Abstract:[Objective] To compare the clinical outcome of accurately targeted (AT) unilateral percutaneous vertebroplasty (PVP) versus the routine counterpart for osteoporotic vertebral compression fractures (OVCF). [Methods] A retrospective analysis was performed on 72 patients who underwent PVP surgery for OVCF in our hospitals from January 2020 to June 2022. According to the surgeon-patient communication, 36 patients received the AT unilateral PVP, while other 36 patients received the routine unilateral PVP. Perioperative period, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups got corresponding surgical operation completed smoothly without serious complications. The AT group was significantly less than the routine group in terms of operation time [(28.9±3.3) min vs (46.2±9.1) min, P＜0.001], intraoperative fluoroscopy times [(13.2±1.0) times vs (17.1±2.6) times, P＜0.001] and puncture needle adjustment times [(3.3±6.5) times vs (4.8±6.5) times, P＜0.001], while the former got significantly greater bone cement injection volume [(6.3±1.0) ml vs (5.6±0.9) ml, P＜0.001], with significantly better bone cement distribution than the latter [I/II/III, (3/16/17) vs (8/22/6), P=0.004]. There were no significant differences in bone cement leakage rate, walking time and hospital stay between the two groups (P＞0.05). As time elapsed in follow-up period lasted for (15.5±0.4) months, the VAS, ODI and JOA scores in both groups were significantly improved (P＜0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P＞0.05). Regarding imaging, the anterior vertebral height and local kyphotic Cobb angle were significantly improved in both groups after surgery compared with those preoperatively (P＜0.05), while which were not statistically significant between the two groups at any matching time points (P＞0.05). [Conclusion] This accurately targeted unilateral percutaneous vertebroplasty achieves satisfactory consequence for osteoporotic vertebral compression fractures, with advantages of accurate puncture path, low intraoperative radiation exposure, minimized tissue damage, and sufficient bilateral bone cement distribution, despite of a certain learning curve.

Abstract:[Objective] To investigate the factors related to early surgical site infection (SSI) after posterior lumbar interbody fusion (PLIF). [Methods] A total of 468 patients who underwent PLIF surgery in our hospital from January 2019 to January 2022 were included in this study. The occurrence of postoperative SSI was observed, and the related factors of SSI were explored by univariate comparison and multiple logistic regression analysis. [Results] The SSI occurred in 18 of 468 patients, accounted for 3.9%. The infection group proved significantly greater than the non-infection group in terms of women proportion [male/female, (5/13) vs (232/218), P=0.048], age [(59.7±7.2) years vs (56.3±8.5) years, P=0.012], preoperative diabetes mellitus [no/mild/medium/severe, (13/2/2/1) vs (408/19/15/8), P=0.012] and urinary tract infections [no/mild/medium/severe, (14/2/1/1) vs (423/23/2/2), P=0.005], operation time [(206.3±15.7) min vs (181.2±12.1) min, P＜ 0.001], postoperative drainage volume [(330.2±53.5) ml vs (292.3±48.6) ml, P＜0.001] and drainage time [(2.4±0.5) days vs (2.0±0.4) days, P＜ 0.001], whereas the former was significantly lower than the latter regarding the preoperative hemoglobin [(135.2±7.4) g/L vs (139.6±8.6) g/L, P=0.008] and albumin [(36.0±3.1) g/L vs (40.4±3.10) g/L, P=0.019]. As results of multivariate logistic regression analysis, the preoperative diabetes mellitus (OR=1.898, P=0.011), urinary tract infection (OR=1.612, P=0.027), and long drainage time (OR=1.426, P=0.015) were risk factors for early postoperative SSI, while the males (OR=0.811, P=0.038) and high albumin levels (OR=0.676, P=0.002) were protective factors for SSI. [Conclusion] Female, preoperative diabetes, urinary tract infection, hypoproteinemia and prolonged drainage time are risk factors for early SSI after posterior lumbar interbody fusion.

