Abstract:[Objective]Tocomparetheclinicaloutcomesofendoscopictransforaminal lumbar interbodyfusion(Endo-TLIF)versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for single-segment lumbar revision. [Methods]Aretrospective studywasconductedon60patientswhounderwent single-level lumbar revisionsurgeryinthespinal surgerydepartmentofourhospital fromOctober2016toJanuary2022.Accordingtodoctor-patientcommunication,30patientsunderwentEndo-TLIFrevision,whereasother 30patientsunderwentMIS-TLIFrevision.Theperioperativeperiod, follow-upandimagingdataof thetwogroupswerecompared. [Results]Theendo-TLIFgroupprovedsignificantlysuperior totheMIS-TLIFgroupintermsofoperationtime[(163.0±11.4)minvs (187.8± 10.9)min,P＜0.001], total incisionlength[(6.0±0.2) cmvs (7.2±0.8) cm,P＜0.001],bloodloss [(88.3±10.5)ml vs (110.2±11.7)ml,P＜ 0.001],intraoperativefluoroscopytimes[(6.0±1.5)timesvs(8.0±1.3)times,P＜0.001],ambulationtime[(3.1±1.8)daysvs(5.7±2.1)days,P＜ 0.001],hospitalizationdays[(4.9±1.5)daysvs(7.9±2.6)days,P＜0.001],however, therewasnosignificantdifferenceintheincidenceof intraoperativecomplicationsbetweenthetwogroups(P＞0.05).Patientsinbothgroupswerefollowedupformorethan12months,andthosein theEndo-TLIFgroupregainedfullweight-bearingactivitiessignificantlyearlier thanthat intheMIS-TLIFgroup[(28.2±3.9)daysvs (35.7±6.5)days,P＜0.001].TheVASsbothforlowerbackpainandlegpain,aswellasODIsignificantlydecreasedinbothgroupsovertime (P＜0.05).TheEndo-TLIFwassignificantlybetter thantheMIS-TLIFintermslowbackpainVAS[(2.9±1.3)vs (4.1±1.7),P=0.006], leg pain VAS [(2.4±1.2) vs (3.2±1.3), P=0.026] and ODI scores [(10.7±3.1) vs (14.1±5.1), P=0.003] 3 months postoperatively. As for imaging, the vertebral canal area and intervertebral space height were significantly increased in both groups after surgery compared with those preoperatively (P＜0.05), whereas there were not statistically significant differences in the above imaging indexes and fusion grades between the two groups at corresponding time points (P＞0.05). [Conclusion] Endo-TLIF can achieve the same therapeutic effect as MIS-TLIF for single-level lumbar revision. By comparison, the Endo-TLIF has less trauma, fewer complications, faster postoperative recovery and higher safety over the MIS-TLIF.

Abstract:[Objective] To compare the clinical efficacy of total knee revision (TKR) using Sleeve system versus constrained condylar knee (CCK) combined with augment. [Methods] A retrospective study was done on 53 patients who received TKR in our hospital from March 2017 to November 2020. According to preoperative bone defects, combined with preoperative planning and surgeon-patient communication, 22 patients had TKR performed with Sleeve system (Sleeve group), while other 31 patients were treated with CCK combined with augment (CCK group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had TKR performed smoothly, and the Sleeve group had significantly longer bone defect than the CCK group [(1.8±0.7) cm vs (1.0± 0.4) cm, P＜0.001], while the former had significantly thinner pad used less than the latter [(11.2±4.2) mm vs (14.4±5.8) mm, P=0.032]. There was no statistical significance in perioperative items, such as operation time, between the two groups (P＞0.05). The Sleeve group spent significantly higher medical fee than the CCK group [(11.6±2.3) 10 k yuan vs (9.9±2.5) 10 k yuan, P=0.015]. With time of follow-up period lasted for a mean of (36.0±3.5) months, the VAS scores, KSS clinical and functional scores, OKS scores and knee extension-flexion ROM in both groups significantly improved (P＜0.05). Although the Sleeve group was significantly inferior to the CCK group in term of preoperative OKS scores [(44.3±10.3) vs (38.2±8.6), P=0.023], but there was no significant difference in the abovesaid score between the two groups at 1 month after surgery and the last follow-up (P＞0.05). As for imaging, the hip-knee-ankle angle (HKA ) and mechanical axis deviation (MAD) significantly improved in both groups at the last follow-up (P＜0.05), but there was no significant change in joint line height (P＞0.05). However, the Sleeve group had significantly lower joint line height than that of CCK group at the last follow-up [(20.4±6.0) mm vs (23.4±4.7) mm, P=0.047]. [Conclusion] Both the prosthetic combinations achieve excellent clinical consequence, with good lower limb alignment and stable knee. The Sleeve has advantages in restoring joint line height and repairing larger bone defects, but intraoperative frac-tures must be vigilant.

