Xenoimplantation of an extracellular-matrix-derived, biphasic, cell-scaffold construct for repairing a large femoral-head high-load-bearing osteochondral defect in a canine model.

This study was aimed to develop an ECM-derived biphasic scaffold and to investigate its regeneration potential loaded with BM-MSCs in repair of large, high-load-bearing osteochondral defects of the canine femoral head. The scaffolds were fabricated using cartilage and bone ECM as a cartilage and bone layer, respectively. Osteochondral constructs were fabricated using induced BM-MSCs and the scaffold. Osteochondral defects (11 mm diameter × 10 mm depth) were created on femoral heads of canine and treated with the constructs. The repaired tissue was evaluated for gross morphology, radiography, histological, biomechanics at 3 and 6 months after implantation. Radiography revealed that femoral heads slightly collapsed at 3 months and severely collapsed at 6 months. Histology revealed that some defects in femoral heads were repaired, but with fibrous tissue or fibrocartilage, and femoral heads with different degrees of collapse. The bone volume fraction was lower for subchondral bone than normal femoral bone at 3 and 6 months. Rigidity was lower in repaired subchondral bone than normal femoral bone at 6 months. The ECM-derived, biphasic scaffold combined with induced BM-MSCs did not successfully repair large, high-load-bearing osteochondral defects of the canine femoral head. However, the experience can help improve the technique of scaffold fabrication and vascularization.

Repairing peripheral nerve defects with revascularized tissue-engineered nerve based on a vascular endothelial growth factor-heparin sustained release system.

To enhance the angiogenic capacity of tissue-engineered peripheral nerves, we have constructed revascularized tissue-engineered nerves based on a vascular endothelial growth factor (VEGF)-heparin sustained release system. However, the effects of the repair of large peripheral nerve defects are not known. In this study, we used the above revascularized tissue-engineered nerve to repair large nerve defects in rats. The repair effects were observed through general observation, functional evaluation of nerve regeneration, ultrasound examination, neural electrophysiology, wet weight ratio of bilateral gastrocnemius muscle, histological evaluation, and quantitative real-time polymerase chain reaction (PCR) analysis. The results showed that the tissue-engineered peripheral nerve based on a VEGF-heparin sustained release system can achieve early vascularization and restore blood supply in the nerve graft area. The realization of early vascularization in the area of the nerve defect greatly promotes the speed of nerve regeneration and reconstruction in the area of the nerve defect, which greatly advances the process of nerve repair and reconstruction and accelerates the restoration of the normal morphological structure and function of peripheral nerves.

The experimental study of X-ray diagnosis of closed reduction rotational displacement of femoral neck fractures / 中华骨科杂志

Objective:To explore the optimal index of rotational displacement of femoral neck fractures by modeling the axial rotational displacement of femoral neck fractures after reduction and based on X-ray projections.Methods:Six dry human femur specimens, comprising 2 males and 4 females, were utilized in the study. Design and manufacture a proximal femur ortholateral and oblique X-ray casting jigs and mounts. The femoral neck fracture was modeled on the femoral specimen, with Pauwells 30°, 50°, and 70° models (2 each) made according to Pauwells typing. The fractures were manually repositioned with residual anterior 20°, 40° and 60° axial rotational displacements. Each fracture model was projected at different angles (pedicled 40°, pedicled 20°, vertical 0°, cephalad 20°, and cephalad 40°), and the trabecular angle and Garden's alignment index of the model were measured to observe the imaging characteristics of the fracture line on the medial oblique and lateral oblique radiographs.Results:In the presence of a 20° and 40° anterior rotational displacement following reduction of a femoral neck fracture, the trabecular angle in the rotationally displaced group was not significantly different from that of the anatomically repositioned group in various projection positions. However, when a residual rotational displacement of 60° was present, the trabeculae appeared blurred at most projection angles in the Pauwells 30° and 50° models, failing to measure trabecular angles. In the Pauwells 70° fracture model, the trabecular angle in the rotational displacement group was significantly different from that in the anatomical reduction group. In anteroposterior radiographs, when the anterior rotation displacement was 60° in the Pauwells 70° group, Garden's contralateral index showed an unsatisfactory restoration (150°, 142°), whereas all rotationally displaced models in the Pauwells 30° and Pauwells 50° groups had a Garden's contralateral index of >155°, which achieved an acceptable restoration. In lateral radiographs, all rotational displacement models with Garden's alignment index>180° failed to achieve acceptable repositioning, and the larger the Pauwells angle the greater the Garden's alignment index at the same rotational displacement. In the internal oblique position with a bias towards the foot side, the image showed partial overlap between the femoral head and the shaft, making it difficult to assess the quality of the reduction. Conversely, when projected cephalad, the femoral neck appeared longer, particularly at a projection angle of 40° cephalad, allowing for clear observation of the fracture line and the anatomy of the proximal femur. The trabeculae were not well visualized in the external oblique position.Conclusion:There are limitations in applying the trabecular angle to assess the axial rotational displacement of the femoral head after reduction of femoral neck fractures. The Pauwells 70° with residual rotational anterior displacement of 60° was the only way to detect axial rotational displacement of the femoral head on anteroposterior radiographs Garden's alignment index. For the determination of axial rotational displacement of the femoral head, the Garden's alignment index on lateral radiographs provides higher reliability.

