Objective: Based on spinopelvic parameters and biomechanical principles, the pedicle-facet joint (PFJ) morphological characteristics of isthmic and degenerative spondylolisthesis were analyzed, and the mechanism of their onset and progression was discussed. Methods: This retrospective cross-sectional study included 194 patients with L5 spondylolysis or L5–S1 low-grade isthmic spondylolisthesis (IS group), 172 patients with L4–5 degenerative spondylolisthesis (DS group), and 366 patients with nonlumbar spondylolysis (NL group). The spinopelvic parameters and PFJ morphological parameters of the patients were measured, the differences in these parameters among and within the 3 groups were compared, and the correlations were analyzed. Results: Sacral slope (SS) and lumbar lordosis (LL) were the highest in the IS group, the second highest in the DS group, and the lowest in the NL group. Among the 3 groups, the L4 facet joint angle (FJA) was the largest in the IS group, the second largest in the NL group, and the smallest in the DS group. The L4 pedicle-facet joint angle (PFA) was the largest in the DS group, the second largest in the IS group, and the smallest in the NL group. Pearson correlation analysis showed that within each group, SS and LL were negatively correlated with FJA and positively correlated with PFA. Conclusion This study found a correlation between the PFJ morphological characteristics of patients with lumbar spondylolisthesis and spinopelvic parameters, suggesting that the morphological characteristics of PFJs may be caused by varying stresses under different spinopelvic morphologies.

Objective: Based on spinopelvic parameters and biomechanical principles, the pedicle-facet joint (PFJ) morphological characteristics of isthmic and degenerative spondylolisthesis were analyzed, and the mechanism of their onset and progression was discussed. Methods: This retrospective cross-sectional study included 194 patients with L5 spondylolysis or L5–S1 low-grade isthmic spondylolisthesis (IS group), 172 patients with L4–5 degenerative spondylolisthesis (DS group), and 366 patients with nonlumbar spondylolysis (NL group). The spinopelvic parameters and PFJ morphological parameters of the patients were measured, the differences in these parameters among and within the 3 groups were compared, and the correlations were analyzed. Results: Sacral slope (SS) and lumbar lordosis (LL) were the highest in the IS group, the second highest in the DS group, and the lowest in the NL group. Among the 3 groups, the L4 facet joint angle (FJA) was the largest in the IS group, the second largest in the NL group, and the smallest in the DS group. The L4 pedicle-facet joint angle (PFA) was the largest in the DS group, the second largest in the IS group, and the smallest in the NL group. Pearson correlation analysis showed that within each group, SS and LL were negatively correlated with FJA and positively correlated with PFA. Conclusion This study found a correlation between the PFJ morphological characteristics of patients with lumbar spondylolisthesis and spinopelvic parameters, suggesting that the morphological characteristics of PFJs may be caused by varying stresses under different spinopelvic morphologies.

