Hidden blood loss and the influential factors after minimally invasive treatment of posterior pelvic ring injury with sacroiliac screw.

BACKGROUND: To analyze the perioperative bleeding and hidden blood loss (HBL) of sacroiliac screw minimally invasive treatment of pelvic posterior ring injury and explore the influential factors of HBL after operation for providing reference for clinical treatment. METHOD: A retrospective analysis was conducted on data from 369 patients with posterior pelvic ring injuries treated with sacroiliac screws internal fixation at our hospital from January 2015 to January 2022. The research was registered in the Chinese Clinical Trial Registry in July 2022 (ChiCTR2200061866). The total blood loss (TBL) and HBL of patients were counted, and the factors such as gender, age, and surgical duration were statistically analyzed. The influential factors of HBL were analyzed by multiple linear regression. RESULTS: The TBL was 417.96 ± 98.05 ml, of which the visible blood loss (VBL) was 37.00 ± 9.0 ml and the HBL was 380.96 ± 68.8 ml. The HBL accounted for 91.14 ± 7.36% of the TBL. Gender, surgical duration, fixed position, and fixed depth had significant effects on the HBL (P < 0.05). CONCLUSIONS: The HBL was the main cause of anemia after minimally invasive treatment of posterior pelvic ring injury with a sacroiliac screw. Gender, surgical duration, fixed position, and fixed depth were closely related to the occurrence of HBL. In clinical treatment, we should consider these influential factors and take effective measures to reduce the impact of HBL on patients.

[Real-time traking and virtual reality technology-assisted trauma orthopaedic surgery robot for femoral neck fractures].

OBJECTIVE: To investigate the effectiveness of real-time tracking and virtual reality technology（RTVI） used to assist the intraoperative alignment of the trauma orthopaedic surgery robot for the treatment of femoral neck fractures and its impact on the treatment outcome. METHODS: A retrospective analysis was conducted on 60 patients with femoral neck fractures treated with trauma orthopedic robotic surgery from September 2020 to September 2022. Patients were divided into two groups according to whether RTVI technology was used during surgery to assist robotic surgery. There were 28 patients in the RTVI group （12 males and 16 females）, with an average age of （46.2±9.3） years old ranging from 28 to 60 years old. There were 32 patients in the simple Tianji surgical robot group, including 15 males and 17 females, aged （48.2±7.8） years old ranging from 32 to 58. The number of registered fluoroscopy, operation time, total number of intraoperative fluoroscopy, intraoperative blood loss, and hospitalization time of the two groups of patients were observed and recorded. All patients received regular follow-up after surgery, and hip X-rays were routinely reviewed to record Garden alignment index, fracture healing time, postoperative complications, and Harris score. RESULTS: All 60 patients were followed up. The RTVI group was followed up for 9 to 16 months with an average of （13.0±1.2） months, and the Tianji surgical robot group alone was followed up for 10 to 14 months with an average of （12.0±1.3） months. During the follow-up period, the femoral neck fractures of both groups of patients healed well, and no complications such as internal fixation loosening and incision infection occurred. The number of registered fluoroscopy, operation time, and number of intraoperative fluoroscopy of patients in the RTVI group were significantly better than those in the simple Tianji surgical robot group（P<0.01）. There was no statistically significant difference in intraoperative blood loss, hospital stay, Garden alignment index, fracture healing time, and hip Harris score between two groups（P>0.05）. CONCLUSION: Although RTVI technology assisted by the surgical robot for femoral neck fracture surgery has little impact on its postoperative outcome, it can effectively reduce the operating time, the number of intraoperative X-ray projections, and the risk of intraoperative radiation exposure to patients. It also shortened the learning curve of the operator and better reflected the precision and efficiency of the trauma orthopaedic surgery robot.

Outcomes of U-shaped internal fixation in the treatment of avulsion fracture of calcaneal tubercle.