Abstract:[Objective] To evaluate the accuracy and significance of 3D printed guide assisted pedicle screw placement for fixation of the upper and middle thoracic spine fractures. [Methods] A retrospective study was performed on 50 patients who underwent surgical treatment for upper and middle thoracic spine fractures from December 2019 to December 2022. According to preoperative doctor-patient communication, 25 patients had screw placed by the 3D printed guides (the guide group), while the remaining 25 patients were managed by traditional freehand technique (the freehand group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All the 50 patients were successfully operated without injuries to aorta, thoracic pulp and nerve root. The guide group proved significantly superior to the freehand group in terms of intraoperative fluoroscopy times [(2.8±1.2) times vs (9.5±2.7) times, P＜0.001], time of single screw placement [(2.2±0.5) min vs (3.5±0.7) min, P＜0.001], success rate of first time screw placement (100.0% vs 90.7%, P＜0.001), whereas the former consumed significantly higher medical fee than the latter [(35 221.4±423.2) yuan vs (34 358.5±442.9) yuan, P＜0.001]. However, there were no significant differences in operation time, total incision length, intraoperative blood loss and hospital stay between the two groups (P＞0.05). As time went on in follow-up period lasted for (16.8±3.4) months, the VAS, ODI and JOA scores, as well as ASIA neurological function classification significantly improved in both groups (P＜0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P＞0.05). As result of postoperative imaging evaluation, the guide group was also proved significantly superior to the freehand group regarding screw placement accuracy [(0/I/II), (146/4/0) vs (122/23/5), P＜0.001]. At the last follow-up, all pa-tients in both groups got fracture healing without loosening of internal implants. [Conclusion] The 3D printed guide assisted pedicle screw placement for fixation of the upper and middle thoracic spine fractures does improves the accuracy with less radiation exposure and higher safety.

Abstract:[Objective] To compare the clinical efficacy of decompression by unilateral biportal endoscopy (UBE) versus extended posterior lumbar interbody fusion (PLIF) for adjacent spondylosis secondary to lumbar fusion. [Methods] From January 2021 to September 2022, 57 patients underwent surgical treatment for adjacent spondylosis after lumbar fusion. According to preoperative doctor-patient discussion, 31 patients received UBE decompression, while other 26 patients received extended PLIF. The documents regarding perioperative period and followup were compared between the two groups. [Results] All patients in both groups had corresponding surgical procedures performed smoothly, despite that 1 case in each group suffered from membrane tear of the outer nerve root with transient pain of lower extremity after surgery, which were treated by symptomatic treatment such as hormone and dehydration. The decompression group proved significantly superior to the extended fusion group in terms of operation time [(84.1±11.5) min vs (149.2±11.4) min, P＜0.05], total length of incision [(2.3± 0.4) cm vs (12.3±1.5) cm, P＜0.05], intraoperative blood loss [(27.9±4.0) ml vs (266.5±16.0) ml, P＜0.05], intraoperative fluoroscopy [(3.1± 0.5) times vs (5.4±0.5) times, P＜0.05], postoperative ambulation time [(2.5±0.5) days vs (3.6±0.6) days, P＜0.05], hospital stay [(5.4±0.6) days vs (9.6±0.6) days, P＜0.05], in addition, the former recovered full weight-bearing activity significantly earlier than the latter [(49.7±3.3) days vs (60.2±1.1) days, P＜0.05]. The VAS for lumbago and leg pain, as well as ODI scores were significantly improved in both groups over time (P＜0.05). In terms of imaging, the vertebral canal area and lateral recess sagittal diameter were significantly increased after surgery in both groups (P＜0.05), whereas the lumbar lordosis remained unchanged remarkably in both of them (P＞0.05). However, the decompression group was significantly less than the extended fusion group in terms of the spinal canal area [(160.3±6.6) mm² vs (179.9±1.8) mm² , P＜0.05] and the lateral recess sagittal diameter [(3.9±.01) mm vs (4.2±0.1) mm, P＜0.05] at the last follow-up. [Conclusion] The decompression under unilateral biportal endoscopy is a safe, feasible, less traumatic technique without destroy to the posterior tension band structure of the lumbar spine, does get fast recovery, and good clinical consequence.