Research progress on mechanisms of mutual regulation between the muscular system and the skeletal system in the elderly / 中华老年医学杂志

Examining mechanisms involved in the mutual regulation between the muscular system and the skeletal system, elucidating the key issues responsible for loss of muscle and bone mass and strength, and thus halting the progression of these conditions are critical measures for reducing fractures caused by falls and subsequent disability and mortality.At present, most studies have treated the muscular system and the skeletal system separately, often ignoring the mutual regulation and connections between them.This article reviews the current research progress on the mechanisms of interaction between the two systems, aiming to provide a basis for the prevention, diagnosis and treatment of disuse-related diseases in the elderly population.

Advances in peripatellar osteotomy for treating recurrent patellar dislocation / 中国修复重建外科杂志

OBJECTIVE@#To summarize the progress of research related to the surgical treatment of recurrent patellar dislocation by peripatellar osteotomy in clinical practice, in order to provide reference for clinical treatment.@*METHODS@#The recent literature on peripatellar osteotomy for recurrent patellar dislocation at home and abroad was reviewed, and the bony structural abnormalities, imaging diagnosis, and treatment status were summarized.@*RESULTS@#Abnormalities in the bony anatomy of the lower limb and poor alignment lead to patellofemoral joint instability through the quadriceps pulling force line and play an important role in the pathogenesis of recurrent patellar dislocation. Identifying the source of the deformity and intervening with peripatellar osteotomy to restore the biomechanical structure of the patellofemoral joint can reduce the risk of soft tissue surgical failure, delay joint degeneration, and achieve the target of treatment.@*CONCLUSION@#In the clinical diagnosis and treatment of recurrent patellar dislocation, the factors causing patellofemoral joint instability should be comprehensively evaluated to guide the selection of surgery and personalized treatment.

Ponte osteotomy combined with bone bridge dissection and intervertebral bone grafting for the treatment of rigid degenerative scoliosis / 中华骨科杂志

Objective:To investigate the effect of Ponte osteotomy combined with bony bridge dissection and intervertebral bone grafting in the treatment of rigid degenerative scoliosis.Methods:From March 2017 to October 2021, this method was used to treat 21 cases of rigid degenerative scoliosis, including 7 males and 14 females, aged 59-76 years, with an average age of 67.6 years. All patients had intractable low back pain and limited standing and walking, while 15 patients had radiation pain in lower limbs. The preoperative standing X-ray film showed that the average Cobb angle of lumbar scoliosis was 51.3°±24.1°, the average lumbar lordosis was 5.4°±13.6°. The coronal balance distance (CBD) was 4.3±2.0 cm (range, 0.5-6.2 cm), and the sagittal vertical axis (SVA) was 5.9±3.1 cm (range, 1.5-6.8 cm). The bending images showed huge osteophyte with bone bridge formation in the vertebral body of the apex region, with poor mobility. Ponte osteotomy was performed according to the degeneration of the deformity. The bone bridge at apex area was cut off, and the intervertebral spaces at apex area and slipped or subluxated levels were release and grafted with granular autogenous decompression bone. During follow-up, the efficacy and deformity improvement were evaluated with visual analogue scale (VAS), Oswestry disability index (ODI) and standing X-ray films.Results:All patients successfully completed the operation. The operation time was 190-330 min, with an average of 250±68 min. The intraoperative bleeding was 700-1600 ml, with an average of 970±260ml. The patients were followed up for 12-36 months, with an average of 20.6±7.2 months. No internal fixation failure, fracture or revision occurred. At the last follow-up, the VAS of low back pain decreased from preoperative 6.1±2.2 to 2.1±1.8 ( t=6.45, P<0.001), and the leg pain decreased from 5.5±3.4 to 1.2±1.0 ( t=5.56, P<0.001).ODI decreased from 52.2%±22.2% to 16.4%±10.6% ( t=6.67, P<0.001). The Cobb angle of lumbar scoliosis was 19.3°±10.5°, with an average correction rate of 62.4%; lumbar lordosis was 34.4°±15.6 °, with average correction of 30°. CBD was 1.9±1.1 cm, with an average correction of 2.4 cm ( t=4.42, P<0.001); and SVA was 1.6±2.1 cm, with an average correction of 4.3 cm ( t=4.90, P<0.001). Conclusion:Ponte osteotomy combined with bone bridge dissection and intervertebral bone grafting is an effective method to treat rigid degenerative scoliosis, which can improve spinal sequence, CBD and SVA, avoid vertebral osteotomy and reduce fusion segments.

Comparison of internal fixation and total hip replacement in elderly patients with femoral neck fractures / 中华老年医学杂志

Objective:To compare the clinical results and costs of treatment between internal fixation and total hip replacement in patients aged 60 to 75 years with femoral neck fractures, in order to provide a reference basis for choosing the appropriate surgical procedure for patients in this age group.Methods:According to the inclusion and exclusion criteria, we selected 69 patients treated with internal fixation and 88 patients treated with total hip replacement for femoral neck fractures, and collected relevant data to analyze the differences in clinical characteristics and prognosis between the two groups.Results:The total hip replacement group was older than the internal fixation group[68(64, 72) vs.63(61, 68), Z=-4.536, P<0.001]. There were 20 men(29.0%)and 49 women(71.0%)in the internal fixation group, and 13 men(14.8%)and 75 women(85.2%)in the total hip replacement group.Both groups had more women than men( χ2=4.706, P=0.030). The ratio of the displaced type to the non-displaced type was higher in the total hip replacement group than in the internal fixation group(90.9% vs.46.4%, χ2=37.510, P<0.001). Postoperative serum albumin levels were lower than preoperative levels in both groups, with greater decreases in the total hip replacement group than in the internal fixation group[(9.06±3.45)g/L vs.(7.07±3.37)g/L, t=-3.393, P=0.001]. The total hip replacement group had a higher intraoperative bleeding volume and blood transfusion volume than the internal fixation group( P<0.05), and the days of hospitalization[12(9, 14)d]and hospitalization costs[￥89222.1(84826.8, 93040.0)]were higher than those in the internal fixation group[9(8, 10)d; ￥51158.9(47816.5, 54098.4), Z=-5.138, -10.737, P<0.001 for both]. Weight-bearing after total hip replacement occurred earlier than the internal fixation group[32.0(28.0, 36.5)d vs.92.0(89.3, 95.5)d, Z=-10.228, P<0.001]. There were no significant differences between the two types of surgery for non-displaced femoral neck fractures at 1 year after surgery in the Harris hip score and the quality of life score EQ-5D.For patients with displacement, the rates of excellent and good outcomes based on the Harris score for the total hip replacement group were significantly higher than those for the internal fixation group at 1 year after surgery(97.5% vs.81.3%, χ2=6.697, P=0.010); the postoperative quality of life score EQ-5D was also better than that of the internal fixation group[0.9(0.7, 1.0) vs.1.0(1.0, 1.0), Z=-4.785, P<0.001], and the incidence of postoperative pain and anxiety was lower than that in the internal fixation group(6.3% vs.28.1%, 1.3%, vs.50.0%, χ2=7.928, 38.032, all P<0.01). Conclusions:The mortality and short-term postoperative complications between internal fixation and total hip replacement have no significant differences.There is no significant difference in postoperative function between the two surgical methods for patients with non-displaced femoral neck fractures.For patients with displacement, total hip arthroplasty is superior to internal fixation.The cost of initial hospitalization for internal fixation is significantly lower than for total hip replacement.

Research progress in application of artificial intelligence to intraoperative navigation assisted by an orthopedic robot / 中华创伤骨科杂志

Orthopedic robots, as intelligent medical devices, have achieved good outcomes in clinical application in some orthopedic surgeries. Artificial intelligence (AI) has played an important role in the development of orthopedic robots due to its powerful capabilities of information processing and decision-making. The developing trends of orthopedic robotics are automation and intelligentization. Since AI has demonstrated great advantages in preoperative planning, an increasing number of researchers have been devoted to AI application in intraoperative navigation by an orthopedic robot. This paper outlines the exploratory efforts in applying AI technology to the intraoperative navigation assisted by an orthopedic robot, describes the advantages of AI in improving accuracy and reducing radiation, and forecasts research prospects in application of AI technology to orthopedic robots based on the current situation.

The predictive function and application value of hip fracture scoring system in the elderly / 中华骨科杂志

Objective:To establish a risk assessment system focusing on surgical and anesthesian-related indicators for the incidence of complications and mortality of hip fracture surgery in senile patients, and to evaluate its prediction accuracy, sensitivity and specificity.Methods:From January 2020 to February 2021, a total of 1 086 elderly patients (493 males and 593 females) aged 76±5 years (ranging from 60 to 94 years) underwent hip fracture surgery in Tianjin Hospital were collected. A total of 543 patients were randomly selected for the establishment of the hip fracture scoring system in senile patients, including 253 males and 290 females, aged 75±6 years (ranging from 60 to 92 years). With the preoperative physiological factor score and surgical risk factor score as independent variables and the occurrence of complications and death as dependent variables, binary logistic regression analysis was performed to establish a surgical risk scoring system for hip fracture in senile patients. The remaining 543 patients, including 240 males and 303 females, aged 74±7 years (range 60-94 years), their data were used to compare AUC, sensitivity, specificity, and compliance of the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), Daping orthopedics operative risk scoring system for senile patient (DORSSSP), and our surgical risk scoring system for hip fracture in senile patients through receiver operating characteristic (ROC) curves, and to compare the predictive value of these systems for complication incidence and mortality.Results:The predictive model equation of the elderly hip fracture scoring system is: ln R1/ (1- R1) =-7.13+0.112× PS+0.148× OS; ln R2/ (1- R2) =-6.14+0.124× PS+0.136× OS; [ R1 is the incidence of complications, R2 is the mortality, PS (physiology score) is the score of preoperative physiological factors, and OS (operation score) is the score of surgical risk factors]. Among the 543 patients whose data were used to compared with the hip fracture scoring system, POSSUM and DORSSSP, 72 actually developed complications and 36 died. The complication rate predicted by surgical risk scoring system for hip fracture in senile patients was 12.05%±6.34% (range 6.18%-61.29%), and 64 cases were predicted to have complications. The predicted mortality was 6.05%±3.26% (range 2.45%-58.36%), and 29 cases were predicted to die. The complication rate predicted by POSSUM was 25.36%±13.95% (range 9.16%-76.34%), and 126 cases were predicted to have complications. The predicted mortality rate was 10.46%±5.31% (range 6.23%-59.34%), and 54 deaths were predicted. The predicted complication rate of DORSSSP was 19.34%±9.67% (range 8.36%-70.85%), and 99 cases were predicted to have complications. The predicted mortality was 10.12%±5.16% (range 7.35%-57.54%), and 52 deaths were predicted. In predicting the incidence of complications, the AUC of surgical risk scoring system for hip fracture in senile patients, POSSUM and DORSSSP were 0.95, 0.82 and 0.75, the sensitivity was 0.89, 0.83 and 0.85, the specificity was 0.80, 0.86 and 0.92, and the compliance rate was 0.94, 0.93 and 0.94, respectively. In the prediction of mortality, the AUC of surgical risk scoring system for hip fracture in senile patients, POSSUM and DORSSSP were 0.87, 0.67 and 0.71, the sensitivity was 0.85, 0.69 and 0.75, the specificity was 0.73, 0.94, 0.95, and the compliance rate was 0.94, 0.93 and 0.94, respectively. Conclusion:Compared with POSSUM and DORSSSP, hip fracture scoring system in elderly patients has improved its ability to predict surgical risk, and can accurately predict the incidence of complications and mortality in elderly patients undergoing hip surgery.

Graded surgical strategy for osteoporotic vertebral compression fractures with kyphosis: application of balanced load concept / 中华骨科杂志

Objective:To explore the application value of graded surgical strategy and balanced load concept for thoracolumbar osteoporotic compression fractures (OVCFs) with kyphosis.Methods:All of 56 patients of thoracolumbar OVCFs with kyphosis were studied, including 11 males and 45 females, with an average of 75.6±9.3 years old. All patients had back pain, and 32 patients had nerve compression, including 5 patients with aggravation of vertebral collapse after conservative treatment, and 1 patient with cement loosening after percutaneous kyphoplasty (PKP) in another hospital. A graded surgical strategy was developed according to the concept of balanced load, including whether there existed nerve compression, kyphosis, sagittal index (SI), vertebral collapse, load capacity of anterior and middle columns, and fracture reducibility. All patients were treated with anti osteoporosis therapy. 24 patients without nerve compression underwent posture reduction and PKP; 32 patients with nerve compression underwent open surgery: 5 patients with arcuate ky-phosis and SI≤15° underwent Ponte osteotomy; 15 patients with angular kyphosis or SI>15° underwent posterior pedicle subtraction osteotomy (PSO) or/and modified PSO including intervertebral space; 11 patients with SI>15° and severe vertebral collapse (the height of anterior and middle vertebral bodies <1/3 of the average height of adjacent vertebral bodies) or cement loosen after PKP underwent vertebrectomy and reconstruction, of which 4 patients underwent posterior vertebral column resection (PVCR), and 8 patients underwent combined surgery including anterior subtotal vertebrectomy with support and posterior pedicle fixation. The clinical efficacy was evaluated by pain visual analog score (VAS) and Oswestry dysfunction index (ODI).Results:All patients were followed up for 12-60 months, with an average of 24.2 months. For the 24 patients with PKP, the symptoms improved significantly, and 1 case had adjacent vertebral fracture that was improved after PKP again. For the 32 patients with open surgery, the intraoperative blood loss was 400-1 800 ml, with an average of 960 ml (PVCR > PSO and combined surgery > Ponte); the operation time was 2-7 h, with an average of 4.3±1.9 h. The neurological symptoms improved after the operation. During follow-up, the artificial vertebral body and titanium mesh collapsed in 3 cases, but did not continue to deteriorate, no vertebral fracture, internal fixation displacement or loosening failure occurred on X-ray films. At the last follow-up, the VAS score and ODI score of 56 patients decreased from 7.0±2.6 and 60.4±16.2 pre-operation to 1.4±1.1 and 9.5+5.8 respectively, and local kyphosis angle improved from 18.1±4.3 pre-operation to 5.6±4.3. According to the overall satisfaction of patients, the effect was fair in 12 cases, good in 30 cases, excellent in 14 cases, and the excellent and good rate was 78.6%.Conclusion:The graded surgical strategy for thoracolumbar OVCFs with kyphosis based on the concept of balanced load can restore the balanced load of the anterior and middle columns of the spine, reduce the fixation and fusion segments, and reduce the risk of internal fixation displacement and loosening failure.

Review on the origin of knee valgus deformity / 中华骨科杂志

The sources of common knee valgus deformities were classified in order to better plan the orthopedic methods, matching prostheses and soft tissue repair of knee valgus deformities.Based on the analysis of typical clinical cases and the operability of classification standards in practical clinical practice, it is of great significance to establish a reasonable morphological classification of knee valgus deformity, in order to grasp the characteristics and patterns of the onset of valgus deformity. According to the origin of the deformity and the tension of the medial and lateral collateral ligaments, the classification of the genu valgus deformity can be divided into the classification of the traditional Genu valgum deformity origin and the classification of the new Genu valgum deformity origin. Although both of them highlight the skeletal characteristics and soft tissue conditions of the valgus deformity, they are quite different. Traditional classification is based on femoral tibial angle, valgus angle, etc; The new classification is divided into mechanical angle, anatomical angle, distal condylar angle, etc. The origin of Genu valgum deformity is generally complex. The traditional classification cannot fully reflect the origin of valgus deformity and the tension state of soft tissue. The new classification, especially based on the classification of anatomical angle valgus deformity, can not only reflect the morphological and anatomical details of knee valgus deformity, but also reflect the tension state of the medial and lateral collateral ligaments and local soft tissue stress state that determine the stability of the knee joint. At present, the commonly used surgical methods for valgus deformity of the knee include periarticular osteotomy of the knee and total knee Joint replacement. The former focuses on correcting extraarticular deformity without over repairing ligaments, and the latter focuses on force line correction, which is the final treatment for terminal valgus deformity. The application of digital technology in clinical orthopedics can improve the accuracy of implant placement. Implant placement needs to be based on the patient's bone characteristics and degree of deformity. For patients with severe deformity, the application of digital technology can improve the accuracy of implant placement and assist in the treatment of knee valgus deformity.

Kinematics and Plantar Pressure Analysis of Varus Femur and Varus Tibia / 医用生物力学

Objective To compare the differences in kinematic parameters and plantar pressures for two types of knee varus with tibial and femoral origins in gait analysis, so as to provide biomechanical theoretical basis for different types of genu varus. Methods Twenty-six patients with unilateral knee osteoarthritis (KOA) varus genu were enrolled, with 13 from femoral and 13 from tibial sources. Using Noraxon MyoMotion three-dimensional (3D) motion capture system and Footscan plantar pressure test system, the gait of the subjects during natural walking was measured, the temporal and spatial parameters of the gait, the kinematics parameters of lower limb joints and plantar pressures were collected, to make comparative analysis between the two groups. Results The range of knee flexion and extension of tibial varus, the peak of hip abduction, the range of motion (ROM) of hip adduction and abduction and the peak of ankle pronation were larger than those of femoral lateral genu varus. The peak of knee flexion and hip adduction was smaller than that of femoral lateral genu varus. Compared with femoral varus, subjects with tibial varus had increased stress time and peak pressure on the plantar of the 4th and 5th metatarsals (P<0.05). In the 3rd metatarsal region, the impulse of healthy femoral limb was greater than that of healthy limb with tibial deformity. While in the medial calcaneal region, the impulse of healthy femoral limb was smaller (P<0.05). Conclusions There are some differences in kinematic parameters and plantar pressures between two different types of unilateral genu varus patients. The results of this study are helpful to understand the abnormal gait caused by genu varus, and provide reliable reference for postoperative rehabilitation and limb exercise for different types of genu varus.

Impacts of different types of triply periodic minimal surface on performance of bone scaffolds: a review / 中华创伤杂志

Bone defects, often accompanied by osteomyelitis, soft tissue contusions, etc, are facing lengthy treatment process and slow healing, seriously jeopardizing the structural integrity of the human bone tissue. Currently, the main treatment for bone defects involves autologous or allogeneic bone transplant. However, autologous bone transplant poses problems, including long surgical duration, increased pain and complications such as infections. Additionally, immune rejection reactions also limit the effectiveness of allogeneic bone transplant of the same species. Bone scaffolds have become a potential alternative for bone transplant, but problems such as sharp edges of the scaffolds and poor compatibility with human tissues exist. Triply periodic minimal surface (TPMS), with an average curvature of zero has lower levels of stress concentration and the ability to be precisely expressed with mathematical formulas, compared with other structures. Its application in bone scaffolds attracts much attention, but there is currently a lack of comprehensive understanding of the impacts of different types of TPMS on the performance of bone scaffolds. With this purpose, the authors reviewed the research progress in the impacts of different types of TPMS on the performance of bone scaffolds, providing a reference for the construction of bone scaffolds.

Treatment of transverse with posterior wall fractures of acetabulum using robot-aided percutaneous anterior column screw combined with posterior plate / 中华骨科杂志

Objective:To explore the effectiveness and safety of robot-aided percutaneous anterior column screw combined with posterior plate fixtation treatment for transverse acetabular fractures with posterior wall.Methods:A retrospective analysis was conducted on the data of 13 patients with transverse acetabular fractures and posterior wall fractures treated by robot-aided percutaneous anterior column screws combined with posterior plate in Tianjin Hospital from May 2016 to May 2021. There were 9 males and 4 females, aged 49.1±8.5 years (range, 25-65 years), 9 cases of vehicle accidents, 2 cases of falling injuries, 2 cases of impact injuries, 7 cases of combined posterior hip dislocations, and 1 case of sciatic nerve injury. Apply Kocher-Langenbeck approach for reduction and fixation of the posterior wall and the posterior column and indirect reduction of the anterior column. Use robot navigation for percutaneous anterior column screw fixation, and record the time of inserting anterior column screws, incision length, and complications. The quality of fracture reduction was evaluated using Matta imaging, and the degree of ectopic ossification was evaluated using Brooker classification. The Matta modified Postel Merle D'Aobigne score was used to evaluate the function at 3, 6 months after surgery and at the last follow-up.Results:All 13 patients successfully completed the surgery. The insertion time of the anterior column screw was 19.4±4.0 min (range, 17-23 min), and the incision length was 8.0±1.4 mm (range, 6-10 mm). Postoperative imaging examination showed that all anterior column screws were located within the bone canal, with a screw length of 108.3±11.2 mm (range, 90-130 mm), and no complications such as nerve or vascular injury or incision infection occurred. All 13 patients were followed up for a period of 12-36 months, with an average of 18.6 months; All fractures healed, with a healing time of 2-6 months, average 3.4 months. According to the Matta imaging evaluation method, 11 of 13 patients had anatomical reduction of fractures, and 2 were evaluated as incomplete reduction due to a 1-2 mm gap in the anterior column. The anatomical reduction rate was 84%. At postoperative 3, 6 months and the last follow-up, the modified Postel Merle D'Aobigne scores were 13.4±1.1, 15.8±1.5, and 17.0±1.7, respectively, with statistically significant differences ( F=7.78, P=0.007). The difference between the last follow-up and postoperative 3 months was statistically significant ( P=0.002), and there was no statistically significant difference compared to postoperative 6 months ( P=0.222). At the last follow-up, 8 cases were excellent, 4 cases were good, and 1 case was fair, with an excellent and good rate of 92%. There was no occurrence of ectopic ossification, traumatic arthritis, or necrosis of the femoral head. Conclusion:Robot-aided percutaneous anterior column screw combined with posterior plate treatment for transverse acetabular fractures with posterior wall is safe and effective, and is worthy of clinical promotion.

A clinical study of different doses and frequencies of Sildenafil in the treatment of erectile dysfunction / 现代泌尿外科杂志

【Objective】 To evaluate the efficacy and safety of different doses and frequencies of oral Sildenafil in the treatment of erectile dysfunction (ED). 【Methods】 The randomized,open clinical trial included 120 ED patients who met the inclusion and exclusion criteria. The patients were randomly divided into the following groups:on-schedule (25 mg/day),on-demand (50 mg,taken irregularly half an hour before each sexual life),new regular group (25 mg/day,50 mg more before each sexual life),regular group (100 mg/time,twice/week). All treatments lasted for 8 weeks. The follow-up indexes included the five-item International Index of Erectile Function (IIEF-5),Erection Hardness Scale (EHS) and Sexual Encounter Profile (SEP2/3). The adverse reactions were recorded. 【Results】 The IIEF-5 scores of the four groups were significantly higher than those after baseline treatment (P0.05). In terms of effective rate,at the 16th week,there were significant differences between the on-demand group (10.7%) and new regular group (62.1%),and between the on-demand group (10.7%) and regular group (50.0%) (P<0.001). In terms of EHS, the percentage of grade 4 patients in regular group was significant higher than that in the on-demand group at the 8th week and 16th week (all P<0.05). In terms of positive rate of SEP-3,there was a significant difference between the on-demand group and regular group (P=0.042) at the 16th week. In the course of treatment,there were transient adverse reactions such as headache,blurred vision,stuffy nose and back pain,which did not affect the treatment. 【Conclusion】 All of the four treatment methods of oral sildenafil showed good efficacy. Both regular group and new regular group maintained good clinical efficacy during the follow-up,which is better than that of the on-demand group. The new regular scheme can be used as a new,safe and effective treatment option.

Stress Distributions Affected by Different Filling Blocks in Medial Opening Wedge High Tibial Osteotomy / 医用生物力学

Objective To analyze the influence from material and size of the filling block on stress distributions of the tibial osteotomy model. Methods The filling blocks with three different materials (iliac bone, cancellous bone and polyetheretherketone (PEEK)) and five different sizes were established and implanted to the tibial osteotomy models, respectively. The mechanical loads were applied on the model, the stress distribution and edge displacement of the model were analyzed. Results For three kinds of materials, the stress at proximal end of the tibia and the plate, as well as edge displacement in the model implanted with filling block by iliac bone material were lower than those of the cancellous bone and PEEK, but the filling block by iliac bone material had the highest stress. When the filling blocks with different sizes were implanted in osteotomy space, the stress distribution on each part of the tibial osteotomy and edge displacement were different. Especially when the width of the filling block was reduced from 30 mm to 10 mm, the peak stress of the proximal tibia, steel plate and filling block was increased by 49. 3% , 92. 7% and 54. 4% on average. Conclusions Different filling block parameters will affect the stress distribution in different parts of the tibial osteotomy. The research results provide the theoretical basis for parameter selection of the tibial osteotomy filling block in clinic.

Research progress on the design of bone scaffolds with different single cell structures / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of design of bone scaffolds with different single cell structures.@*METHODS@#The related literature on the study of bone scaffolds with different single cell structures at home and abroad in recent years was extensively reviewed, and the research progress was summarized.@*RESULTS@#The single cell structure of bone scaffold can be divided into regular cell structure, irregular cell structure, cell structure designed based on topology optimization theory, and cell structure designed based on triply periodic minimal surface. Different single cell structures have different structural morphology and geometric characteristics, and the selection of single cell structure directly determines the mechanical properties and biological properties of bone scaffold. It is very important to choose a reasonable cell structure for bone scaffold to replace the original bone tissue.@*CONCLUSION@#Bone scaffolds have been widely studied, but there are many kinds of bone scaffolds at present, and the optimization of single cell structure should be considered comprehensively, which is helpful to develop bone scaffolds with excellent performance and provide effective support for bone tissue.

Research progress in influence of microstructure on performance of triply-periodic minimal surface bone scaffolds / 中国修复重建外科杂志

OBJECTIVE@#To summarize the influence of microstructure on performance of triply-periodic minimal surface (TPMS) bone scaffolds.@*METHODS@#The relevant literature on the microstructure of TPMS bone scaffolds both domestically and internationally in recent years was widely reviewed, and the research progress in the imfluence of microstructure on the performance of bone scaffolds was summarized.@*RESULTS@#The microstructure characteristics of TPMS bone scaffolds, such as pore shape, porosity, pore size, curvature, specific surface area, and tortuosity, exert a profound influence on bone scaffold performance. By finely adjusting the above parameters, it becomes feasible to substantially optimize the structural mechanical characteristics of the scaffold, thereby effectively preempting the occurrence of stress shielding phenomena. Concurrently, the manipulation of these parameters can also optimize the scaffold's biological performance, facilitating cell adhesion, proliferation, and growth, while facilitating the ingrowth and permeation of bone tissue. Ultimately, the ideal bone fusion results will obtain.@*CONCLUSION@#The microstructure significantly and substantially influences the performance of TPMS bone scaffolds. By deeply exploring the characteristics of these microstructure effects on the performance of bone scaffolds, the design of bone scaffolds can be further optimized to better match specific implantation regions.

Application of navigation algorithms of fracture reduction robot in femur fracture reduction: a review / 中华创伤杂志

Femoral fracture is a common type of fracture in clinical practice, and poor fracture reduction may lead to malunion and dysfunction. At present, traditional reduction with manipulation and intramedullary nailing are the mainstream treatments, but there exist problems such as X-ray exposure or poor reduction. Fracture reduction robots are of positive significance in improving the safety of surgical treatment of femur fracture, avoiding repetitive operations and poor alignment, and shortening the patients′ postoperative recovery time. Navigation algorithm is the key to achieve the function of femoral repositioning. Understanding the advantages and disadvantages that various types of navigation algorithms demonstrated in femoral reduction applications is important for giving full play to the value of fracture reduction robots in femoral reduction. Therefore, the authors reviewed the research progress in existing robot navigation algorithms applied in femoral fracture repositioning from the following four aspects, including image alignment algorithm, algorithm for establishing the target pose of femoral repositioning, algorithm for compensating the mechanical error, and algorithm for path planning, hoping to provide a reference for the application and research of navigation algorithms of fracture reduction robots.

Guideline for clinical perioperative care of orthopedic trauma patients in the new stage of novel corona virus infection (version 2023) / 中华创伤杂志

As the National Health Commission changes the management of novel corona virus infection, the situation and preventive policies for controlling the epidemic have also entered a new stage in China. Perioperative care strategies for orthopedic trauma such as designated isolation and nucleic acid test screening have also been adjusted in the new stage. Based on the perioperative work experiences in the new stage of epidemic from the frontline anti-epidemic staff of orthopedics in domestic hospitals and combined with the literature and relevant evidence-based medical data in perioperative care of orthopedic trauma patients under the current anti-epidemic policies at home and abroad, Chinese Orthopedic Association and Chinese Society of Traumatology organized relevant experts to formulate the Guideline for clinical perioperative care of orthopedic trauma patients in the new stage of novel corona virus infection ( version 2023). The guideline summarized 16 recommendations from the aspects of preoperative diagnosis and treatment, infection prevention, emergency operation and postoperative management to systematically standardize the perioperative clinical pathways, diagnosis and treatment processes of orthopedic trauma in the new stage of novel corona virus infection, so as to provide a guidance and reference for hospitals at all levels to carry out relevant work in current epidemic control policies.