Abstract:[Objective] To compare the clinical outcomes of arthroscopic reduction and percutaneous cannulated screw fixation versus open reduction and internal fixation (ORIF) with plate through tarsal sinus approach for calcaneal fractures. [Methods] A total of 102 patients with calcaneal fracture admitted to our hospital from January 2019 to October 2022 were included into this study and randomly divided into two groups by drawing lots. Among them, 51 patients were treated with arthroscopic reduction and percutaneous screw fixation (the ARPSF group), while other 51 patients underwent ORIF through tarsal sinus approach (the ORIF group). The data of perioperative period, follow-up and auxiliary examination were compared between the two groups. [Results] The ARPSF group consumed significantly longer operation time than the ORIF group [(48.5±5.2) min vs (45.7±4.6) min, P=0.007], but the former proved significantly superior to the latter in terms of incision length [(1.6±0.5) cm vs (4.0±1.0) cm, P＜0.001], intraoperative blood loss [(10.5±3.4) ml vs (30.3±9.2) ml, P＜0.001] and length of stay [(5.7±1.8) days vs (7.4±2.0) days, P＜0.001]. All patients in both groups were followed up for (18.2±2.6) months in a mean, and the ARPSF group resumed ambulation [(38.5±4.6) days vs (42.0±5.4) days, P＜0.001] and full weight-bearing activity [(65.8±6.7) days vs (70.5±8.0) days, P=0.003] significantly earlier than the ORIF group. As time went on, the dorsal-plantar ankle range of motion (ROM), inversion-eversion ROM and AOFAS score were significantly increased (P＜0.05), while the VAS scores were significantly decreased in both groups (P＜0.05), which in the ARPSF group at 3 months after operation were significantly better than those in the ORIF group (P＜0.05). As for auxiliary examination, the levels of serum BMP-2 and IGF-1 were significantly increased (P＜0.05), while the levels of sVCAM-1 and HMGB1 were significantly decreased in both groups (P＜0.05), which in the ARPSF group proved significantly better than those in the ORIF group 3 months after surgery (P＜0.05). In addition, the Bohler and Gissane angles, as well as joint surface collapse were significantly im-proved in both groups at the last follow-up compared with those preoperatively (P＜0.05), whereas which were not significantly different between the two groups at any matching time points (P＞0.05). [Conclusion] The arthroscopic reduction and percutaneous cannulated screw fixation of calcaneal fracture does significantly reduce surgical trauma, shorten hospital stay, and facilitates the process of functional rehabilitation.