Abstract:[Objective] To compare the clinical efficacy of unilateral biportal endoscopy (UBE) and open bilateral paravertebral intermuscular (IM) approaches for discectomy and lumbar interbody fusion in the treatment of lumbar disc herniation in middle-aged and elderly. [Methods] From January 2019 to December 2021, 67 patients who were undergoing surgical treatments for lumbar disc herniation in our hospital were included in this study, and were divided into two groups according to random number table method. The patients in the UBE group had operation conducted under UBE, while those in the IM group got discectomy and interbody fusion through the open bilateral paravertebral intermuscular approaches. The perioperative period, follow-up and imaging documents of the two groups were compared. [Results] The UBE group proved significantly less than the IM group in terms of incision length [(5.4±0.5) cm vs (7.4±0.9) cm, P＜0.001], intraoperative blood loss [(128.7±10.4) ml vs (209.6±15.4) ml, P＜0.001], time to regain walking [(3.2±0.6) days vs (5.8±1.5) days, P＜0.001] and hospitalization time [(9.6±1.3) days vs (11.4±1.5) days, P＜0.001], but the former was significantly greater than the latter in terms of operative time [(153.2±12.7) min vs (135.5±10.6) min, P＜0.001] and the number of intraoperative fluoroscopy [(5.8±1.4) times vs (4.5±0.8) times, P＜0.001]. In addition, the incidence of dural tear in UBE group was significantly higher than that in the IM group (20.6% vs 3.0%, P=0.026). With time of follow-up lasted for (15.2±1.0) months, the VAS and ODI scores in both groups were significantly reduced (P＜0.05). The UBE group was significantly superior to the IM group regrading VAS score [(2.7±0.6) vs (3.0±0.5), P=0.029] and ODI score [(30.5±4.6) vs (33.6±5.2), P= 0.012] a month after surgery, as well as ODI score 3 months after operation [(21.5±3.7) vs (24.1±4.7), P=0.014]. With respect of imaging, the dural sac area, lumbar intervertebral space height, and lumbar lordotic angle significantly increased postoperatively compared with those preoperatively (P＜0.05), while Lenke grade for fusion significantly improved over time in both groups (P＜0.05). However, there were no statistically significant differences in the above image indicators between the two groups at any corresponding time points (P＞0.05). [Conclusion] The UBE discectomy and fusion for lumbar disc herniation in the middle-aged and elderly can shorten hospital stay and reduce blood loss, which is conducive to the recovery of patients.

Abstract:Osteoporosis (OP), a systemic metabolic bone disease with characteristics of bone loss and bone mass reduction, with bone tissue microstructure destruction and increase of bone fragility that is prone to fracture, is an important hidden danger affecting the bone health in the middle-aged and elderly people in China. Accurate assessment is crucial for prevent and treatment of OP. In recent years, more and more scholars have paid attention to the research of osteoporosis by various imaging techniques, including dual-energy X-ray, computed tomography, quantitative ultrasound, magnetic resonance imaging and other technologies. In this article the research progress regarding OP assessments is reviewed to provide a reference for clinicians.

Abstract:Total joint arthroplasty (TJA) is the most common and effective treatment for end-stage joint disease, but it is often associated with a series of complications. Aseptic loosening (AL) is a key factor leading to surgical failure and subsequent revision surgery, therefore, a full understanding of the mechanism of AL is necessary for the development of an effective treatment program. Currently, it is believed that the main mechanism of AL is the activation of a series of inflammatory cells by wear debris to produce pro-inflammatory cytokines, which leads to the disruption of the dynamic bone balance of the organism, thus triggering AL. In this article, we summarize the current research status of AL, which is mainly classified into two categories: biological factors (wear debris, chemokines, autophagy, etc.) and mechanical factors (lower limb force lines, cement and implant design, and stress shielding), and elaborates on the mechanisms of its occurrence and influencing factors, with a view to providing theoretical basis for the treatment and prevention of AL.