BACKGROUND:Osteoporotic vertebral fractures are the most common complication in patients with osteoporosis.As a new imaging technique,spine magnetic resonance imaging(MRI)is much more sensitive than X-ray film in the diagnosis of osteoporotic vertebral fractures.However,total spine MRI is costly and takes a long time to scan.Therefore,there is no consensus on whether all patients with osteoporotic vertebral fractures need to undergo total spine MRI scan and which patients need to undergo total spine MRI. OBJECTIVE:To analyze the distribution characteristics of vertebral fractures and explore their clinical significance by observing the whole spine MRI data of osteoporotic vertebral fractures patients. METHODS:Data of cases and MRI images of all patients diagnosed with fresh osteoporotic vertebral fractures who visited the Department of Orthopedics,Affiliated Hospital of Southwest Medical University from August 2018 to September 2022 were retrospectively analyzed.903 patients were included in the study based on inclusion and exclusion criteria.General information(age,gender,and body mass index),medical history characteristics(duration of illness,history of trauma surgery,percussion pain area,and pain score)were collected.The characteristics of vertebral fractures were analyzed through whole spine magnetic resonance imaging.Firstly,based on the number of vertebral fractures in patients,they were divided into the single vertebral fracture group(484 cases)and the multi-vertebral fracture group(419 cases),and the differences were analyzed between the two groups.Then,based on whether the farthest interval between the fractured vertebrae was greater than or equal to 5,the multi vertebral fracture group was further divided into two subgroups.Among them,Group A(the farthest interval between the fractured vertebrae was less than 5)contained 306 cases;Group B(with the farthest interval between fractured vertebral bodies greater than 5)included 113 cases.The differences were analyzed between two subgroups. RESULTS AND CONCLUSION:(1)Among 903 patients,419 patients(46.4%)had more than two fractured vertebrae.There were 654 patients(72.4%)with thoracolumbar fractures,and 54 patients(6%)with fractures in the thoracic plus lumbar region and the entire thoracic to lumbar region.In group B,96.5%of patients had multiregional percussion pain.(2)Compared with the patients in the single vertebral fracture group and the multi-vertebral fracture group,there were significant differences in bone mineral density,whether the medical history was greater than or equal to 1 month,the history of low energy injury,and the distribution and number of axial percussion pain areas in the spine during physical examination between the two groups(P<0.05).Age,gender,body mass index,whether there was underlying disease,pain visual analog scale score,whether there was a history of elderly thoracolumbar fracture,and whether there was a history of thoracolumbar surgery,and the number of fractured vertebrae had no statistical significance(P>0.05).(3)There were statistically significant differences between the Groups A and B in bone mineral density,the distribution and quantity of percussion pain area,and the history of low energy injury(P<0.05).There were no significant differences in age,gender,history of old fractures,visual analog scale score,body mass index,whether the medical history was longer than or equal to 1 month,history of underlying diseases,and history of thoracolumbar surgery between the two groups(P>0.05).(4)Patients with multiple low-energy trauma history,history of more than 1 month,multiple percussion pain,and the lower bone mineral density should be alert to the occurrence of multiple vertebral fracture and jump fracture.We recommend the whole spinal MRI for these patients.

Objective: Based on spinopelvic parameters and biomechanical principles, the pedicle-facet joint (PFJ) morphological characteristics of isthmic and degenerative spondylolisthesis were analyzed, and the mechanism of their onset and progression was discussed. Methods: This retrospective cross-sectional study included 194 patients with L5 spondylolysis or L5–S1 low-grade isthmic spondylolisthesis (IS group), 172 patients with L4–5 degenerative spondylolisthesis (DS group), and 366 patients with nonlumbar spondylolysis (NL group). The spinopelvic parameters and PFJ morphological parameters of the patients were measured, the differences in these parameters among and within the 3 groups were compared, and the correlations were analyzed. Results: Sacral slope (SS) and lumbar lordosis (LL) were the highest in the IS group, the second highest in the DS group, and the lowest in the NL group. Among the 3 groups, the L4 facet joint angle (FJA) was the largest in the IS group, the second largest in the NL group, and the smallest in the DS group. The L4 pedicle-facet joint angle (PFA) was the largest in the DS group, the second largest in the IS group, and the smallest in the NL group. Pearson correlation analysis showed that within each group, SS and LL were negatively correlated with FJA and positively correlated with PFA. Conclusion This study found a correlation between the PFJ morphological characteristics of patients with lumbar spondylolisthesis and spinopelvic parameters, suggesting that the morphological characteristics of PFJs may be caused by varying stresses under different spinopelvic morphologies.

Objective: Based on spinopelvic parameters and biomechanical principles, the pedicle-facet joint (PFJ) morphological characteristics of isthmic and degenerative spondylolisthesis were analyzed, and the mechanism of their onset and progression was discussed. Methods: This retrospective cross-sectional study included 194 patients with L5 spondylolysis or L5–S1 low-grade isthmic spondylolisthesis (IS group), 172 patients with L4–5 degenerative spondylolisthesis (DS group), and 366 patients with nonlumbar spondylolysis (NL group). The spinopelvic parameters and PFJ morphological parameters of the patients were measured, the differences in these parameters among and within the 3 groups were compared, and the correlations were analyzed. Results: Sacral slope (SS) and lumbar lordosis (LL) were the highest in the IS group, the second highest in the DS group, and the lowest in the NL group. Among the 3 groups, the L4 facet joint angle (FJA) was the largest in the IS group, the second largest in the NL group, and the smallest in the DS group. The L4 pedicle-facet joint angle (PFA) was the largest in the DS group, the second largest in the IS group, and the smallest in the NL group. Pearson correlation analysis showed that within each group, SS and LL were negatively correlated with FJA and positively correlated with PFA. Conclusion This study found a correlation between the PFJ morphological characteristics of patients with lumbar spondylolisthesis and spinopelvic parameters, suggesting that the morphological characteristics of PFJs may be caused by varying stresses under different spinopelvic morphologies.

Objective:To investigate the clinical efficacy of minimally invasive percutaneous internal fixation with double screws for delayed union or nonunion of scaphoid fracture.Methods:A retrospective study was conducted to analyze the 12 patients with delayed union or nonunion of scaphoid fracture who had been treated at Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University from March 2021 to December 2023. They were 11 males and 1 female, with an age of (29.9±13.8) years and an interval from injury to surgery of (5.1±2.6) months. They were all treated by minimally invasive percutaneous internal fixation with 2 hollow compression screws. The visual analogue scale (VAS), grip strength (percentage of the affected side to the healthy side), wrist range of motion, modified Mayo wrist score and other data were recorded and compared between pre-surgery and the last follow-up. The incidence of complications was recorded.Results:Follow-up for all patients lasted for (20.8±8.9) months. All patients achieved bony union after (10.1±3.2) weeks with no complications like infection. No post-surgery imaging revealed screw misplacement or penetration. At the last follow-up, the VAS pain score was 0 (0, 1) point, the wrist grip strength 100.6%±7.2%, the wrist flexion 88.3°±2.5°, the wrist dorsiflexion 88.5°±2.2°, and the modified Mayo wrist score (98.3±2.5) points, all significantly better than the pre-surgery values [4 (4, 5) points, 69.1%±16.0%, 61.3°±13.5°, 64.7°±9.1°, and (61.7±10.1) points] (all P < 0.05). Conclusion:In the treatment of delayed union or nonunion of scaphoid fracture, minimally invasive percutaneous internal fixation with double screws shows advantages of minimal invasion, quick fracture healing, fine functional recovery, and no need of bone grafting.

Objective: Based on spinopelvic parameters and biomechanical principles, the pedicle-facet joint (PFJ) morphological characteristics of isthmic and degenerative spondylolisthesis were analyzed, and the mechanism of their onset and progression was discussed. Methods: This retrospective cross-sectional study included 194 patients with L5 spondylolysis or L5–S1 low-grade isthmic spondylolisthesis (IS group), 172 patients with L4–5 degenerative spondylolisthesis (DS group), and 366 patients with nonlumbar spondylolysis (NL group). The spinopelvic parameters and PFJ morphological parameters of the patients were measured, the differences in these parameters among and within the 3 groups were compared, and the correlations were analyzed. Results: Sacral slope (SS) and lumbar lordosis (LL) were the highest in the IS group, the second highest in the DS group, and the lowest in the NL group. Among the 3 groups, the L4 facet joint angle (FJA) was the largest in the IS group, the second largest in the NL group, and the smallest in the DS group. The L4 pedicle-facet joint angle (PFA) was the largest in the DS group, the second largest in the IS group, and the smallest in the NL group. Pearson correlation analysis showed that within each group, SS and LL were negatively correlated with FJA and positively correlated with PFA. Conclusion This study found a correlation between the PFJ morphological characteristics of patients with lumbar spondylolisthesis and spinopelvic parameters, suggesting that the morphological characteristics of PFJs may be caused by varying stresses under different spinopelvic morphologies.

Objective:To compare the efficacy and safety among traditional open suture, modified Kessler method, and minimally invasive suture with threaded rivets in acute closed Achilles tendon rupture.Methods:A total of 60 patients with acute closed Achilles tendon rupture diagnosed and treated in the Affiliated Hospital of Jining Medical College from January 2018 to August 2022 were selected retrospectively as the study subjects and divided into group A (20 patients with traditional open suture), group B (20 patients with modified Kessler method) and group C (20 patients with minimally invasive suture with threaded rivets) according to operative method. The clinical efficacy, perioperative indexes, Achilles tendon activity, postoperative recovery work and exercise time, visual analog scale (VAS) score and complications were compared among the three groups.Results:The total effective rate in the group C was higher than that in the group A : 18/20 vs. 12/20, there was statistical difference ( χ2 = 4.80, P<0.05). The total effective rate in the group B and group C had no statistical difference ( P>0.05). The operation time, intraoperative blood loss, incision length, hospitalization time, time to return to work, exercise and VAS scores in the group B and group C were lower than those in the group A: (49.32 ± 4.74), (48.12 ± 4.68) min vs. (66.71 ± 5.84) min; (15.32 ± 1.01), (15.62 ± 0.79) ml vs.(19.86 ± 1.20) ml; (7.69 ± 0.57), (3.76 ± 0.50) cm vs. (8.98 ± 0.62) cm; (7.01 ± 0.91), (6.82 ± 0.83) d vs.(8.74 ± 1.12) d; (56.32 ± 8.01), (55.17 ± 7.84) d vs. (63.17 ± 6.68) d; (6.13 ± 1.20), (5.94 ± 1.04) months vs. (8.21 ± 1.20) months; (2.76 ± 0.50), (2.55 ± 0.76) scores vs. (3.98 ± 0.62) scores, there were statistical differences ( P<0.05). At 1, 6 and 12 months after surgery, the American Society for Foot and Ankle Surgery (AOFAS) scores in the three groups were significantly increased, and the AOFAS scores in the group B and group C were higher than those in the group A, there were statistical differences ( P<0.05). The total incidence of complications in the group C was lower than that in the group A: 2/20 vs. 8/20, there was statistical difference ( χ2 = 4.80, P<0.05). The total incidence of complications in the group B and group C had no statistical difference ( P>0.05). Conclusions:Modified Kessler method and minimally invasive suture with threaded rivets have the advantages of high efficiency and safety in the treatment of acute closed Achilles tendon rupture, and their efficacy is higher than that of traditional open suture.

Objective:To analyzed the correlation between the sacral slope (SS) and the slip degree of vertebral body, the morphological parameters of intervertebral disc, paraspinal muscle and pedicle in patient with degenerative lumbar spondylolisthesis (DLS).Methods:A retrospective cohort study was conducted. One hundred and forty patients with L 4-5 degenerative spondylolisthesis who visited the Department of Orthopedics, the Affiliated Hospital of Southwest Medical University from July 2018 to October 2022 were included. There were 32 males and 108 females, with an age of (62.6±10.0) years (range: 42 to 87 years) and the body mass index was (23.8±2.8) kg/m 2(range: 14.7 to 28.7 kg/m 2). General information and imaging data (lumbar X-ray, CT three-dimensional reconstruction, MRI images) of the patients were collected. SS and the slip degree (SD) of the L 4 vertebral body were measured on lateral lumbar radiographs. Based on Roussouly classification, 140 patients with DLS were divided into a low SS group (SS<35°), a medium SS group (35°≤SS<45°), and a high SS group (SS≥45°). The morphological parameters of the L 4 pedicle of the patient were measured on the lumbar CT three-dimensional reconstruction images, including pedicle length (PL), pedicle width (PW), pedicle screw trajectory length (PSTL), pedicle camber angle(PCA) and pedicle height (PH). The morphological parameters of the paraspinal muscles (psoas major, multifidus and erector spinae) were measured on MRI images, including total cross-sectional muscle area (TCSA), functional cross-sectional muscle area (FCSA), and the ratio of functional cross-sectional muscle area (FCSA/TCSA) was calculated. The degree of degeneration of the L 4-5 disc was assessed on MRI images. The slip degree, morphological parameters of the pedicle, intervertebral disc, and paraspinal muscles among the groups were compared and their correlation was analyzed. The comparison of quantitative data was conducted using one-way analysis of variance, and the post hoc analysis for pairwise comparisons among groups was performed using the least significant difference method. The comparison of unordered categorical data was carried out using the χ2 test, and the comparison of ordered categorical data was conducted using the Kruskal-Wallis rank sum test. Pearson correlation analysis was used to test the correlation. Results:Among the 140 patients, there were 70 in the low SS group, 48 in the medium SS group, and 22 in the high SS group. The SD and PL of the low SS group were the lowest ((18.6±4.2)%, (14.0±1.0) mm), those of the medium SS group were slightly higher ((21.0±3.6)%, (15.7±0.9) mm), and those of the high SS group were the highest ((23.7±2.8)%, (16.2±0.7) mm), with statistically significant differences among the groups (all P<0.01). The PW, PH and PCA of the low SS group were the highest ((11.0±1.1) mm, (11.0±1.0) mm, 22.9°±1.1°), those of the medium SS group were slightly lower ((10.2±1.1) mm, (10.4±0.9) mm, 21.6°±1.3°), and those of the high SS group were the lowest ((9.6±0.9) mm, (9.4±0.7) mm, 18.7°±1.5°), with statistically significant differences among the groups (all P<0.05). The FSCA/TCSA of the psoas major, erector spinae and multifidus muscles in the low SS group were the highest ((93.1±4.0)% and (77.6±6.4) %), next were those in the medium SS group ((90.9±3.5)% and (74.9±6.1)%), and those in the high SS group were the lowest ((88.6±4.4)% and (71.2±7.4) %), with statistically significant differences among the different groups (all P<0.05). Pearson correlation analysis showed that SS was positively correlated with SD( r=0.557, P<0.01); SS was negatively correlated with the FSCA/TCSA of the paraspinal muscles (psoas major, erector spinae+multifidus) ( r=-0.393,-0.394,both P<0.01); SS was positively correlated with PL and PSTL ( r=0.706, P<0.01; r=0.264, P<0.01), and negatively correlated with PW, PCA and PH ( r=-0.469,-0.669,-0.549, all P<0.01). The Pfirrmann grade of intervertebral disc degeneration in the low SS group was better than that in the medium SS group and the high SS group( H=23.128, P<0.01). Conclusions:In DLS patients, as SS increases, the SD of the L 4 vertebral body gradually increases, the proportion of paraspinal muscle functional area gradually decreases, the degree of intervertebral disc degeneration gradually worsens, the pedicle gradually becomes slender, and the pedicle camber angle gradually decreases. There is a correlation between SS and the degree of vertebral slippage, as well as morphological parameters of pedicle, intervertebral disc, and paraspinal muscles.

Objective:To compare the efficacy and safety among traditional open suture, modified Kessler method, and minimally invasive suture with threaded rivets in acute closed Achilles tendon rupture.Methods:A total of 60 patients with acute closed Achilles tendon rupture diagnosed and treated in the Affiliated Hospital of Jining Medical College from January 2018 to August 2022 were selected retrospectively as the study subjects and divided into group A (20 patients with traditional open suture), group B (20 patients with modified Kessler method) and group C (20 patients with minimally invasive suture with threaded rivets) according to operative method. The clinical efficacy, perioperative indexes, Achilles tendon activity, postoperative recovery work and exercise time, visual analog scale (VAS) score and complications were compared among the three groups.Results:The total effective rate in the group C was higher than that in the group A : 18/20 vs. 12/20, there was statistical difference ( χ2 = 4.80, P<0.05). The total effective rate in the group B and group C had no statistical difference ( P>0.05). The operation time, intraoperative blood loss, incision length, hospitalization time, time to return to work, exercise and VAS scores in the group B and group C were lower than those in the group A: (49.32 ± 4.74), (48.12 ± 4.68) min vs. (66.71 ± 5.84) min; (15.32 ± 1.01), (15.62 ± 0.79) ml vs.(19.86 ± 1.20) ml; (7.69 ± 0.57), (3.76 ± 0.50) cm vs. (8.98 ± 0.62) cm; (7.01 ± 0.91), (6.82 ± 0.83) d vs.(8.74 ± 1.12) d; (56.32 ± 8.01), (55.17 ± 7.84) d vs. (63.17 ± 6.68) d; (6.13 ± 1.20), (5.94 ± 1.04) months vs. (8.21 ± 1.20) months; (2.76 ± 0.50), (2.55 ± 0.76) scores vs. (3.98 ± 0.62) scores, there were statistical differences ( P<0.05). At 1, 6 and 12 months after surgery, the American Society for Foot and Ankle Surgery (AOFAS) scores in the three groups were significantly increased, and the AOFAS scores in the group B and group C were higher than those in the group A, there were statistical differences ( P<0.05). The total incidence of complications in the group C was lower than that in the group A: 2/20 vs. 8/20, there was statistical difference ( χ2 = 4.80, P<0.05). The total incidence of complications in the group B and group C had no statistical difference ( P>0.05). Conclusions:Modified Kessler method and minimally invasive suture with threaded rivets have the advantages of high efficiency and safety in the treatment of acute closed Achilles tendon rupture, and their efficacy is higher than that of traditional open suture.