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Abstract:[Objective] To search the related factors of rotator cuff retear after repair and establish and verify the prediction model.[Methods] A total of 92 patients with large rotator cuff tear admitted to our hospital from January 2019 to October 2022 were selected as theresearch subject, all of whom were given the large rotator cuff tear repair, and the re-tear was observed within 12 months after surgery. Uni-variate comparison and logistic regression analysis were used to explore the factors related to retear, and the prediction model of retear aftersurgery was established and validated. [Results] Of the 92 patients, 21 were confirmed as postoperative rotator cuff retear, accounting for22.8%. As for univariate comparison, the re-tear group proved significantly greater than the healed group in terms of primary tear length[(4.1±0.6) cm vs (3.5±0.4) cm, P＜0.001], the degree of tendon retraction [I/II/III, (7/10/4) vs (2/49/20), P=0.003], the degree of rotator cuff fatinfiltration [I/II/III, (10/8/3) vs (41/29/1), P=0.039], while the former was significantly less than the latter in terms of the acromiohumeral dis-tance (AHD) [(3.7±0.3) mm vs (4.1±0.4) mm, P＜0.001], and tendon repair quality [1/2, (13/8) vs (59/12), P=0.039]. As results of logistic re-gression, poor tendon repair quality (OR=5.333, P＜0.001), less AHD (OR=5.145, P＜0.001), greater tendon retraction degree (OR=4.707, P＜0.001), longer tear length (OR=4.384, P＜0.001) were the risk factors for postoperative re-tear. The results of the nomogram prediction modelshowed that the C-index index was 0.809 (95%CI 0.763~0.841), and the correction curve for predicting retear after repair of giant rotatorcuff tear was close to the ideal curve (P＞0.05). ROC curve results showed that the sensitivity, specificity and area under curve (AUC) of thenomogram model for predicting postoperative retear were 81.0%, 84.5%, and 0.856 (95%CI 0.776~0.939). [Conclusion] Tear length, ten-don retraction degree, acromiohumeral distance and tendon repair quality are risk factors for postoperative retear, and the nomogram modelis effective in predicting the risk of retear after repair of giant rotator cuff tear.

Abstract:[Objective] To evaluate the clinical outcomes of meniscal allograft transplantation (MAT). [Methods] The literatures wereretrieved from CNKI, CBM, Wanfang, VIP, PubMed, Embase and Cochrane Collaborative Library databases up to October 1, 2023. Accord-ing to the inclusion criteria, literatures with an average follow-up time of 10 years or more after MAT were collected. After reading the full pa-per and extracting the data met the including criteria, a meta-analysis was conducted by using Revman 5.3 software. [Results] Ten papers,involving 382 patients, and 395 menisci, were included, with a mean follow-up of 13.4 years. As meta analysis results, there were no statisti-cally significant differences in terms of Tegner and VAS scores after MAT surgery compared with those before surgery (P＞0.05). However, ,Lysholm score (MD=-18.29, 95%CI -26.33~-10.26, P＜0.001); KOOS score [pain: (MD=-16.67, 95%CI -28.63~-4.71, P=0.006), symp-toms: (MD=-14.25, 95%CI -26.52~-1.97, P=0.02), activities of daily living: (MD=-14.34, 95%CI -21.33~-7.35, P＜0.001), sports and rec-reation: (MD=-14.87, 95%CI -24.84~-4.91, P=0.003), quality of life: (MD=-14.69, 95%CI -26.48~-2.90, P=0.010)]; IKDC score (MD=-23.59, 95%CI -27.42~-19.75, P＜0.001) and SF-36 [physical health (MD=-15.98, 95%CI -20.10~-11.87, P＜0.001) and mental health(MD=-15.58, 95%CI -20.97~-10.19, P＜0.001)] increased significantly after MAT compared with those before surgery. [Conclusion] MAThas a good long-term clinical consequences, which does effectively improve knee joint function.

Abstract:Artificial joint replacement is widely used in clinical practice, while periprosthetic joint infection (PJI) is its catastrophic complication. Biofilms are special membrane-like structures that bacteria form on the surface of biomedical materials that protect them from antibiotics and the immune system, making eradication difficult. The drug resistance of pathogenic bacteria caused by PJI is one of the reasons for postoperative PJI persistence, and it is also the focus of PJI treatment. At present, the overall therapeutic effect of PJI remains not ideal with a high failure rate, which is related to the lack of a safe, effective and easy implement method to remove the bacterial biofilm. Therefore, this paper will review the removal strategies of biofilm from physical removal, chemical removal and biological removal, in order to provide a reference for the clinical treatment of PJI.