Abstract:Subtalar arthroereisis implant has been recognized by clinicians to a certain extent because of its minimal trauma, quick recovery and easy operation. As an operative method for the treatment of flat foot in children, it has achieved good results. However, its clinical efficacy remains controversial for the treatment of acquired flat foot in adult, whereas which has still been recognized by some scholars. We reviewed the literature on subtalar arthroereisis implant use in adult acquired flat foot in recent years, reviewed the new progress in the staging classification of the foot, arthroereisis implant classification and clinical consequences of arthroereisis implant used for adult acquired flat foot in this article.

Abstract:Sacroiliac injury is a part of pelvic injury, which is often caused by high-energy trauma and often leads to the instability of the pelvic ring. At present, surgical treatment is often used to achieve reduction and fixation, so as to allow patients to move early and reduce postoperative complications. There are a variety of internal fixations for sacroiliac separation, including sacroiliac screw, anterior sacroiliac joint plate, sacral rod, tension band plate, adjustable minimally invasive plate, TightRope, S₂AI screw, posterior screw rod, anterior screw rod and Curvafix. Each method has its own characteristics, many researchers have conducted comparative studies on various methods from the perspectives of biomechanics, clinical effects, and postoperative complications, etc. However, which method is more suitable is still a challenging problem for orthopedic surgeons. This article reviews the fixation methods of sacroiliac joint dislocation at home and abroad, in order to provide reference for clinicians.

Abstract:[Objective] To investigate the potential intervention mechanism of Yougui Pills on the degenerative lumbar disc structure in rats. [Methods] Thirty male SD rats were randomly divided into 3 groups with 10 rats in each group. The normal control group was healthy rats without special treatment, while, the model group had intervertebral disc degeneration established by annulus fibrosus punctured. In addition, the drug group was given Yougui pill for 2 weeks on the basis of the model group. Serum levels of inflammatory cytokines, including IL-10, MIF and TNF-α were detected by ELISA, while the expression levels of type II collagen and Notch1 protein in intervertebral disc tissues were detected by western blot. [Results] Compared with normal control group, the serum interleukin-10 (IL-10) [(22.3±2.8) pg/ml vs (30.9±1.7) pg/ml vs (53.2±7.5) pg/ml, P＜0.001], macrophage migration inhibitory factor (MIF) [(0.3±0.0) pg/ml vs (1.3±0.3) pg/ml vs (0.6± 0.2) pg/ml, P＜0.001] and tumor necrosis factor-α (TNF-α) [(12.5±3.0) pg/ml vs (52.6±1.5) pg/ml vs (34.9±3.2) pg/ml, P＜0.001], additionally, the tissue expression of Notch1 protein significantly increased [(0.1±0.0) vs (0.8±0.1) vs (0.4±0.0), P＜0.001], while the type II collagen protein expression decreased significantly [(0.9±0.1) vs (0.2±0.0) vs (0.6±0.3), P＜0.001] in the model group and drug group. However, the drug group proved significantly higher serum IL-10 (P＜0.05), whereas significantly lower MIF and TNF-α (P＜0.05), as well as significantly higher tissue expression of type II collagen than the model group (P＜0.05). [Conclusion] TheYougui Pill can inhibit the inflammatory response and reduce the degradation of extracellular matrix in rats with intervertebral disc degeneration, thus alleviating the intervertebral disc degeneration in rats. The mechanism may be related to the regulation of Notch signaling pathway.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcomes of unilateral extrapedicular percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCF). [Methods] A total of 26 patients received unilateral extrapedicular percutaneous kyphoplasty for OVCF. The puncture needle was gradually punctured along the puncture point to the outer edge of the pedicle, and the puncture needle was adjusted. As puncture needle tip was located at the outer edge of the pedicle on the anteroposterior (AP) image, and the needle tip was adjusted to locate at the median line of the pedicle on the lateral image, then the needle was inserted about 1 cm parallel to the upper endplate. Subsequently, a trephine was inserted and advanced about 2 cm before removed. A balloon was placed along the puncture working cannula, then was slowly expanded to recover at the height of the collapsed vertebral body. After the balloon was withdrawn, and the bone cement injector was used to push the bone cement into the vertebral body at low pressure with caution until the vertebral body was filled. [Results] All the 26 patients had the extrapedicular PKP performed successfully with 1 case of bone cement leakage, 1 case of knife edge infection, 2 cases of skin edge necrosis, 3 cases of knife edge hematoma. Follow-up period lasted from 6 months to 3 years, with an average of 1.6 years. All patients got significant pain relief and regain daily life activity capacity, except 2 cases who were found new onset of fractures in other vertebrae, were given PKP again and got satisfactory recovery. No death or other serious complications occurred in anyone of them. [Conclusion] Unilateral extrapedicular percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures is feasible with shortened operation time and reliable outcomes.

Abstract:[Objective] To describe the surgical technique and preliminary clinical results of a novel load-sharing technique for arthroscopic repair of full-thickness rotator cuff tear. [Methods] From January to June 2022, 30 patients with total rotator cuff tears were treated with abovesaid arthroscopic technique. The inner row of anchors was implanted at the outer edge of the cartilage, and then the outer row of anchors was implanted anteriorly and posteriorly in the footprint area. As sutures of outer row anchors were tensioned, and the remaining sutures of inner and outer rows were tied with a double-pulley technique, in this way continuous tension distribution of the sutures achieved to avoid the direct pulling effect of the tissues by the traditional suture. Ultimately the sutures were formed W shaped network construct covering the rotator cuff tissues. [Results] All the 30 patients successfully completed the surgery without complications, with the average operation time of (94.3±21.4) min, and were followed up for (14.8±3.1) months. The VAS score decreased significantly [(4.6±0.9), (1.1±0.8), P＜ 0.001]; while the Constant-Murley score [(42.6±5.5), (76.4±3.7), P＜0.001] and the UCLA shoulder score [(12.6±2.0), (28.8±1.8), P＜0.001] improved significantly at the latest follow-up compared with those preoperatively. In addition, the shoulder forward flexion, abduction and external rotation range of motions also improved significantly (P＜0.05), and no postoperative shoulder stiffness was observed in anyone of them. Images revealed good healing and continuity of the rotator cuff at the latest follow-up. [Conclusion] This new load-sharing technique under arthroscopy is simple and feasible method to repair full-thickness rotator cuff tear, and achieves satisfactory short-term clinical outcome.

Abstract:[Objective] To investigate the clinical outcomes of lumbar decompression in the treatment of lumbo-knee syndrome. [Methods] A retrospective study was done on 35 patients who received lumbar decompression for lumbo-knee syndrome from October 2021 to January 2023. The clinical and imaging documents were evaluated. [Results] All patients had lumbar decompression performed successfully, with no cerebrospinal fluid leakage, allergic reaction, gastrointestinal discomfort and other complications. All of them were followed up for an average of (5.2±1.6) months. With time went from the point preoperatively to those 1 week, 1 month and 3 months postoperatively, the VAS score for lower limb radiation pain [(6.2±1.0), (2.4±0.7), (1.1±0.7), (0.5±0.7), P＜0.001], the VAS score for pain around the knee [(5.1±1.1), (2.1±1.1), (1.2±0.7), (0.9±0.9), P＜0.001], WOMAC score [(51.1 ±9.5), (31.5±6.6), (16.9±.0), (10.3±3.7), P＜0.001] significantly decreased, while the JOA score [(9.2±2.1), (21.3±1.8), (23.5±1.7), (24.6±1.9), P＜0.001] and Lysholm score [(55.8± 9.8), (72.3±7.3), (77.9±6.2), (85.3± 3.9), P＜0.001] significantly increased. In terms of imaging, the spinal canal area was significantly increased at 3 months after surgery compared with that before surgery [(151.9±37.2) mm² , (180.3±34.9) mm² , P=0.002]. [Conclusion] After lumbar decompression for lumbo-knee syndrome, the radiative pain of lower limbs and pain around the knee are significantly reduced, while the function of the lumbar spine and knee, as well as spinal canal area are significantly improved.

Abstract:[Objective] To evaluate the safety and clinical efficacy of unilateral biportal endoscopy (UBE) for sequestrated lumbar disc herniation (SLDH). [Methods] A retrospective study was conducted on 27 patients who received endoscopic discectomy of SLDH from July 2020 to October 2021. All the patients had the prolapsed free nucleus pulposus tissue removed by UBE under general anesthesia in prone position, and the clinical and imaging results were evaluated. [Results] All the 27 patients were operated successfully, with the average operation time of (88.5±12.8) min, with no vascular, nerve injury, spinal hyperbaric reaction and other related complications occurred during the operation, despite of dural tear in a case. As time went from that preoperative to 6 months postoperatively and the last follow-up, which was lasted for the average of (19.2±4.0) months, the VAS score for the low back pain [(3.2±1.8), (0.8±0.5), (0.2±0.2), P＜0.001], VAS score for leg pain [(7.8±1.1), (1.0±0.4), (0.4±0.4), P＜0.001] and ODI scores [(74.4±5.3), (17.8±1.3), (10.7±1.3), P＜0.001] significantly reduced, whereas the JOA score significantly increased [(14.5±2.7), (22.6±3.1), (25.9±2.8), P＜0.001]. At the last follow-up, only one patient got recurrence, and the excellent rate of clinical outcome was 96.3% based on the modified MacNa's criteria. As for imaging, the spinal canal occupied rate decreased significantly over time [(56.4±13.3)%, (8.9±3.0)%, (8.9±3.0)%, P＜0.001], while the disc height and lumbar lordotic angle of the involved level remained unchanged significantly (P＞0.05). [Conclusion] The unilateral biportal endoscopy is safe and effective in the treatment of sequestrated lumbar disc herniation, and achieves satisfactory clinical outcomes.

Abstract:[Objective] To compare the early results of tourniquet versus controlled hypotension in total knee arthroplasty. [Methods] A total of 125 patients who underwent unilateral total knee arthroplasty for knee osteoarthritis from September 2022 to January 2023 were included in this study, and divided into two groups using the random number table method. Of them, 60 patients were treated with tourniquet (the TQ group), while other 65 patients were treated with controlled hypotension (the CH group). The early clinical and laboratory data of the two groups were compared. [Results] The operation was successfully completed in both groups. Although the TQ group had significantly lower intraoperative blood loss than the CH group [(60.2±12.7) ml vs (89.1±16.5) ml, P＜0.001], the former proved significantly greater than the latter in terms of postoperative drainage volume [(160.1±39.4) ml vs (128.0±37.5) ml, P＜0.001], latent blood loss [(550.2±277.7) ml vs (420.4±273.1) ml, P=0.009], total blood loss [(770.5±275.1) ml vs (637.4±271.2) ml, P=0.007]. The ROM and HSS scores significantly increased in both groups, 5 days and 1 month postoperatively compared with those preoperatively (P＜0.05). The TQ group was significantly inferior to the CH group in terms of knee ROM [(95.5±6.4)° vs (100.5±7.1)°, P＜0.001; (106.2±8.3)° vs (109.4±7.6)°, P=0.025] and HSS score [(67.7±5.9) vs (72.3±6.9), P＜0.001; (81.1±4.6) vs (83.3±4.5), P=0.010] 5 days and 1month postoperatively. As for laboratory test, there were no statistically significant differences in preoperative Hb, Hct, APTT, PT, Fib, D-D, CRP and IL-6 between the two groups (P＜0.05). The TQ group had significantly lower Hb, Hct, APTT, PT 1 day after surgery, Hb, Hct, APTT 3 days after surgery, whereas significantly higher DD, CRP, IL-6 one day and 3 days postoperatively than the CH group (P＜0.05). [Conclusion] Total knee arthroplasty under controlled hypotension does reduce total blood loss, relieve postoperative hypercoagulability, reduce inflammatory response, and promote early recovery of knee function.

Abstract:[Objective] To investigate the clinical efficacy of tibial tuberosity osteotomy combined with double-tunnel isometric reconstruction of medial patellofemoral ligament (MPFL) in the treatment of recurrent patellar dislocation. [Methods] A retrospective study was conducted on 20 patients who received surgical treatment for recurrent patellar dislocation in our hospital from May 2017 to May 2022. All of them underwent double-tunnel isometric reconstruction MPFL combined with tibial tuberosity osteotomy. The clinical and imaging data were evaluated. [Results] All the patients had operation performed successfully with operation time of (65.3±6.7) min, and were followed up for (12.2±0.7) months. Compared with those before operation, the Lysholm score [(53.7±9.9), (86.5±6.0), P＜0.001], Kujala score [(55.5±6.3), (83.7±7.9), P＜0.001] and IKDC scores [(54.6±8.7), (86.7±6.9), P＜0.001] were significantly increased 12 months postoperatively. No further dislocation occurred in anyone of them utill the last follow-up. Radiographically, the patellofemoral congruence angle (PCA) [(28.2±4.4)°, (13.3±2.6)°, P＜0.001], patella title angle (PTA) [(23.1±4.8)°, (8.9±2.9)°, P＜0.001], tibial tubercle-trochlear groove distance (TT-TG) [(22.1± 1.74) mm, (11.9±1.9) mm, P＜0.001] and quadricep angle (Q Angle) [(23.1±2.4)°, (15.1±2.6)°, P＜0.001] decreased significantly 12 months after operation compared with those preoperatively, but the patellofemoral cartilage thickness remained unchanged (P＞0.05). [Conclusion] The tibial tuberosity osteotomy combined with double-tunnel isometric reconstruction of MPFL is an effective treatment for recurrent patellar dislocation.

Abstract:[Objective] To investigate the medium-term clinical efficacy of autologous fascia lata patch used to bridge unrepairable giant rotator cuff tear. [Methods] A retrospective study was done on 12 patients who underwent autologous fascia lata bridging for unrepairable giant rotator cuff tear from January 2017 to December 2019. According to the results of doctor-patient communication, 6 patients received open surgery (open group), while other 6 patients received arthroscopic fascia lata patch bridging (arthroscopic group). The clinical and imaging documents of the two groups were compared. [Results] All patients in both groups were successfully operated on. The open group proved significantly superior to the arthroscopic group in term of operation time [(120.0±6.6) min vs (174.1±7.3) min, P＜0.001], while the former was significantly inferior to the latter in terms of incision length [(16.5±1.0) cm vs (11.5±1.2) cm, P＜0.001] and intraoperative blood loss [(31.6±7.5) ml vs (14.1±4.9) ml, P＜0.001]. At the latest follow-up lasted for (43.1±6.4) months in an average, the VAS, ASES and Constant-Murley scores were significantly improved compared with those before surgery in both groups (P＜0.05), however, there were no significant differences in the above items between the two groups at any corresponding time points (P＞0.05). Regarding imaging, the subacromial space (SAS) was significantly increased postoperatively in both groups compared with that before operation (P＜0.05), whereas there was no significant difference in SAS between the two groups at any time points accordingly (P＞0.05). MRI showed that the fascia lata patch healed well with the supraspinatus tendon stump and the greater tubercle of humerus. [Conclusion] Fascia lata patch bridging for huge unrepairable rotator cuff tear has good medium-term efficacy, and there is no significant difference between the open surgery and the arthroscopic counterpart.

Abstract: