Abstract:[Objective] To investigate the factors related to hidden blood loss in endoscopic lumbar interbody fusion. [Methods] A retrospective study was conducted in 120 patients who underwent endoscopic lumbar interbody fusion from September 2018 to June 2022. Of them, 37 patients underwent endoscopic transforaminal lumbar interbody fusion (E-TLIF), 30 patients underwent endoscopic posterior lumbar interbody fusion (E-PLIF), and 53 patients were treated with unilateral biportal endoscopic posterior lumbar interbody fusion (UBEPLIF). The univariate comparison, univariate correlation and multiple linear stepwise regression were conducted to research the factors related to the hidden blood loss. [Results] All patients had surgical procedures accordingly performed successfully with no significant differences in operation time, preoperative Hb, RBC, Hct and coagulation parameters among the three groups (P＞0.05). The Hb, RBC and Hct of all the three groups significantly decreased after surgery (P＜0.05), which were not significantly different between E-TLIF group and E-PLIF group (P＞0.05), whereas the UBE-PLIF group was significantly lower than the E-TLIF group in terms of Hb [(111.7±12.7) g/L vs (123.9±16.0) g/L, P＜0.05], RBC [(4.0±0.7) 10¹² vs (4.4±0.6) 10¹², P＜0.05] and Hct [(34.7±5.0)% vs (36.8±4.7)%, P＜0.05]. In addition, the UBE-PLIF group proved significantly greater than the E-TLIF and E-PLIF groups in terms of intraoperative blood loss [(161.8±77.9) ml vs (63.8±45.1) ml vs (56.3±30.1) ml, P＜0.05], total blood loss [(553.8±459.7) ml vs (257.2±283.1) ml vs (262.5±302.3) ml, P＜0.05] and hidden blood loss [(392.1± 419.2) ml vs (193.4±269.9) ml vs (145.5±205.2) ml, P＜0.05], whereas there was no significant differences in the above indexes between the E-TLIF group and the E-PLIF group (P＞0.05). As consequence of univariate correlation, the surgical method (UBE-PLIF) and preoperative Hct were significantly positively correlated with hidden blood loss (P＜0.05). Regarding to multiple linear regression analysis, the UBE-PLIF and preoperative Hct were independent risk factors for hidden blood loss (P＜0.05). [Conclusion] Endoscopic lumbar interbody fusion also has the possibility of large amounts of hidden blood loss perioperatively, especially the UBE-PLIF.

Abstract: [Objective] To evaluate the safety and efficacy of endoscopic discectomy with targeted foraminoplasty by visual trephine in the treatment of lumbar disc prolapse. [Methods] A retrospective study was done on 58 patients who underwent percutaneous transforaminal endoscopic discectomy (PTED) for lumbar disc prolapse in our department from March 2019 to July 2021. According to doctor-patient communication, 30 patients underwent targeted foraminoplasty with visual trephine in the PTED (the visible group), with other 28 patients were with invisible trephine (the invisible group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] The visual group proved significantly superior to the invisible group in terms of operation time [(63.2±5.3 min) vs (75.8±7.4) min, P＜0.001], intraoperative blood loss [(51.8±3.4) ml vs (59.2±4.9) ml, P＜0.001] and intraoperative fluoroscopy times [(4.2±0.6) times vs (10.5±1.2) times, P＜ 0.001], but there was no significant difference in incision length and hospital stay between the two groups (P＞0.05). The mean follow-up time was of (17.4±6.5) months, and there was no significant difference between the two groups in the time to return to full weight-bearing activities (P＞0.05). With time elapsed, the VAS and ODI scores were significantly decreased in both groups (P＜0.05), whereas which were not statistically significant between the two groups at any time point accordingly (P＞0.05). With regard of imaging, the vertebral canal space occupancy rate was significantly decreased (P＜0.05), whereas the vertebral space height and lumbar lordotic angle remained unchanged in both groups postoperatively compared with those preoperatively (P＞0.05), and there were no statistically significant differences in the abovementioned image parameters between the two groups at any time points correspondingly (P＞0.05). [Conclusion] The targeted foraminoplasty with visual trephine in PTED does achieve satisfactory clinical consequence for lumbar disc prolapse, with advantages of meeting the demand properly, reducing the number of X-ray fluoroscopy, shortening the puncture catheterization time, reducing bleeding, declining intraoperative pain of patients, and improving the patient's intraoperative experience.

Abstract:[Objective] To investigate the clinical value of serum homocysteine (Hcy) detecting in the early diagnosis of nontraumatic necrosis of the femoral head (NONFH). [Methods] From January 2023 to October 2023, 73 patients with NONFH and 68 healthy subjects who underwent routine physical examination during the same period were included in this study. Serum Hcy levels were determined by enzymelinked immunosorbent assay (ELISA). The difference of Hcy level between patients and normal controls, as well as groups stratified by clinical indicators in the patients was compared, and the correlation between Hcy level and relevant clinical data was analyzed, and the value of Hcy level to determine whether NONFH was conducted by receiver operator characteristic curve (ROC). [Results] The serum Hcy level in NONFH patients was significantly higher than that in normal controls [(36.3±11.8) nmol/ml vs (19.2±13.7) nmol/ml, P＜0.001]. In terms of stratified comparison of 73 patients, the Hcy in the bilateral affected was significantly higher than that in the unilateral involved [(44.2±5.2) nmol/ml vs (29.4±11.7) nmol/ml, P＜0.001], while the Hcy in the femoral head collapse was significantly higher than that in the non-collapsed [(43.7±4.5) nmol/ml vs (24.4±10.1) nmol/ml, P＜0.001]. With the upgrade of ARCO classification, the serum Hcy level increased significantly, which was of statistically significant differences among different stages [I/II/III/IV, (15.1±2.4) nmol/ml vs (29.8±9.2) nmol/ml vs (42.1±4.4) nmol/ml vs (46.2±3.5) nmol/ml, P＜0.001]. In term of correlation analysis, the serum Hcy level was of significantly positive correlation with VAS score (r=0.747, P＜0.001) and ARCO staging (r=0.791, P＜0.001), whereas significantly negative correlation with Harris score (r=-0.706, P＜0.001). As result of ROC analysis, the sensitivity and specificity of serum Hcy level for predicting NONFH was of 67.1%, and 85.3%, with area under curve (AUC) of 0.818. [Conclusion] Serum Hcy level in NONFH is significantly elevated and positively correlated with disease severity, suggesting that Hcy maybe a potential diagnostic marker for NONFH.

Abstract: [Objective] To analyze the factors affecting the operation time of severely displaced humeral supracondylar fractures in children. [Methods] A retrospective analysis was performed on severely displaced supracondylar fractures of humerus in 4 tertiary hospitals in Wuxi and Suzhou from April 2018 to April 2023. Pearson correlation analysis was performed between operation time and other measurement data before and after operation. With operation time as the dependent variable, and other data as independent variables, including age, BMI (body mass index), Baumann angle, degree of fracture rotation, length of the injured limb recovered from closed reduction in the emergency room, and preoperative waiting time, a multiple stepwise regression analysis was performed, and the effects of related factors were evaluated according to the size of the partial regression coefficient. [Results] All the patients were successfully operated without serious intraoperative complications. VAS scores for pain, maximum elbow flexion range of motion (ROM), maximum elbow extension ROM and Mayo elbow performance score (MEPS) were significantly improved over time (P＜0.05). In term of Pearson correlation analysis, there was a significant negative correlation between the operation time and the length of the injured limb recovered from emergency room reduction (r= -0.433, P=0.001). In addition, the operation time was significantly negatively correlated with the ROM at 8 weeks after surgery (r=-0.324, P=0.031), and significantly negatively correlated with MEPS at 6 weeks (r=-0.356, P=0.020), 8 weeks (r=-0.320, P=0.037) and 6 months (r=-0.301, P=0.045). As results of multiple linear stepwise regression, the operation time (Y) was correlated with the length (X1) of the affected limb recovered from the emergency room reduction, and BMI (X2), with the regression equation of Y=54.6-24.5X1+14.09X2. [Conclusion] The length of the affected limb restored by emergency closed reduction and the patient's BMI are factors that affect the operation time. Emergency reduction to restore the length of the affected limb can reduce the operation time and obtain a good prognosis, while the operation time of high BMI children can be extended.

Abstract:[Objective] To explore the clinical efficacy and possible mechanism of arthroscopic debridement combined with platelet rich plasma (PRP) in the treatment of mild-to-moderate knee osteoarthritis (KOA). [Methods] A total of 110 patients with mild to moderate KOA admitted from January 2021 to April 2022 were randomly divided into two groups, with 55 patients in each group. The combined group received arthroscopic debridement combined with PRP, while the debridement group received arthroscopic debridement only. The documents regarding perioperative period, follow-up and auxiliary examination were compared between the two groups. [Results] There were no significant differences in operation time, total incision length, intraoperative blood loss, walking time, incision healing grade and hospital stay between the two groups (P＞0.05), while the combined group proved significantly superior to the debridement in term of the swelling VAS score 7 days postoperatively [(4.0±1.1) vs (4.5±1.0), P＜0.05]. The follow-up period lasted for more than 12 months, and the combined group resumed full weight-bearing activity significantly earlier than the debridement group [(45.2±6.2) days vs (50.1±7.2) days, P＜0.05]. The VAS, WOMAC and Lysholm scores were significantly improved over time in both groups (P＜0.05). The combined group proved significantly better than the debridement group in terms of VAS [(1.3±0.4) vs (2.1± 0.6), P＜0.05], WOMAC [(25.0±5.2) vs (31.5± 5.0), P＜0.05] and Lysholm scores [(90.5±8.0) vs (85.3±8.1), P＜0.05]. Regarding auxiliary examination, the serum levels of TLR-4, MMP-9 and SDF-1 in both groups were significantly decreased 1 month after treatment compared with those before treatment (P＜0.05). The combined group was significantly lower than the debridement group in TLR-4 [(7.0±2.0) ng/ml vs (8.4±2.2 ng/ml, P＜0.05], MMP- 9 [(26.0±7.0) pg/ml vs (30.1±7.3) pg/ml, P＜0.05] and SDF-1 [(453.4±47.2) μg/L vs (495.8±52.2) μg /L, P＜0.05]. [Conclusion] The arthroscopic debridement combined with PRP does relieve pain and improve knee joint function for mid and moderate KOA, its mechanism may be related to reducing blood TLR-4, MMP-9 and SDF-1 levels.

Abstract:[Objective] To compare the clinical efficacy of screw and washer versus double-row anchor suture bridge for open reduction and internal fixation (ORIF) of posterior cruciate ligament tibial avulsion fracture. [Methods] A retrospective study was conducted on 72 patients who received ORIF for acute posterior cruciate ligament tibial avulsion fractures in our hospital from January 2016 to December 2021. According to the fracture conditions, 43 patients had fracture fixed by screw and washer (the screw group), while the remaining 29 patients were fixed by double-row anchor suture bridge (the suture bridge group). The perioperative conditions, follow-up and imaging documents were compared between the two groups. [Results] All patients in both groups were operated on successfully with no serious complications, such as nerve and vascular injury. The screw group was significantly less than that of suture bridge group regarding operation time [(53.8±10.1) min vs (65.2±11.1) min, P＜0.05], although there were no statistically significant differences in incision length, intraoperative fluoroscopy times, postoperative drainage volume, ambulation time, incision healing grade, and hospital stay between the two groups (P＞ 0.05). The mean follow-up time was (12.6±2.9) months, and there was no significant difference between the two groups in the time to return to full weight-bearing activities (P＞0.05). The VAS, Lysholm and IKDC scores, as well as knee ROM and posterior drawer tests were significantly improved in both groups over time after surgery (P＜0.05), which were not statistically significant between the two groups at any time points accordingly (P＞0.05). Radiographically, the fracture with fragment diameter ＞ 10 mm all got proper reduction, but in those with the fragment diameter ≤10 mm, the suture bridge group was significantly better than the screw group in term of reduction quality [excellent/ good/poor, (21/0/0) vs (13/2/2), P＜0.05]. However, there were no statistically significant differences in fracture healing time and K-L grading accordingly between the two groups (P＞0.05). [Conclusion] Both screw-washer and double-row anchor suture bridge fixation for posterior cruciate ligament tibial avulsion fracture do achieve better clinical outcomes. However, for fracture with fragment diameter ≤10 mm or comminuted fracture, the double-row anchor suture bridge fixation might be the better selection.

Abstract:[Objective] To explore the factors affecting the consequence of ulnar nerve anterior transposition (UNAT) for cubital tunnel syndrome (CTS). [Methods] A retrospective study was done on 89 patients who received UNAT for CTS in our department from December 2018 to June 2021. The clinical status was evaluated using Gu's scale, and the patients were divided into good group and poor group at the last follow-up. The factors impacting outcome of UNAT for CTS were investigated by univariate comparison and binary logistic regression analysis. [Results] All patients had the ulnar nerve release and anterior transposition performed smoothly without incision infection, nonunion and other complications, and followed up for 18 to 36 months, with an average of 26.5 months. According to Gu's functional evaluation criteria for CTS, 46 patient were excellent, 25 cases were good, 11 cases were fair, 7 cases were poor, with excellent and good rate of 79.8%. A total of 71 patients who rated as excellent and good were classified into the good group, while the remaining 18 patients rated as fair and poor were classified into the poor group. Regarding univariate comparison, the poor group was significantly greater than the good group in terms of diabetes mellitus [y/n, (10/61) vs (7/11), P=0.017], the elbow injury history [(5/66) vs (10/8), P＜0.001], preoperative disease severity [mild/moderate /severe, (9/43/19) vs (0/6/12), P＜0.001], elbow osteoarthritis [(5/66) vs (5/13), P=0.013]. However, there were no significant differences between the two groups in age, sex, affected side, and history of essential hypertension (P＞0.05). As results of logistic regression, diabetes mellitus (OR=4.652, 95% CI 1.091~19.832, P=0.038), history of elbow trauma (OR=10.111, 95% CI 2.252~ 45.398, P=0.003), preoperative disease severity (OR=4.193, 95%CI 1.138~15.456, P=0.031) were independent risk factors for poor clinical outcomes of UNAT for CTS. [Conclusion] Diabetes mellitus, history of elbow trauma and preoperative disease severity are risk factors for poor clinical effect of ulnar nerve anterior transposition for cubital tunnel syndrome, which should be paid attention to by clinicians.

Abstract:[Objective] A meta-analysis was performed to evaluate the clinical outcomes of anterior controllable antedisplacement and fusion (ACAF) versus posterior laminoplasty (laminoplasty, LP) for the cervical ossification of the posterior longitudinal ligament (OPLL). [Methods] Literature search was conducted in PubMed, Embase, Cochrane, Science Direct, CNKI and other databases, with relevant journals manually searched, the full text was read and the effect data was extracted. Finally, STATA 17.0 software was used for meta-analysis. [Results] The ACAF group proved significantly superior to the LP group in terms of postoperative JOA score (WMD=1.011, 95%CI 0.462~ 1.559, P＜0.001), improvement rate of JOA score (WMD=8.903, 95%CI 5.964~11.841, P＜0.05), postoperative VAS score (WMD=-1.059, 95%CI -1.885~-0.232, P=0.012), postoperative cervical curvature index (WMD=7.604, 95%CI 5.013~10.195, P＜0.05), the incidence of C₅ nerve root paralysis (OR=0.236, 95%CI 0.082-0.678, P=0.007), and the incidence of axial symptoms (OR=0.148, 95%CI 0.042-0.525, P= 0.003), whereas the former was significantly inferior to the latter in terms of the operation time (WMD=90.593, 95%CI 47.949~133.237, P＜ 0.001), the incidence of postoperative dysphagia (OR=11.276, 95%CI 2.073~61.332, P=0.005), and postoperative cervical motion (WMD= -3.599, 95% CI -6.394~-0.804, P=0.012). However, there were no significant differences in terms of intraoperative blood loss (WMD= -155.872, 95%CI -366.687~48.943, P=0.134), incidence of cerebrospinal fluid leakage (OR=0.983, 95%CI 0.337~2.871, P=0.976) and in the total incidence of postoperative complications (OR=0.606, 95% CI 0.361~1.019, P=0.059). [Conclusion] Both ACAF and LP can achieve good clinical results in the treatment of OPLL, by comparison the ACAF takes advantages over the LP in terms of the neurological function recovery, the incidence of postoperative axial symptoms and C₅ nerve root paralysis.

Abstract: [Objective] To systematically evaluate the clinical efficacy of surgical versus non-surgical treatment of Rockwood type III acromioclavicular dislocation. [Methods] The literatures regarding comparison of surgical versus non-surgical treatment of Rockwood type III acromioclavicular dislocation were searched from the databases, including Cochrane Library, PubMed, Web of science, EMBASE, CNKI database, Wanfang database and China Biomedical Database until June 2022, and then a meta-analysis was performed using RevMan 5.2 software. [Results] A total of 17 articles involving 1 006 patients were included. As results of meta-analysis, the surgical group was significantly greater than the non-surgical group in terms of incidence of acromioclavicular arthritis (OR=6.01, 95%CI 2.16~16.68, P=0.0006), infection (OR=5.92, 95%CI 1.35~22.91, P=0.02) and ectopic ossification (OR=1.98, 95%CI 1.18~3.32, P=0.009), while the nonsurgical group was significantly better than the surgical group in terms of functional excellence rate (OR=1.75, 95% CI 1.19~2.58) and Constant score (WMD=1.79, 95%CI 1.14~2.43, P＜0.05). However, there was no significant difference between the two groups in terms of incidence of complications (OR=1.73, 95%CI 0.65~4.63, P=0.27), shoulder pain (OR=1.23, 95%CI 0.61~2.47, P=0.57) and lateral clavicular osteolysis (OR=1.31, 95%CI 0.39~4.38, P=0.66). [Conclusion] There is no difference between surgical treatment and non-surgical treatment in terms of complications, pain and osteolysis of acromioclavicular joint, but non-surgical treatment has obvious advantages over the surgical treatment in terms of infection, acromioclavicular arthritis, ectopic ossification, outcome function and constant score.

Abstract:Total ankle arthroplasty (TAA) is used as an alternative treatment for end stage ankle arthritis. Early clinical results of TAA were poor, but better clinical results have been achieved with the advent of third-generation prostheses and the development of surgical techniques. Currently, there is a trend of gradual expansion of the indications for TAA. The surgical approach is still mainly the anterior approach, although several other approaches have emerged. The overall survival rate of the prosthesis is satisfactory, but there is some variation from region to region. The clinical advantages of computer-assisted TAA are not obvious. There is no uniform treatment for TAA after failure, and revision arthroplasty or conversion to fusion can be performed according to the actual situation.

Abstract:Cartilage has limited capacity of regeneration due to its lack of blood vessels, nerves, and lymph. Traditional clinical treatment methods cannot achieve satisfactory curative effect, but tissue engineering technology provides a new direction for the repair of cartilage damage. Currently, great progress has been made in cartilage regeneration, but the repair of osteochondral interface and full-thickness articular cartilage defects remains challenging. Supramolecular hydrogel is a kind of self-assembled network structures formed by non-covalent interactions of hydrogels, which has the advantages of adjustable mechanical strength, shear thinning, strong selfhealing ability, good biocompatibility and injectability. It can effectively promote cartilage regeneration due to its properties. In this paper, the characteristics, synthesis mechanism, cartilage regeneration and insufficient application of supramolecular hydrogels were reviewed.

Abstract: [Objective] To investigate the influence of different factors on the spectrophotometry of hydroxyproline (HYP) in allogeneic tendon. [Methods] The HYP content of allograft tendons was detected by spectrophotometer based on orthogonal test. Four factors, including enzymolysis time (4 h, 12 h, 24 h) , water bath temperature (37℃, 60℃, 100℃), acid-enzyme ratio (1∶2, 1∶1, 1∶1), and water bath oscillation frequency (180 r/min, 200 r/min, 250 r/min) were set to explore the optimal assay conditions. [Results] The results of single factor analysis showed that under the condition that other variables remained unchanged, the enzymolysis time was 12 h, the water bath temperature was 60℃, the acid-enzyme ratio was 2∶1, the pH value was about 7.4, and the shock frequency of 200 r/min could ensure the best enzymolysis effect of HYP. Orthogonal test and range analysis showed that the acid-enzyme ratio had the greatest effect. Other influencing factors are bath temperature, oscillation frequency and time. [Conclusion] In spectrophotometry of HYP content in allograft tendon, pH value, temperature, shock frequency and enzymolysis time should be adjusted to ensure high enzyme activity, so as to achieve the highest detection rate of samples, so as to rationally use resources and achieve the best assay efficiency.

Abstract:[Objective] To investigate the correlation between clinical characteristics and local histologic manifestations and CXCL16 level around aseptic loosening prosthesis of total hip arthroplasty (THA). [Methods] From June 2017 to June 2023, 44 patients who underwent revision THA for aseptic loosening were included in the revision group, while 44 patients who underwent primary total hip arthroplasty in our hospital during the same period were included in the primary group. Histological score and CXCL16 detection were performed in the synovium harvested during the operation, and histological assay parameters were compared based on different clinical states, and the correlation between them was analyzed. [Results] There was more infiltration of nuclear giant cells in the prosthetic boundary membrane in the revision group, and the revision group got significantly higher histological score than the primary group [(5.9±1.8) vs (0.6±0.8), P＜0.001]. Immunohistochemical staining showed that CXCL16 level in the revision group was significantly higher than that in the primary group (χ² = 55.942, P＜0.001). As results of stratified comparison in the 44 revision patients based on clinical characteristics, there was significant differences in histological scores among different prosthesis types (P＜0.05). In addition, there were significant differences in CXCL16 levels among different prosthesis types and prosthesis survival time (P＜0.05). As for correlation analysis, the histological score was significantly positively correlated with implant survival period (r=0.383, P=0.010). Futhermore, the CXCL16 expression grade was significantly positively correlated to the implant survival period (r=0.350, P=0.020), whereas significantly negative correlation with Harris score before revision (r=-0.345, P=0.022). [Conclusion] The expression of CXCL16 in the prosthetic boundary membrane tissue harvested from revision THA for aseptic loosening was significantly higher than that in the primary THA, which might be involved in the pathogenesis of aseptic loosening.

Abstract:[Objective] To present the surgical techniques and preliminary clinical results of endoscopic anterior cervical discectomy and fusion (E-ACDF). [Methods] E-ACDF was performed on 15 patients with cervical spondylotic myelopathy from January 2021 to February 2023. The intervertebral disc tissue, osteophyte on the vertebral body, and posterior longitudinal ligament protruding into the spinal canal were removed under endoscope, and the anterior dural space was confirmed to be completely decompressed without compression, and the dural beating was restored. As the intervertebral space was extended with a distractor, a fusion cage was implanted into the space, and then anterior cervical plate was placed directly in front of the fusion segment, and was fixed with screws. [Results] All patients were successfully operated without serious complications, and followed up for 6 to 12 months. Compared with those preoperatively, VAS score [(4.7±0.2), (2.2± 0.1), P＜0.001], NDI score [(31.7±1.4), (11.3±0.7), P＜0.001], JOA score [(5.1±0.2), (11.5±0.3), P＜0.001] significantly improved at the latest follow up. Postoperative cervical images revealed internal fixation implants in proper position, with completely decompressed dura and nerve roots. [Conclusion] E-ACDF takes advantage of clear visual surgical field for the treatment of cervical spondylotic myelopathy. It is an accurate, safe and reliable surgical method for full decompression, and achieve satisfactory outcome in short-term.

Abstract:[Objective] To explore the clinical outcome of bone transport for severe traumatic tibial defect. [Methods] A retrospective study was done on 12 patients who received bone transport for severe traumatic tibial defect in our departments from May 2018 to July 2022. The perioperative and follow-up results were evaluated. [Results] All patients had the operation performed successfully without important nerve and vascular injury during the operation. The length of bone defect was of (6.9±1.2) cm, the carrying time of external fixator was of (606.3±55.2) days, with the bone healing index of (62.4±5.0) day /cm. With time of 1 month after operation, frame removed and the latest follow-up lasted for (26.3±7.5) months, the HSS score [(71.4±7.5), (85.3±5.7), (90.2±3.2), P＜0.001], AOFAS score [(70.4±4.9), (83.1± 4.4), (89.8±3.2), P＜0.001], knee extension-flexion ROM [(98.8±5.2)°, (112.6±6.0)°, (123.6±4.3)° , P＜0.001] and ankle dorsal extensionmetatarsal flexion ROM [(44.1±2.6)°, (51.4±3.3)°, (58.8±2.8)° , P＜0.001] increased significantly. The tibial length discrepancy between bilateral sides decreased significantly [(4.9±1.2) cm, (1.3±0.2) cm, (0.9±0.2) cm, P＜0.001], the tibial alignment [excellent /good/fair/poor, (8/ 4/0/0), (12/0/0/0), (12/0/0/0), P=0.009] improved significantly over time. In addition, all patients got sound bony healing at both ends of the transported bone segment at the latest follow-up. [Conclusion] Bone transport is an effective method for the treatment of severe traumatic tibial defect. Designing the transport scheme in advance, especially the distal interface, is necessary to achieve smooth healing of the interface area.

Abstract:[Objective] To investigate the clinical outcome of a modified Chevron osteotomy in the treatment of moderate and severe hallux valgus. [Methods] From January 2019 to January 2021, 50 patients with moderate and severe bunion valgus underwent the modified Chevron osteotomy at the distal first metatarsal. The clinical and imaging consequences in short term were evaluated. [Results] All patients had the surgical procedure performed smoothly with the average operation time of (50.2±18.3) min, the amount of blood loss of (45.8±12.0) mL, and incisions healed in stage I. All patients were followed up for an average of (8.1±2.1) months. With time from preoperatively to 3 months postoperative and the last follow-up, the VAS score [(5.8±1.2), (2.3±0.5), (1.5±0.3), P＜0.001] and AOFAS score [(66.9±7.9), (82.7± 6.6), (93.8±4.1), P＜0.001] are improved significantly. Regarding image, the hallux valgus angle (HVA) [(34.3±5.3)°, (7.7±2.1)°, (7.8±1.9)°, P＜0.001], 1, 2 intermetatarsal angle (IMA) [(13.5±3.3)°, (5.2±1.4)°, (5.3±1.2)°, P＜0.001] and distal metatarsal articular angle (DMAA) [(19.7±3.6)°, (7.1±1.6)°, (7.2±1.8)°, P＜0.001] were also significantly improved. The mean healing time of osteotomy was of (10.9±2.2) weeks, and no adverse imaging changes such as bone nonunion, necrosis of the first metatarsal head, osteomyelitis, etc were found in anyone of them until the last follow-up. [Conclusion] This modified Chevron osteotomy at the distal first metatarsal is a reliable method for the treatment of moderate and severe bunions with satisfactory short-term results.

Abstract:[Objective] To explore the analgesic effect of adductor canal block (ACB) combined with the interspace between the popliteal artery and capsule of the knee (IPACK) block in total knee arthroplasty (TKA). [Methods] From February 2020 to June 2022, 84 patients with end-stage knee osteoarthritis underwent primary unilateral TKA under intravenous general anesthesia. According to preoperative doctor-patient communication, 42 patients received ACB combined with IPACK blocks (combined group), while other 42 patients received ACB block alone (ACB group). The perioperative clinical and analgesic data were compared between the two groups. [Results] There were no significant differences in operation time, total adverse reactions，and intraoperative blood loss between the two groups (P＜0.05), whereas the combined group resumed postoperative walking significantly earlier than the ACB group [(18.5±4.3) h vs (30.4±6.7) h, P＜0.001], and the former got significantly greater knee range of motion (ROM) than the latter [(69.3±7.3)° vs (64.8±6.9)°, P=0.005] 8 hours postoperatively and [(70.1±6.3)° vs (65.2±6.7)°, P=0.001] 24 hours after surgery. The VAS scores for pain in both groups significantly increased from 2h to 24h after surgery, whereas which in the combined group proved significantly lower than those in the ACB group at all time points postoperatively (P＜0.05). In addition, the combined group was also significantly better than the ACB group in terms of first remedy analgesia time [(6.3±1.8) h vs (10.4±2.3) h, P＜0.001], analgesia pump pressure times [(3.0±0.5) times vs (5.7±0.7) times, P＜0.001], the use of vasoactive drugs [(1.0± 0.2) times vs (1.7±0.4) times, P＜0.001], and the use of additional analgesics [(1.4±0.4) time vs (1.9±0.6) times, P＜0.001]. [Conclusion] The ACB combined with IPACK blocks do reduce pain after TKA, improve knee joint motion and shorten recovery time.