Abstract:Chronic compartment syndrome (CCS) is a disease in which swelling, pain, paresthesia and neurological dysfunction are caused mainly by exertion or exercise. Its main mechanism is tissue perfusion ischemia caused by increased pressure in the fascia compartment, which is rare and usually underdiagnosed in clinic setting, and its pathophysiology remains unclear. Intramuscular compartment pressure (IMCP) measurement is the current diagnostic method, and non-invasive testing is becoming an alternative diagnostic method. Fascioto- my is still the treatment of choice, and new techniques such as minimally invasive and endoscopy have shown good results. At present, the clinical diagnosis, treatment, prevention and rehabilitation of CCS lack standardized guidance. This paper mainly reviews the diagnosis, treatment and rehabilitation of CCS, in order to provide a reference for the study of this condition.

Abstract:Tumor-induced osteomalacia (TIO) is a rare disease and the phosphaturic mesenchymal tumor (PMT) is the pathological basis of most TIO. PMT has abnormal oversecretion of fibroblast growth factor 23 (FGF-23), which leads abnormal depletion of kidney phosphate, decline of blood phosphorus, limb weakness, skeletal muscle pain and other symptoms. TIO can be cured by surgical resection of the tumor, but the tumor is often small in size and hidden in location, which makes diagnosis and treatment difficult. In 2021, the author's team surgically treated a patient who had complete osteolysis of the third metacarpal bone caused by direct tumor erosion, and finally recovered 28 months after surgery. This paper reports and reviews relevant literature to summarize the pathogenesis, characteristics, clinical manifestations and treatment of this disease.

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Abstract:[Objective] To introduce the design and application of the inverted L-shaped approach for proximal humerus fractures andthe preliminary clinical results. [Method] From June 2021 to June 2022, 20 patients with proximal humeral fractures were treated throughan inverted "L" approach. A horizontal skin incisions were extended along the acromial process from the anterolateral to the posterolateralborder. After skin, subcutaneous and fascial layers were cut, and the incision was extended about 4 cm in length down to the lateral arm.The deltoid was detached from the acromial process along the length of the horizontal incision, the deltoid flap was stretched backwards, theexposed area was identified. As the bone fragments and blood clots were removed, the fracture was reduced, were temporarily immobilizedwith 2 Kirschner wires, and then fixed by PHILOS plate. [Results] The exposed areas measured in the cadaveric specimens were ranked asinverted "L" approach, deltoid split approach and pectodeltoid approach [(20.6±5.6) cm2 vs (15.1±3.7) cm2 vs (14.0±5.0) cm2, P＜0.001]. Allpatients had open reduction and internal fixation performed successfully without any complications, such as nerve damage during the opera-tion. All patients were followed up for an average of (13.2±3.4) months. The X-rays showed that all fractures were healed 6 months after theoperation, with healing time of (127.5±11.5) days on average. The Constant score increased significantly from (45.3±2.6) before surgery to(94.9±2.2) at the last follow-up. [Conclusion] This inverted L approach is convenient and feasible for the treatment of proximal humerusfracture with satisfactory early results.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcomes of flexor tendon release and transpositionin the treatment of congenital flexor tendon shortening in children. [Methods] Two children with congenital flexor tendon shortening weretreated surgically. After preoperative preparation, a small longitudinal incision was made in the middle of the palm wrist corresponding to theaffected finger to expose the superficial and deep flexor tendons of the involved fingers with protection of the blood vessels and nerves, andjudging the overall extent of tendon shortening. As the superficial and deep tendons were cut in proper level, the proximal end of the superfi-cial flexor tendon was firmly sutured with the distal end of the deep flexor tendon of the finger under proper tension in the rest position. Thesuperficial flexor muscle of the finger was used as the power muscle to flex the affected finger, so as to improve the appearance and functionof the flexor finger. [Results] The operation was successfully completed in each affected finger of the 2 patients, without vascular or nerve in-jury during the operation. The range of motion of the proximal interphalangeal (PIP) joint improved from 0°~30° before operation to 0°~100°1 year postoperatively, with significant improvement in the appearance of the deformity and no decline in muscle strength. [Conclusion]This tendon release and transposition in the treatment of congenital flexor tendon shortening in children is simple and effective, and the func-tion and appearance of the affected finger are significantly improved after operation.

Abstract:[Objective] To evaluate the clinical efficacy of a new brace for correction of adolescent idiopathic scoliosis. [Methods] FromOctober 2021 to January 2023, 52 children who were newly diagnosed of adolescent idiopathic scoliosis, were included in this study and di-vided into two groups by randomized number table method. Of them, 26 patients were treated with the new brace (the NB group), while other26 patients were treated with the traditional brace (the TB group). The clinical and imaging data of the two groups were compared. [Results]Compared with those before treatment, the body height and SRS-22 scores in both groups were significantly increased 12 months after treat-ment (P＜0.05). At 12 months after treatment, the NB group proved significantly better than the TB group regarding SRS-22 scores [(90.3±8.8) vs (82.1±4.7), P＜0.001]. As for imaging, Cobb angle and apical translation (AT) of main curve were significantly decreased in bothgroups immediately after wearing the brace and 12 months after treatment compared with those before treatment (P＜0.05). The NB group wassignificantly superior to the TB group in terms of Cobb angle immediately after wearing brace and 12 months after treatment [(5.6±3.6)° vs(8.1±4.7)°, P=0.041; (10.1±8.5)° vs (13.4±6.5)°, P=0.032], and AT 12 months after treatment [(7.9±7.7) mm vs (11.3±5.8) mm, P=0.029]. Inaddition, the NB group was also significantly superior to the TB group in terms of immediate correction rate [(78.1±10.2)% vs (65.0±11.2)%,P=0.035) and the final correction rate [(64.3±15.2)% vs (44.5±14.3)%, P=0.004]. [Conclusion] Both kinds of braces are effective in the cor-rection of adolescent idiopathic scoliosis. By contrast, the new brace had considerably better correction efficiency, with better quality of lifeof the patients over the the traditional brace.

Abstract:[Objective] To evaluate the clinical outcome of arthroscopic debridement combined with distal femoral osteotomy for kneeosteoarthritis. [Methods] A retrospective study was done on 56 patients who received abovesaid treatment for knee osteoarthritis in our de-partment from February 2019 to February 2022. The clinical and imaging data were evaluated. [Results] All patients had operation per-formed successfully, with no serious complications, such as neurovascular injury, and followed up for a mean of (21.6±2.7) months. Com-pared with the preoperative results, VAS score significantly reduced [(6.2±0.9), (0.5±0.5), P=0.003], KSS score [(36.4±8.1), (81.4±1.1), P＜0.001], knee ROM [(130.1±0.3)°, (139.3±0.4)°, P＜0.001] increased significantly at the last follow-up. In term of imaging, the patients hadfemorotibial angle (FTA) [(80.6±0.4)°, (87.4±0.3)°, P=0.002], mechanical lateral distal femoral angle (mLDFA) [(167.7±2.8)°, (176.8±0.2)°,P＜0.001] significantly increased at the last follow-up compared with those preoperatively, with no complications, such as bone nonunion orplate fracture found in anyone of them. [Conclusion] Arthroscopic debridement combined with distal femoral osteotomy for the treatment ofknee osteoarthritis can relive the symptoms and delay the progression of osteoarthritis.

Abstract:[Objective] To compare the clinical consequences of total knee arthroplasty (TKA) for knee osteoarthritis (KO) with or with-out indwelling drainage tube. [Methods] A retrospective study was conducted on 130 patients who received TKA for KO in our hospital fromJuly 2019 to January 2023. According to the results of doctor-patient communication, 65 patients had not drainage placed (the ND group) ,whereas other 65 patients had drainage placed (the D group). The documents regarding to perioperative period and follow-up were comparedbetween the two groups. [Results] All patients in both groups had TKA performed successfully. The ND group proved significantly superiorto the D group in terms of total blood loss [(340.8±101.5) ml vs (389.2±80.8) ml, P=0.049] and postoperative hospital stay [(2.0±0.7) days vs(4.4±0.9) days, P＜0.001], although there was no significant difference in the incidence of postoperative complications between the twogroups (P＞0.05). As time went on, the pain VAS scores significantly decreased (P＜0.05), while the knee flexion-extension range of motion(ROM) and AKSS scores significantly increased in both groups (P＜0.05). The ND group proved significantly better than the D group in termsVAS score [(1.7±0.7) vs (2.7±1.0), P=0.002], the knee ROM [DHS (119.8±4.1)° vs (116.3±6.6)°, P＜0.001] 1 month postoperatively. [Conclu-sion] Compared with indwelling drainage, no indwelling drainage after total knee arthroplasty has the advantages of reducing short-term post-operative pain and shortening hospital stay.

Abstract: [Objective] To search the risk factors of deep vain thrombosis (DVT) after total hip arthroplasty (THA). [Methods] A retro-spective study was conducted on 364 patients who received initial THA in our hospital from June 2018 to June 2022. According to postopera-tive clinical and ultrasound examination, patients were divided into DVT group and non-DVT group. The data of the two groups were com-pared, and binary multi-factor logistic regression analysis was performed, and the prediction nomogram was constructed according to the re-sults of logical analysis. The predictive efficiency of the nomogram was evaluated by the receiver operating characteristic curve analysis. [Re-sults] Among 364 patients, 72 had DVT, accounting for 19.8%, whereas the other 292 patients did not develop DVT, accounting for 80.2%.The DVT group proved significantly greater than the non-DVT group in terms of age, BMI, diabetes mellitus, history of thrombosis, operationtime, bilateral replacement ratio and bed rest time (P＜0.05), but the former was significantly less than the latter regarding to the ratio of anti-coagulant usage (P＜0.05). As results of logical analysis, the age≥70 years (OR=4.127, 95%CI 1.712~5.392, P=0.012), BMI≥28 years (OR=2.916, 95%CI 1.153~4.124, P=0.063), diabetes mellitus (OR=2.328, 95%CI 1.412~4.411, P=0.067), previous history of thrombosis (OR=5.270, 95%CI 1.091~2.559, P=0.011), operation time ≥120 min (OR=3.541, 95%CI 1.215~4.089, P=0.027), bilateral replacement (OR=2.286, 95%CI 1.407~4.531, P=0.034), and postoperative bed rest ≥3 d (OR=4.427, 95%CI 1.136~1.973, P=0.023) were the risk factor forDVT, whereas the use of anticoagulants was a protective factor for DVT (OR=-2.019, 95%CI -1.723~-5.802, P＜0.001). A nomogram predic-tion model was created based on the logical regression outcome and verified by ROC with area under curve (AUC) of 0.867 (95%CI 0.711~1.000). [Conclusion] In this study, advanced age, diabetes, previous thrombosis, operative time, bilateral joint replacement, and bed resttime were selected as the related factors for deep vein thrombosis after total hip arthroplasty, and a better predictive model was established,which may provide reference for the prevention and treatment of DVT.

Abstract:[Objective] To investigate the clinical outcome of arthroscopic 270° capsular release in the treatment of frozen shoulder.[Methods] A retrospective study was conducted on 36 patients who received arthroscopic 270° capsular release for primary frozen shoulderin our hospital from January 2019 to July 2021. The clinical documentations were evaluated. [Results] All patients had operation performedsuccessfully, with no complications of vascular and nerve injury occurred during the operation. All patients were followed up for an averageof (17.0±3.6) months. As time elapsed from that before surgery to 1 month, 6 months postoperatively and the latest follow-up, the Chineseshoulder score [(35.1±2.8), (58.4±3.8), (64.2±3.7), (67.4±5.3), P＜0.001], Constant-Murley score [(38.2±5.5), (59.1±4.5), (77.4±3.5), (82.8±5.4), P＜0.001], forward flexion ROM [(64.1±8.6)°, (111.8±7.8)°, (114.8±9.5)°, (153.6±6.3)°, P＜0.001], abduction ROM [(59.3±5.3)°, (110.6±6.0)°, (144.4±6.5)°, (149.2±6.3)°, P＜0.001], body side external rotation ROM [(13.6±4.1)°, (29.5±5.9)°, (40.1±5.3)°, (48.8±6.3)°, P＜0.001]were significantly improved. [Conclusion] Arthroscopic 270° capsular release for the treatment of primary frozen shoulder does significant-ly relief pain, and effectively improve shoulder joint motion, with satisfactory clinical results.