphoid fracture. [Methods] A total of 12 patients received abovementionedsurgical treatment for the old scaphoid fracture from July 2021 to September 2023. As the fibrous scar and sclerotic bone at the fractureends were completely removed under the arthroscope, a guide pine was placed along the long axis of scaphoid through the dorsal approach.After confirming the accurate position of the guide pin, the cancellous bone autografts were inserted into the bone gap through the cannulaunder the arthroscope, and finally a cannulated screw was placed along the guide pin for fixation. [Results] All the 12 patients were fol-lowed up for an average of (12.7±2.8) months. Compared with those preoperatively, the VAS scores [(5.1±0.8), (1.1±0.6), P＜0.001], Mayowrist function score [(54.6±6.9), (86.7±6.8), P＜0.001] improved significantly at the last follow-up. In addition, all patients got the fractureshealed well with a mean healing time of (5.7±1.5) months. [Conclusion] The arthroscopic debridement, bone grafting and dorsal percutane-ous screw fixation for the treatment of old scaphoid bone fracture do achieve minimally invasive debridement and bone grafting, avoid sec-ondary damage to scaphoid blood flow, and have high healing rate and satisfactory outcome.

Abstract:[Objective] To introduce the surgical techniques and preliminary clinical results of 3D printing assisted open reduction andinternal fixation of severe olecranon fractures. [Methods] Preoperative CT data in DICOM format was used to manufacture 1:1 fracture 3Dmodel for simulated reduction, and the plate type and placement positions of the implants were determined. The spatial information of thekey screw hole was obtained by referring to anatomical markers and the edge distance of fracture fragment, and the spatial information wasre-imported into the software. Combining the spatial information of the key screw hole in the major bone pieces in the software, mimic frac-ture reduction and fixation were conducted to restore to the initial position. Intraoperatively, fracture reduction and internal fixation wereperformed based on the 3D printing templates. [Results] All patients had operation performed successfully without vascular and nerve inju-ry complications. At the latest follow-up lasted for more than 12 months, all the patients got fractures healed well, one of them was of ecto-pic ossification, and 2 cases of osteoarthritis. However, 12 months after operation, the affected side proved inferior to the healthy side interms of elbow flexion [(126.1±10.0)° vs (133.2±12.1)°, P=0.023], extesion [(14.2±6.2)° vs (9.1±5.0)°, P＜0.001], and range of motion of theelbow [(111.1±11.2)° vs (124.0±14.1)°, P=0.001]. The Mayo elbow performance score was of (86.0±14.2), while the excellent and good rateof clinical outcome rate was of 73.1%. [Conclusion] 3D printing assisted open reduction and internal fixation for severe olecranon fracturedo simplify the operation, and improve the accuracy and efficiency of fracture reduction and fixation.

Abstract:[Objective] To investigate the clinical outcomes of oblique T-shaped buttress plate for posterolateral tibial plateau frac-tures through a posterior midline small incision. [Methods] A retrospective research was done on 21 patients who received open reductionand internal fixation for tibial plateau fractures complicated with posterolateral plateau collapse from June 2018 to June 2022. All the pa-tients had the posterolateral bone fragments fixed with an oblique T-shaped buttress plate through a posterior midline small incision. Clini-cal and imaging documents were evaluated. [Results] All the 21 patients successfully completed the operation, without vascular, nerve inju-ry and other complications occurred during the operation, while with operation time of (119.1±11.5) min, and incision length was (6.1±1.1)cm. All patients were followed up for an average of (16.3±1.4) months. As time went from 1 month, 3 months postoperatively to the last fol-low-up, the VAS score [(1.2±1.3), (0.5±0.8), (0.0±0.0), P＜0.001], HSS score [(48.6±11.5), (69.6±12.6), (91.3±5.5), P＜0.001], knee ROM[(91.1±20.2)°, (114.4±11.5)°, (123.4±8.7)°, P＜0.001] significantly improved. In term of imaging, compared with those 1 month after sur-gery, the medial proximal tibial angle (MPTA), posterior tibial slope (PTS) and Rasmussen image scores remained unchanged 3 months aftersurgery and at the last follow-up (P＞0.05). [Conclusion] This oblique T-shaped buttress plate for posterolateral tibial plateau fracturesthrough a posterior midline small incision has good clinical consequences in this study.

Abstract:[Objective] To investigate the clinical outcomes of anterolateral Gerdy tubercle osteotomy for reduction and fixation of later-al tibial plateau fractures. [Methods] From January 2020 to March 2022, 73 patients received the anterolateral Gerdy tubercle osteotomyfor reduction and fixation of the lateral condylar collapsed of tibial plateau fractures. Clinical and imaging data were evaluated. [Results]All the 73 patients successfully completed the operation without serious complications, and followed up for (15.4±3.9) months. As timeelapsed from the point preoperatively to that 3 months postoperatively and the latest follow-up, the HSS score [(26.1±5.2), (80.6±4.1),(89.4±3.2), P＜0.001], VAS score [(8.5±0.8), (1.3±0.4), (0.3±0.1), P＜0.001], knee ROM [(3.1±0.4)°, (120.4±4.7)°, (132.3±5.6)°, P＜0.001]were significantly improved. As for imaging, the medial proximal tibial angle (MPTA) [(89.3±1.0)°, (86.2±1.6)°, (86.1±1.5)°, P＜0.001], pos-terior tibial slope (PTS) [(9.0±0.8)°, (6.3±0.9)°, (6.2±0.8)°, P＜0.001] and Rasmussen score [(5.1±0.7), (17.4±0.4), (17.5±0.4), P＜0.001]were significantly improved. Up to the last follow-up, all patients had no nonunion, internal fixation loosening and broken. [Conclusion]The anterolateral Gerdy tubercle osteotomy for reduction and fixation of lateral tibial plateau fractures can reveal both lateral and posterolat-eral columns, with benefits of little soft tissue damage, simple operation and satisfactory short-term efficacy.

Abstract:[Objective] To analyze the effect of extended home nursing guidance after surgical treatment for hip fractures in elderly.[Methods] A total of 136 elderly patients who had hip fractures treated surgically in our hospital from June 2021 to December 2023 wereenrolled into this study, and divided into two groups according to random coin toss method. Of them, 68 patients in the routine group werenot given extended home care when discharged, while other 68 patients in the guidance group were given extended home care guidance for12 weeks after discharge. The clinical data of the two groups were compared. [Results] All patients in both groups had operation performedsuccessfully. The guidance group proved significantly lower incidence of adverse events than the routine group, including secondary frac-tures, falls, pulmonary infections, and urinary tract infections during the study period (1.5% vs 10.3%, P=0.029). At 12 weeks after dis-charge the Harris score, Barthel index and NRS score in both groups were significantly improved compared with those at discharge (P＜0.05). Although there were no significant differences in Harris score, Barthel index and NRS score between the two groups at discharge (P＞0.05), the guidance group was significantly superior to the routine group in terms of Harris scores [(52.7±3.2) vs (45.4±3.2), P＜0.001], Barth-el index [(51.4±3.1) vs (44.8±3.1), P＜0.001] and pain NRS score [(0.7±0.1) vs (1.2 ±0.3), P＜0.001] 12 weeks after discharge. [Conclusion]The extended home nursing guidance after surgical treatment for hip fractures in the elderly reduces the incidence of adverse events or com-plications, relieve pain, and promote the recovery of hip function.

Abstract:[Objective] To evaluate the relationship between peroneal tendon dislocation and type of calcaneal fracture by CT. [Methods] A retrospective case series study was conducted to analyze the data of 421 patients with closed calcaneal fractures treated from June2016 to June 2022. The CT cross-sectional images were reconstructed at 1cm proximal to the level of the ankle joint by using the picture ar-chiving and communication system (PACS). Drawing the best fitting circle to fit the anterolateral curved surface of the fibula, the peronealtendon shadow straddled or crossed the circle was termed as positive the "escape sign" of the tendon. The number of positive cases of pero-neal tendon dislocation in different types of calcaneal fractures was compared. [Results] Of 421 patients with calcaneal fractures, 34 weredescribed or diagnosed in preoperative CT reports accounted for 8.1% , and dislocation of peroneal tendon was mentioned in medical recordin 51 cases (12.1%), while the positive "escape sign" of peroneal tendon was noted in 76 cases by this CT image analysis, with the inci-dence of calcaneal fracture complicated with peroneal tendon dislocation of 18%. Forty two more cases compared with original CT diagnosis(P＜0.001), and 15 more cases compared with clinical diagnosis (P=0.021) were found in this study based on "escape sign" as the criterion.Although there were no significant differences in age or gender between the dislocation group and nondislocation groups (P＞0.05), the dis-location group had significantly higher ratio of posterior articular surface collapse than the non-dislocation group [collapse/tongue shape,(65/11) vs (256/89), P=0.039]. [Conclusion] Collapse calcaneus fracture is more likely to be associated with peroneal tendon dislocation byusing the "escape sign" on CT cross-section image as the criterion.

Abstract:[Objective] To evaluate the short-term efficacy of total hip arthroplasty (THA) through direct anterior approach in lateraldecubitus position. [Methods] A total of 50 patients received THA in our hospital from October 2022 to September 2023. Based on preoper-ative patient communication, 25 patients had THA performed through the direct anterior approach (DAA) in lateral decubitus position,while other 25 patients were through the traditional posterolateral approach (PLA). Short-term clinical and imaging data were compared be-tween the two groups. [Results] All patients in both groups were successfully operated on without serious complications. The DAA groupproved significantly superior to the PLA group in terms of operation time [(48.5±2.2) min vs (63.9±3.9) min, P＜0.001], incision length [(7.8±3.1) cm vs (10.4±3.2) cm, P=0.005], intraoperative blood loss [(222.0±39.8) ml vs (292.3±53.6) ml, P＜0.001], ambulation time [(2.1±0.5)days vs (3.5±0.9) days, P＜0.001], and hospitalization [(5.1±1.0) days vs (8.1±1.7) days, P＜0.001]. All the patients were followed up for morethan 6 months. Compared with those at discharge, the VAS scores and Harris scores significantly improved in both groups at the last followup(P＜0.05). At the last follow-up, the DAA group was significantly better than the PLA group regarding VAS score [(1.6±1.1) vs (2.5±1.5),P=0.033] and Harris score [(81.2±11.6) vs (72.5±9.9), P=0.007]. Postoperative images showed that the prosthetic position was good in allpatients of both groups, and there were no significant differences in acetabular anterior inclination and abduction angle between the twogroups (P＞0.05). [Conclusion] Compared with the traditional posterolateral approach, the direct anterior approach in lateral decubitus posi-tion does reduce surgical trauma, and is more beneficial to early recovery.