Abstract: [Objective] To investigate the factors related to hip dislocation in children with spastic cerebral palsy. [Methods] This study involved a total of 322 children who visited our hospital and were diagnosed with spastic cerebral palsy from January 2016 to January 2024. The gross motor function classification system (GMFCS), modified Ashworth scale (MAS) and femoral head migration percentage (MP) were used to hierarchically compare differences in clinical and imaging indicators among the subgroups. The pairwise correlation between MP and clinical and imaging indexes and multiple linear stepwise regression analysis was performed to evaluate the role of related factors. [Results] According to GMFCS, there were 57 cases (17.7%) in grade I, 92 cases (28.6%) in grade II, 82 cases (25.5%) in grade III, 60 cases (18.6%) in grade IV, and 31 cases (9.6%) in grade V. According to MAS grouping, there were 22 cases (6.8%) in grade 1, 131 cases (40.7%) in grade 2, 127 cases (39.4%) in grade 3, and 42 cases (13.1%) in grade 4. According to MP group, there were 42 cases (13.0%) in ≤20% group, 109 cases (33.9%) in 20%~30% group, 90 cases (28.0%) in 30%~40% group, and 81 cases (25.1%) in ≥40% group. As results of pairwise correlation, GMFCS had a significant positive correlation with MP (r=0.621, P＜0.001), MAS had a significant positive correlation with MP (r=0.694, P＜0.001), neck-shaft angle (NSA) of the femur had a significant positive correlation with MP (r=0.701, P＜ 0.001). In addition, there was significant positive correlation between acetabular index (AI) and MP (r=0.682, P＜0.001). However, MP had no significant correlation with gestational age, birth weight, sex, age and admission weight (P＞0.05). The multiple linear stepwise regression equation was Y (MP) = -49.095+0.540×AI+4.887×MAS+0.326×NSA+2.291×GMFCS. [Conclusion] The GMFCS, MAS, NSA and AI are related factors of femoral head lateral displacement in children with spastic cerebral palsy.

Abstract:[Objective] To explore the factors impacting the postoperative outcomes of total knee arthroplasty (TKA) in hemophilia. [Methods] A retrospective study was conducted on 83 hemophilia patients (111 knees) who underwent TKA in our hospital from January 2012 to December 2020. Univariate comparison and multiple logistic regression analysis were used to explore the factors affecting the postoperative efficacy of TKA in hemophilia. [Results] All patients had significant improvement in knee function, mobility and knee score after operation. As result of univariate comparison, the excellent group proved significantly lesser than the poor group in terms of preoperative Hamilton depression scale(HAMD) [(5.1±2.3) vs (7.2±3.9), P=0.003], preoperative flexion contracture degree [(6.6±6.2)° vs (15.3±15.7)°, P= 0.003], preoperative VAS score [(2.6±1.02) vs (3.7±1.5), P＜0.001], hemophilia severity classification [mild/medium/severe, (29/17/25) vs (1/ 8/31), P＜0.001], and intraoperative blood loss [(522.5±172.5) mL vs (665.0±270.4) mL, P＜0.001], intraoperative quadriceps plasty [yes/no, (0/71) vs (7/33), P＜0.001], bilateral knee replacement under single anesthesia [yes/no, (20/51) vs (20/20), P=0.021]，while the former was significantly greater than the latter in preoperative knee ROM [(88.2 ±13.6)° vs (46.2±23.2)°, P＜0.001]. At the last follow-up, the excellent group was significantly greater than the poor group in HSS, KSS, KSF scores and postoperative knee ROM (P＜0.05), while the former proved significantly lesser than the latter in remained extent of flexion contracture, the proportion of hematoma and the proportion of revision surgery (P＜0.05). Based on the logistic regression analysis, the preoperative flexion contracture (OR=1.139, P=0.041) was an independent risk factor for poor outcome, while preoperative ROM (OR=0.872, P=0.027) was a protective factor. [Conclusion] TKA can significantly improve knee function in hemophilia, while the TKA consequence in hemophiliac is related to the preoperative ROM and the extent of flexion contracture. The better the preoperative knee motion, the better the outcome, and the greater the extent of preoperative flexion contracture, the worse the clinical consequence.

Abstract:[Objective] To explore the clinical efficacy of ankle arthroscopic debridement combined with Ilizarov technique in correcting adult talipes equinovarus. [Methods] A total of 37 adult patients (44 feet) with clubfoot from May 2019 to May 2023 were included in this study, and were divided into two groups by the random number table method. Of them, 23 feet received Ilizarov technique combined with ankle arthroscopic debridement (the debridement group), while the other 21 feet underwent traditional Ilizarov technique only without ankle arthroscopic debridement (the non-debridement group). The documents regarding to treatment period, follow-up and images were compared between the two groups. [Results] Although the debridement group consumed significantly longer operation time than the non-debridement group [(121.6±28.5) min vs (92.3±18.4) min, P＜0.001], the former had significantly shorter external fixator bearing time than the latter [(71.3±10.5) days vs (82.5±11.9) days, P=0.012]. There were no statistically significant differences in intraoperative blood loss, incision healing grade, walking time, hospital stay, the number of external fixation adjustments, and the overall incidence of complications between the two groups (P＞0.05). The patients in both groups were followed up for (6.3±3.2) months in a mean. The VAS, ICFSG and AOFAS scores, as well as ankle plantarflexion-dorsiflexion range of motion (ROM) and inversion-eversion ROM were significantly improved in both groups at the latest follow-up compared with those preoperatively (P＜0.05). There was no statistically significant difference in the abovesaid items between the two groups before the operation (P＞0.05), however, the debridement group proved significantly superior to the non-debridement group at the last follow-up in terms of VAS score [(1.8±1.2) vs (3.8±1.4) , P＜0.001], AOFAS score [(85.7±10.7) vs (74.8±11.4) , P=0.005] and ankle plantarflexion-dorsiflexion ROM [(42.8±11.4)° vs (33.6±7.8)°, P=0.005]. Moreover, the debridement group was also significantly better than the non-debridement group in the clinical excellent and good rate at the last follow-up (91.3% vs 66.7%, P=0.043). As for imaging, the debridement group was significantly better over the non-debridement group in Takakura's degeneration grade at the last follow-up [I/ II/III/IV, (16/7/0/0) vs (7/10/4/0), P=0.025], despite the fact that no statistically significant differences were noted between the two groups regarding the lateral talocalcaneal angle (LTCA), talocalcaneal angle (TCA), and talo-first metatarsal angle (TFMA) (P＞0.05). [Conclusion] The ankle arthroscopic debridement does enhance clinical consequece of Ilizarov technique correcting adult talipes equinovarus, with advantages of reducing external fixator bearing time and improving functional recovery.

Abstract:[Objective] To compare the clinical efficacy of robot-assisted total knee arthroplasty (TKA) versus traditional technique TKA for knee osteoarthritis complicated with varus deformity. [Methods] A retrospective study was conducted on 92 patients who received TKA for knee osteoarthritis complicated with varus deformity in our hospital from January 2021 to October 2023. According to preoperative doctor-patient communication, 46 patients received robot-assisted TKA (robot group), while other 46 patients received traditional TKA (traditional group). The perioperative, follow-up and imaging data were compared between the two groups. [Results] Although the robot group consumed significantly longer operative time than the traditional group [(97.2±7.8) min vs (86.7±6.5) min, P＜0.001], the former had significantly less blood loss than the latter group [(224.1±21.8) mL vs [240.2±23.6] mL, P＜0.001]. However, there was no significant difference in incision length, bed rest time, hospital stay, incision healing time and complication rate between the two groups (P＞0.05). The WOMAC score and VAS score were significantly decreased, while HSS score and extension-flexion ROM were significantly increased in both groups over time (P＜0.05), which were not statistically significant between the two groups at any time points accordingly (P＞0.05). Regarding to imaging, the FTA was significantly decreased, while the MPTA and PTS were increased in both groups postoperatively compared with those preoperatively (P＜0.05). At the latest follow-up, the robot group had significantly lesser FTA [(172.7±10.5)° vs (178.4±12.6)°, P＜0.05], while significantly greater MPTA than the traditional group [(87.7±7.4)° vs (78.8±6.5)°, P＜0.001]. [Conclusion] Robot-assisted TKA for knee osteoarthritis complicated with varus deformity achieves the same clinical efficacy as traditional TKA surgery. However, the robot-assisted surgery has longer operation time, less blood loss, and better lower limb alignment correction.

Abstract:Osteoarthritis is a common complex and multifactorial degenerative joint disease among the elderly, which is caused by various factors including but not limited to mechanical stress and aging, and is characterized by the degradation of extracellular matrix of chon-drocytes and the reduction of chondrocytes. Autophagy is a mechanism that maintains intracellular homeostasis through lysosomal degradation, and it plays a role in slowing down the progression of osteoarthritis to some extent. Various signaling pathways in the body can affect the role of autophagy in osteoarthritis. In order to explore the effects of different signaling pathways on autophagy, this study aims to discover new therapeutic strategies by reviewing a large number of literature.

Abstract:Biofilm formation is a major challenge in treating periprosthetic joint infections (PJI), often leading to tolerance to the immune system and antibiotics. However, there are few reports on intelligent non-surgical or non-invasive treatment methods for combating biofilms already formed on the implants. In recent years, photothermal therapy (PTT) and photodynamic therapy (PDT) have received increasing attention for their potential applications in the medical field due to its advantages of deeper tissue penetration, precise drug release, minimal damage to normal tissues, and high selectivity. This article provides an overview of conventional clinical methods for treating PJI and their limitations, as well as the progress in biofilm eradication following PJI using PTT and PDT, and discusses the remaining design and application challenges of these therapies in PJI treatment. It also offers new insights for clinical or preclinical research aimed at eliminating biofilms on the infected periprosthetic components.

Abstract:Knee osteoarthritis (KOA) is a common degenerative total joint disease in orthopaedics with clinical manifestations including joint pain, swelling, stiffness and limited mobility, which seriously affect the quality of life of 30% of the elderly population in China. The pathogenesis and optimal treatment of KOA are not fully understood. With the application of integrated Chinese and Western medicine in the treatment of bone and joint diseases, acupotomy therapy has been proved to be effective in alleviating joint pain in KOA, improving bone metabolism around the joint and improving joint function. Meanwhile, in recent years, the role of Ca2/NFATc1 signaling pathway in the occurrence and development of KOA has been gradually recognized, and it plays an important role in the regulation of articular cartilage. This will provide new ideas for the in-depth study of the pathogenesis of KOA and the exploration of the best treatment plan. In this study, we reviewed the research progress of the effect of acupotomy on bone metabolism in Ca2/NFATc1 signaling pathway, in order to promote the application of acupotomy in KOA.

Abstract:Aneurysmal bone cysts (ABCs) secondary to osteoblastoma (OB) is a rare primary bone tumor, most commonly seen in the spine, particularly affecting the posterior elements of the vertebrae. The majority of patients present with localized pain in the neck and back, which can lead to painful scoliosis and corresponding nerve compression symptoms. Due to its histological similarity to osteoid osteoma, multimodal imaging and pathological differentiation are necessary. Currently, surgical treatment is the most important approach for this disease, including traditional open surgery and minimally invasive surgery. This paper reports a case of lumbar OB secondary to ABCs and reviews and summarizes the literature published both domestically and internationally.

Abstract:Adult acquired flatfoot deformity is very common in clinical practice, with local pain and disrupting motor activity as the main manifestations. Currently, there is still great controversy about the treatment measures for patients. To this end, we searched PubMed, Web of Science, The Cochrane Library, the Chinese Biomedical Literature Database, and the VIP database to conduct a comprehensive analysis of the related literature. It is found that posterior tibial tendon dysfunction or spring ligament injury is the main cause of flatfoot. Symptomatic flatfoot could be treated conservatively first, and according to the characteristics of different stages of the disease, the combination of multiple surgical methods could usually achieve good results and improve the quality of life of patients. This paper comprehensively reviews the status quo to provide a basis for standardized clinical treatment for this disease.

Abstract:Ischial lesions in children are rare in clinic, with various types of disorder. It is difficult to diagnose by clinical manifestations and imaging manifestations alone, and the diagnosis and treatment are challenging due to the lack of clear guidelines for treatment selection. In this paper, 6 patients with ischial diseases were reported, and the previous literature was reviewed and summarized. Through the combination of clinical manifestations, laboratory test, imaging examination and pathological findings, a total of 29 patients were diagnosed with 14 kinds of disease, including benign tumors, specific or non-specific infections, whereas malignant tumors were rare. After the definitive diagnosis, the final treatment should be diversified according to the type and location of the lesion, among which surgical treatment is the mainstream choice, and clinicians should formulate a reasonable surgical approach to avoid iatrogenic injury.

Abstract:Sarcopenia, a muscle degeneration syndrome that develops with age, is characterized by decreased volume and number of skeletal muscle fibers, decreased muscle strength, and functional decline. First proposed by Rosenberg in 1989, it was formally defined by the European Working Group on Sarcopenia in Older People (EWGSOP) in 2010. Sarcopenia is a common skeletal muscle disease mostly in the elderly, can lead to the continuous reduction of skeletal muscle mass and strength, and is seriously harmful to patients with orthopedic diseases, and increases the occurrence of complications during treatment, which is not conducive to the rehabilitation and prognosis of patients. In this paper, the definition, epidemiology and diagnostic consensus of sarcopenia were summarized, and the influence of sarcopenia on orthopedic surgery in elderly was summarizedto provide a reference for clinical research.

Abstract: [Objective] A Mendelian randomization (MR) study was conducted to explore the causal association between multiple risk factors and osteonecrosis. [Methods] Relationship of the nucleotide polymorphisms of exposure factors, including smoking, alcohol abuse, obesity, anxiety, depression, glucocorticoids and outcome events (osteonecrosis) were investigated by means of publicly available genomewide association study (GWAS) databases and the FinnGen Biobank (FGB). The inverse-variance weighted (IVW) method, supplemented by the MREgger method, weighted median (WME), weighted mode (WM), and simple mode (SM), were used to testing and calibrating the results of the study. Heterogeneity test, sensitivity analysis, and multiple validity test were conducted to verify the stability of the results. [Results] As results of IVW, smoking (OR=1.379, 95%CI: 1.073~1.773, P=0.012), alcohol abuse (OR=3.059, 95%CI: 1.080~8.665, P=0.039), depression (OR=1.542, 95%CI: 1.050~2.264, P=0.027), and glucocorticoids (OR=1.357, 95%CI: 1.046~1.760, P=0.021) were positively and causally associated with the risk of osteonecrosis. The sensitivity analyses showed the consequence was stable and reliable, while the tests for multiplicity showed no horizontal pleiotropy. [Conclusion] The results of this study suggest that smoking, alcohol abuse, depression, and glucocorticoids increase the risk of developing osteonecrosis, whereas there is insufficient evidence of a causal association between obesity and anxiety and osteonecrosis.

Abstract:[Objective] To introduce the technique and preliminary clinical consequence of staging treatment of proximal femoral benign tumor complicated with pathological fractures. [Methods] From January 2016 to September 2021, 16 patients received abovementioned treatment for proximal femoral benign tumors with pathological fractures. After admission, the general condition of the patients was assessed, the nature of the tumor was determined by puncture biopsy, and conservative treatment methods such as bed rest and traction were given. As the fractures basically healed according to X-ray taken regularly, the surgical intervention was conducted. During the operation, a fenestration on the bone shell was made to debride the lesion carefully and thoroughly with curettes, and then bone graft substitutes was fully filled into the bone cavity without leaving empty space, finally, appropriate internal fixation was placed to strengthen the local bone strength. [Results] All the 16 patients successfully completed the operation, without complications such as nerve and vascular injury. The patients were followed up for 8 to 80 months with a mean of (23.8±18.6) months. At the last follow-up, all the patients regained normal range of motions of the hip with MSTS lower extremity score of (28.7±1.0), ranged from 27 to 30. No recurrence or metastasis happened in anyone of them during the followup. [Conclusion] This staging treatment does preserve joint function, avoid joint replacement, and achieve good clinical outcome, which is a feasible therapy for neoplastic pathological fractures of the proximal femur.

Abstract:[Objective] To introduce the surgical techniques and preliminary clinical results of capsuloplasty combined with pelvic osteotomy for the treatment of congenital dislocation of the hip (CDH) in older children. [Methods] A total of 19 older children (19 hips) received Colonna capsuloplasty combined with Chiari pelvic osteotomy for mismatched CDH from September 2017 to August 2021. The Bikini approach was used to expose the anterior hip capsule and protect the ascending branch of the medial femoral circumflex artery. The capsule was cut at anterior surface, inferomedial margin, superomedial margin and posterior surface successively to release the transverse ligament at the base of the acetabulum. The capsule was trimmed to enclose the femoral head, and then acetabulum was reamed step by step to match the head capsule complex. Finally, the pelvic transverse transportation was conducted as pelvic osteotomy finished to enhance coverage of the head capsule complex. [Results] All the 19 patients were followed up for an average of (1.9±0.8) years. At the latest follow-up, RI was of (0.02±0.06), while the CEA was of (40.2±4.3)°. At the last follow-up, all children achieved stable gait and joint motion, and had no complications, such as avascular necrosis of the femoral head and implant broken. According to the improved Severin classification the excellent and good rate was of 84.2%, while based on the McKay creatria, the excellent and good rate of 78.9%. [Conclusion] The Colonna capsuloplasty combined with Chiari pelvic osteotomy for mismatched CDH in older children does achieve satisfactory early clinical outcome.

Abstract: [Objective] To investigate the clinical efficacy of single-plane distal tibial tuberosity high tibial osteotomy (DTT-HTO) in the treatment of medial knee osteoarthritis. [Methods] A retrospective research was done on 70 patients who had medial knee osteoarthritis treated by DTT-HTO in our hospital from March 2021 to March 2023. The clinical and imaging documents were evaluated. [Results] All the 70 patients had DTT-HTO performed successfully without serious adverse reactions and complications. All patients were followed up for an average of (19.5±3.7) months, and resumed the full weight-bearing activity in an average of (58.0±5.2) days. With time elapsed 1, 8 weeks and the last follow-up, the local pain VAS score [(4.8±0.9), (0.5±0.8), (0.1±0.3), P＜0.001] and knee pain VAS score [(6.9±0.9), (2.4±0.7), (1.4±0.7), (0.7±0.6), P＜0.001] were significantly declined, while the HSS score [(54.0±9.2), (64.9±3.7), (82.0±4.1), (86.5±4.0), P＜0.001] and Lysholm score [(45.8±6.3), (59.5±3.9), (83.5±4.1), (89.6±3.6), P＜0.001] were significantly increased. Radiographically, the weight-bearing alignment ratio (WBAR), femorotibial angle (FTA), medial proximal tibial angle (MPTA), posterior tibial slope (PTS) and K-L scale were significantly improved over time preoperatively, 1, 8 weeks postoperatively and at the last follow-up (P＜0.001). [Conclusion] This singleplane DTT-HTO is an effective treatment for medial knee osteoarthritis. The main source of early postoperative pain comes from operative area, and targeted rehabilitation exercise and treatment should be carried out.

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