Abstract:[Objective] To explore the clinical efficacy of minimally invasive osteotomy Ilizarov technique combined with intramedullary nail versus conventional Ilizarov technique for correcting leg shortening. [Methods] A retrospective research was conducted on 51 patients who underwent Ilizarov technique for leg shortening in our department from May 2013 to July 2022. According to preoperative doctorpatient communication, 19 patients received minimally invasive osteotomy Ilizarov technique combined with intramedullary nail (the modified group), while the other 32 patients were treated with traditional Ilizarov technique for leg lengthening (the conventional group). The perioperative, follow-up and imaging documents of the two groups were compared. [Results] All patients in both groups had the corresponding surgical procedures performed successfully. The modified group consumed significantly longer total incision length [(8.8±0.4) cm vs (1.9±0.2) cm, P＜0.001] and more intraoperative blood loss [(147.4±22.3) mL vs (25.9±4.1) mL, P＜0.001] than the conventional group, while the former proved significantly superior to the latter in terms of the bone lengthening speed [(1.80±0.11) cm/month vs (1.83±0.12) cm/ month, P=0.038], external fixation frame wearing time [(4.1 ± 1.1) weeks vs (15.8 ± 3.1) weeks, P=0.008] and total complication rate [5 (26.3%) vs 25 (78.1%), P=0.002]. There were no statistically significant differences in operation time, intraoperative fluoroscopy times and external fixation index between the two groups (P＞0.05). All patients were followed up for (24.2±12.1) months in a mean, and there was no a statistically significant difference in the time to regain full weight-bearing activity between the two groups (P＞0.05). Compared with that at the time of removing the external fixator, the pain VAS, HSS, AOFAS scores and knee range of motion (ROM), ankle ROM were significant-y improved in both groups at the last follow-up (P＜0.05). At the last follow-up, the modified group was significantly better than the conventional group in terms of knee ROM [(112.6±10.1) ° vs (89.4±5.7) °, P=0.005] and ankle ROM [(31.6±4.1) ° vs (15.3±3.8) °, P＜0.001]. As for imaging, although there were no statistically significant differences in tibial coronal plane deformity, tibial sagittal plane deformity, and medial proximal tibial angle (MPTA) at other corresponding time points between the two groups (P＞0.05), the modified group was also significantly better than the conventional group regarding the bilateral tibial length discrepancy at the latest follow-up [(2.6±1.0) mm vs (4.8±1.0) mm, P＜0.001]. [Conclusion] This minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for leg lengthening does shorten the external frame wearing time and optimizes the function of knee and ankle joints after surgery.

Abstract:[Objective] To evaluate clinical efficacy of open wedge high tibial osteotomy (OWHTO) combined with intraarticular injection of plateletrich plasma (PRP) for medial knee osteoarthritis (MKOA). [Methods] A retrospective study was conducted on 45 patients who received OWHTO for MKOA in our hospital from March 2021 to May 2022. According to doctor-patient communication, 21 patients only underwent OWHTO without PRP injection (the non-PRP group), while other 24 patients received OWHTO combined with three times intra-articular injections of PRP after the OWHTO (the PRP group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both group had OWHTO performed successfully without statistically significant differences in terms of operation time, total incision length, intraoperative blood loss, postoperative drainage volume, walking time, active flexion of 90° time , incision healing grade, and hospital stay between the two groups (P＞0.05). However, the non-PRP group consumed significantly less hospitalization cost than the PRP group [(23 000±1 000) yuan vs (30 000±12 000) yuan, P＜0.001]. All of them were followed up for more than 24 months. The NRS, KSS, HSS and Lysholm scores, as well as knee flexion-extension range of motion (ROM) in both groups were significantly improved over time (P＜0.05). At the last follow-up, the non-PRP group proved significantly inferior to the PRP group in terms of KSS score [(94.0±2.8) vs (95.8±2.0), P=0.020], Lysholm score [(93.4±2.5) vs (95.8±2.5), P=0.002] and knee flexion-extension ROM [(110.9±5.5)° vs (115.4±8.8)°, P=0.042]. Regarding imaging, the posterior tibial slope (PTS), femur tibia angle (FTA), and medial proximal tibial angle (MPTA) and hip-knee-ankle angle (HKA) in both groups were significantly improved at the latest follow-up compared with those before the operation (P＜0.05), whereas which were not statistically significant between the two groups at any corresponding time points (P＞0.05). [Conclusion] Intraarticular injection of PRP does significantly improve the clinical outcomes of OWHTO, and is beneficial for the functional recovery of patients

Abstract:[Objective] To explore the prognostic factors of ulnar nerve in situ decompression combined with maximal medial epicondylectomy (UNDME) in the treatment of cubital tunnel syndrome. [Methods] A retrospective analysis was conducted on 132 patients who underwent UNDME for cubital tunnel syndrome from 2021 to 2023. At the last follow-up, according to Gu Yu-dong's ulnar nerve function assessment criteria, the patients in "fair" and "poor" were classified as the poor group, while those in "excellent" and "good" were classified as the good group. The univariate comparison and binary multivariate logistic regression were used to research the factors related to prognosis. [Results] The patients were followed up for more than 12 months after the operation. Of them, 20 patients were fall into the poor group, accounting for 15.2%, while 112 patients were in the excellent group, accounting for 84.8%. As results of univariate comparison, the poor groups proved significantly greater than the good group in terms of age [(59.5±6.8) years vs (52.1±9.1) years, P＜0.001], diabetes rates [yes/ no, (10/10) vs (18/94), P=0.002], smoking rate [yes/no, (10/10) vs (20/92), P=0.003], disease duration [(17.1 ± 2.6) months vs (11.9 ± 3.6) months, P＜0.001] and ratio of severe grades in preoperative McGowan classification [I/II/III, (0/6/14) vs (18/64/30), P=0.002], whereas the former was significantly slower than the latter in preoperative motor nerve conduction velocity (MCV) [(33.6±10.0) m/s vs (40.7±8.2) m/s, P＜ 0.001] and sensory nerve conduction velocity (SCV) [(41.8±8.4) m/s vs (47.7±8.5) m/s, P=0.005]. However, there were no statistically significant differences in other variables between the two groups (P＞0.05). Regarding to binary multivariate logistic regression, the longer disease duration (OR=1.941, 95%CI: 1.371~2.748, P＜0.001), more severity of McGowan grade (OR=2.897, 95%CI: 1.003~8.362, P=0.049), and smoking (OR=5.396, 95%CI: 1.340~21.712, P=0.018) were the independent risk factor for poor recovery of ulnar nerve function after UNDME. [Conclusion] This modified ulnar nerve in-situ decompression combined with maximal medial epicondylectomy can relieve the compression and tensile strain on the ulnar nerve and improve nerve function. The advanced age, diabetes, smoking, longer disease duration and severe preoperative McGowan grade are the factors related to poor postoperative recovery.

Abstract:Bone marrow edema-like lesions are a prevalent MRI imaging characteristic in knee osteoarthritis. They are typically observed as areas of increased signal intensity on T2-weighted images within the subchondral bone region of the femur, tibia, and/or patella. Research indicates that subchondral bone marrow lesions changes are not only closely associated with pain and functional impairment in knee osteoarthritis but also are considered a potential driving factor in the progression of the OA. In recent years, a multitude of studies have conducted in-depth explorations into the evolution of the terminology, pathogenesis, histopathology, epidemiology, natural history, and treatment methods related to subchondral bone marrow edema-like changes. This article aims to provide a comprehensive review of these literatures, with the goal of offering clinicians and researchers a thorough overview of the role of subchondral bone marrow edema-like lesions changes in knee osteoarthritis.

Abstract:Osteoarthritis (OA) is a chronic degenerative joint disease caused by chondrocyte loss, matrix degradation and synovial inflammation, which widely affects the health of the global population. At present, there is no effective treatment method that can delay the progression of the disease. Recent studies have shown that the hypoxia-inducible factors (HIFs) family plays a key role in regulating extracellular matrix metabolism, apoptosis, inflammatory response, autophagy and ferroptosis of chondrocytes. Targeted regulation of HIFs expression through gene silencing, magnesium-based biomaterials and small molecule compounds has been proven to improve cartilage degeneration and slow down the process of OA. Therefore, HIFs is regarded as a potential target in the treatment of OA. This article reviews the research progress of HIFs in OA in the existing literature, analyzes the role of different subtypes of HIFs in osteoarthritis, and discusses the targeted treatment strategies for OA based on HIFs, aiming to provide new ideas and insights for the treatment of osteoarthritis.

Abstract:Infectious nonunion is a serious complication of the fracture that is difficult to treat and can lead to amputation and permanent disability. Traditional treatments, including antibiotic application and lesion debridement, are symptomatic methods with disadvantages such as recurrence of infection. Many doctors have found that the Ilizarov technique can completely remove the infectious lesion through osteotomy, cure the infection, and apply axial distraction and squeezing stress to stimulate cell proliferation and angiogenesis, promote bone formation, and ultimately cure infectious nonunion, and its efficacy has been confirmed by several studies. This article briefly reviews the research on the use of Ilizarov technology in the treatment of infectious non-union at home and abroad, looks forward to its prospect based on the current development of medical technology to provide reference for future clinical treatment.

Abstract:Osteoarthritis is a common degenerative disease characterized by cartilage degeneration, osteophyte formation, subchondral bone remodeling and synovial inflammation. Non-operative therapies, such as medications and weight control, are often adopted for the early stages of OA, whereas surgical treatment may be necessary if the condition worsened. Cuproptosis is a new cell death modality proposed recently, in which copper can directly bind to the fatty acylated components of the tricarboxylic acid cycle, resulting in the accumulation of fatty acylated proteins and the loss of iron sulfur tuftin, resulting in protein toxic stress and eventually cell death. Inhibition of cuproptosis can affect the survival and proliferation of various cells associated with OA development. In this paper, we summarize the relationship between cuproptosis and the key genes regulating cuproptosis and the pathological mechanism of OA and its effects on various immune cells, so as to find a new method for the treatment of OA

Abstract:[Objective] To study the mechanism of kaempferol against osteoporosis by protein and metabolomics. [Methods] Eighteen female SD rats were randomly divided into three groups with six animals in each group. After ovariectomy or sham operation performed correspondingly, 40 mg/kg of kaempferol was given intragastrically in the kaempferol group, while distilled water was given intragastrically in the model group and sham groups. After 12 consecutive weeks of intervention, the rat femur specimens were taken for four-dimensional data-independent acquisition (4D-DIA) proteomics and broadly targeted metabolomics analysis, combined with bioinformatics to explore the correlation between differential proteins and metabolites and metabolic pathways. [Results] As results of the 4D-DIA proteomics, a total of 12 shared differential proteins were identified among the three groups, and the expression of proteins such as XDH, IBSP, MGP, and F2RL3 was up-regulated in the kaempferol group (P＜0.05). In term of extensively targeted metabolomics, differential expression of 25 metabolites, including pantothenic acid and L-arginine-L-alanine, were found among the three groups. The differential proteins and metabolites were jointly involved in vitamin digestion and absorption pathways and metabolic pathways. Specifically, 10 differential metabolites and 3 differential proteins are closely associated with metabolic pathways. [Conclusion] The kaempferol may exert its anti-osteoporotic effects by modulating the expression of proteins such as XDH, IBSP, MGP, and F2RL3, regulating the metabolism of amino acids and their metabolites, as well as vitamin digestion and absorption pathways

Abstract:[Objective] To investigate the effects of tetrandrine (TET) on proteoglycan-induced rheumatoid arthritis (RA) in vivo and in vitro, search the possible mechanism of action. [Methods] In vivo experiment, 42 BALB/C mice were randomly divided into the normal control group, model group, as well as tetrandrine low dose (LD) group, medium dose (MD) group, high dose (HD) group and control group. Except the normal group, all animals in other groups underwent proteoglycan-induced arthritis (PGIA) treatment to create RA mouse model. The LD group was given TET 7.5 mg/kg · d-1 , the MD group was 15 mg/kg · d-1 , the HD group was 30 mg/kg · d-1 , while the normal group and the model group were given equal volume of normal saline, and the control group was given celecoxib 60.7 mg/kg · d-1 for 28 days. In vitro experiments, MH7A cells were treated with TET in similar manner as in vivo test. [Results] In vivo experiment, compared with the model group, the LD group, MD group, HD groups and the control group had significant improvements in terms of the paw thickness [(5.1± 0.1) mm vs (3.6±0.2) mm vs (3.0±0.2) mm vs (2.4±0.2) mm vs (3.6±0.1) mm, P＜0.001], arthritis score [7.0 (7.0, 7.0) vs 5.0 (4.0, 5.0) vs 4.0 (4.0, 4.0) vs 2.0 (1.0, 2.0) vs 2.0 (1.0, 2.0), P＜0.001], serum TNF-alpha [(320.6±7.2) pg/mL vs (264.5±13.1) pg/mL vs (217.3±40.0) pg/mL vs (159.8±17.2) pg/mL vs (160.7±11.3) pg/mL, P＜0.001], IL-1 beta [(365.1±32.2) pg/mL vs (217.7±18.8) pg/mL vs (161.1±18.3) pg/mL vs (110.6 ±4.8) pg/mL, (110.4±3.8) pg/mL, P＜0.001], IL-6 [(435.5±33.3) pg/mL vs (261.7±30.6) pg/mL vs (189.0±8.1) pg/mL vs (152.9±13.3) pg/mL vs (154.7±11.1) pg/mL, P＜0.001], the histological score (P＜0.05) and μCT score (P＜0.05). In vitro experiment, compared with the model group, the LD group, MD group and HD groups had significant improvements in terms of number of EdU positive cells (P＜0.05), PAkt and P-P65 protein expression levels (P＜0.05), infiltration of M2 macrophages and infiltration of activated mast cells (P＜0.05). [Conclusion] Tetrandrine can inhibit the progression of inflammation and synovial hyperplasia in rheumatoid models, and the mechanism may be related to the regulation of AKT and NF-κB signaling pathways.

Abstract: [Objective] To introduce the surgical technique and preliminary clinical results of three-dimensional planned rotational osteotomy at the femoral neckbase for osteonecrosis of the femoral head (ONFH). [Methods] A total of 16 patients (17 hips) received the abovementioned surgical treatment for femoral head necrosis. The preoperative CT data were transformed into a three- dimensional model that could be operated and observed. The osteotomy line was designed at the base of the femoral neck using the construction surface tool. Under the condition of ensuring no hip joint impact, the planned rotation angle was taken when the integrity rate of the weight-bearing area of the femoral head was the highest. If necessary, the coxa vara adjustment could be moderately carried out. In the real operation, the patient was in a lateral position after general anesthesia. A longitudinal incision was made with greater trochanter as the center, and osteotomy of the greater trochanter was conducted. Under hip flexion, abduction and external rotation, "Z"-shaped capsulotomy was done, and bone cutting of rear one-third femoral neck base was performed inside out. One Kirschner wire was inserted along the central axis of the femoral neck as the rotation axis, and then two parallel Kirschner pins were inserted perpendicularly to the central axis of the femoral neck as rotation levers. The remaining femoral neck base was cut perpendicularly between the two levers, and the femoral head was rotated according to the preoperative design by using the relative angles of the two positioning axes as the reference to transfer the femoral head necrotic area out the weight-bearing area properly, without significant impact on the blood supply of the femoral head. Finally, the femoral neck base osteotomy was fixed with three cannulated screws, and the greater trochanter was reduced and fixed with screws, the incision was closed in layers. [Results] All patients had the operation performed successfully without serious complications. Of them, 11 patients (12 hips) had intraoperative rotation angles completely consistent with the preoperative design, 5 patients (5 hips) had differences from 5° to 10°. The VAS score [(5.2±0.5), (0.7± 0.6), P＜0.001], Harris score [(70.8±8.6), (87.5±5.4), P＜0.001] and iHOT-12 score [(66.4±9.0), (84.9±9.8), P＜0.001] were significantly improved at the latest follow-up range from 12 to 36 months after operation compared with those before the operation. At the last follow-up, 13 patients (14 hips) presented good femoral head shape in the weight-bearing area on the images. [Conclusion] This preoperative three-dimensional planning provides accurate technical parameters for the rotational osteotomy at the femoral neck base, and achieves satisfactory preliminary clinical outcome.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of metatarsophalangeal arthroplasty with Kirschner wire fixation in the treatment of advanced Freiberg disease. [Methods] From March 2020 to December 2023, 20 patients with end-stage Freiberg disease underwent metatarsophalangeal shaping with the concave-convex reamers and Kirschner wire fixation. A longitudinal incision was made on the dorsal side of the metatarsophalangeal joint of the affected side, which was made layer by layer to protect and retract the extensor digitorum longus tendon. The metatarsophalangeal capsule was cut from the back side to expose the the metatarso-phalangeal space, remove the free and exfoliated cartilage around the joint. Displace the joint, polish the metatarsal head with the concave reamer, while the phalangeal base with convex reamer to remove the cartilage and hardened bone, and trim the hyperplastic osteophyte until the metatarsal head and phalangeal base became smooth. The metatarsophalangeal joint was fixed by one or two percutaneous titanium Kirschner wires, with the joint space filled with the surrounding fat tissue, severed extensor brevis tendon and part of capsule tissue. [Results] All patients were operated on smoothly and followed up for an average of (20.1±11.2) months. AOFAS score was significantly increased from (68.7±6.1) before surgery to (91.0±4.2) 6 months postoperatively (P＜0.05). There was no significant change in plantar flexiondorsal extension range of motion of the joint 6 months after operation compared with that before operation (P＞0.05). [Conclusion] This metatarsophalangeal arthroplasty with concave-convex reamers combined with Kirschner wire fixation for advanced Freiberg disease is a relatively reliable treatment with benefits of less trauma and simple operation.

Abstract:[Objective] To investigate the clinical efficacy of posteromedial tibial osteotomy and transverse bone fragment transport for diabetic foot ulcer. [Methods] A retrospective study was performed on 52 patients (56 feet) who had diabetic foot ulcers treated by abovesaid surgical technique from March 2019 to October 2022. The relative clinical documents were evaluated. [Results] All 56 feet were operated on successfully with the operation time from 20 min to 40 min, the incision length from 5 cm to 7 cm, and the osteotomy bone fragment from 5 cm×1.5 cm to 6 cm×1.8 cm in size. Among them, 3 feet got osteotomy incision exudation after surgery, which healed after dressing change and delayed bone transportation for 2 weeks. The patients were followed up for (15.5±2.7) months in a mean, with amputation rate of 5.4% and the success rate of limb salvage of 94.6%, frame bearing time 6 weeks in the minimum and 17 weeks in the maximum. With time elapsed preoperatively, 7 days and 12 months after surgery, the VAS score [(6.2±0.7), (3.2±0.6), (1.0±0.3), P=0.022], ankle brachial index (ABI) [(0.7±0.1), (0.8±0.1), (1.0±0.2), P=0.042] and toe skin temperature [(28.2±2.1)℃, (32.3±0.5)℃, (36.1±0.63)℃, P=0.031] were significantly improved. Except 3 foot amputation, all the patients had the ulcer healed well over time [healing /non-healing/ amputation, (0/56/0), (0/56/ 0), (3/53/0), P＜0.001]. [Conclusion] The posteromedial tibial osteotomy and transverse bone fragment transport does effectively improve blood supply of the foot, with advantages of simplifying therapeutic operation, high safety and less complications.

Abstract:[Objective] To investigate the clinical outcomes of implantation of vancomycin and calcium sulfate composite in the treatment of osteomyelitis secondary to open reduction and internal fixation (ORIF) of tibial plateau fracture. [Methods] A retrospective study was conducted on 37 patients who suffered from osteomyelitis after ORIF of tibial plateau fractures in our hospital from March 2014 to April 2022. All patients underwent debridement and implantation of vancomycin and calcium sulfate composite. The clinical and laboratory documents were evaluated. [Results] All 37 patients underwent successful surgery, with an average surgical time of (113.1±39.5) min and an average intraoperative blood loss of (156.8±78.3) mL, and were followed up for (38.3±22.8) months in a mean. Two patients had recurrent infection after surgery, which was controlled by revision of debridement and implantation of vancomycin calcium sulfate composite. All patients got bony healing in a mean of (7.9±2.9) months. With time that before operation, at discharge and the latest follow-up, the range of motion (ROM) of the knee [(39.4±7.3)°, (55.4±7.3)°, (106.1±17.3)°, P＜0.001] and KSS clinical score [(19.1±3.9), (30.0±2.7), (80.8±5.0), P＜0.001]、KSS functional score [(19.9±14.7), (38.8±4.9), (85.7±5.1), P＜0.001]、HHS score [(31.8±6.4), (40.0±5.4), (73.8±9.1), P＜0.001] were significantly increased. Regarding laboratory test, the CRP, WBC, and ESR significantly declined at discharge and the latest followup compared with those preoperatively, which returned to be normal in (5.4±2.5) weeks after the operation on an average. [Conclusion] According to the infection and fracture healing situation, debridement with retaining or removing the internal fixation by alternation of external fixator, and implantation of vancomycin-calcium sulfate composite in a timely manner are a reliable method for treating infection after internal fixation of tibial plateau fractures. It can effectively control infection and promote functional recovery.

Abstract:[Objective] To evaluate the clinical outcome of percutaneous osteotomy for correction of hallux valgus deformity. [Methods] A retrospective study was conducted on 20 patients who received percutaneous osteotomy to correct hallux valgus deformity from 2020 to 2023. All patients received percutaneous Chevron osteotomy, while percutaneous Akin osteotomy added if necessary. The clinical and imaging data were evaluated. [Results] All patients were successfully operated without serious complications such as vascular and nerve injury, and followed up for more than 12 months. With time elapsed preoperatively, 3 months postoperatively and the latest follow-up, the pain visual analogue scale (VAS) [(6.0±0.9), (3.2±0.8), (0.7±0.5), P＜0.001] and the Mancher-Oxford Foot Questionnaire (MOXFQ) score [(66.5±3.1), (53.2±3.9), (12.9±3.0), P＜0.001] were significantly reduced, whereas the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores [(49.4±5.4), (65.2±5.8), (88.9±3.2), P＜0.001] was significantly increased. Up to the latest follow-up, none of the 20 patients had recurrent deformity or revision surgery. As for Imaging, compared to those preoperatively, the hallux valgus angle (HVA) [(37.0±8.1)°, (19.7± 3.1)°, (19.8±3.3)°, P＜0.001] and the 1st intermetatarsal angle (IMA) [(16.9±3.0)°, (9.5±1.3)°, (9.6±1.7)°, P＜0.001] were significantly declined 3 months after surgery and at the last follow-up. All patients had osteotomy healed 6 months after surgery. [Conclusion] Percutaneous osteotomy for correction of hallux valgus deformity is a safe and effective technique with advantages of minimal iatrogenic trauma and rapid recovery.

Abstract:[Objective] To observe the clinical consequence of minimally invasive cortical osteotomy combined with intramedullary nailing in the treatment of old tibiofibular fractures. [Methods] From October 2021 to February 2023, 13 patients had old tibiofibular fractures over 3 weeks with varying degrees of deformity at the fracture site treated surgically in our department. During the operation, two small incisions were made for cortical osteotomy performed at the fracture site with the surrounding soft tissues released for restoration of the tibial alignment and length. Subsequently, intramedullary nailing was performed through the suprapatellar approach. The clinical and imaging data were evaluated. [Results] All the 13 patients had the operations performed successfully without injury to major blood vessels or nerves. The followup was conducted for more than 12 months, and the clinical fracture healing time was of (7.8±1.5) months in a mean. The VAS [(5.7±1.7) score, (1.6±0.7) score, (1.2±0.4) score, P＜0.001], HSS [(54.1±7.0) score, (87.7±2.7) score, (91.5±2.7) score, P＜0.001], knee flexion-extension ROM [(92.3±9.3)°, (121.3±25.8)°, (130.6±17.6)°, P＜0.001], and ankle AOFAS [(69.5±4.6) score, (88.0±2.9) score, (99.5±0.8) score, P＜ 0.001] all significantly improved over time preoperatively, 3 months postoperatively and at the latest follow-up. During the follow-up period, no patients had re-fracture or revision surgery. As for imaging, the tibial alignment significantly improved [n, excellent/good/poor, (0/0/13), (4/ 9/0), (10/3/0), P＜0.001], while the tibial length discrepancy between both sides significantly decreased over time [(7.3±5.3) mm, (1.3±1.0) mm, (0.4±0.3) mm, P＜0.001]. The continuous callus remodeling time was (7.0±1.5) weeks after surgery. By the last followup, all 13 patients achieved complete fracture healing and remodeling, without loosening or breakage of the internal fixation implants. [Conclusion] This small incision osteotomy at the fracture site does effectively assist in the reduction and intramedullary nailing of old tibial fractures with advantages of minimally invasive operation and little impact on the blood supply at the fracture site, and achieves satisfactory clinical outcome.

Abstract:[Objective] To investigate the analgesic effect of ultrasound-guided anterior iliopsoas space block on pain relief and functional recovery after hip arthroplasty (HA). [Methods] A total of 60 patients who were undergoing HA in the Affiliated Hospital of Jiangsu University from June 2023 to May 2024 were enrolled into this study, and randomly divided into the block group and the non-block group, with 30 cases in each group. Both groups received subarachnoid anesthesia, additionally, the block group received anterior iliopsoas space block before the operation, while the non-block group received no block. Both groups received patient-controlled intravenous analgesia after the operation. The data regarding postoperative analgesia were compared between the two groups. [Results] All patients in both groups had HA performed successfully. The block group proved significantly superior to the nonblock group in terms of ambulation time [(4.2±0.9) days vs (6.0±1.2) days, P＜0.001], total sufentanil consumption after surgery [(19.3±3.1) μg vs (22.7±5.6) μg, P=0.007], rescue analgesia rate [4 (13.3%) vs 18 (60.0%), P＜0.001], and total adverse reaction rate [7 (23.3%) vs 24 (80.0%), P＜0.001], although there were no statistically significant differences in the incidence of postoperative urinary retention, respiratory depression, and delirium between the two groups (P＞ 0.05). In addition, the block group was significantly better than the non-block group in the pain VAS scores at 6 hours, 1, 3, and 7 days after surgery [(1.8±1.0) score vs (3.5±1.5) score, P＜0.001; (2.4±0.5) score vs (3.0±0.9) score, P=0.005; (1.9±0.6) score vs (2.3±0.6) score, P= 0.017; (0.9±0.6) score vs (1.3±0.6) score, P=0.012], and the 2-minute walking distance at 24 and 48 hours after surgery [(44.2±12.0) m vs (36.2±10.5) m, P=0.020; (170.4±9.9) m vs (120.9±18.2) m, P＜0.001]. [Conclusion] The ultrasound-guided anterior iliopsoas space block does effectively alleviate postoperative pain after hip arthroplasty, promote functional recovery, and does not increase adverse reactions.

Abstract: [Objective] To measure the gait parameters of the affected limb before and after total knee arthroplasty (TKA) using a portable dynamic gait analysis system, evaluate the characteristics of gait changes, thereby guiding postoperative rehabilitation and obtaining an applicable assessment method in clinical practice. [Methods] Gait analysis was conducted with the portable dynamic gait analysis system before and 3 months after the TKA, respectively, to evaluate the improvement degree of each gait parameter before and after the operation. [Results] Compared with those before operation, the patients got significant improvements 3 months postoperatively in terms of the stride length [(81.9±2.6) cm, (110.6±7.4) cm, P＜0.001], stride height [(10.5±2.2) cm, (20.6±1.5) cm, P＜0.001], unilateral total support time [(49.1±3.1)%, (63.8±1.1)%, P＜0.001], unilateral swing time [(50.9±3.1)%, (36.2±1.3)%, P＜0.001], single foot support time [(30.1±0.5)%, (35.3±0.7)%, P＜ 0.001], landing elevation [(11.7±1.6)°, (19.5±1.4)°, P＜0.001], liftoff elevation [(47.4±1.6)°, (60.7±2.8)°, P＜0.001] and maximum swing speed [(2.7±0.2) m/s, (3.9±0.3) m/s, P＜0.001] of the affected lower extremity. However, the patients remained inferior to the normal persons 3 months after TKA in terms of landing elevation [(19.5±1.4)° vs (20.5±1.5)°, P=0.012] and maximum swing speed [(3.9±0.3) m/s vs (4.1± 0.2) m/s, P=0.006]. [Conclusion] The patients have significant gait improvements 3 months after TKA. The portable dynamic gait analysis system can quantitatively evaluate the gait characteristics of patients before and after TKA, and might have targeted guiding value for rehabilitation exercises.

Abstract: