Abstract:[Objective] To investigate the significance of synovial D-Dimer (D-D) and synovial fibrin degradation product (sFDP) in the diagnosis of periprosthetic joint infection (PJI). [Methods] A retrospective study was conducted on 49 patients with PJI (the PJI group) and 32 patients with aseptic prosthesis loosening (the APL group) in our hospital from March 2020 to June 2023. The receiver operating characteristic curve was used to analyze the area under curve (AUC), optimal cutoff value, sensitivity and specificity of each parameter for PJI diagnosis. The statistical method of Delong et al. (1988) was used to compare the ROC results of each item in PJI diagnosis. [Results] The PJI group proved significantly higher than the APL group in terms of WBC [(6.8±2.1)×10⁹ /L vs (5.8±1.6)×10⁹ /L, P=0.026], neutrophils ratio [(63.8±8.2)% vs (55.5±13.0)%, P＜0.001], C-reactive protein (CRP) [(29.8±35.6) mg/L vs (1.7±2.6) mg/L, P＜0.001], erythrocyte sedimentation rate (ESR) [(63.4±32.5) mm/h vs (16.2±14.6) mm/h, P＜0.001], fibrinogen, FIB) [(4.8±1.5) g/L vs (2.8±0.7) g/L, P＜0.001], D-dimer (D-D) [(961.3±639.4) g/L vs (385.2±429.4) g/L, P＜0.001], sFDP [(3 514.3±2 030.7) mg/L vs (1 222.0±1 352.6) mg/L, P＜0.001]. As results of ROC analysis, the CRP (AUC=0.924, sensitivity=87.8%, specificity=84.4%), ESR (AUC=0.913, sensitivity=85.4%, specificity= 81.3%), FIB (AUC=0.892, sensitivity=73.5%, specificity=96.9%), sFDP (AUC=0.875, sensitivity=71.4%, specificity=90.6%) showed good value in the diagnosis of PJI, while D-D value was average (AUC=0.809, sensitivity=65.3%, specificity=84.4%). [Conclusion] sFDP can be used as a new auxiliary parameter in the diagnosis of PJI.

Abstract:[Objective] To explore the factors related to perioperative hypoproteinemia of total hip arthroplasty (THA) in elderly women. [Methods] A total of 476 elderly female who had THA performed in our hospital from January 2022 to June 2023 were included in this study. Univariate comparison and multiple logistic regression analysis were used to explore the related factors of hypoproteinemia. R software was used to construct the nomogram prediction model, and ROC curve, calibration curve and decision curve were drawn to analyze and evaluate the efficiency of the model. [Results] Among 476 female patients, 109 suffered from perioperative hypoproteinemia, accounting for 22.9%. As consequence of univariate comparison, the hypoproteinemia group proved significantly higher than the normal group in terms of age [(75.7±4.8) years vs (69.7±5.0) years, P＜0.001], the proportion of femoral neck fracture [femoral neck fracture/femoral head necrosis, (73/ 36) vs (191/176), P=0.006], Creactive protein (CRP) [(22.1±25.9) mg/L vs (14.8±21.5) mg/L, P=0.008], erythrocyte sedimentation rate (ESR) [(29.6±22.1) mm/h vs (22.0±16.7) mm/h, P＜0.001], D-dimer (DD) [(5.2±5.7) μg/mL vs (3.1±1.1) μg/mL, P＜0.001], hospital stay [(10.9±4.4) days vs (9.7±3.2) days, P=0.002], whereas the former was significantly lower than the latter in terms of diabetes [yes/no, (9/100) vs (77/290), P=0.002], BMI [ (23.3±3.8) kg/m2 vs (24.5±3.6) kg/m2 , P=0.002], RBC [(4.0±0.4) 10¹²/L vs (4.2±0.5) 10¹²/L, P＜0.001], PLT [(184.9±64.8) 10⁹ /L vs (200.9±66.2) 10⁹ /L, P=0.027], Ca [(2.26±0.11) mmol/L vs (2.32±0.11) mmol/L, P＜0.001]. Regarding to multivariate logic regression, age (OR=1.266, P＜0.05), preoperative ESR (OR=1.029, P＜0.001) were risk factors for postoperative hypoalbuminemia, while the diabetes (OR=0.336, P=0.013), BMI (OR=0.924, P=0.040), preoperative PLT (OR=0.995, P=0.015) and preoperative serum Ca(OR=0.050, P=0.016) were protective factors. The area under curve (AUC) of the nomogram model was of 0.857, indicating that the prediction model had a good differentiation capacity. [Conclusion] Based on six independent risk factors: age, BMI, diabetes mellitus, preoperative platelet, preoperative calcium and preoperative sedimentation rate, the histogram can effectively predict the risk of postoperative hypoproteinemia of THA in elderly women. The nomogram model has good differentiation ability and accuracy, and might lead better clinical net benefits for patients.

Abstract: [Objective] To explore the clinical efficacy of proximal femoral posterolateral wing plate combined with proximal femoral nail anti-rotation (PFNA) in the treatment of the femoral intertrochanteric fractures involving the lateral wall. [Methods] A retrospective study was conducted on 60 patients who underwent surgical treatment for the intertrochanteric fractures involving the lateral wall in our hospital from January 2021 to January 2022. According to doctor-patient communication, 30 patients were treated with proximal femoral posterolateral wing plate combined with PFNA (the combined group), while other 30 patients underwent PFNA alone (the simple group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] Although the combined group consumed significantly longer total incision length [(7.3±2.4) cm vs (6.1±1.4) cm, P=0.018] with more intraoperative blood loss [(32.4±11.3) mL vs (25.5±15.2) mL, P=0.036] than the simple group, there were no statistically significant differences in operation time, intraoperative fluoroscopy times, incision healing grades, hospital stay, and ambulation time between the two groups (P>0.05). Over time of the follow-up period lasted for (18.5± 3.2) months in a mean, the VAS and Harris scores, as well as hip flexion-extension range of motion (ROM) and internal-external rotation ROM were significantly improved in both groups (P<0.05). The combined group proved significantly superior to the simple group in terms of the VAS score [(1.4±0.7) vs (3.2±2.3), P<0.001], Harris score [(89.6±12.6) vs (58.3±17.5), P<0.001], hip flexion-extension ROM [(136.9± 7.4)° vs (78.4±24.2)°, P<0.001] and internal-external rotation ROM [(39.5±3.3)° vs (17.3±8.3)°, P<0.001] 12 months postoperatively. As for imaging, the combined group was significantly better than the simple group in Baumgaertner fracture reduction grade [excellent/fair/poor, (26/4/0) vs (15/7/8), P=0.003]. At 12 months after surgery, the combined group was also significantly better than the simple group regarding femoral neck shaft angle (FNSA) [(113.9±6.3)° vs (87.3±23.9)°, P<0.001] and tip-apex distance (TAD) of the PFNA helical blade [(14.3±5.4) mm vs (31.6±13.2) mm, P<0.001]. In addition, the combined group proved significantly higher proportion of fracture healing within 12 weeks and 12~20 weeks after surgery over the simple group (P<0.05). [Conclusion] Compared with simple PFNA, the proximal femoral posterolateral wing plate combined with PFNA does significantly promote functional recovery and fracture healing for femoral intertrochanteric fractures involving the lateral wall.

Abstract:[Objective] To explore the factors related non-infection poor incision healing after hip and knee surgeries. [Methods] A retrospective study was done on wound healing condition of 938 patients who underwent hip and knee surgeries from June 2021 to June 2024. Univariate comparison and multiple factor logistic regression analysis were used to explore the factors related to poor incision healing. [Results] All the 938 patients had corresponding surgical procedures performed successfully, with 30 patient graded as postoperative non-infection poor incision healing (PIH), accounting for 3.2%. The PIH group proved significantly greater than the normal healing group in terms of BMI [(26.0±3.6) kg/m2 vs (23.6±3.8) kg/m2 , P=0.004], diabetes mellitus [yes/no, (14/16) vs (11/49), P=0.020], smoking [yes/no, (16/14) vs (11/ 49), P＜0.001], proportion of DAA approach [DAA/PLA/ anterior knee, (25/1/4) vs (25/29/6), P＜0.001], intraoperative blood loss [115.0± 73.2) mL vs (95.9±83.5) mL, P=0.013], surgeon skill level [primary/medium/high, (9/17/4) vs 6/25/29), P＜0.001]. As consequence of multivariate logistic regression, smoking (OR=6.776, P=0.003), surgeon skill level (OR=3.865, P=0.007) and surgical approach (OR=2.379, P= 0.040) were independent risk factors for poor incision healing after hip and knee surgeries. [Conclusion] Surgical approach, the surgeon skill level and smoking are the main risk factors for postoperative poor incision healing.

Abstract:[Objective] To compare the clinical efficacy of navigation assisted high tibial osteotomy (NA-HTO) versus conventional free-hand HTO (FH-HTO). [Methods] A retrospective research was done on 40 patients who had knee osteoarthritis treated by HTO in our hospital. According to the preoperative doctor-patient communication, 20 patients received NA-HTO, while other 20 patients underwent FH-HTO. The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had corresponding surgical procedures conducted successfully. Although the NA-HTO consumed significantly longer operation timer than the FHHTO group [(118.3±9.6) min vs (86.0±14.5) min, P＜0.001], the former was significantly better than the latter in terms of fluoroscopic times [(23.9±2.9) vs (30.6±2.0), P＜0.001), total incision length [(6.4±0.8) cm vs (8.2±1.0) cm, P＜0.001], intraoperative blood loss [(68.5±16.3) mL vs (104.5±21.4) mL, P＜0.001], ambulation time [(3.4±0.5) days vs (4.8±0.84) days, P＜0.001] and hospital stay [(6.8±1.0) days vs (8.6±1.4) days, P＜0.001]. The patients in both groups were followed up for more than 12 months, and the NA-HTO group resumed full weight-bearing activity significantly earlier than the FH-HTO group [(41.1±4.8) days vs (54.2±6.8) days, P＜0.001]. The VAS, Lysholm, HSS scores and knee ROM were significantly improved in both groups over time (P＜0.05). The NA-HTO group was significantly superior to the FH-HTO group in Lysholm [(69.2±3.2) vs (64.6±4.1), P＜0.001] and HSS scores [(67.3±3.1) vs (62.0±1.7), P＜0.001] one month postoperatively, whereas which became not statistically significant between the two groups 6 and 12 months after surgery (P＞0.05). Regarding imaging, the femoro-tibial angle (FTA), medial proximal tibial angle (MPTA) and mechanical axis deviation (MAD were significantly improved at the last followup compared to those preoperatively (P＜0.05). However, the posterior tibial slope (PTS) remained not significantly changed in the NA-HTO group (P＞0.05), while significantly increased in the FH-HTO group (P＜0.05). At the last follow-up, the NA-HTO was also proved significantly superior to the FH_HTO group regarding FTA [(172.7±1.0)° vs (174.9±1.7)°, P＜0.001], PTS [(6.5±1.0)° vs (7.9±1.7)°, P=0.002] and MAD [(4.2±2.9) mm vs (7.9±4.5) mm, P=0.004]. [Conclusion] Compared with the conventional freehand HTO, the navigation assisted HTO has significant advantages in intraoperative accuracy, trauma reduction and alignment correction.

Abstract: [Objective] To assess the impact of depression on total knee arthroplasty (TKA) outcomes by using the large-scale PearlDiv-er database. [Methods] A total of 126 513 patients with depression and 126 513 patients without depression who underwent primary TKA between 2010 and 2022 were identified and matching selected from the PearlDiver database. Multivariable regression analysis was performed to compare medical complications within 90 days postoperatively and surgical complications within 5 years between the two groups. [Results] Within 90 days postoperatively, the depression group proved significantly higher than the non-depression group in terms of pneumonia incidences [n (%), 1 766 (1.40) vs 1 225 (0.97), P＜0.001], cerebrovascular accident [929 (0.7) vs 657 (0.5), P＜0.001], deep vein thrombosis [3 057 (2.4) vs 2 738 (2.2), P＜0.001], blood transfusion [3 213 (2.5) vs 2 518 (2.0), P＜0.001], acute kidney damage [2 214 (1.8) vs 1 859 (1.5), P＜0.001], urinary tract infection [6 388 (5.1) vs 4 855 (3.8), P＜0.001], sepsis [902 (0.7) vs 575 (0.5), P＜0.001] and wound complications [1 667 (1.3) vs 1 226 (1.0), P＜0.001]. In addition, the depression group was also significantly greater than the non-depression group in terms of incidence of periprosthetic joint infection, prosthesis instability, periprosthetic fracture and revision TKA 90 days, 1 year, 2 years and 5 years after surgery (P＜0.001). The depression group also had significantly higher chance of emergency department visits and readmission than the non-depression group within 90 days after surgery (P＜0.001). The depression group proved significantly higher incidence of aseptic loosening than the non-depression group 1, 2 and 5 years after surgery (P＜0.001). However, the depression group had significantly lower number of manipulation under anesthesia (MUA) than the non-depression group 90 days, 1 year, 2 years and 5 years after TKA (P＜0.001), and there were no a significant difference in the incidence of aseptic loosening between the two groups 90 days after surgery (P= 0.042). [Conclusion] The depression before TKA is associated with higher risk of medical and surgical complications, which should be evaluated carefully, and take better perioperative planning and more detailed post-operative management to improve surgical outcomes.

Abstract:This article reports six-case revision total hip arthroplasty (THA) for failed THA in patients with congenital dislocation of the hip (CDH), with the failure causes of prosthetic loosening, periprosthetic fractures, and acetabular or femoral bone defects. Due to the inherent anatomical abnormalities in CDH, the complications following THA and revision surgeries are particularly challenging. In this study, all six patients underwent preoperative planning assisted by the Artificial Intelligence Preoperative Planning System for Total Hip Arthroplasty (AI-HIP), which helped design the revision strategies tailored to their specific hip structures, and achieved satisfactory outcomes. Additionally, this article reviews the literature to highlight the structural characteristics of CDH, reasons for revision, surgical challenges, and the application of AI-HIP in revision planning, aiming to provide a reference for clinical practice.

Abstract:Ankle sprain (AS) is one of the most common injuries of the human locomotor system, and about 40% of patients with acute ankle sprain will eventually develop chronic ankle instability (CAI), and the prevention and treatment of its long-term complications has become an important research topic in the field of sports medicine. The mechanism of CAI involves multiple factors and the interactions between them, such as proprioceptive disorders, neuromuscular control abnormalities, and changes in joint mechanics. The main risk factors include endogenous factors, such as age, weight, and biomechanics, and exogenous factors, such as exercise habits and posture control. This article summarizes the relevant literature at home and abroad in recent years, and reviews the research progress of CAI-related risk factors, in order to provide a reference for early identification of high-risk factors and targeted preventive measures, reducing the incidence of CAI, and improving the prognosis of the patients.

Abstract:The ankle medial ligament, also known as deltoid ligament complex (DLC), is one of major ligamentous structures to maintain the ankle stability, which limits excessive valgus and external rotation of the ankle, and keeps the talus in normal anatomical position. However, the DLC injury is often overlooked in present clinical practice, and there is a lack of unified diagnostic and therapeutic standards for this ligament. This article collects relevant domestic and foreign literatures, and makes a review on the anatomical characteristics, clinical manifestations and imaging features of DL injury, as well as the latest treatment methods for DLC injury aiming to improve understanding of DL injury, avoid the incidence of misdiagnosis and missed diagnosis, provide timely and accurate diagnosis for the majority of patients, and formulate standardized treatment methods for clinical reference.

Abstract:[Objective] To analyze the Caveolin-1 expression variation in diabetes mellitus (DM) and osteoarthritis (OA) in rat. [Meth ods] Forty 8-week-old male SD rats were randomly divided into 4 groups, including normal control (NC) group, DM group, OA group, and DM+OA group. Accordingly, the OA model was created by modified Hulth method, while the DM model was induced by high-fat and highsugar diet for 4 weeks plus intraperitoneal injection of low dose streptozocin (STZ). The DM+OA model had DM made 4 weeks after OA modeling. At the 12th week, the rats were executed and the knee cartilage tissues were harvested to evaluate the degree of articular cartilage degeneration, detect the expression of caveolin-1, and analyze the correlation between caveolin-1 and Mankin's score. [Results] After 4 weeks of high-fat feeding, the DM group and DM+OA group were significantly higher than the NC group and OA group in terms of body weight [(412.5±18.5) g vs (410.6±11.0) g vs (382.3±18.6) g vs (380.0±16.0) g, P＜0.001] and blood glucose [(5.8±0.1) mmol/L vs (5.9± 0.1) mmol/L vs (5.6±0.1) mmol/L vs (5.6±0.1) mmol/L, P＜0.001]. However, the DM and DM+OA groups were significantly lower than the NC and OA groups in body weight [(336.7±17.0) g vs (333.4±14.2) g vs (403.8±8.7) g vs (398.1±13.2) g, P＜0.001], although former remained significantly higher blood glucose than the latter [(8.9±0.6) mmol/L vs (8.8±0.4) mmol/L vs (5.6±0.3) mmol/L vs (5.6±0.3) mmol/L, P＜0.001] 2 weeks after STZ injection. Compared with NC group and OA group, the DM group and DM+OA group were significantly increased in serum insulin [(13.0±1.0) μU/mL vs (13.5±1.0) μU/mL vs (27.9±0.8.0) μU/mL vs (28.2±1.2) μU/mL, P＜0.001] and insulin resistance index [(3.2±0.3) vs (3.3±0.3) vs (11.9±0.5) vs (12.1±0.6), P＜0.001]. Compared with that in the NC group, the Mankin's score [(0.5±0.1) vs (3.5±0.7) vs (7.1±0.7) vs (11.7±1.0), P＜0.001] in the DM, OA and DM+OA groups was significantly increased, with statistical significance in pairwise comparison between any two groups (P＜0.05). Compared with that in the NC group, the caveolin-1 expression in DM, OA and DM+OA group was significantly increased [(0.7±0.7) vs (2.2±0.9) vs (9.0±2.0) vs (11.0±1.5), P＜0.001], with statistical significance in pairwise comparison between any two groups (P＜0.05). The expression level of caveolin-1 in rat cartilage was positively correlated with Mankin's score (r=0.910, P＜0.001). [Conclusion] The expression of caveolin-1 is increased in articular chondrocytes of rats with OA and T2 DM, which is positively correlated with the extent of articular cartilage injury.

Abstract:[Objective] To compare the stress shielding and biomechanical performance of the extramedullary proximal femoral prosthesis versus the intramedullary counterpart. [Methods] CT data of the sawbones femur were collected to establish the femoral model. Models of the extramedullary prosthesis and intramedullary prosthesis were respectively constructed, and the static load of 2 300 N was applied based on ISO 7206-4 standard in the Abaqus software, and the stress shielding and stress distribution of the femur after implantation in the extra-medullary group and intramedullary group were compared and analyzed. [Results] Under a physiological load of 2 300 N, the extramedullary group was significantly lower than the intramedullary group in terms of stress shielding IX1 [(-10.6±0.5)% vs (48.2±0.5)%, P=0.008], I2 [(- 26.0±3.2)% vs (42.4±0.5)%, P=0.008], IX2 [(-13.0±2.1)% vs (45.4±2.1)%, P＜0.001], I3 [(-16.4±3.9)% vs (46.2±2.3)%, P＜0.001], I4 [(- 22.6±7.4)% vs (39.0±2.3)%, P＜0.001], O1 [(14.2±13.6)% vs (57.6±6.2)%, P=0.008], O2 [(-27.8±13.0)% vs (42.6±6.6)%, P＜0.001], O3 [(- 54.0±17.6)% vs (43.2±7.3)%, P＜0.001], and O4 [(-52.0±10.4)% vs (15.4±8.8)%, P＜0.001]. There was no statistically significant difference in the stress shielding degree at the I1 site between the two groups (P＞0.05). However, there was no a statistically significant difference in the mean stress on the femur at the I1 site between the two groups (P＞0.05). The extramedullary group was significantly higher than the intramedullary group regarding the mean stress at the other sites (P＜0.05). [Conclusion] The extramedullary proximal femoral prosthesis can significantly reduce the stress shielding effect and enhance the biomechanical strength on the femur, providing a new idea for the design of hip prostheses.

Abstract:[Objective] To present the surgical technique and preliminary clinical outcomes of long-term cement-occupying fixation of knee for periprosthetic joint infection (PJI). [Methods] A total of 13 patients received abovesaid treatment for knee PJI. The original incision was used to debride and remove all the prosthetic components. After that, an intramedullary cemented rods were made according to the size of medullary cavities, and tightly inserted into the cavities. Subsequently, bone cement was mixed and filled into the knee joint cavity, holding the knee flexion of 5°~10° and axial alignment of 180° in coronal plane until the cement solidified. [Results] All patients underwent surgery successfully and were followed up for 18~24 months. At the last follow-up, 12 patients (92.3%) had no recurrent infection, with remarkably relieved pain and improved knee function. [Conclusion] As compromised patients with knee PJI have large bone defects, sinus tract and poor soft tissue conditions, the risk of reinfection is a considerable problem. In this condition, long-term cement spacer could effectively eradicate infection and improve postoperative pain and function, restore partial lower limb function.

Abstract: [Objective] To investigate the improved imaging evaluation of acetabular prosthetic coverage after total hip arthroplasty (THA) for Crowe type III developmental dysplasia of the hip (DDH). [Methods] In this study, based on the CT data of 15 patients (16 hips) with Crowe type III DDH, the 3D printed pelvic models were made to simulate THA operation, and standard anteroposterior X rays were taken. The traditional technique (the traditional group) and improved technique (the improved group) were used to calculate the coverage rate based measurements on the X ray films, in addition, the real prosthetic coverage was measured on the 3D printed models. The measurement accuracy of the two methods was compared with the real data. [Results] The mean prosthetic coverage rates of the traditional group, the improved group and the real data were (71.3±3.2)%, (77.4±3.5)%, and (79.7±2.9)%, respectively, and the mean differences among the three groups were statistically significant (P＜0.001). The difference between the traditional method and the real measurement was of 8.4% (P＜ 0.001), while the difference between the improved method and the real measurement was considerably decreased, only 2.4% (P=0.041). [Conclusion] Compared with the traditional method, the improved method does more accurately evaluate the coverage of acetabular component after total hip arthroplasty for Crowe type III DDH.

Abstract: [Objective] To evaluate the clinical efficacy of periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH) complicated with osteonecrosis of the femoral head (ONFH). [Methods] A retrospective study was performed on 7 patients (8 hips) who received PAO for DDH complicated with ONFH in our hospital from 2017 to 2023. The clinical and imaging data were evaluated. [Results] All patients had PAO performed smoothly. Compared with those preoperatively, the iHOT-12 [(65.5±13.0), (85.0±25.0), P=0.024], Harris score [(63.8±10.6), (81.9±15.5), P=0.013], hip extension ROM [(8.9±2.3)°, (11.7±3.5)°, P=0.015], hip rotation ROM [(11.1±7.5)°, (22.2±10.0)°, P=0.013] were significantly increased at the latest follow-up. As for imaging, the acetabulum coverage [(66.1±5.7)%, (92.4± 3.4)%, P＜0.001], Sharp angle [(45.4±2.2)°, (33.9±5.5)°, P＜0.001], lateral center-edge angle (LCEA) [(16.3±5.8)°, (43.4±3.2)°, P＜0.001], Tonnis angle [(18.0±6.5)°, (7.0±5.6)°, P＜0.001] were significantly improved at the last followup compared with those before operation. [Conclusion] On the basis of improving acetabular containment for DDH, the PAO can also transfer the necrotic area of ONFH to the nonweight-bearing area. It can achieve the purpose of promoting bone repair, improving hip joint function and delaying arthritis.

Abstract:[Objective] To evaluate the diagnostic value of metagenomic next-generation sequencing (mNGS) for osteoarticular tuberculosis. [Methods] A retrospective study was conducted on 72 patients who were diagnosed with osteoarticular infectious diseases in Qingdao Public Health Clinical Center from January 2022 to June 2023, including 46 cases (63.9%) of tuberculosis (the tuberculosis group) and 26 cases (36.1%) of non-tuberculosis (the non-tuberculosis group). The data of the two groups were compared to evaluate the efficacy of three tuberculosis detection methods and their combined detection. [Results] Although the tuberculosis group had significantly lower ESR [(62.9± 38.4) mm/h vs (85.5±42.6) mm/h, P=0.033], and CRP [(38.8±35.3) mg/L vs (75.4±53.6) mg/L, P=0.001] than the non-tuberculosis group, the former proved significantly higher than the latter in terms of positive rates of conventional culture [n, positive/negative, (27/19) vs (0/26), P＜ 0.001], Xpert [n, positive/negative, (30/16) vs (0/26), P＜0.001], and mNGS [n, positive/negative, (32/14) vs (0/26), P＜0.001]. Regarding efficient comparison of the 3 tuberculosis detections, and their combinations, the mNGS (sensitivity 69.6%, negative predictive value 65.0%, Kappa value 0.623) and Xpert (sensitivity 65.2%, negative predictive value 61.9%, Kappa value 0.575) were significantly superior to the conventional culture (sensitivity 58.7%, negative predictive value 57.8%, Kappa value 0.506) in diagnostic efficacy for osteoarticular tuberculosis. Moreover, the combined tests of mNGS with conventional culture, or Xpert had better diagnostic efficacy than any single detection method. [Conclusion] The mNGS can effectively detect the pathogenic bacteria of osteoarticular infectious diseases and has important diagnostic value in the diagnosis of osteoarticular tuberculosis.

Abstract: [Objective] To evaluate the clinical efficacy of arthroscopic repair of Palmer type IB triangular fibrocartilage complex (TF- CC) tear. [Methods] A total of 22 patients had Palmer type IB TFCC injury repaired under arthroscope from January 2019 to April 2023. Under arthroscope, a shaver was introduced into the wrist capsule to debride the damaged or hyperplastic tissue. Exposing the TFCC torn site, the mattress sutures were conducted to repair the TFCC tear. The clinical data were recorded and evaluated. [Results] All the 22 patients had the arthroscopic procedures performed successfully with no conversion to open surgery and no serious complications. The surgical time was of (105.2±13.9) minutes, with intraoperative blood loss of (27.8±8.6) mL, and the incision length of (4.5±0.4) cm. The patients were followed up for more than 12 months, with an average of (13.8±1.0) months. Compared with those preoperatively, the VAS score was significantly decreased [(3.7±1.1), (0.8±0.3), P＜0.001], whereas the Mayo score [(42.8±5.4), (91.7±3.7), P＜0.001], ulnar deviation ROM [(18.6±3.4)°, (35.5±4.4)°, P＜0.001], extension-flexion ROM [(97.7±12.4)°, (150.5±15.9)°, P＜0.001] and pronation-supination ROM [(105.8±9.7)°, (155.7±10.7)°, P＜0.001] were significantly increased at the latest follow-up. As for imaging, the MRI at the latest follow revealed continuous TFCC with the radioulnar gap of (2.3±0.4) mm. [Conclusion] Arthroscopic repair of Palmer type IB TFCC tear has advantages of minimizing iatrogenic trauma and reducing complications, and can significantly improve wrist function and the ROMs.

Abstract: [Objective] To investigate the analgesic effect of gastrocnemius plane block in open reduction and internal fixation (ORIF) of ankle fracture. [Methods] From May 2021 to July 2023, 68 patients received ORIF for ankle fractures under general anesthesia. According to doctor-patient communication, 36 patients received intravenous analgesia combined with gastrecnemius plane block (observation group), while other 32 patients received routine intravenous controlled analgesia (control group) after surgery. The clinical and analgesic data of the two groups were compared. [Results] There was no significant difference in operation time, blood loss, incision length, hospital stay and time to regain ambulation between the two groups (P＞0.05). The observation group proved significantly superior to the control group in terms of first active ankle movement time [(6.8±1.9) hours vs (9.1±2.0) hours, P＜0.001] and bed rest time [(20.5±4.7) hours vs (25.1±6.2) hours, P=0.001]. The VAS score in the two groups increased first and then decreased postoperatively, but which in the observation group was significantly lower than the control group at 3 hour, 6 hours, 12 hours and 1 day after surgery (P＜0.05), and then became not statistically significant between them 2 days and 4 days after surgery (P＞0.05). In addition, the observation group was significantly better than the control group in terms of first time of PICA compression, total times of PICA compression and the ratio of salvage analgesia (P＜0.05). Moreover, the former had significantly higher satisfaction of analgesia than the latter (P＜0.05). [Conclusion] Gastrocnemius plane block can reduce the pain symptoms after ORIF of ankle fracture, promote early activity, reduce the number of postoperative analgesia, and improve the satisfaction of analgesia.

Abstract:[Objective] To evaluate the effectiveness of adductor canal block (ACB) combined with popliteal plexus block (PPB) in total knee arthroplasty (TKA). [Methods] From January 2022 to January 2023, a total of 100 patients who underwent the primary unilateral TKA under intravenous and inhalant combined general anesthesia for knee osteoarthritis were included in this study, and randomly divided into two groups by random number table method. Of them, 50 patients received PPB combined ACB (the combined group), while the other 50 patients received ACB only (the ACB group). The clinical and analgesic data of the two groups were compared. [Results] There was no significant difference in intraoperative blood loss, operation time and total adverse reactions between the two groups (P＞0.05). The combined group proved significantly superior to the ACB group in terms of ambulation time [(22.5±4.4) days vs (28.6±5.7) days, P＜0.001] and hospital stay [(7.2±1.1) days vs (8.0±1.3) days, P＜0.001]. In addition, the combined group was also significantly superior to the ACB group in knee ROM 1 day and 3 days postoperatively [(88.4±15.8)° vs (67.7±14.5)°, P＜0.001; (96.6±17.9)° vs (83.5±15.7)°, P＜0.001]. As for analgesia data, the combined group had significantly lower NRS score than the ACB group from 2 hous to 48 hous after surgery (P＜0.05), despite of the fact that the difference between the two group became not statistically significant 72 hours after surgery (P＞0.05). Furthermore, the combined group was significantly superior to the ACB group regarding to the first time of analgesic pump compressed [(7.4±2.0) hours vs (5.5±1.6) hours, P＜0.001], the number of analgesic pump compression times, vasoactive drug use times and number of remedial analgesia (P＜0.05). [Conclusion] The use of PPB combined with ACB in TKA does alleviate early postoperative pain symptoms, shorten bed rest and hospital stay, and is conducive to the recovery of knee ROM.