Abstract:[Objective] To explore the risk factors for symptomatic deep vein thrombosis (DVT) after total knee arthroplasty (TKA). [Methods] A total of 926 patients who underwent TKA in the First People's Hospital of Zunyi City from 2018 to 2023 were included in the study. The occurrence of DVT was determined by clinical and ultrasound and the risk factors for DVT occurrence were searched by using univariate comparison and multiple logistic regression analysis. [Results] Among 926 patients, 76 were diagnosed with symptomatic DVT by postoperative clinical and ultrasound examinations, with an incidence of 8.2% (76/926); while 1 case was diagnosed with pulmonary embolism by pulmonary artery CTA examination, with an incidence of 0.1% (1/926). Regarding univariate comparison, the DVT group proved significantly greater in terms of proportion of male [male/female, (23/53) vs (147/703), P=0.006], the proportion of smokers [yes/no, (14/62) vs (75/775), P=0.008], concomitant hypertension [yes/no, (50/26) vs (413/437), P=0.004], arrhythmia [yes/no, (7/69) vs (33/817), P=0.029], and lower limb venous valve dysfunction [yes/no, (57/19) vs (488/362), P=0.004], and intraoperative blood loss [(151.4±77.9) ml vs (136.0±62.3) ml, P=0.045], platelet/lymphocyte ratio (PLR) [(168.5±96.3) vs (135.5±59.7), P=0.045], neutrophil/lymphocyte ratio (NLR) [(2.9±2.0) vs (2.3±1.7), P=0.010], ESR [(20.6±19.2) mm/h vs (15.7±11.7) mm/h, P=0.002], PT [(11.5±1.3) s vs (11.3±0.8) s, P=0.007], Fbg [(3.6±2.2) g/L vs (3.0±0.7) g/L, P＜0.001], CRP [(21.8±27.4) mg/L vs (12.6±7.4) mg/L, P＜0.001], while significantly less in terms of INR [(1.0±0.1)% vs (1.1±0.1)%, P=0.007] and TT [(16.6±2.0) s vs (17.0±1.1) s, P=0.030] than the asymptomatic group. As results of multivariate logistic regression, smoking (OR=2.330, P=0.008), lower limb venous valve insufficiency (OR=2.230, P=0.027), PLR (OR=1.840, P＜0.001), hypertension (OR=1.240, P＜0.001), and CRP (OR=1.040, P=0.031) were risk factors for symptomatic DVT after TKA. [Conclusion] This study found that smoking, lower limb venous valve insufficiency, PLR, hypertension, and CRP are risk factors for symptomatic DVT after TKA, which should be noted by clinicians.

Abstract:[Objective] To explore the factors related to recurrent lumbar disc herniation (rLDH) after percutaneous endoscopic lumbar discectomy (PELD) and establish a predicting model. [Methods] A retrospective study was conducted on 286 patients who underwent PELD for lumbar disc herniation in our hospital from January 2017 to January 2020. Based on whether rLDH happened within 3 years after the primary PELD, the patients were fell into the recurrence group and non-recurrence group. Univariate comparison and multiple logistic regression analysis were performed to search the factors related to the recurrence, establish a mathematical predicting model and draw a Nomogram figure. Then, receiver operating characteristic (ROC) curve, and relative analysis were used to evaluate the clinical significance of this model. [Results] Among the 286 patients, 44 patients were diagnosed of rLDH, accounting for 15.4%, while the remaining 242 patients were confirmed as the non-rLDH, accounting for 84.6%. Regarding univariate comparison, the rLDH group was significantly greater than the nonrLDH group in terms of BMI [(25.8±3.0) vs (24.2±3.3), P=0.004] and course of disease [(17.9±18.3) months vs (10.7±16.8) months, P= 0.009]. In addition, the rLDH group had significantly more Modic change in preoperative images than the non-rLDH group[no/yes, (30/14) vs (206/36), P=0.006], the former got significantly greater range of motion (ROM) in the affected segment measured on preoperative radiographs than the latter [(9.3±3.4)° vs (7.1±2.8)°, P＜0.001]. Moreover, the rLDH group had significantly higher ratio the transforaminal approach than the non-rLDH group [transforaminal/interlaminar, (29/15) vs (118/124), P=0.036]. As results of logistic regression, the BMI (OR=1.154, 95% CI 1.031~1.291, P=0.013), disease course (OR=1.023, 95%CI 1.005~1.042, P=0.013), Modic changes (OR=3.143, 95%CI 1.369~7.070, P= 0.007), intervertebral ROM (OR=1.264, 95% CI 1.126~1.419, P＜0.001) and surgical approach ratio (foraminal/interlaminar) (OR=2.104, 95%CI 1.007~4.396, P=0.048) were independent risk factors for recurrence. The predicting model obtained by logistic regression got area under the curve (AUC) of 0.787 (95%CI 0.721~0.853) by ROC analysis, is in good agreement with the actual curve, and a large net benefit with risk threshold between 10%~50% by decision curve analysis (DCA). [Conclusion] In this study, the BMI, disease course, preoperative Modic changes, preoperative intervertebral ROM and surgical approach were risk factors for rLDH after PELD, while this predicting mode might be helpful for clinicians to determine the risk of recurrence after surgery.

Abstract:[Objective] To investigate the diagnostic value of neutrophil extracellular traps (NETs) in peripheral blood for postoperative pneumonia in elderly patients with hip fracture. [Methods] A prospective study was conducted on 57 elderly patients who underwent surgical treatments for hip fracture in our hospitals from January 2019 to February 2022. Based on whether pneumonia developed after surgery, the patients were divided into two groups, and univariate comparison and logistic regression analysis were performed to search the independent risk factor of pneumonia. Furthermore, significance of the risk factors used for predicting postoperative pneumonia was evaluated. [Results] Among the 57 patients, 19 patients (33.3%) were diagnosed with pneumonia, while the remaining 38 patients (66.7%) were of nonpneumonia. Regarding univariate comparison, the pneumonia group was significantly greater than the non-pneumonia group in terms of blood plasma myeloperoxidase-deoxyribonucleic acid (MPO-DNA) that represented NETs [(6.5±2.0) ng/ml vs (3.6±0.7) ng/ml, P＜0.05], neutrophil to lymphocyte ratio (NLR) [(6.7±1.9) vs (5.8±0.9), P＜0.05] and neutrophil to lymphocyte and platelet ratio (N/LPR) [(6.7±2.0) vs (5.4±0.8), P＜0.05], although there were no significant differences in neutrophils, lymphocytes and platelets between the two groups (P＞ 0.05). As results of logistic regression analysis, the peripheral blood NETs (OR=7.289, 95%CI 1.980~26.836, P＜0.05) and N/LPR (OR= 2.087, 95%CI 1.005~4.333, P＜0.05) were independent risk factors for postoperative pneumonia. Receiver operating characteristic (ROC) analysis showed that peripheral blood NETs predicted postoperative pneumonia with an area under curve (AUC) of 0.892, optimal cut-off of 4.2, sensitivity of 84.2%, and specificity of 76.3%. Subgroup analysis showed that the incidence of postoperative pneumonia in patients with peripheral blood NETs ≥4.2 was significantly higher than that in NETs content ＜4.2 group (64.00% vs 9.4%, P＜0.05). [Conclusion] The increased content of NETs in peripheral blood is a risk factor for postoperative pneumonia in elderly patients with hip fracture. Monitoring the content of NETs in peripheral blood is significant for the prevention and treatment of postoperative pneumonia in elderly patients with hip fracture.

Abstract:[Objective] To compare the early clinical outcomes of robot-assisted total hip arthroplasty (rTHA) with manual total hip arthroplasty (mTHA). [Methods] A retrospective research was performed on 58 patients who underwent THA in our hospital from April 2022 to November 2022. According to preoperative doctor-patient communication, 28 patients underwent the rTHA, while other 30 patients had the conventional mTHA performed. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had corresponding THA conducted successfully, with no intraoperative complications. The rTHA consumed significantly longer operation time, with significantly greater total incision length and treatment cost than those of the mTHA group (P＜0.05). However, no postoperative dislocation happened in the rTHA group, while 1 case in the mTHA group underwent revision for dislocation due to poor placement of the prosthesis. The VAS score, Harris score, hip extension-flexion and internal-external rotation (ROM) were significantly improved in both groups over time (P＜0.05). The rTHA group proved significantly superior to the mTHA group in terms of Harris score 1 month after operation [(70.8±3.3) vs (68.2±5.1), P=0.043] and at the last follow-up [(92.0±3.6) vs (89.7± 4.2), P=0.025], as well as internalexternal rotation ROM 6 months postoperatively [(48.5±5.9)° vs (44.1±6.6)°, P=0.009]. With respect of imaging, the rTHA group was significantly better than the mTHA in terms of leg length discrepancy (LLD) [(0.4±0.2) mm vs (0.6±0.3) mm, P=0.003], bilateral difference of femoral offset deviation (FOD) [(0.3±0.2) mm vs (0.7±0.5) mm, P＜0.001], bilateral difference of acetabular offset deviation (AOD) [(0.3±0.2) mm vs (0.5±0.3) mm, P=0.004], and bilateral difference of combined offset deviation (COD) [(0.4±0.4) mm vs (0.8±0.6) mm, P＜0.001], despite of that there was no significant difference in acetabular abduction angle (AAA) and acetabular anteversion (AA) between the two groups (P＞0.05). Taking Lewinnek safe zone as the standard, the rTHA group was also significantly superior to the mTHA group [cases (%), 26 (92.9) vs 21 (70.0), P=0.026]. [Conclusion] This ARTHROBOT-assisted THA does make the implant placement more accurate, with higher ratio of acetabular cup in the safe zone, which can better restore the off-set of the affected hip, and is conducive to reducing LLD with better curative effect.

Abstract:[Objective] To explore the significance of anchored Kirschner wire used as a guide in endoscopic lumbar interbody fusion (Endo-LIF) for lumbar degenerative diseases (LDD). [Methods] A retrospective study was done on 108 patients who received Endo-LIF for LDD in our hospital from January 2021 to January 2023. According to preoperative doctor-patient discussion, 53 patients had Endo-LIF performed in conventional manner with the visualizing trephine (the traditional group), while other 55 patients received Endo-LIF with the visualizing trephine following the guide by anchored Kirschner wire (the K-wire group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups successfully completed operation without serious complications. The K-wrie group proved significantly superior to the traditional group in terms of operative time [(108.1±5.5) min vs (122.4±6.5) min, P＜0.001], intraoperative blood loss [(56.3±6.7) ml vs (71.5±10.2) ml, P＜0.001], intraoperative fluoroscopy duration [(13.1±1.3) s vs (17.2±0.9) s, P＜0.001], despite of the fact that no significant differences were noted in postoperative walking time and hospital stay between them (P＞0.05).All patients in the two groups were followed up for (20.8±4.0) months, and there was no significant difference in time to regain full weight-bearing activities between the two groups (P＞0.05). As time went on, lower back pain VAS, leg pain VAS and ODI scores significantly decreased (P＜0.05), while JOA scores significantly increased in both groups (P＜0.05), whereas which were not significantly different between the two cohorts at any time points accordingly. With respect of imaging, there were no significant changes in lumbar lordosis angle in both groups at the last follow-up compared with that preoperatively (P＞0.05). At the last follow-up, there was no a significant difference in the Bridwell grade of interbody fusion between the two groups (P＞0.05). [Conclusion] Endo-LIF following guide of anchored Kirschner wiredoes achieve good results in the treatment of LDD, which can not only improve the efficiency of intraoperative laminar fenestration, reduce intraoperative bleeding, but also reduce doctor and patient radiation.

Abstract:[Objective] To compare the clinical outcomes of anterior cervical decompression and fusion (ACDF) with zero notch self-stabilizing cervical fusion cage (ROI-C) versus titanium plate-cage system (PC) for cervical spondylotic myelopathy (CSM). [Methods] A total of 112 patients who admitted to our hospital for CSM from January 2021 to July 2022 were included into this study and randomly divided into two groups by lottery. Among them, 56 patients received ROI-C, while the other 56 patients received PC as instrumented fusion implant in ACDF. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] The ROI-C group proved significantly superior to the PC group in terms of surgery time [(105.8±24.6) min vs (128.2±30.5) min, P＜0.001], intraoperative blood loss [(26.0± 4.3) ml vs (31.0±5.8) ml, P＜0.001], time to resume postoperative walking [(1.3±0.4) days vs (1.6±0.5) days, P＜0.001] and the incidence of early complications (7.1% vs 26.8%, P=0.006). There was no significant difference in time to return full weight-bearing activities between the two groups (P＞0.05). The JOA and NDI scores, as well as pyramidal tract sign were significantly improved in both groups over time (P＜ 0.05). The NDI score in ROI-C group was significantly better than that in the PC group 3 months postoperatively [(18.6±4.2) vs (20.8±4.5), P=0.009], which became not statistically significant since then between them (P＞0.05). In addition, there were no statistically significant differences in the JOA score and pyramidal tract sign between the two groups at any time points accordingly (P＞0.05). In terms of imaging, compared with pre-operation, the cervical lordosis angle and minimum sagittal spinal canal diameter were significantly increased in both groups at the last follow-up (P＜0.05), while the cervical ROM was significantly decreased (P＜0.05). At the corresponding time point, there were no statistically significant differences in the above imaging indexes between the two groups (P＞0.05). At the last follow-up, there was no statistically significant difference between the two groups in term of fusion subsidence (12.5% vs 3.6%, P=0.164). [Conclusion] The clinical outcomes of ACDF with both the instrumented-fusion methods were similar. In contrast, the ROI-C had less surgical trauma and lower incidence of early complications, and better the early clinical consequences over the PC.

Abstract:[Objective] To search the factors related to cage subsidence after posterior lumbar interbody fusion (PLIF). [Methods] A total of 91 patients who underwent L_4/5 single-segment PLIF from January to March 2018 were included in this study to observe whether cage subsidence (CS) happened after surgery. Univariate comparison and multiple logistic regression analysis were used to explore the related factors of the cage subsidence. [Results] Up to the last follow-up, 21 cases (23.1%) had CS, while the remaining 70 cases (76.9%) were of nonCS. The CS group proved significantly higher proportion of osteoporosis than the non-CS group [yes/no, (9/12) vs (10/60), P=0.005]. There were no statistically significant differences in operation time, incision length and intraoperative blood loss between the two groups (P＞0.05), but the CS group had significantly higher intraoperative endplate injury rate than the non-CS [yes/no, (3/18) vs (1/69), P=0.012]. In terms of preoperative imaging, the CS group was significantly less than the non-CS group regarding psoas major muscle rCSA [(1.5±0.4) vs (1.7±0.5), P=0.038], paravertebral muscle CSA [(4 530.3±776.6) mm² vs (5 000.5±912.8) mm² , P=0.035], paravertebral muscle rCSA [(3.0±0.7) vs (3.9± 0.8), P＜0.001], paravertebral muscle rFCSA [(2.3±0.6) vs (2.9±0.7), P＜0.001], but the former was significantly greater than the latter in vertebral body CSA [(1 547.8±309.9) mm² vs (1 321.2±296.0) mm² , P=0.003]. In term of postoperative imaging, the CS group was significantly greater than the non-CS group in PI-LL [(11.7±7.0)° vs (6.4±9.6)°, P=0.022], segmental lordosis (SL) [(6.0±3.3)° vs (3.0±3.4)°, P＜0.001], intervertebral space height [(2.9±1.3) mm vs (1.9±1.0) mm, P＜0.001]. In addition, the former got intervertebral fusion significantly later than the latter [(6.7±1.8) months vs (5.2±1.4) months, P＜0.001]. As consequence of binary multifactor logistic regression, the osteoporosis (OR= 5.967, P=0.030), greater postoperative intervertebral space height (OR=2.296, P=0.013), and greater SL (OR=1.256, P=0.041) were the risk factors, while greater paravertebral muscle rFCSA (OR=0.525, P=0.048) was the protective factor for CS. [Conclusion] Osteoporosis, excessively corrected intervertebral space height, excessively corrected SL, and smaller preoperative paravertebral muscle rFCSA are risk factors for CS after PLIF.

Abstract:[Objective] To investigate the effect of gradient-compression leg covers on stress bone injury of lower limbs in recruit training. [Method] This study was carried out at a recruit training base of a group army from March to June 2023. A total of 460 newly trained male recruits were included in this study, and were divided into wearing group and non-wearing group by random number table method, with 230 participants in each group. The new trainees in the wearing group wore the gradient compression legs cover throughout the course, while the non-wearing group did not wear the leg cover. Both groups received the same training subjects. Assessment was performed before, 1 month and 2 months after the trial to determine the occurrence of stress bone injury and compare the degrees of pain and fatigue between the two groups. [Results] At end of 2-month trial, the subjects with positive signs of stress bone injury were of 11 cases (4.8%) in the wearing group , while 44 cases (19.1%) in the non-wearing group. In addition, persons who were diagnosed with stress bone injury by MRI were of 3 cases (1.3%) in the wearing group, whereas 14 cases (6.1%) in the non-wearing group, the difference between the two groups was statistically significant (P=0.011). There was no significant difference in VAS score and Borg score between the two groups before the trail (P＞ 0.05). One month and 2 months after the trail, the wearing group proved significantly superior to the non-wearing group in terms of pain VAS score [(1.3±1.2) vs (1.7±1.3), P=0.001; (1.4±1.3) vs (1.9±1.5), P＜0.001] and Borg score [(13.0±1.1) vs (13.7±1.3), P＜0.001; (13.2±1.1) vs (13.8±1.4), P＜0.001]. [Conclusion] In the process of recruit training, the gradient compression leg cover does effectively improve the pain and fatigue relief after lower limb exercise, and reduce the incidence of stress bone injury.

Abstract:Osteoarthritis (OA) is a common joint degenerative disease with pathological changes involving articular cartilage, subchondral bone, ligaments, joint capsule and synovium. Its main manifestations are progressive cartilage degeneration and secondary hyperostosis. Early treatment options for OA include exercise and medication, but when the condition worsens, surgical treatment is required. With the continuous disclosure of human genome information, gene therapy provides a new way to solve OA. Gene therapy utilizes viral or non-viral vectors to transfer target genes into the degenerative joint cavity, enabling stable, controllable and targeted expression of target genes in joints. By reducing local inflammation, inhibiting cartilage matrix degradation and promoting cartilage matrix synthesis, gene therapy protects and repairs damaged cartilage. This article reviews the effects of OA gene therapy on inflammation and cartilage matrix metabolism, gene delivery systems, micro ribonucleic acid (microRNA) and long non-coding ribonucleic acid (LncRNA) related to this field.

Abstract:Intervertebral disc degeneration (IVDD) is a prevalent orthopedic condition that imposes a significant burden on both the social economy and human health. Currently, treatments for IVDD can only relieve patients' symptoms but cannot stop the process of disc degeneration. Inflammation stands as one of the key contributors to intervertebral disc degeneration, while damage-associated molecular pattern (DAMP) represents an essential immune response mechanism in vivo. Alarmin, as a ligand of DAMP, is a class of molecules that play an important role in inflammatory response. Alarmins encompass high mobility group box- 1 protein (HMGB1), heat shock proteins (HSPs), S100 protein family, interleukin-1α (IL-1α), and interleukin-33 (IL-33). This review aims to explore the effects and mechanisms of different alarmins on intervertebral disc degeneration, providing valuable references for future studies.

Abstract:Total knee arthroplasty (TKA) is the main treatment for the end-stage knee diseases currently. However, whether the knee prosthesis is loose has become a decisive factor to determine the success or failure of the surgical procedure, and the bone loss around the prosthesis has become an important evaluation basis. In addition, bone mass loss usually occurs in early stage secondary to TKA, which is highly correlated with implant design, surgical technique, bone loading status, and functional exercise. Despite advances in implant design and surgical techniques, TKA is still at high risk of loosening the implant. In this paper, the stress transfer mechanism, particles, inflammation, evaluation of bone loss around the prosthesis, and repair criteria after prosthetic implantation were reviewed, so as to provide reference for the prevention of prosthetic loosening in clinical settings.

Abstract:Ischemic stroke is one of the rare, but serious complications after hip arthroplasty. It has a high disability rate, and is lifethreatening in severe cases. Its pathogenesis is closely related to traumatic inflammation and thrombosis. Recent studies have found that neutrophil extracellular traps (NETs) are involved in the formation of arterial thrombosis. After hip arthroplasty, neutrophils are activated by inflammation and platelet activation, inducing the production and release of NETs, keeping blood in a hypercoagulable state, efficiently aggregating platelets, promoting thrombin production, activating part of coagulation factors, and reducing the stability of atherosclerotic plaques, leading to ischemic stroke after surgery. The detection of NETs related biomarkers can predict the occurrence of postoperative ischemic stroke, inhibit the production or promote the degradation of NETs, and provide a new direction for the prevention and treatment of postoperative ischemic stroke, and provide a new idea for the development of new drugs.

Abstract:Low back pain is a common degenerative disease of the spine that has developed to be a serious social problem. Recent studies have shown that intervertebral disc degeneration (IDD) is the primary cause of low back pain, whereas inhibiting IDD is an important target for preventing and treating LBP. Causes of IDD include ageing, genetics, mechanical stress, and nutritional deficiencies. In recent years, an increasing number of studies have reported IDD caused by mechanical stress (MS), but the exact mechanism is still unclear. This paper intends to review the mechanisms of MS-induced IDD and provide theoretical references for clinical prevention and treatment of low back pain.

Abstract:[Objective] To present the surgical technique and preliminary clinical results of unilateral biportal endoscopy (UBE) with keyhole technique for paracentral cervical disc herniation. [Methods] A patient with paracentral cervical disc herniation underwent the above treatment. The positions of the surgical portals were determined according to the preoperative images, then the working channel tube was placed onto the upper and lower sides of the lower margin of the right C₅ lamina, while the endoscope was placed in the lower portal. As surgical instruments were used in the working channel, the marginal lamina was ground thin, part of the soft tissue and the yellow ligament were removed until the responsible nerve root was fully exposed. After the adhesive tissue was removed, the protruded disc was resected by using nucleus pulposus forceps. [Results] The patient was operated on successfully, had symptoms significantly relieved postoperatively, and could get out of bed the next day. Followup period lasted for 1 year, the VAS score significantly decreased from neck and shoulder score of 5 and upper limb of 7 preoperatively to both of 2 at the latest follow-up. The NDI score significantly declined from 26.7% before surgery to 6% at the last follow-up. No long-term complications and recurrent symptoms were found. [Conclusion] Keyhole technique under UBE does significantly improve the clinical symptoms of patients with paracentral cervical disc herniation while achieving minimally invasive purpose.

Abstract:[Objective] To introduce the surgical techniques and preliminary outcomes of endoscopic decompression with facet process preservation for thoracic ossification of ligamentum flavum. [Methods] A total of 24 patients underwent abovementioned surgical treatment for thoracic ossification of ligamentum flavum. The patient was paced in prone position, and local anesthesia combined with intravenous anesthesia were used. Under C-arm fluoroscopy, a trephine was inserted onto the facet process medial margin of the affected segment. As the endoscopic system was connected, partial ipsilateral laminectomy was conducted to expose the dura with the visualizing trephine. By using laminar rongeur and grinding drill, the ipsilateral lamina was completely resected cephalocaudally. Furthermore, the contralateral lamina was removed under the base of the spinous process, and the ossified ligamentum flavum involving the spinal canal were separated and excised gradually to finish decompression to both sides of the dural edge, 1 cm above and below of the ossified ligament to regain dural pulsation. After complete hemostasis, the incision was closed in layers. [Results] All the patients were operated successfully with no serious complications, such as dural tear, nerve and blood vessel injury. Compared with those preoperatively, VAS score [(6.2±0.9), (1.6±0.7), (1.5±0.5), P＜0.001], ODI score [(55.4±8.2), (18.6±3.1), (8.5±1.2), P＜0.001] significantly improved 3 months postoperatively and at the latest follow-up. Based on the modified Macnab's criteria, the excellent and good rate of clinical outcomes was of 83.3%. [Conclusion] This endoscopic decompression with facet process preservation for thoracic ossification of ligamentum flavum is a safe and effective surgical procedure with advantage of sufficient decompression of the spinal canal and avoiding iatrogenic segmental instability in the later stage.

Abstract:[Objective] To compare the early outcomes of total knee arthroplasty (TKA) with or without plugging femoral intramedullary positioning hole. [Methods] From October 2019 to October 2021, a total of 60 patients who were undergoing initial unilateral TKA were included in this study and randomly divided into two groups. Among them, 30 patients used bone plug to seal the femoral intramedullary positioning hole, while other 30 patients had not the hole sealed, and the other surgical manipulations were the same in both groups. The early clinical and blood test results of the two groups were compared. [Results] Although there were no significant differences in operation time, incision length, postoperative walking time, and hospital stay between the two groups (P＞0.05), the plugging group proved significantly superior to the non-plugging group in terms of intraoperative blood loss [(278.7±41.3) ml vs (319.7±50.9) ml, P＜0.001] and total blood loss [(1 155.7±260.4) ml vs (1 312.0±228.3) ml, P=0.016]. The mean follow-up time was of (10.6±2.4) months. There was no significant difference in VAS and HSS scores between the two groups before surgery (P＞0.05), however, the plugging group was significantly better than the non-plugging group in terms of VAS score at 1 day [(6.7±0.4) vs (7.1±0.5), P=0.010] and 7 day [(5.4±0.6) vs (6.3±0.6), P＜0.001] postoperatively, and HSS score [(53.7±4.9) vs (49.6±3.7), P＜0.001] 1 day after surgery. With regard to blood test, there were no significant differences in Hb, Hct, ESR and CRP between the two groups before surgery (P＞0.05), the plugging group was significantly superior to the nonplugging groups regarding Hb, Hct and Hct, ESR and CRP 1, 3 and 5 days after surgery (P＜0.05). [Conclusion] Bone plug used to seal the femoral intramedullary positioning hole is simple, but efficient method to reduce blood loss in primary TKA.

Abstract:[Objective] To investigate the effect of removal of medial tibial osteophytes during unicompartmental knee arthroplasty (UKA) on postoperative lower limb alignment. [Methods] A retrospective study was done on 186 patients who received UKA in our hospital from December 2019 to December 2021. The difference of osteophyte size and hipknee-ankle angle(HKA) before and after surgery was compared, and the correlation between them was analyzed. [Results] Compared with those preoperatively, the HKA [(172.9±3.7)°, (177.2± 3.1)°, P＜0.001] increased significantly, while the osteophyte uplift [(3.6±1.9) mm, (0.3±1.0) mm, P＜0.001] decreased significantly postoperatively. In addition, Kennedy partition [0/1/2/C/3, (30/69/66/21/0), (1/20/89/71/5), P＜0.001] and osteophyte classification [large/medium/ small: (21/86/79), (0/5/181), P＜0.001] were significantly improved. Regarding correlation, the preoperative HKA was negatively correlated with preoperative osteopathic values (r=-0.308, P＜0.001). The preoperative HKA was negatively correlated with preoperative and postoperative osteophyte difference (r=-0.256, P＜0.001). In addition, there was a significant negative correlation between postoperative HKA and preoperative osteophyte value (r=-0.163, P=0.026), whereas a significant positive correlation between preoperative and postoperative HKA difference and preoperative osteophyte value (r=0.227, P=0.002), a significant positive correlation between the differences of HKA and osteophyte before and after surgery (r=0.239, P＜0.001). [Conclusion] The alignment of lower limbs after UKA is mild varus, which is mainly influenced by preoperative HKA, while the difference of medial tibial osteophytes before and after operation has no a significant impact on postoperative alignment of the lower limb.