BACKGROUND: The purpose of this study was to analyze the efficacy of U-shaped internal fixation for calcaneal tubercle fracture after nearly 3 years of case follow-up and data collection. METHOD: We retrospectively analyzed the collected data from 16 patients with avulsion fracture of calcaneal tubercle between December 2018 and February 2021 at our institute. All patients were required to conform to regular follow up postoperatively. X-ray film was applied to all cases. The American Orthopaedic Foot and Ankle Association (AOFAS) score, Cedell score and the visual analog scale (VAS) were used to evaluate functional results. RESULTS: All patients achieved bone union. The preoperative AOFAS score was 26.34 ± 3.34, which was significantly different from 91.38 ± 6.15 half a year after operation (p = 0.003). The preoperative Cedell score was 31.05 ± 4.18 and the score half a year after operation was 92.17 ± 5.39(p = 0.011). The VAS score was 8.91 ± 1.51 before operation and decreased to 0.58 ± 1.31 half a year after operation (p = 0.014). CONCLUSIONS: In the treatments of calcaneal tubercle fracture, U-shaped internal fixation is a new attempt. Through the short-term follow-up study, we found that its therapeutic effect is excellent, which is a recommended treatment in clinic.

Current status of robot-assisted surgery in the clinical application of trauma orthopedics in China: A systematic review.

Background and Aims: To elaborate on the development and characteristics of trauma orthopedic robots and their real curative effect in a clinical application through the collection and analysis of relevant literature and reported clinical results. Method: We conducted the Embase, ScienceDirect, Pubmed, Medline, Wanfang, CNKI, and VIP search of the literature on robotic-assisted surgery in trauma orthopedics in China. We combined search terms with "robotic surgery/artificial intelligence surgery/navigation surgery," "trauma/trauma orthopedics," and "China/Chinese." The exclusion criteria were: (1) articles in languages other than English or Chinese, (2) articles focused on other topics other than robotic-assisted surgery in trauma orthopedics of China, (3) article types were not clinical studies (reviews, basic research, etc.), and (4) articles were not included in the Chinese core journals or science citation index. Authors, type of surgery, robot type, and clinical research results were recorded and analyzed. Results: There were three categories of surgical robots in the clinical application of trauma orthopedics (TiRobot, electromagnetic navigation surgical robots, and small medical robots developed by Beijing Jishuitan Hospital). In terms of blood loss, the fluoroscopy time, and fluoroscopy frequency, most studies found that the robot group was significantly better than the traditional group. Conclusions: Robot-assisted surgery has obvious advantages in accuracy, stability, and reducing intraoperative radiation exposure, but there is no final conclusion about functional recovery.

Berberine Attenuates IL-1ß-Induced Damage of Nucleus Pulposus Cells via Activating the AMPK/mTOR/Ulk1 Pathway.

Intervertebral disc degeneration (IDD) is a chronic progressive condition mainly caused by excessive inflammatory cytokines. Berberine (BBR) exerts anti-inflammatory effect on diseases and protective effect against IDD. However, the mechanism is not uncertain. This study is aimed at investigating the molecular mechanism of BBR on IDD. Nucleus pulposus (NP) cells were treated with BBR at different concentrations. The IDD rat model was established by acupuncture. The effect of BBR on interleukin- (IL-) 1ß-induced cell proliferation was measured by CCK-8 assay and BrdU staining. The role of BBR in IL-1ß-induced apoptosis, autophagy repression, and extracellular matrix (ECM) degradation was measured by Annexin/PI staining, immunofluorescence, and immunoblot. The effect of BBR on IDD was investigated in rat. Our findings showed that BBR restored cell growth and attenuated apoptosis in IL-1ß-induced NP cells. BBR also prevented the IL-1ß-induced ECM degradation through regulating ECM-related enzymes and factors. Additionally, BBR significantly activated autophagy repressed by IL-1ß. Autophagy stimulated by BBR was diminished by the inhibition of the AMPK/mTOR/Ulk1 signaling pathway. In vivo study also showed BBR attenuated intervertebral disc degeneration. BBR could attenuate NP cells apoptosis and ECM degradation induced by IL-1ß through autophagy by the AMPK/mTOR/Ulk1 pathway. This study suggests BBR might function as an AMPK activator to alleviate IDD progression.

A new surgical approach for the treatment of scapular glenoid fractures- Axillary approach: A single center case series.

Background: The purpose of this study was to assess the efficacy of the scapular glenoid fractures by a new surgical approach (Axillary approach) through follow-up studies. Method: We retrospectively analyzed the prospectively collected data from 11cases of glenoid fractures were treated by open reduction and internal fixation through a Axillary approach approach between July 2019 and October 2020. All patients were required to conform to regular follow up postoperatively. X-ray film and CT scan was applied to all cases. The Constant score system, the UCLA score system and DASH score system were used to evaluate functional results. Results: All patients achieved bone union. At the final follow-up, the mean Constant score was 92.5 ± 3.0 (range 85-97) points and the mean UCLA score was 33.5 ± 1.6 (range 31-36) points. According to the UCLA score system, two patients achieved excellent results and one patients had good results. The mean DASH scores were 7.7 ± 3.2 (range 4-12). Compared with the preoperative functional score, it was significantly improved (P < 0.01). Conclusions: The axillary approach as a new method for scapular glenoid fractures (especially the fracture of the lower half of the scapular glenoid) has achieved desired results, and it can provide new options for clinical treatment. Level of evidence: Level III; Development or Validation of Outcome Instrument© 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Influential factors of subacromial impingement syndrome after hook plate fixation for acromioclavicular joint dislocation: A retrospective study.

ABSTRACT: Subacromial impingement syndrome (SIS) after hook plate fixation for acromioclavicular joint (AC) dislocation was the most common complication. However, the researches on its' influential factors were rare. The purpose of this study was to identify the risk factors by analyzing the influencing factors of postoperative SIS and minimize the incidence of SIS in clinical surgery.We retrospectively analyzed the prospectively collected data from 330 consecutive patients with AC joint dislocation between August 2014 and August 2017 at our institute. The SIS was presented as the dependent variable at the last follow-up when the internal fixation was removed. The independent variables included age, gender, body-mass index (BMI), smoking status, alcohol consumption, type of injury, Rockwood Classification, site of injury, operation time, injury-to-surgery, the distance between the hook body and the acromion (DBA), the depth of hook tip (DHT), the distance between the hook plate and the humeral head (DHH), the distance between the acromion and the humeral head (DAH), the hook plate angle (AHP) and acromial shape. Logistic regression analysis was performed to identify independent influential factors of SIS.A total of 312 cases were included and 18 cases were lost. The follow-up rate was 94.5%. In without SIS group, there were 225 cases (123 males and 102 females). In with SIS group, a total of 87 cases were included (56 males and 31 females). The incidence of SIS was 27.8%. DHT (OR = 9.385, 95% CI = 4.883 to 18.040, P < .001) and DBA (OR = 2.444, 95% CI = 1.591 to 3.755, P < .001) were the significant independent risk factor for SIS of AC dislocation treat with hook plate. DAH (OR = 0.597, 95% CI = 0.396 to 0.900, P = .014) and acromial shape with flat and straight (OR = 0.325, 95% CI = 0.135 to 0.785, P = .012) were also independent factors of SIS, but they were all protective.The SIS had a high incidence in fixation of clavicular hook plate for AC dislocation. DHT and DBA were two independent risk factors, DAH and acromial shape with flat and straight were two independent protective factors for SIS. In clinical surgery, we should avoid risk factors to reduce the incidence of SIS.

The Treatment of Avulsion Fracture of the Calcaneal Tuberosity: A New Technique of 180-Degree Annular Internal Fixation.

Due to the traction of the Achilles tendon and osteoporosis, a large number of reports have shown that a series of complications such as skin flap necrosis and failure of internal fixation after surgery often cause nonunion or malunion of calcaneal tuberosity fractures. At the same time, there is no uniform standard for the operative procedure in the treatment of the avulsion fractures of the calcaneal tuberosity. We presented a new technique for the treatment of avulsion fractures of the calcaneal tuberosity, which is fixed with a 180-degree microplate. We aim to provide a simple, safe, and strong internal fixation technique for avulsion fractures of the calcaneal tuberosity as one of the treatment options.