Abstract:[Objective] To compare the clinical outcomes and complications of transforaminal lumbar interbody fusion (TLIF) versus oblique lateral interbody fusion (OLIF) combined with pedicle screw fixation through posterior intermuscular channel approaches for degenerative diseases of the lumbar spine. [Methods] A retrospective study was conducted on 157 patients who underwent lumbar interbody fusion for lumbar degenerative diseases in our hospitals from January 2016 to December 2018. According to the doctor-patient communication, 81 patients received TLIF, while other 76 patients were treated with OLIF. The clinical documents, including complications, of the two groups were observed and compared. [Results] Although there were no significant differences in operation time and ambulation time between the two groups (P＞0.05), the OLIF groups proved significantly superior to the TLIF group in terms of intraoperative blood loss [(79.8±26.5) ml vs (258.2±49.9) ml, P＜0.05] and the hospital stay [(7.4±0.8) days vs (9.3±1.0) days, P＜0.05]. With time of follow-up lasted for (20.8± 10.8) months on an average, the VAS scores for lower back pain and leg pain, as well as ODI score were significantly reduced in both groups (P＜0.05), which was not statistically significant between the two groups at any time points accordingly (P＞0.05). Radiologically, intervertebral height, coronal and sagittal Cobb angle of lumbar spine significantly improved in both groups at the last follow-up compared with those preoperatively (P＜0.05), whereas which were statistically insignificant between the two groups at any time accordingly (P＞0.05). Regarding to complications, the OLIF group was significantly higher in term of early incidence than the TLIF group (34.2% vs 19.8%, P＜0.05), despite insignificant difference in late complication incidence between the two groups (1.3% vs 1.2%, P＞0.05). [Conclusion] The incidence and composition of complications are different between the two lumbar fusion due to differences in spinal canal decompression methods, interbody fusion approach, size and area of fusion cage used.

Abstract:[Objective] To evaluate the clinical efficacy of percutaneous endoscopic interlaminar discectomy (PEID) combined with intervertebral implantation of platelet-rich plasma capsule for lumbar disc herniation (LDH). [Methods] A retrospective study was performed on 87 patients who received PEID for LDH from March 2018 to February 2020. According to the preoperative doctor-patient communication, 45 patients received PEID combined with PRP capsule (the PRP group), while other 42 patients received PEID alone (the nonPRP group). By propensity score matching (PSM), 30 patients in the PRP group and 30 patients in the non-PRP were included in this study. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] There were no significant differences in operation time, total incision length, intraoperative blood loss, intraoperative fluoroscopy times, walking time, incision healing grade and hospital stay between the two groups (P＞0.05). The follow-up period lasted for (27.2±2.0) months on a mean, and there was no significant difference in time to resume full weight-bearing activity between the two groups (P＞0.05). The VASs, ODI and JOA score were significantly improved over time in both groups (P＜0.05). At 6 months postoperatively, the PRP group proved significantly superior to the non-PRP group in terms of low back pain VAS [(1.9 ±0.8) vs (2.5±0.8), P＜0.05], leg pain VAS [(2.6±0.9) vs (3.1± 0.9), P＜0.05], ODI [(24.5± 8.0) vs (29.5± 8.3), P＜ 0.05] and JOA score [(22.2±2.2) vs (21.0±2.1), P＜0.05]. Radiographically, the dural sac cross-sectional surface area (DCSA), disc height index (DHI), and signal intensity ratio (SIR) between nucleus pulposus and cerebrospinal fluid were significantly improved in both group over time (P＜0.05). At the last follow-up, the PRP group were significantly better than non-PRPgroup in terms of DCSA [(215.6±12.9) mm² vs (208.3±13.2) mm² , P=0.034], Pfirrmann grade of disc degeneration [I/II/III/IV/V, (0/0/23/7/0) vs (0/0/15/11/4), P=0.037], and SIR [(24.6± 2.3)% vs (23.0±3.3)%, P=0.033]. [Conclusion] The PEID combined with PRP capsule is effective and safe in the treatment of LDH, and might delay the degeneration of intervertebral disc to a certain extent.

Abstract:[Objective] To compare the clinical outcomes of anterior cervical corpectomy and fusion (ACCF) with or without posterior longitudinal ligament (PLL) removal for cervical spondylotic myelopathy (CSM). [Methods] A retrospective study was done on 81 patients who received single-segment ACCF for CSM in our hospital from March 2017 to March 2022. According to whether calcification of PLL was seen on preoperative images and the intraoperative findings, the PLL was retained in 38 patients (the retained group), whereas was resected in the other 43 patients (the resected group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had corresponding surgical procedures conducted successfully. Although there were no statistically significant differences between the two groups in the number of fluoroscopy, the total incision length, postoperative ambulation time, incision healing grade and hospital stay (P＞0.05), the retained group proved significantly superior to the resected group in terms of the early complication rate (13.2% vs 34.9%, P=0.024), operation time [(110.3±11.4) min vs (147.2±13.4) min, P＜0.001] and intraoperative blood loss [(61.7±10.2) ml vs (133.7±12.0) ml, P＜0.001]. The follow-up period lasted for (22.6±13.1) months in a mean, and there was no significant difference between the two groups in the time to return to full weight-bearing activities (P＞0.05). The NDI and JOA scores and pyramidal tract signs improved significantly over time in both groups (P＜0.05). The retained group proved significantly inferior to the resected group regarding JOA score at 3 months postoperatively [(10.5±1.9) vs (11.4±2.5), P＜0.001], 6 months [(12.4±2.5) vs (13.7±2.1), P=0.026], and at the latest followup [(13.3±2.2) vs (14.8±1.7), P＜0.001], but there were no statistically significant differences in NDI scores and pyramidal tract signs between the two groups at any time points accordingly (P＞0.05). Radiologically, the cervical lordosis and minimum sagittal diameter of the spinal canal significantly increased (P＜0.001), while the cervical ROM significantly reduced in both groups at the last follow-up compared with those preoperatively (P＜0.001). At the last follow-up, there were no statistically significant differences in the cervical lordosis and ROM between the two groups (P＞0.05), however, the retained group was significantly less than the resected group in term of minimum sagittal diameter of the responsible segment [(9.0±0.8) mm vs (9.8±0.9) mm, P＜0.001]. [Conclusion] As singlesegment ACCF is performed for CSM, PLL should be resected according to preoperative imaging data and intraoperative findings. Although PLL resection does provide better decompression, it leads to more iatrogenic trauma and high risk of complications.

Abstract:[Objective] To compare the clinical outcomes of unilateral biportal endoscopic (UBE) decompression of the responsible segment versus posterior lumbar interbody fusion (PLIF) for degenerative spinal stenosis in the elderly. [Methods] A retrospective study was performed on 65 patients who underwent surgical treatment for lumbar spinal stenosis in our hospital from January 2018 to March 2021. According to doctor-patient communication, 28 patients received UBE decompression, while the other 37 patients received PLIF. The perioperative, follow-up and imaging results were compared between the two groups. [Results] Although there was no significant difference in operation time between two groups, the UBE group was suprior to the PLIF group in terms of total incision length [(2.1±0.9) cm vs (11.2±1.12) cm, P＜0.05], intraoperative fluoroscopy times [(3.3±0.8) vs (5.9±1.2) times, P＜0.05], intraoperative blood loss [(36.2±10.2) ml vs (201.3±11.3) ml, P＜0.05], ambulation time [(22.7±5.1) days vs (40.2±8.5) days, P＜0.05] and hospital stay [(7.3±2.2) days vs (11.2±3.0) days, P＜0.05]. The mean follow-up period lasted for (14.1±1.1) months, and the UBE group resumed full weight-bearing activity significantly earlier than the PLIF group [(4.3±2.8) weeks vs (10.6±3.4) weeks, P＜0.05]. The VAS scores for low back pain and leg pain, as well as ODI scores significantly improved in both groups over time postoperatively (P＜0.05), which was not statistically significant between the two groups before surgery (P＞0.05). The UBE group was significantly better than the PLIF group regarding low back pain VAS score [(2.3±0.7) vs (2.8 ±0.9), P＜0.05], leg pain VAS score [(2.5± 0.6) vs (2.9±0.7), P＜0.05], and ODI score [(20.6±3.3) vs (23.4±2.9), P＜0.05] 3 months postoperatively, while which became not statistically significant between the two groups at latest follow up (P＞0.05). Regarding imaging, the lateral recess diameter and spinal canal cross-section significantly increased in both groups at the last follow-up, compared with those before surgery (P＜0.05), the lumbar scoliotic Cobb angle remained unchanged significantly in the UBE group (P＞0.05), but decreased significantly in PLIF group (P＜0.05). There were no significant differences in lateral recess diameter, vertebral canal cross-sectional area and scoliotic Cobb angle between the two groups before surgery (P＞0.05), however, the PLIF group got significantly less scoliotic angle than the UBE group at the latest interview [(15.7±3.3)° vs (17.8±4.6)°, P＜0.05]. [Conclusion] The unilateral biportal endoscopic decompression of the responsible segment has benefits of less trauma and better short-term clinical consequences over the traditional open PLIF for degenerative lumbar spinal stenosis in the elderly.

Abstract:[Objective] To investigate the correlation between imaging and clinical data in endoscopic decompression for lumbar spinal stenosis (LSS). [Methods] From January 2020 to August 2022, 76 patients with LSS underwent percutaneous transforaminal endoscopic decompression in our hospital. At the last follow-up, patients were grouped according to the clinical efficacy evaluated by modified Macnab criteria. The clinical and imaging data of patients were compared, and the correlation between the imaging parameters and VAS score or ODI score was analyzed. [Results] According to Macnab criteria, 36 cases were excellent, 32 cases were good, and 8 cases were fair at the last follow-up. There were significantly differences in terms of VAS score [(1.3±0.2) vs (1.7±0.4) vs (2.6±0.8), P＜0.001], ODI score [(20.9±4.3)% vs (25.5±5.3)% vs (32.4±3.4)%, P＜0.001], as well as the radiographic measurements including central canal crosssectional area (CCCSA) [(169.3±18.3) mm² vs (164.5±15.8) mm² vs (156.4±13.4) mm² , P＜0.001], lateral recess anteroposterior diameter (LRAPD) [(5.3±0.7) mm vs (4.9±0.6) mm vs (4.2±0.4) mm, P＜0.001], sagittal area of the intervertebral foramen (SAIF) [(90.2±9.0) mm² vs (86.4±8.1) mm² vs (80.5±6.8) mm² , P＜0.001], dural sac cross-sectional area (DSCSA) [(138.5±10.3) mm² vs (134.4±9.2) mm² vs (126.3±8.6) mm² , P＜0.001] and the dural sac maximum sagittal diameter (DSMSD) [(21.7±4.0) mm vs (19.6±3.3) mm vs (17.9±2.8) mm, P＜0.001]. As results of correlation analysis, the VAS score was significantly negatively correlated with CCCSA (r=-0.429, P＜0.001), LRAPD (r=-0.346, P＜0.001), SAIF (r=-0.354, P＜ 0.001), DSCSA (r=-0.216, P=0.023) and DSMSD (r=-0.254, P=0.014). Similarly, the ODI score proved significantly negatively correlated with CCCSA (r=-0.420, P＜0.001), LRAPD (r=-0.335, P＜0.001), SAIF (r=-0.373, P＜0.001), DSCSA (r=-0.213, P=0.022) and DSMSD (r=-0.252, P=0.013). [Conclusion] After percutaneous transforaminal endoscopic decompression for LSS, the measured parameters of CT and MRI images are significantly correlated with clinical pain and dysfunction scores.

Abstract:[Objective] To investigate the efficacy of distally based sural flap (DBSF) for traumatic middle-lower tibiofibular and foot osteomyelitis complicated with skin and soft tissue defect, and to analyze the factors affecting the recurrence of osteomyelitis. [Methods] A total of 174 patients received DBSF for traumatic middle-lower tibiofibular and foot osteomyelitis complicated with skin and soft tissue defect from November 2003 to February 2021. The function of the affected limb was evaluated according to the modified Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. The factors influencing the recurrence of osteomyelitis were analyzed by univariate comparison and binary multifactor logistic regression. [Results] Of 174 patients, 12 cases (6.9%) got partially necrotic flap, while 162 cases (93.1%) had completely alive flap. On other hand, 22 cases (12.6%) had osteomyelitis recurred, whereas 152 cases (87.4%) got primarily cured. According to the modified ASAMI criteria, 74 cases (42.5%) were excellent, 83 cases (47.7%) were good, 14 cases (8.0%) were fair, and 3 cases (1.7%) were poor, with an overall excellent and good rate of 90.2% at the last follow-up. Regarding univariate comparison, there were no significant differences in gender composition, lesion location, anatomic classification of osteomyelitis, flap area and fracture management between the recurrence group and the cure group (P＞0.05). However, the recurrence group proved significantly greater than the cure group in age and course of disease (P＜0.05). As consequence of logistic regression, the old age (OR=1.024, P=0.046), long course of disease (OR=4.664, P=0.004) and severe Cierny-Mader IV classification (OR=4.086, P=0.041) were independent risk factors for osteomyelitis recurrence. [Conclusion] Distally based sural flap combined with appropriate osteomyelitis treatment is an effective method for traumatic middle-lower tibiofibular and foot osteomyelitis complicated with skin and soft tissue defect. The recurrence rate of osteomyelitis is closely related to Cierny-Mader classification, course of disease and age of patients.

Abstract:[Objective] To explore the clinical significance of detection of serum nuclear factor erythroid 2-related factor 2 (NFE2L2) in nontraumatic osteonecrosis of the femoral head (NONFH). [Methods] A total of 78 patients with NONFH (the necrosis group) and 80 healthy controls (the normal group) admitted to Linyi People's Hospital from August 2021 to February 2022 were included in this study. Serum NFE2L2 levels in both groups were detected by ELISA. The difference of serum NFE2L2 level between necrotic group and normal group was compared. The levels of serum NFE2L2 in necrotic group were compared in stratified manner according to different factors. The correlation between serum NFE2L2 level and other clinical data was analyzed, and the significance of serum NFE2L2 diagnosis of NONFH was evaluated by drawing ROC diagnostic curve. [Results] Serum NFE2L2 level in necrotic group was significantly higher than that in normal group [(289.2±130.7) pg/ml vs (173.7±75.7) pg/ml, P＜0.001]. Although there was no significant difference in the level of serum NFE2L2 between different causes and different sides in the necrotic group (P＞0.05), the serum NFE2L2 level after femoral head collapse was significantly higher than that before femoral head collapse [(320.0±131.2) pg/ml vs (199.8±79.4) pg/ml, P=0.004]. In addition, the serum NFE2L2 level increased significantly with the progression of ARCO stages, with statistically significant differences among the different stages (P＜0.05). In term of correlation analysis, the serum NFE2L2 level was significantly positively correlated with ARCO stage and VAS score (P＜0.05), whereas significantly negatively correlated with Harris score (P＜0.05). In term of ROC analysis, the area under curve (AUC) of serum NFE2L2 level for the diagnosis of NONFH was of 0.769. [Conclusion] Serum NFE2L2 level is significantly elevated in patients with NONFH, which correlates with the severity of NONFH and may be a potential serum marker for the diagnosis of NONFH.

Abstract:[Objective] To systematically evaluate the clinical consequences of the extramedullary (EM) localizations versus the intramedullary (IM) counterpart for femoral osteotomy in primary total knee arthroplasty (TKA). [Methods] The controlled studies on EM and IM for femoral osteotomy in TKA were searched from data bases, including CNKI, Wanfang, VIP, Chinese Biomedical Literature Database, PubMed, Embase, Cochrane Library and Web of Science databases. A metaanalysis was performed using Stata 15.0 software. [Results] Eight randomized controlled studies were included in this study, with a total of 804 patients, including 404 cases in the EM group and 400 cased in the IM group. As results of the meta-analysis, The EM group was significantly superior to the IM group in terms of coronal angle of femoral prosthesis (RR=0.184, 95%CI 0.07-0.45, P＜0.001), and the blood loss (MD=-161.24, 95%CI -233.93~-88.55, P=0.016). However, there were no significant differences in terms of coronal alignment of lower limbs (RR=1.2, 95%CI 0.28~5.21, P=0.809), sagittal angle of femoral prosthesis (RR=0.18, 95%CI 0.07~0.45, P=0.541), operative time (MD=-0.74, 95%CI -4.04~-2.57, P=0.665) between the two groups. [Conclusion] EM localization for femoral osteotomy in TKA get more accurate coronal angle of femur prosthesis with less blood loss over the IM localization, while the two techniques are similar in terms of coronal position alignment of lower limb, sagittal angle of femur prosthesis and operation time.

Abstract:Kümmell's disease is a complicated spinal condition which remains controversial in the pathophysiology, clinical presentation, imaging and treatment options, which may be the comprehensive effect of multiple factors. The most important clinical feature of this disease is delayed vertebral collapse occurring after the history of minimal trauma. The intravertebral vacuum cleft phenomenon is considered a radiographic sign of avascular osteonecrosis of the vertebral body and is highly suggestive of Kümmell's disease. Treatment options include nonsurgical and surgical treatment. This article reviews the progress of Kümmell 's disease to provide a reference for diagnosis and treatment.

Abstract:Cervical spondylosis (CS) is a disease that involves degenerative changes of cervical discs and surrounding tissue, and has clinical manifestations corresponding to its imaging changes. Currently, neck pain has become the second leading cause of disability in China, which in female are more common than that in male with a trend of affecting younger. Cervical support pillows are used to aid in the treatment of cervical spondylosis, and the right cervical pillow may be helpful to develop treatment plan for the cervical spondylosis, however, there is insufficient clarity regarding the optimal design and efficacy of cervical support pillows. In this article, we analyze the classification design and application of cervical support pillows by summarizing the articles related to cervical support pillows in recent years, aiming to provide reference for clinical workers and researchers, improve academic research, and promote the professionalization and scientization of cervical support pillows development and application.

Abstract:Pulsed electromagnetic fields (PEMFs), as a non-invasive physical method, can induce microcurrents to the whole-body tissue or deliver them to local tissues by targeted transport without the need of implanted electrodes in the body. It can promote the growth and healing of muscle and bone by a variety of signal transduction pathways, anti-inflammatory effects, growth factors and other pathways. It can be used in the treatment of delayed fracture healing, muscle injury, angiogenesis and other diseases in the field of musculoskeletal medicine, so it has gradually become an important treatment method in the field of musculoskeletal medicine. This paper reviews the mechanisms of action and progress in application of pulsed electromagnetic fields on muscle and bone tissue.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of percutaneous retrograde screw fixation of acetabular fractures without significant displacement. [Methods] A total of 19 patients received percutaneous retrograde screw fixation of unremarkably displaced acetabular fractures. Preoperative virtual surgical design was carried out by using relevant computer software technology to obtain individualized screw placement parameters. The insertion point was determined by combining preoperative planning and intraoperative fluoroscopy, and the blunt separation to the bone surface was conducted. The guide wire was placed at the entry point with direction determined by C-arm fluoroscopy. Finally the screws were individually placed to fix the fracture in safe and accurate manner. [Results] All the 19 patients had percutaneous retrograde acetabular anterior-posterior column screws placed successfully without neurovascular injury or involvement of the hip cavity, with average operation time of (99.7±18.8) min, and the average intraoperative fluoroscopy times of (97.6±16.6). The postoperative X-ray and CT recheck revealed satisfactory screw placement in position and length. At the last follow-up, the excellent rate of the Merle d 'Aubigne and Postel functional scores was 89.4%, and no complications such as screw loosening and broken, fracture nonunion and re-displacement were found in anyone of them. [Conclusion] This percutaneous retrograde acetabular anteriorposterior column screw fixation based on individual preoperative computer planning for the treatment of non-displaced acetabular fractures is feasible minimal invasive technique and does achieve good clinical outcomes in a short period of time.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of polyester sutures with Nice knots for fixation of transverse patella fractures. [Methods] A total of 20 patients underwent non-absorbable polyester sutures with Nice knots for fixation of transverse patellar fractures. After anterior midline incision of the knee was made to expose the patella, the fractures were debrided and reduced, and 4 evenly distributed bone tunnels were established along the longitudinal axis of the patella. The tension band of the suture in figure of 8 was performed on the surface of the patella after the 5 # non-absorbable polyester sutures were introduced through the deeper 2 bone tunnels near articular surface. Finally, a circular band was performed with 5 # non-absorbable polyester sutures through the other superficial 2 bone tunnels. All the suture bundles were tensioned and fastened with Nice knots to fix the fracture. [Results] All the patients had operation performed successfully without serious complications, while with operation time of 50~90 min. At the latest follow up lasted for 12 to 18 months, all of them achieved fracture healing with B?stman patellar fracture function score of (28.3±1.6), and the knee range of motion of (132.3 ± 4.2)°. According to the B?stman patellar fracture function score, all patients were graded as excellent in term of knee function. [Conclusion] Polyester sutures with Nice knots for fixation of transverse patellar fracture has the advantages of reliable fixation, less complications, and no need for reoperation to remove the internal fixation, does achieve satisfactory clinical consequences in short-term.

Abstract:[Objective] To evaluate the clinical outcomes of open acromioplasty and osteoplasty of the humeral greater tuberosity combined with rotator cuff reattachment by doublerow suture anchors for the subacromial impingement secondary to malunion of humeral greater tuberosity fractures. [Methods] From June 2018 to October 2022, 17 patients received abovementioned surgical procedures for subacromial impingement secondary to malunion of humeral greater tuberosity fractures. The functional recovery of the affected shoulder was evaluated. [Results] All the 17 patients were smoothly operated on with incision healing in the first-stage without infection, and were followed up for 6~12 months. Compared with those preoperatively, the VAS score [(7.5±1.1), (1.2±0.7), P＜0.001], UCLA score [(12.9±3.8), (30.9±2.2), P＜0.001], Constant-Murley score [(50.7±12.1), (95.1±9.4), P＜0.001] and lifting ROM [(94.9±12.1)°, (151.5±10.2)°, P＜0.001], as well as relative height of humerus head measured on images [(6.1±1.2) mm, (10.3±0.7) mm, P＜0.001] were significantly improved at the latest follow-up, although there were no significant changes in subacromial space, acromial index, and acromial tilt angle (P＞0.05). [Conclusion] The open acromioplasty and osteoplasty of the humeral greater tuberosity combined with rotator cuff reattachment by double-row suture anchors do effectively improve the mobility of the affected shoulder, with improvement of the relative height of the humerus head for subacromial impingement secondary to malunion of humeral greater tuberosity fractures.

Abstract:[Objective] To evaluate the value of bone scan in determining responsible vertebral fractures of percutaneous vertebroplasty in patients who were contraindicated to magnetic resonance imaging (MRI) in the diagnosis of multiple osteoporotic compression fractures (MOVCFs). [Methods] A retrospective study was performed on 14 patients who were treated for MOVCFs in our hospital from January 2013 to June 2022. All patients received X-ray, CT and bone scan examinations. The responsible vertebrae were determined based on bone scan and followed by percutaneous vertebroplasty (PVP) performed. The clinical outcome was evaluated. [Results] X-ray and CT showed a total of 32 vertebral compression fractures in 14 patients. However, bone scan showed that one of them had normal vertebral nuclide uptake, whereas the other 13 patients who had a total of 30 vertebral wedges change seen by X-ray and CT, had only 17 wedged vertebrae with uptake concentration on bone scan imaging, with a positive rate of 53.1% on bone scan imaging. As identified as responsible vertebrae, the 13 patients received PVP, including single segment in 9 cases and double segments in 4 cases. All patients had PVP performed successfully without complications. Compared with those preoperatively, VAS [(7.9± 2.4), (3.6±1.8), (4.1±1.2), P＜0.001] and ODI [(42.4±6.8), (12.5± 3.1), (14.7±2.9), P＜0.001] scores decreased significantly 1 day postoperatively and at the latest follow up. [Conclusion] Bone scan is an effective method to locate the responsible vertebrae in patients with multiple osteoporotic vertebral compression fractures if MRI is contraindicated.

Abstract:[Objective] To compare the expression of transforming growth factor-β1 (TGF-β1) in serum and in knee cartilage and subchondral bone in knee osteoarthritis (KOA) and non-KOA patients. [Methods] Thirty patients with KOA who underwent total knee replacement (the KOA group) and another 30 patients without KOA, including 13 patients with acute anterior cruciate ligament injury who underwent ligament reconstruction and intercondylar fossaplasty (the control group) had TGF-β1 detected in serum, knee cartilage and subchondral bone. [Results] The results of TGF-β1 in serum by ELISA were (1 929.1±76.8) pg/ml in the KOA group, while (1 611.4±105.9) pg/ml in the control group, with a statistically significant difference (P=0.022). Immunohistochemical staining of TGF-β1 in cartilage and bone tissues showed that there were 24 strong positive cases and 6 negative cases in KOA group with a positive rate of 80.0%, whereas 4 positive cases and 9 negative cases with the positive rate of 30.8% in the control group, and the positive rate of TGF-β1 immunohistochemical staining in KOA group was higher than that in control group (P=0.002). [Conclusion] Compared with non-KOA patients, TGF-β1 expression in serum and knee joint related tissues was significantly increased in the KOA patients.

Abstract:[Objective] To explore the factors affecting the quality of life of patients with osteosarcoma after treatment. [Methods] A total of 80 patients who received treatments for osteosarcoma in our hospital from March 2020 to March 2022 were retrospectively analyzed. Three months after surgery, the patients were divided into good quality of life and poor quality of life group according to QLQ-C30 score of cancer patients' quality of life. Univariate comparison and logistic regression analysis were used to analyze the factors impacting quality of life of patients with osteosarcoma. [Results] All the 80 patients with osteosarcoma survived 3 months after treatments, with the survival rate of 100% (80/80). Of them, 23 patients with QLQ-C30 scores below 70 were classified as poor quality of life group, accounting for 28.8%, while the remaining 57 patients with scores ≥70 were classified as good quality of life group, accounting for 71.2%. As results of the univariate comparison, the poor group proved significantly inferior to the good group in terms of the nutritional status before treatment, pathological fracture, surgical mode of amputation, distant metastasis, sleep quality before treatment, family function and coping attitude (P＜0.05). Regarding binary multifactor logistic analysis, the poor nutritional status (OR=6.667, 95% CI 2.241~19.830, P＜0.001), clinical stage III (OR= 3.240, 95% CI 1.058~9.920, P＜0.001), pathological fracture (OR=7.736, 95% CI 2.621~22.836, P＜0.001), amputation (OR=6.505, 95% CI 2.243~18.868, P＜0.001), distant metastasis (OR=20.611, 95% CI 5.523~76.913, P＜0.001), poor sleep quality (OR=6.346, 95%CI 2.203~ 18.278, P＜0.001), low level of family function (OR=5.436, 95%CI 1.893-15.608, P=0.002), improper coping alttitude (OR=6.682, 95% CI 2.206~20.370, P=0.002) were independent risk factors for poor quality of life in patients with osteosarcoma. [Conclusion] Poor nutritional status, clinical stage III, pathological fracture and amputation are risk factors affecting the quality of life of patients with osteosarcoma. Targeted intervention is needed to improve the quality of life of patients with osteosarcoma.

Abstract:[Objective] To investigate the effect of cervical alignment variation on imaging measurement of C_4/5 intervertebral foramen. [Methods] A total of 162 subjects who underwent cervical X-ray and CT examination with complete data in our hospital from January 2022 to May 2023 were enrolled into this study. Of them, 52 cases were fall into the lordotic group, 79 cases were in the straightening group, and 32 cases were classified into the kyphotic group according to Borden's method of cervical alignment. The morphological parameters of C_4/5 were measured, including foraminal height (FH), foraminal width (FW), foraminal cross-sectional area (FA), and the anterior and posterior heights of the vertebral space. The data were compared among the 3 conditions. [Results] The proportion of regular foramen, including round, quasi-round and square, was 83.7% in the lordotic group, 53.5% in the straightening group and 45.2% in the kyphotic group respectively. The anterior height of C_4/5 intervertebral space was ranked as the lordotic group ＞ the straightening group ＞ the kyphotic group [(4.1± 0.5) mm vs (3.7±0.5) mm vs (3.2±0.4) mm, P＜0.001]. However, the straightening group got significantly greater FH [(9.7±0.8) mm vs (9.1±0.9) mm vs (9.2±0.8) mm, P＜0.001] and FA [(0.5±0.1) mm² vs (0.4±0.7) mm² vs (0.5±0.7) mm² , P=0.001] than the lordotic and kyphotic groups. There were no significant differences in terms of FH, FW and FA between the left and right sides of C_4/5 in the three states (P＞0.05). [Conclusion] The change of cervical alignment does significantly cause the morphological variation of the intervertebral foramen at C_4/5 level. The straightening cervical spine increases FW and FA at C_4/5 level, while decreases the anterior and posterior height of the intervertebral space. The kyphosis decreases FW at C_4/5 level with loss of the anterior and posterior height of the intervertebral space.