Abstract:[Objective] To search the risk factors for intensive care unit (ICU) stay after proximal femoral nail anti-rotation (PFNA) for femoral intertrochanteric fractures in the elderly. [Methods] A retrospective study was conducted on 437 elderly patients who received PFNA for femoral intertrochanteric fractures in our hospital from January 2013 to August 2018. According to whether the patients had ICU stay after operation, they were divided into ICU group and non-ICU group. Univariate comparison and multi-factor binary logistic regression analysis were used to explore the risk factors related to ICU stay after surgery. [Results] Among the 437 patients, 66 patients had ICU stay, accounting for 15.1%, whereas the remaining 371 patients had no ICU stay, accounting for 84.9%. As results of univariate comparison, the ICU group proved significantly greater than the non-ICU group in terms of proportions of cerebrovascular disease (15.2% vs 6.5%, P= 0.015), Alzheimer's disease (6.1% vs 1.1%, P=0.021), ASA grade ≥3 (48.5% vs 24.0%, P＜0.001) and general anesthesia (80.3% vs 18.9%, P＜0.001). However, there were no statistically significant differences between the two groups in gender composition, age, BMI and other common medical complications, including diabetes mellitus, chronic kidney disease, chronic lung disease, coronary heart disease, tumor, as well as interval from injury to operation, AO classification of the fracture, preoperative examination parameters, intraoperative blood loss, intraoperative blood transfusion ratio, and operation time (P＞0.05). As for Multi-factor binary logistic regression analysis, the general anesthesia (OR=18.970, 95%CI: 9.560~37.640, P＜0.001) and ASA grade ≥3 (OR=3.553, 95%CI: 1.856~6.799, P＜0.001) were independent risk factors for ICU stay after internal fixation of femoral intertrochanteric fractures in the elderly. [Conclusion] General anesthesia and ASA grade ≥3 are independent risk factors for ICU stay after internal fixation of femoral intertrochanteric fractures in the elderly.

Abstract:[Objective] To investigate the clinical characteristics and risk factors of in-hospital death in patients ≥80 years after surgery for hip fractures. [Methods] A retrospective study was conducted on 725 patients aged ≥80 years who underwent surgical treatment for hip fractures in People's Hospital of Liaocheng City from October 2019 to March 2024. They were divided into the death group and the survival group according to whether death occurred during hospitalization. Univariate comparison and multiple logistic regression were used to analyze the risk factors for the in-hospital death. [Results] Of the 725 patients, 24 died in hospital, accounting for 3.3% with immediate death causes of pulmonary infection [14 (58.3%)] and acute myocardial infarction [4 (16.7%)]. As results of univariate comparison, there were statistically significant differences between the death group and the survival group in the following items: gender [n, male/female, (15/ 9) vs (196/505), P 0.001], ADL scores before injury [(4.7±0.9) vs (5.4±1.1), P 0.001], damage energy [low/medium/high, (0/21/3) vs (6/679/ 16), P 0.036], coexisting chronic pulmonary disease [n (%) 8 (33.3)vs 115 (16.4), P 0.047], leukocyte level [(9.6±2.4) 109 /L vs (8.4±2.8) 109 / L, P 0.042], albumin [(32.8±4.1) g/L vs (34.5±4.2) g/L, P 0.047], urea [(10.3±7.6) mmol/L vs (6.8±3.2) mmol/L, P 0.035], oxygen saturation before operation [(92.4±6.5)% vs (95.2±4.3)%, P 0.047], intraoperative blood transfusion [n (%) 6 (25) vs 71 (10.1), P 0.033], and postoperative ICU stay [n (%) 16 (66.7) vs 32 (4.6), P 0.001]. Regarding multivariate logistic regression analysis, the male (OR=3.202,P= 0.023), high preoperative creatinine (OR=1.013,P=0.002) and postoperative ICU stay (OR=51.892, P＜0.001) were the independent risk factors for in-hospital death in elderly patients ≥80 years old after operation for hip fractures. [Conclusion] Pulmonary infection is the main direct cause of in-hospital death in elderly patients after surgery for hip fractures. In addition, male gender, high preoperative creatinine and postoperative ICU stay are independent risk factors for the in-hospital death.

Abstract:[Objective] To investigate the correlation between fibular head height (FHH) and the occurrence and development of knee osteoarthritis (KOA). [Methods] A total of 116 patients who visited our hospital from June 2015 to June 2021 were included in this study, with the average time interval of two X rays taken of (31.0±2.9) months. The data of the two time points were compared, and pairwise correlation analysis was conducted between K-L grading and other indicators. Using FHH value as dependent variable and other factors as independent variables, multiple linear stepwise regression analysis was performed to explore the correlation between FHH and severity of the knee osteoarthritis. [Results] The age [(60.5±6.8), (63.1±7.0), P＜0.001], WOMAC score [(34.0±6.2), (47.7±6.3), P＜0.001], K-L grade [I/ II/III/IV, (0/89/22/5), (0/0/22/94), P＜0.001], FTA [(178.6±3.7)°, (181.8±5.3)°, P＜0.001], JLCA [(2.8±1.1)°, (4.4±1.7)°, P＜0.001] were significantly increased, whereas the HSS score [(72.2±8.2), (56.5±7.8), P＜0.001], the knee flexion-extension ROM [(109.7±7.8)°, (97.6±6.1)°, P＜0.001], MPTA [(86.5±1.8)°, (85.0±2.4)°, P＜0.001], AMTP [(8.7±4.2) mm, (5.2±4.9) mm, P＜0.001], FHH [(10.3±3.5) mm, (7.9±3.8) mm, P＜0.001], FHTPA [(7.5±2.2)°, (4.7±2.0)°, P＜0.001] were significantly reduced at the last X ray check compared with those in initial X ray examination. Regarding to pairwise correlation analysis, the K-L grading was significantly positively correlated with age, WOMAC score, FTA, MPTA and JLCA (P＜0.05), while was significantly negatively correlated with HSS score, AMTP, ROM, FHH and FHTPA (P＜0.05). As results of multiple stepwise regression analysis, the FHH was significantly negatively correlated with JLCA and WOMAC (P＜0.05), while significantly positively correlated with ROM and AMTP (P＜0.05). [Conclusion] This study visually confirmed that the progression of KOA is related to FHH through continuous imaging measurements, proving that FHH might be influencing factor for the disease progression of KOA, and FHH can be used as an X-ray measurement and evaluation index for KOA.

Abstract:Osteoarthritis is a common degenerative disease involving pathological changes in joint tissues, with a complex pathogenesis involving mechanical loading, injury, metabolism and inflammatory stimuli, which seriously affects the quality of life of the patients. Ferroptosis, a newly discovered irondependent cell death mode characterized by lipid peroxide accumulation, mainly involves iron metabolism and redox homeostasis, and is involved in pathogenesis of many degenerative diseases. Meanwhile, studies on the association between ferroptosis and osteoarthritis have been increasing, providing a large amount of evidence for in-depth exploration of its mechanism of action. Therefore, this review summarizes the research progress on the pathogenesis and treatment of ferroptosis in osteoarthritis, aiming to find the possibility of providing early prevention strategies for the clinical treatment of osteoarthritis, as well as exploring further research directions and therapeutic targets.

Abstract:Osteoarthritis (OA) is a common joint degenerative disease, leading pathology of intro-articular cartilage, subchondral bone, synovial membrane and other tissues, which significantly affect patients' quality of life. Currently, there is no effective treatment for osteoarthritis other than joint replacement for the end-stage patients, which also results in a significant burden on the medical system and social economy. Osteoclast, a large multi-nucleated cell, plays a clear role in bone resorption. It participates in subchondral bone remodeling and induce the formation of osteophyte and bone cysts in OA. Chondrocyte, cell in articular cartilage, plays a crucial role in both cartilage formation and maintenance, as well as participating in chondrolysis in OA. At present, there are limited reports on the role of osteoclasts-chondrocytes crosstalk in osteoarthritis degenerative diseases. This article reviewed the relevant literature and summarized the osteoclasts-chondrocytes crosstalk

Abstract:Knee osteoarthritis (KOA) is a common joint disease characterized by destruction of articular cartilage and osteophyte formation. Hypoxia-inducible factor-1α (HIF-1α) and hypoxia-inducible factor-2α (HIF-2α) are nuclear transcription factors that regulate the cellular response to hypoxia, and play important roles in synovial inflammation, cartilage degeneration, and bone autophagy. HIF-1α mainly maintains the synthesis and differentiation of chondrocytes and promotes the balance of articular cartilage autophagy in vivo, while HIF2α leads to the degeneration and degradation of articular cartilage mainly through the direct or indirect modulation of various catabolic factors. In addition to the regulation of the oxygen receptor, the expression of HIF-1α/-2α is regulated by several signaling pathways including Wnt/β-catenin, NF-κB, AMPK/mTOR, PI3K/Akt, NLRP3, JAK2/STAT3, and so on. This paper reviews the signaling pathways that regulate the expression of HIF-1α/-2α, aiming to provide new insights and ideas for the prevention and treatment of KOA.

Abstract:Osteonecrosis of the femoral head (ONFH) is one of the common hip diseases in orthopaedics, and there is no definite drug that can completely prevent the development of ONFH. In recent years, the study on the role of HIF-1 α signaling pathway in ONFH has gradually increased. It has been found that HIF-1α signaling pathway is activated in mesenchymal stem cells, endothelial progenitor cells and chondrocytes, this in turn stimulates the secretion of angiogenesis and bone repair-related cytokines to promote ONFH repair. In addition, many drugs can also promote bone repair and angiogenesis of ONFH by activating intracellular HIF-1α signaling pathway, which has potential application value in the treatment of ONFH. In this article, we reviewed the research status of HIF-1α signal pathway in ONFH, and provided some potential approach and ideas for clinical treatment of ONFH.

Abstract:With the widespread use of glucocorticoids, the incidence of steroid-induced osteonecrosis of the femoral head (SONFH) is increasing year by year, and the patient population tends to be younger. Currently, the pathogenesis of SONFH remains unclear. Previous studies have suggested that SONFH is associated with femoral head coagulation dysfunction, lipid metabolism disorders, increased intraos-seous pressure, oxidative stress, apoptosis, autophagy, genetic factors and non-coding RNA abnormalities. Recent studies have found that bone immunity may play an important role in the pathogenesis of SONFH, and chronic inflammatory stimulation caused by immune dysregulation promotes the occurrence and development of SONFH. In this paper, we review the mechanisms of immune cells, inflammatory factors and signaling pathways related to bone immunity in the pathogenesis of SONFH, and explore the intrinsic links between bone immunity and the development of SONFH, so as to provide new ideas for the prevention and treatment of SONFH.

Abstract:[Objective] To compare the biomechanical differences between vascular pedicled iliac flap grafting and femoral neck baserotation osteotomy by fine element analysis (FEA). [Methods] The the proximal femur model (necrosis group) was established by importingthe CT data of a patient with China-Japan Friendship Hospital (CJFH) type L2 femoral head necrosis into Mimics 21.0. After Geomagic op-timization, the vascular pedicled iliac flap transplantation model (graft group) was established in Solidworks 2021 to simulate the position ofvascular pedicled iliac flap placed inside the femoral head at 20° forward in the coronal plane. The model of femoral neck rotation osteoto-my (osteotomy group) was established with 90° anterior rotation through the base of the femoral neck and fixed by femoral neck system(FNS). The mechanical changes of the three models were compared and analyzed in ANSYS 17.0. [Results] The peak stress of the femurmodel in the necrotic group (69.56 MPa) was the largest and concentrated in the stress region, followed by that in the graft group (59.97MPa), and that in the osteotomy group was the smallest (57.91 MPa). The maximum displacement was in the necrotic group (1.85 mm) ＞ thegraft group (1.37 mm) ＞ the osteotomy group (1.23 mm). [Conclusion] Both rotary osteotomy at the base of the femoral neck and vascular-ized iliac flap grafting can reduce stress concentration in the necrotic area, and improve and restore the internal biomechanical status of thefemoral head. The femoral neck base rotation osteotomy is superior to vascular pedicled iliac flap grafting in improving the mechanics offemoral head

Abstract:[Objective] To investigate the effects of semaphorin 6D (SEMA6D) on the proliferation and invasion of osteosarcoma cells and its mechanism. [Methods] MG63 cells were divided into blank control group (the Ctrl group), negative control group (the si-NC group) and the group transfected with si-RNA targeting SEMA6D (the si-SEMA6D group), and corresponding transfection was performed in vitro. The changes of proliferation, migration and invasion ability of MG63 cells were detected by CCK-8, cell scratch and Transwell invasion assay. In addition, western blot analysis was performed to detect the protein expression of downstream related signaling pathways. [Results] After 24 hours culture, there was no significant difference in CCK-8 among the three groups (P＞0.05). At 48 hours and 72 hours, the Ctrl and si-NC groups were significantly higher than the si-SEMA6D groups in CCK-8 assay [(0.7±0.1) vs (0.7±0.1) vs (0.4±0.1), P＜0.001; (1.7±0.1) vs (1.6±0.1) vs (1.0±0.1), P＜0.001]. The Ctrl and si-NC groups were significantly higher than the si-SEMA6D group in Transwell invasion assay [(435.0±28.2) vs (400.7±41.4) vs (291.3±31.1), P=0.022]. At 24 hours and 48 hours, the Ctrl and si-NC groups had significantly higher scratch healing rate than the si-SEMA6D group [(48.8±3.3)% vs (40.6±3.4)% vs (16.6±2.4)%, P＜0.001; (74.7±1.1)% vs (67.6± 3.0)% vs (49.5±2.3)%, P＜0.001]. As consequence of western blot analysis, the Ctrl group and si-NC group were significantly increased compared with the si-SEMA6D group in protein expression levels of p-PI3K, p-AKT, p-P38 and MMP2 (P＜0.05), although there were no significant differences in the expression levels of P13K, AKT, p38, Bcl-2 and Bax among the three groups (P＞0.05). [Conclusion] SEMA6D silencing of osteosarcoma MG63 cells can inhibit cell proliferation, migration and invasion by inhibiting PI3K/AKT and p38-MAPK signaling pathways.

Abstract:[Objective] A bidirectional two-sample Mendelian randomization study was conducted to investigate the causal relationship between hallux valgus and knee osteoarthritis. [Methods] Based on GWAS (Genome-wide Association Study) database, IVW (inverse-variance weighted), weighted mode and MR-Egger were used to conduct bidirectional two-sample Mendelian randomization analysis. [Results] There was a positive causal relationship between hallux valgus and increased risk of knee osteoarthritis, with IVW (OR=1.14, 95%CI: 1.03~ 1.27, P=0.015). There was also a positive causal relationship between knee osteoarthritis and increased risk of hallux valgus with IVW (OR= 1.65, 95%CI: 1.31~2.06, P＜0.001). There was no horizontal pleiotropy in the bidirectional two-sample Mendelian randomization study (P＞ 0.05). The results of bidirectional twosample Mendelian randomization are robust. [Conclusion] From a large sample size and genetics, hallux valgus is a risk factor for knee osteoarthritis. On other hand, knee osteoarthritis is also a risk factor for hallux valgus, and there is independence and stability between the two outcomes.

Abstract:[Objective] To retrospectively analyze the etiology, clinical diagnosis and current status of misdiagnosis of the inpatients who were undergoing surgical treatment for non-traumatic osteonecrosis of femoral head (ONFH) between January 2018 and January 2023 for providing a reference of the prevention, diagnosis and treatment of this disease. [Methods] Clinical data of patients were collected, involving gender, age, etiology, stage, grade of hospital at first visiting, diagnosis, etc. The data were listed in the information table and statistic analysis was conducted. [Results] A total of 180 patients with ONFH were included in the study, 55.6% were steroid, 30.6% were alcoholic, and 13.9% were idiopathic. The average onset time of steroid ONFH was (17.3±3.7) months, with the average dose of (9.3±3.7) g; the average drinking of alcoholic ONFH lasted for (15.7±6.9) years, with the average drinking of (374.7±163.6) mL per day, while the idiopathic ONFH had no obvious cause. The mean age of patients in alcohol group was significantly higher than that in steroid group and idiopathic group [(44.9±9.8) years vs (39.2±13.6) years vs (39.7±10.2) years, P=0.005]. The proportion of male in the alcohol group was the highest (98.2%), while the proportion of female in the idiopathicgroup was the highest (32.0%), with statistically significant differences (P＜0.05). The course of disease in the alcohol group was significantly longer than that in the steroid group and the idiopathic group [(18.2±6.0) months vs (15.3± 2.7) months vs (8.7±3.3) months, P=0.013]. The diagnosis rate at the first visit was the highest (61.9%) in the top grade hospitals, and the lowest (22.2%) in the primary hospitals, with statistical significance (P＜0.05). The ONFH was most commonly misdiagnosed as lumbar disc herniation. [Conclusion] The majority of non-traumatic ONFH patients are middle-aged men, and hormone use is still the primary cause of ONFH. The misdiagnosis rate of ONFH is higher.

