Abstract:[Objective] To compare the clinical efficacy of transiliac internal fixator (TIFI) versus sacroiliac screw (SIS) combined withanterior ring fixation for type B pelvic fracture. [Methods] A retrospective study was conducted on 47 patients who had Tile type B pelvicfracture treated surgically in our hospital from October 2016 to July 2021. According to doctor-patient communication, 23 patients weretreated with TIFI combined with minimally invasive anterior ring plate (the TIFI group), while other 24 patients had the sacroiliac jointfixed with SIS combined with anterior ring plate ( the SIS group). The documents regarding perioperative period, follow-up and images werecompared between the two groups. [Results] The TIFI group proved significantly superior to the SIS group in terms of operation time[(262.4±33.2) min vs (316.9±46.9) min, P＜0.001], intraoperative blood loss [(107.6±13.0) ml vs (128.8±13.3) ml, P＜0.001] and fluoroscopytimes [(13.0±3.1) vs (27.9±5.6), P＜0.001], but the former consumed significantly longer total incision length than the latter [(13.3±1.1) cmvs (10.7±1.2) cm, P＜0.001]. All patients in both groups were followed up for more than 12 months, and there was no significant difference intime to regain ambulation and full weight bearing activity between the two groups (P＞0.05). The VAS scores and Majeed scores were signifi-cantly improved in both groups over time (P＜0.05), whereas which were not significantly different between the two groups at any time pointsaccordingly (P＞0.05). With respect of imaging, the Matta scale in both groups was significantly improved at the last follow-up comparedwith that preoperatively (P＜0.05), which was not statistically significant between the two groups at any corresponding same time points (P＞0.05). There was no significant difference in fracture healing time between the two groups (P＞0.05). [Conclusion] TIFI combined with mini-mally invasive anterior ring fixation in the treatment of Tile type B pelvic fracture has the advantages of shortening operation time, reducingbleeding, declining fluoroscopy and achieves satisfactory fracture reduction.

Abstract:[Objective] To prospectively investigate the clinical efficacy of small incision (minimally invasive percutaneous plating os-teosynthesis, MIPPO) versus open reduction and internal fixation (ORIF) in the treatment of proximal humerus fractures in the elderly.[Methods] A total of 87 elderly patients with proximal humerus fracture admitted to our Department of Orthopedics from March 2019 toMarch 2022 were included into this study. The patients were divided into the MIPPO group (44 cases) and the routine ORIF group (43 cases)by random number table method. The documents regarding perioperative period, follow-up and images were compared between the twogroups. [Results] All patients in both group had operation performed successfully. Although the MIPPO consumed significantly longer opera-tion time than the ORIF group [(94.3±9.2) min vs (79.1±10.8) min, P＜0.001], the former proved significantly superior to the ORIF group interms of incision length [(7.4±0.9) cm vs (10.8±1.5) cm, P＜0.001], intraoperative blood loss [(138.6±8.9) ml vs (190.2±13.7) ml, P＜0.001], ac-tive movement time [(6.4±1.8) days vs (8.9±1.5) days, P＜0.001] and hospital stay [(8.5±0.7) days vs (9.7±1.1) days, P＜0.001]. The VASscore, Constant-Murley score, forward flexion-uplift range of motion (ROM) and abduction- uplift ROM significantly improved over time inboth groups (P＜0.05). At 3 months and the last follow-up, the MIPPO group was significantly better than the ORIF group regarding to VASscore [(1.3±0.5) vs (1.6±0.7), P=0.024; (0.8±0.4) vs (1.0±0.5), P=0.042]. In addition, at 1 and 3 months after surgery, the MIPPO group wasalso superior to the ORIF group in Constant-Murley scores [(70.3±3.2) vs (68.3±3.9), P=0.011; (82.5±5.7) vs (80.1±4.5), P=0.032]. At all cor-responding time points after operation, the MIPPO group proved significantly better than the ORIF in ROMs (P＜0.05). As for imaging, therewas no significant difference in fracture reduction quality between the two groups (P＞0.05), while the fracture healing rate 8 weeks after sur-gery in the MIPPO group was better than the ORIF group [cases (%), 34 (77.3) vs 25 (58.1) P=0.028]. There was no significant difference insubacromial interval (SAI) between the two groups at any corresponding time points (P＞0.05). [Conclusion] Both MIPPO and traditional OR-IF can be used in the treatment of proximal humerus fractures in elderly. By comparison, the MIPPO can effectively protect the local bloodcirculation near the fracture ends, which is conducive to early healing and rehabilitation of fractures.

Abstract:[Objective] To compare the clinical consequence of unilateral biportal endoscopy transforaminal lumbar interbody fusion(UBE-TLIF) versus minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF) for mild to moderate lumbar spondylolisthesis(LS). [Methods] A retrospective study was done on106 patients who had LS treated surgically in our hospital from January 2022 to March2023. According to preoperative doctor-patient communication, 50 patients received UBE-TLIF, while other 56 patients underwent MISTLIF.The documents regarding perioperative period, follow-up and images of the two groups were compared. [Results] Although the UBETLIFgroup consumed significantly longer operation time than the MIS-TLIF group [(145.0±31.2) min vs (124.8±20.5) min, P＜0.001], the for-mer proved significantly superior to the latter in terms of the total incision length [(3.4±0.5) cm vs (6.2±0.8) cm, P＜0.001], intraoperativeblood loss [(113.54±30.8) ml vs (125.3±22.6) ml, P=0.026], intraoperative fluoroscopy times [(5.0±1.7) times vs (7.0±2.5) times, P＜0.001],walking time [(1.8±0.7) days vs (2.3±0.6) days, P＜0.001] and hospital stay [(6.2±1.8) days vs (7.5±2.6) days, P=0.004]. With time of the fol-low-up lasted for (16.5±3.1) months in a mean, the VAS scores for back pain and leg pain, as well as ODI scores were significantly decreased(P＜0.05), while JOA scores were significantly increased in both groups (P＜0.05). The UBE-TLIF group proved significantly better than theMIS-TLIF group in back pain VAS score [(3.4±0.9) vs (4.0±1.0), P=0.002] 1 week after surgery. With respect of imaging, compared withthose preoperatively, the disc height (DH), lumbar lordosis (LL), foraminal area (FA), and vertebral spondylolisthesis percentage were signifi-cantly improved in both groups after surgery (P＜0.05). The UBE-TLIF group had significantly greater DH [(11.8±2.0) mm vs (11.0±1.8) mm,P=0.033] and FA [(13.4±2.0) mm2 vs (12.5±2.1) mm2, P=0.026] than the MIS-TLIF group one week after surgery. [Conclusion] UBE-TLIFachieve similar outcomes to MIS-TLIF in the treatment of single-segment mild to moderate LS, but UBE-TLIF has advantages of smaller in-cisions, less bleeding and faster early postoperative recovery over the MIS-TLIF.

Abstract:[Objective] To compare the clinical consequence of unilateral biportal endoscopic discectomy (UBED) and percutaneoustransforaminal endoscopic discectomy (PTED) in the treatment of single-segment lumbar disc herniation. [Methods] A retrospective re-search was done on 118 patients who had single-segment lumbar disc herniation treated by endoscopic surgery from January 2021 to De-cember 2021. According to preoperative doctor-patient communication, 58 patients were treated with UBED, while other 60 patients werewith PTED. The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had oper-ation performed successfully. Although the UBED group had significantly less intraoperative fluoroscopy times [(1.4±0.5) vs (7.4±1.5), P＜0.001] than the PTED group, there were no significant differences between the two groups in terms of operation time [(60.6±0.9) min vs(62.0±9.4) min, P=0.470], bed rest time [(1.7±0.5) days vs (1.6±0.6) days, P=0.705] and hospital stay [(4.4±1.0) days vs (4.4±0.9) days, P=0.862]. However, the UBED group consumed significantly higher medical cost than the PTED group [(30.5±0.8) k-yuan vs (26.4±1.6) k-yu-an, P＜0.001]. As time went on, the VAS and ODI scores in both groups were significantly improved (P＜0.05), which proved not significant-ly different between the two groups at any corresponding time points (P＞0.05). Regarding imaging, the spinal canal occupied area ratio de-creased significantly in both groups at the last follow-up compared with that preoperatively (P＜0.05), while the intervertebral space heightand lumbar lordotic angle remained unchanged significantly (P＞0.05). [Conclusion] UBED achieves comparable clinical outcome to PTEDin the treatment of single-segment lumbar disc herniation, although UBED has less fluoroscopic radiation, while more hospitalization costsover the PTED.

Abstract:[Objective] To search the related factors and prediction of claudication after total hip arthroplasty (THA) for developmentaldysplasia of the hip (DDH). [Methods] A total 106 patients who received THA for DDH were enrolled into this study in Affiliated Hospital ofQinghai University from January 2019 to January 2023. According to whether or not lameness happened after THA and Harris score 6months after operation, the patients were divided into lameness group and normal gait group. Univariate comparison and multiple logistic re-gression analysis were used to explore the influencing factors of claudication after THA for DDH, furthermore a prediction model based onthe related factors was created and verified. [Results] Of the 106 patients with DDH, lameness happened in 36 patients, accounting for34.0%. Regarding univariate comparison, the limp group proved significantly less than the normal gait group in terms of depth of femoralcomponent placed [(134.7±21.1) mm vs (156.7±23.9) mm, P＜0.001], hip rotation center height [(9.6±5.8) mm vs (31.0±4.2) mm, P＜0.001],while the former was significantly greater than the latter in terms of femoral calar length [(18.7±3.3) mm vs (15.1±2.1) mm, P＜0.001] and thefemoral eccentricity [(36.9±2.5) mm vs (34.8±2.8) mm, P＜0.001]. As results of logistic regression, the greater depth of femoral componentplaced (OR=0.259, 95%CI 0.089~0.759) was the protective factor for lameness after THA in DDH, while the larger femoral eccentricity (OR=4.084, 95%CI 1.395~11.947), the more length of femoral calaris retained (OR=3.050, 95%CI 1.042~8.922), and the higher the center of rota-tion of the hip (OR=2.998, 95%CI 1.025~8.772) were the risk factors for claudication after THA in DDH. Based on the factors abovemen-tioned, a nomogram predicting model was created, and verified by ROC analysis, which had sensitivity of 0.791 (95%CI 0.653~0.872), speci-ficity of 0.847 (95%CI 0.752~0.936) and AUC of 0.839 (95%CI 0.791~0.927) for predicting claudication after THA in DDH. [Conclusion]The depth of femoral prosthetic placement, length of preserved femoral calar after surgery, height of hip rotation center and femoral eccentric-ity are the influencing factors for claudication after THA in DDH, while the prediction model based the factors might be helpful to predictclaudication after THA.

Abstract:[Objective] To investigate the clinical efficiency of digital planning (DP) open reduction and internal fixation (ORIF) of Pi-lon fractures. [Methods] A total of 102 patients who had Pilon fractures being treated surgically from May 2019 to May 2022 were randomlydivided into two groups. Of them, 51 patients received ORIF based on DP to simulate fracture reduction before the real surgery, while other51 patients underwent the conventional ORIF. The perioperative period, follow-up and imaging data of the two groups were compared. [Re-sults] The DP group proved significantly superior to the conventional group in terms of operation time [(93.6±18.0) min vs (107.6±20.3) min,P＜0.001], total incision length [(14.6±2.9) cm vs (17.2±3.4) cm, P＜0.001], intraoperative blood loss [(72.6±19.4) ml vs (87.2±20.5) ml, P＜0.001], intraoperative fluoroscopy times [(4.8±1.4) times vs (6.9±1.7) times, P＜0.001], incision healing scale [A/B, (50/1) vs (44/7), P=0.027],and hospital stay [(18.3±5.9) days vs (21.7±4.3) days, P＜0.001]. However, there was no significant difference in the time to resume fullweight-bearing activities between the two groups (P＞0.05). The ROM, VAS and AOFAS scores in both groups were significantly improvedover time postoperatively (P＜0.05), which were not statistically significant between the two groups at any time points accordingly (P＞0.05).As for imaging, there was no statistically significant difference in the quality of fracture reduction between the two groups (P＞0.05). [Con-clusion] Preoperative digital planning for open reduction and internal fixation of Pilon fractures is helpful to shorten the operative time andfracture healing time, and promote the recovery of ankle joint function.

Abstract:The upper cervical spine has a special anatomical position and complex structure. It connects with the skull above and thespine below, with important nerve and vascular structures around it. Trauma to the head and neck is prone to lead to fracture and disloca-tion of the upper cervical spine, even complicated with spinal cord injury. In terms of treatment, conventional open surgery has considerableiatrogenic trauma with many complications, which is difficult to be accepted by most patients. However, conservative treatment has limitedindications and other shortages. Minimally invasive surgery has gradually become a new choice due to its advantages of less tissue damageand fewer complications. This article reviews the development of minimally invasive surgical techniques for upper cervical spine fracturesand dislocations, in order to provide reference for clinical practice.

Abstract:The change of joint line height after total knee arthroplasty (TKA) may lead to the limitation of flexion and extension afteroperation. Excessive upward migration of joint line can lead to the impact of tibial plateau or spacer on the lower edge of patella duringknee flexion, which affects the knee extension device, increases the stress of patellofemoral joint, causes flexion limitation and patellarpain, even causes failure of the extensor mechanism. At present, most of the studies on the change of joint line height are theoretical, andthe clinical research is relatively less. This article reviews the domestic and foreign literature in recent years through the databases ofCNKI, Pubmed and SCI, and reviews the measurement of joint line height, biomechanical research, influence on clinical function and pre-vention strategies to provide theoretical reference for clinical surgeons, so as to improve the clinical function and patient's satisfaction.

Abstract:[Objective] To explore the relationship between frozen shoulder (FS) and gene polymorphism of IL-1β and interleukin-1receptor antagonist (IL-1Ra). [Methods] From January 2021 to August 2023, 225 patients who were treated in our hospital were selected asthe frozen shoulder group, while other 275 normal persons as the normal group. The genotypes of the two groups in IL-1β gene loci were de-tected by polymerase chain reaction and restriction fragment length polymorphism. The correlation between the haploids and the risk rate offrozen shoulder disease was analyzed. In addition, the correlation between different genotypes of interleukin-l receptor antagonist allele*2,(IL-1RN) and the susceptibility to frozen shoulder disease was also analyzed. [Results] Compared with wild-type CC (non-mutated geno-type), patients with heterozygous CT genotype (mutated genotype) had a significantly higher risk of FS (OR=1.952, 95%CI 1.142~3.320, P=0.014). The C gene at the IL-1B+3954 locus may be a protective gene, and the risk of FS in the C gene was significantly reduced at the IL-1B+3954 locus (OR=0.577, 95%CI 0.309~0.987, P=0.049). The risk of FS for CT genotype at IL-1B-31C/T locus was significantly higherthan that for TT genotype (OR=1.791, 95%CI 1.171~2.742, P=0.004). Haplotype analysis found that haplotype TTT was more strongly asso-ciated with a higher risk of FS than the most common CCT haplotype (OR=7.100, 95%CI 1.492~33.870, P=0.014). Unconditional Logisticregression analysis showed that there was no statistically significant difference in the distribution of four genes of IL-1RN (VNTR) betweenthe two groups (P=0.521), and the risk of FS in the IL-1RN variant group (1/2 and 2/2) was 1.895 times higher than that in the non-variantgroup (1/1, 1/3, 1/4), whereas which was not statistically significant (P＞0.05). [Conclusion] CT genotypes of IL-1β gene rs1143627 andrs1143634 were associated with susceptibility to frozen shoulder in frozen shoulder group. Haploid TTT formed by three gene loci may in-crease the risk of frozen shoulder, and no susceptibility genotype for frozen shoulder was found in IL-1RN.

Abstract:[Objective] To investigate the protective effect of glycitin (GL) on apoptosis and oxidative stress injury of osteoblasts in-duced by dexamethasone (DEX), and to explore its possible molecular mechanism. [Methods] MC3T3-E1 cells were stimulated with DEX tosimulate the hormonal environment in vivo in glucocorticoids-induced osteonecrosis of the femoral head (GC-ONFH). According to differenttreatments, the cells divided into 3 groups, including blank control group (BC) with the same amount of PBS added into the medium, the DEXgroup with DEX in 100 μmol/L added into the medium, and the DEX+GL group with DEX in 100 μmol/L and GLin 15 μmol/L added to themedium, and the intervention time of 24 h. The MC3T3-E1 cells were routinely cultured for 48 h, and the cell medium was changed to osteo-genic induction medium. [Results] In term of flow cytometry, the apoptosis rate of DEX group was significantly increased compared with thatof the BC group, while which of DXM+GL group was significantly decreased compared with the DEX group [(9.8±1.5)% vs (17.7±1.4)% vs(13.6±0.4)%, P＜0.001]. In term of RT-qPCR detection, the gene expression levels of BC, DEX and DXM+GL groups were as follows: Colla-gen I [(1.0±0.0) vs (0.5±0.3) vs (1.0±0.2), P=0.011]. Runx-2 [(1.0±0.0) vs (0.6±0.1) vs (1.1±0.0), P＜0.001]. cleaved Caspase 3 [(1.0±0.0) vs(1.3±1.3) vs (0.9 ±0.0), P=0.002], BAX [(1.0±0.0) vs (1.4±0.3) vs (0.8±0.1), P=0.008] respectively, with statistically significant differencesamong the 3 groups. In term of western blot assay, protein expression levels of ALP, Collagen I, Runx-2, Bcl-2, Wnt3a and β-catenin in DEX group were significantly decreased compared with those in BC group (P＜0.05), while which in DXM+GL group were significantly in-creased compared with those in the DEX group (P＜0.05). Howerver, the protein expression levels of Cleaved Caspase 3 and BAX in the DEXgroup were significantly increased compared with the BC group (P＜0.05), while which were significantly decreased in the DXM+GL groupcompared with those in DEX group (P＜0.05). The green fluorescence of DEX group was significantly enhanced compared with that in the BCgroup (P＜0.05), whereas which in DXM+GL group was significantly weakened compared with that in the DEX group (P＜0.05). [Conclu-sion] GL does reverse DEX-mediated osteoblast inhibition, improve DEX-mediated osteoblast apoptosis, and protect Dex-mediated osteo-blast oxidative stress injury, which may be related to the activation of Wnt3a/β-Catenin signaling pathway by GL.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of debridement and bone grafting of femo-ral head necrosis through a modified surgical dislocation without greater trochanter osteotomy. [Methods] After general anesthesia andnerve block, place the patient in lateral position with the affected side facing upward. Harvest bone autografts form the iliac crest on thesame side, and then make a straight longitudinal incision about 10 cm in length along the long axis of the femur with the femoral greater tro-chanter as the center. Cut the fascia between the gluteus maximus and the tensor fascia lata, dissect the gap between gluteus minimus andgluteus medius about 3cm, and sever the gluteus minimus sharply near to its insertion on the greater trochanter. Cut capsule sharply alongthe long axis of the femoral neck to expose the joint. As adduct and rotate outward the affected limb, dislocate the femoral head. Make bonefenestration 2 cm in diameter along the femoral neck axis in front at the junction of the femoral head and neck with drill and chisel. After cu-reting the necrotic tissue within the femoral head properly, implant the iliac bones trimmed into the granular shape into the cavity of thefemoral head through the bone fenestration. [Results] All the patients in this group successfully completed the operation, and no seriouscomplications occurred during and after the operation. The Harris hip function score significantly improved from (60.5±7.0) preoperativelyto (89.0±8.4) at the last follow-up, with the excellent rate of 87.5% in term of clinical evaluation at the latest follow-up. [Conclusion] Thismodified surgical dislocation without greater trochanter osteotomy is technically feasible for debridement and bone grafting of CJFH L3 com-bined with ARCO III femoral bone necrosis. It is a relatively minimally invasive, safe and practical hip salvage option, significantly improvethe hip function of patients in a short period.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopic treatment of habitual anteri-or glenohumeral dislocation through the subscapularis portal. [Methods] After general anesthesia, the patients was placed in supine posi-tion with the affected limb suspended at 40° of abduction, and the arthroscopy was inserted through the anterosuperior portal. Under ar-throscopic vision, a 16 gauge puncture needle, followed by a 1.0 mm Kirschner wire with self-made sleeves in different diameters were in-serted to establish the the subscapularis portal, with a tuber 4 mm in diameter placed. The anterosuperior portal was used to release, refreshand marke the positions of the anchors, while the subscapularis portal was used to insert the 2.8 mm anchors sequentially, with the farthestanchor located at 5∶30 (right shoulder) or 6∶30 (left shoulder) position. The glenoid labrum and capsule were repair with the routine tech-niques. [Results] All the patients underwent the arthroscopic procedures successfully without complications such as infection or vascularand nerve damage. Of them, 25 patients were followed up for an average of (12.0±0.3) months. Compared with those preoperatively, theASES score [(64.8±7.9), (95.0±3.9), P＜0.001] and Rowe score [(42.4±6.9), (92.4±6.8), P＜0.001] significantly improved at 12 months postsurgery. The excellent rate of postoperative shoulder joint function was of 100%. [Conclusion] This arthroscopic technique using subscapu-laris portal for treatment of habitual anterior glenohumeral dislocation is feasible and beneficial for anchor placement, does achieve satisfac-tory primary clinical outcomes.

Abstract:[Objective] To introduce the surgical method and preliminary clinical results of arthroscopic fixation of tibial intercondylarspine fractures without involving the epiphyseal plate in children. [Methods] As the anteromedial (AM) and anterolateral (AL) portals weremade, the arthroscope and instruments were placed to debride the blocking synovium and the blood clot in the fracture fragments. Suturehooks were passed across the lower insertion of the anterior cruciate ligament, with a PDS suture introduced, followed by a high-strength su-ture introduced, and then the high-strength suture was led out of AM. The fracture fragments were reduced by traction. As optimal locationfor outer row anchors was determined at the anteromedial epiphysis of the proximal tibia, a 2.0 mm Kirschner wire was drilled, with the posi-tion confirmed by fluoroscopy. A 0.3 cm incision was made at the entry point of the Kirschner wire, and then the positioning Kirschner wirewas removed. The high-strength suture was transferred out the incision, and fixed in proper fracture reduction with a outer row anchor with-out involving the epiphyseal plate. The reduction of the fracture and the tightness of the anterior cruciate ligament were examined again.[Results] All patients successfully completed the operation, with the average operation time of (59.4±1.7) min, the average intraoperativeblood loss of (44.2±2.0) ml. The postoperative X-ray showed that the fracture reduction was satisfactory in all the patients. Compared withthose preoperatively, Lysholm scores [(34.6±7.9), (94.4±3.5), P＜0.001], IKDC scores [(32.3±8.7), (93.2±4.5), P＜0.001] increased signifi-cantly at the latest follow-up lasted for a mean of (23.4±10.7) months. [Conclusion] This technique is a minimally invasive, safe and effec-tive for fresh tibial intercondylar spine fractures in children. The outer row anchor fixation is reliable to avoid injury of epiphyseal plate, per-mits early functional exercise.

Abstract:[Objective] To explore the relationship between ankle pain and imaging parameters of lower extremity after total knee ar-throplasty. [Methods] From September 2023 to February 2024, 41 patients who underwent primary TKA for knee osteoarthritis were en-rolled in this study. The incidence of ankle pain 6 months after operation was observed, the imaging parameters of lower limbs were mea-sured, and the relationship between ankle pain and imaging parameters was analyzed. [Results] Of the 41 patients, 13 (31.7%) had anklejoint pain 6 months after operation, whereas other 28 (68.3%) had no ankle pain. The pain group proved significantly greater HKA, TAA,TTA and TI than the painless group before surgery (P＜0.05), significantly greater TAA, TTA, TI and mLDTA than the painless group 6months postoperatively (P＜0.05). However, there were no significant differences in ADTA and HAA between the two groups before opera-tion and 6 months after surgery (P＞0.05). As results of ROC analysis, the area under curve (AUC) of ?HKA and ?mLDTA were 0.893 and0.955 in predicting postoperative ankle pain respectively. [Conclusion] Over-corrected knee varus and under-compensated ankle may berelated to ankle pain after total knee arthroplasty.

Abstract:[Objective] To evaluate the clinical efficacy of modified hybrid external fixator for tibiofibular metaphyseal fractures com-plicated with severe soft tissue injury in the elderly. [Methods] A retrospective study was performed on 27 patients who aged of (68.4±4.5)years, and had tibiofibular metaphyseal fractures complicated with severe soft tissue injury was treated with improved hybrid external fix-ators as a full treatment from May 2020 to April 2023. The documents regarding to treatment period and follow-up were evaluated. [Re-sults] All patients received the treatment successfully and had the wound healed satisfactorily. The fracture reduction on imaging wasmarked as excellent in 17 cases (63.0%), good in 10 cases (37.0%), and poor in 0 cases. The patients had hospital stay of (7.4±2.4) days,and time to get partial weight-bearing of (19.7±4.5) days. The VAS score decreased significantly with time before surgery, 3 days after sur-gery, and 1 month postoperatively [(7.1±1.4), (3.7±1.3), (1.1±1.3), P＜0.001]. All the patients were followed up for (24.0±6.4) months, and 5patients (18.5%) of them developed pin tract infection, which didn't lead adverse consequences. In addition, 2 patients suffered from de-layed union of the fracture were given local bone grafting with the original external fixator in place. Finally, all the 27 patients got the frac-tures healed well at the last follow-up, with low extremity functional score (LEFS) significantly increased over time 3, 6 and 12 monthspostoperatively [(36.7±9.7), (60.1±4.1), (75.9±2.9), P＜0.001]. [Conclusion] The modified hybrid external fixator is a safe and effective tech-nique for the treatment of tibiofibular fractures complicated with severe soft tissue injury in the elderly.

Abstract:[Objective] To investigate the clinical outcomes of unilateral biportal endoscopic decompression (UBED) versus channel de-compression (CD) in the treatment of lumbar spinal stenosis (LSS). [Methods] A total of 60 patients with LSS who met the criteria were in-cluded in this study. According to doctor-patient communication, 27 patients were treated with UBED, while other 33 patients were treatedwith CD. The perioperative, follow-up and imaging data of the two groups were compared. [Results] The corresponding operation was suc-cessfully completed in both groups. The UBDE group proved significantly superior to the CD group in terms of operative time [(45.9±7.6)min vs (54.4±2.9) min, P＜0.001], opioid consumption 3 day postoperatively [(215.6±49.3) mg vs (260.4±67.5) mg, P=0.006], CRP 1 daypostoperatively [(15.6±3.7) mg/L vs (17.9±2.1) mg/L, P=0.004], postoperative ambulation time [(1.2±0.4) days vs (1.6±0.2) days, P＜0.001],postoperative hospitalization [(5.1±1.3) days vs (6.0±0.8) days, P=0.002]. The VAS and ODI scores in both groups were significantly de-creased over time (P＜0.05), and ODI scores in the UBED group were significantly better than that in the CD group 2 months after surgery(P＜0.05). Regarding to imaging, the spinal canal area significantly increased in both groups after surgery (P＜0.05). The paravertebral mus-cle cross sectional area (CSA) in the UBED group remained unchanged (P＞0.05), while which in the CD group was significantly decreasedover time (P＜0.05). There was no significant difference in spinal canal area between the two groups at corresponding time points (P＞0.05),and CSA in the UBED group was significantly higher than that in the CD group at all corresponding time points after surgery (P＜0.05).[Conclusion] Both UBED and CD are effective methods for the treatment of LSS. By comparison, the UBED takes advantages of reducingthe amount of postoperative anesthetic drugs, intraoperative tissue injury and postoperative inflammation over the CD.

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