Abstract:[Objective] To explore the role of secreted frizzled-related proteins 5 (SFRP5) in non-traumatic osteonecrosis of the femoral head (NONFH). [Methods] A total of 71 patients who were diagnosed of NONFH in Linyi People's Hospital from September 2023 to January 2024 were selected as the necrosis group, while other 68 healthy persons who underwent regular health physical examination and were matched in gender and age with the necrosis group were selected as the normal group. Serum SFRP5 levels in the two groups were detected by ELISA. General data between the two groups were compared, while the serum SFRP5 in the necrotic group were compared according to different factors (ARCO stage, side, etiology, etc.), and ROC curve was drawn to analyze the diagnostic value of serum SFRP5 for NONFH. [Results] The necrotic group had significantly lower serum SFRP5 than the healthy group [(16.9±12.7) pg/mL vs (32.9±17.2) pg/mL, P＜0.001]. In the necrosis group, the SFRP5 was significantly lower in the patients who had femoral head collapse than those without collapse (P＜0.05), whereas which was not statistically significant between the patients with bilateral necrosis and those with unilateral necrosis (P＞0.05). However, the SFRP5 was significantly decreased with the increasing of the ARCO stages (P＜0.05). In term of pairwise correlation analysis, SFRP5 was significantly positively correlated with Harris score (P＜0.05), while significantly negatively correlated with ARCO stage and VAS score (P＜0.05). In term of ROC analysis, the SFRP5 predicting NONFH was with sensitivity of 70.4% and specificity of 80.9% and area under curve (AUC) of 0.787. [Conclusion] Serum SFRP5 decreases with the progression of non-traumatic osteonecrosis of the femoral head, and SFRP5 may be a potential serum marker for the diagnosis of NONFH

Abstract:[Objective] To evaluate the short term clinical outcome of proximal first metatarsal lateral displacement osteotomy for the treatment of moderate to severe hallux valgus. [Methods] From January 2019 to March 2023, 21 patients with moderate to severe hallux valgus were treated by proximal displacement osteotomy in our hospital, including 2 males and 19 females aged (59.4±10.5) years on an average. The clinical and imaging data were evaluated. [Results] All patients were operated on successfully, and were followed up for an average of (7.4±3.5) months. Compared with those preoperatively, the VAS scores [(2.7±0.8), (0.3±0.5), P＜0.001] significantly reduced, while AOFAS score [(42.8±3.2), (94.0±2.7), P＜0.001] significantly increased at the latest follow-up. In terms of imaging, the hallux valugs angle (HVA) [(40.5±7.4)°, (11.3±4.0)°, P＜0.001], intermetatarsal anlge (IMA) [(16.0±2.8)°, (6.7±3.2)°, P＜0.001] significantly decreased, whereas the distal metatarsal articular angle (DMAA) [(17.3±9.4)°, (6.9±4.0)°, P＜0.001], Handy-Clapham scale of sesamoid bone significantly improved (P＜0.05), despite of that the relative first metatarsal length (RML) remained unchanged (P＞0.05). [Conclusion] The first proximal metatarsal displacement osteotomy does effectively correct valgus deformity and improve the clinical symptoms of patients.

Abstract:[Objective] To explore the factors related to femoral head necrosis (FHN) after internal fixation of femoral neck fracture (FNF). [Methods] From January 2021 to January 2023, 100 patients received reduction and internal fixation under general anesthesia for FNF, and followed up for a mean of (2.1±0.4) years to observe whether FHN happened. The general data and serum levels of endothelin-1 (ET-1) and matrix metalloproteinase (MMP-13) were compared and analyzed between the FHN group and non-FHN group. [Results] FHN occurred in 21 of the 100 patients. In term of univariate comparison, the FHN group proved significantly greater than the non-FHN group regarding to ratio of severe Garden classification [I~II/III~IV, (8/13) vs (58/21), P=0.002], the ratio of combined diabetes [yes/no, (7/14) vs (10/69), P=0.025], combined hypertension [yes/no, (8/13) vs (13/66), P=0.030], serum levels of ET-1 [(7.8±1.8) μg/L vs (6.4±1.5) μg/L, P＜ 0.001] and MMP-13 [(42.1±4.3) μg/L vs (36.4±4.0) μg/L, P＜0.001], despite of the fact that there were no statistically significant differences in age, sex, body mass index, fracture side and fracture cause between the two groups (P＞0.05). As results of binary multi-factor logistic regression , the severe Garden grade (OR=3.056, 95%CI: 1.597~11.686), diabetes mellitus (OR=2.430, 95%CI: 1.640~8.790), high serum ET-1 level (OR=2.694, 95%CI: 1.537~9.570) and high level of MMP-13 (OR=2.745, 95%CI: 1.455~10.708) were risk factors for FHN after internal fixation of FNF. [Conclusion] Serum ET-1 and MMP-13 are closely related to postoperative FHN in patients who had FNF fixed.

Abstract:[Objective] To investigate the clinical consequence of hip arhtroplasty in the treatment of unstable intertrochanteric femoral fracture (ITF) in elderly. [Methods] A retrospective study was conducted on 28 elderly patients who received hip arthroplasty for unstable ITF in our hospital from January 1, 2013 to December 31, 2023. The clinical and imaging documents were evaluated. [Results] All patients had operation performed successfully with operation time of (59.9±5.4) min and intraoperative blood loss of (269.8±76.4) mL, and were followed up for more than 6 months. With time1 month , 3 months and 6 months postoperatively, the VAS score [(3.9 ±0.6), (2.1±0.4), (0.8±0.4), P＜0.001], Harris score [(73.2±3.5), (79.3±4.6), (83.3±2.2), P＜0.001], hip extensionflexion ROM [(95.6±2.3)°, (113.8±5.4)°, (134.9±3.5)°, P＜0.001] and internal-external rotation ROM [(63.1±7.0)°, (72.1±6.0)°, (78.6±2.5)°, P＜0.001] were significantly improved. As for imaging, there were no significant changes in shaft-neck angle, head and neck length, anteversion of the femoral component at the last follow-up compared with those immediate postoperatively (P＞0.05). [Conclusion] Hip arthroplasty achieve good results in the treatment of unstable ITF in elderly, in which the patients can undergo rehabilitation exercise as soon as possible after surgery to reduce the pain.

Abstract:[Objective] To investigate the short-term clinical consequence of core decompression combined with porous titanium cage implantation for early femoral head necrosis. [Methods] A retrospective study was conducted on 10 patients (12 hips) who had early-stage femoral head necrosis treated by core decompression combined with porous titanium cage implantation in our department from October 2022 to March 2023. The clinical and imaging documents were evaluated. [Results] All the patients had abovesaid surgical procedures performed successfully without important vascular and nerve injuries, and other complications, and were followed up for an average of (14.5± 2.1) months. Compared with those before surgery, the VAS score was significantly decreased [(7.0±1.2), (2.0±1.0), P＜0.001], whereas the Harris score [(72.0±4.2), (91.0±3.5), P＜0.001], hip flexion-extension range of motion (ROM) [(54.8±3.7)°, (89.7±3.3)°, P＜0.001], hip internal-external rotation ROM [(35.3±3.2)°, (60.7±2.9)°, P＜0.001] were significantly increased at the last follow-up. As for imaging, there were no significant changes in ARCO stage and JIC stage at the last follow-up compared with those before surgery (P＞0.05). At the last followup, 1 patient had aggravation in the necrotic area of the femoral head. [Conclusion] The core decompression and porous titanium cage implantation achieve satisfactory clinical outcome in the short term for the earl-stage femoral head necrosis.

Abstract: