Objective:This study was aimed to investigate the clinical efficacy of unilateral biportal endoscopic spine surgery (UBE)-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system in the treatment of thoracolumbar burst fractures with neurological deficits.Methods:This was a retrospective observational study conducted on 21 patients with thoracolumbar burst fractures and neurological deficits treated with UBE-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system from April 2022 to August 2023. There were 13 males and 8 females, with an average age of 48.48±14.04 years (ranging from 25 to 72 years). Injured segments were T 12 in 2 cases, L 1 in 7 cases, L 2 in 6 cases, L 3 in 3 cases, L 4 in 2 cases, and L 5 in 1 case. According to the AOSpine Thoracolumbar Spine Injury Classification System, there were 14 cases of A3N2, 2 cases of A3N3, 4 cases of A4N2, and 1 case of A4N3. Surgery time, postoperative hospital stays, and complications were recorded. Local Cobb angle, vertebral fragment intrusion area, spinal canal occupation rate, and anterior vertebral height compression rate were measured preoperatively, postoperatively, and at the last follow-up. Screw placement accuracy was assessed using postoperative CT. Neurological function was evaluated using the American Spinal Injury Association (ASIA) grading system, and clinical efficacy was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI). Results:All patients successfully underwent the operation without any conversions to open surgery during the procedure. A total of 105 percutaneous pedicle screws were placed, with an accuracy rate of 96.2%. Internal fixation devices were removed in 18 cases at the last follow-up. The 21 patients were followed up for 18.38±3.66 months (ranging from 12 to 25 months). The surgery time was 150.29±18.84 min (ranging from 111 to 185 min). Postoperative hospital stay was 5.19±1.15 d (ranging from 3 to 7 d). One patient underwent interbody fusion with an autologous iliac crest bone graft and achieved bony fusion at 12 months postoperatively. Preoperative local Cobb angle, anterior vertebral height compression rate, vertebral fragment intrusion area, and spinal canal occupation rate were 22.90°±4.48°, 54.49%±7.53%, 142.90±21.00 mm 2, and 69.91%±7.07%, respectively. Postoperative values improved to 2.57°±1.09°, 5.19%±1.04%, 56.33±11.35 mm 2, and 25.72%±4.24%, with last follow-up values of 3.19°±1.01°, 5.75%±0.92%, 34.90±5.14 mm 2, and 18.25%±2.44% with significant differences ( P<0.05). Preoperatively, all patients were ASIA grade D. Within 48 hours postoperatively, 10 patients improved to grade E, and at the last follow-up, all patients achieved grade E. VAS scores significantly decreased from 8.10±0.92 preoperatively to 3.48±0.59 postoperatively and 1.52±0.73 at the last follow-up ( F=486.032, P<0.001); ODI significantly improved from 58.14%±5.08% preoperatively to 27.20%±2.65% postoperatively and 8.89%±1.19% at the last follow-up ( F=2'001.348, P<0.001). One patient developed a postoperative wound infection, which healed with regular dressing changes. Conclusions:UBE-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system was a safe and effective approach for the treatment of thoracolumbar burst fractures with neurological deficits. This method achieved vertebral reduction, improved neurological function, stabilized spinal alignment, and maximally preserved the integrity of posterior spinal bony and ligamentous structures.

Objective:This study was aimed to investigate the clinical efficacy of unilateral biportal endoscopic spine surgery (UBE)-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system in the treatment of thoracolumbar burst fractures with neurological deficits.Methods:This was a retrospective observational study conducted on 21 patients with thoracolumbar burst fractures and neurological deficits treated with UBE-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system from April 2022 to August 2023. There were 13 males and 8 females, with an average age of 48.48±14.04 years (ranging from 25 to 72 years). Injured segments were T 12 in 2 cases, L 1 in 7 cases, L 2 in 6 cases, L 3 in 3 cases, L 4 in 2 cases, and L 5 in 1 case. According to the AOSpine Thoracolumbar Spine Injury Classification System, there were 14 cases of A3N2, 2 cases of A3N3, 4 cases of A4N2, and 1 case of A4N3. Surgery time, postoperative hospital stays, and complications were recorded. Local Cobb angle, vertebral fragment intrusion area, spinal canal occupation rate, and anterior vertebral height compression rate were measured preoperatively, postoperatively, and at the last follow-up. Screw placement accuracy was assessed using postoperative CT. Neurological function was evaluated using the American Spinal Injury Association (ASIA) grading system, and clinical efficacy was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI). Results:All patients successfully underwent the operation without any conversions to open surgery during the procedure. A total of 105 percutaneous pedicle screws were placed, with an accuracy rate of 96.2%. Internal fixation devices were removed in 18 cases at the last follow-up. The 21 patients were followed up for 18.38±3.66 months (ranging from 12 to 25 months). The surgery time was 150.29±18.84 min (ranging from 111 to 185 min). Postoperative hospital stay was 5.19±1.15 d (ranging from 3 to 7 d). One patient underwent interbody fusion with an autologous iliac crest bone graft and achieved bony fusion at 12 months postoperatively. Preoperative local Cobb angle, anterior vertebral height compression rate, vertebral fragment intrusion area, and spinal canal occupation rate were 22.90°±4.48°, 54.49%±7.53%, 142.90±21.00 mm 2, and 69.91%±7.07%, respectively. Postoperative values improved to 2.57°±1.09°, 5.19%±1.04%, 56.33±11.35 mm 2, and 25.72%±4.24%, with last follow-up values of 3.19°±1.01°, 5.75%±0.92%, 34.90±5.14 mm 2, and 18.25%±2.44% with significant differences ( P<0.05). Preoperatively, all patients were ASIA grade D. Within 48 hours postoperatively, 10 patients improved to grade E, and at the last follow-up, all patients achieved grade E. VAS scores significantly decreased from 8.10±0.92 preoperatively to 3.48±0.59 postoperatively and 1.52±0.73 at the last follow-up ( F=486.032, P<0.001); ODI significantly improved from 58.14%±5.08% preoperatively to 27.20%±2.65% postoperatively and 8.89%±1.19% at the last follow-up ( F=2'001.348, P<0.001). One patient developed a postoperative wound infection, which healed with regular dressing changes. Conclusions:UBE-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system was a safe and effective approach for the treatment of thoracolumbar burst fractures with neurological deficits. This method achieved vertebral reduction, improved neurological function, stabilized spinal alignment, and maximally preserved the integrity of posterior spinal bony and ligamentous structures.

Abstract Ferroptosis is a novel form of cell death characterized by the iron-dependent accumulation of lipid hydroperoxides. Since it was first proposed in 2012,Ferroptosis has gradually attracted attention and developed rapidly. Ferroptosis plays an important role in cardiovascular diseases,malignant tumors and neurological diseases,and has become a research hotspot in the field of life science and medicine. Ferroptosis is closely related to iron overload. Iron overload and the accumulation of lipid peroxidation jointly contributes to the disruption of intervertebral disc homeostasis,leading to intervertebral disc degeneration. However,the specific mechanisms of ferroptosis in regulating intervertebral disc degeneration is not yet clear. This review discusses the relationship between ferroptosis and intervertebral disc degeneration,their molecular regulatory mechanisms,and their potential clinical applications,aiming to provide new therapeutic targets for intervertebral disc degeneration.

BACKGROUND:For elderly patients with traumatic hip fractures,the related factors of prognosis are very complex,and the integrity of the lateral wall is one of the influencing factors.It is of important clinical value to understand the effect of lateral wall injury on the prognosis of femoral intertrochanteric fracture. OBJECTIVE:To evaluate the relationship between the integrity of the lateral wall and hip functional recovery and other outcomes in patients with femoral intertrochanteric fractures. METHODS:Totally 82 patients with femoral intertrochanteric fractures were screened and all patients received proximal femoral nail antirotation fixation.According to the thickness of the lateral wall,the patients were divided into the lateral wall intact group(n=31)and lateral wall risk group(n=51).The perioperative indexes,weight-bearing time,fracture healing time,hip joint function and range of motion,postoperative pain and complications were compared between the two groups. RESULTS AND CONCLUSION:(1)The time of hospitalization and the number of fluoroscopies during operation in the lateral wall intact group were significantly lower than those in the lateral wall risk group(P<0.05),but there was no significant difference in other perioperative indexes.(2)Both groups were able to get down to the ground early after surgery and finally complete weight-bearing,but in the lateral wall risk group,the time of fracture healing was longer;the time of complete weight-bearing was significantly delayed;the Harris score of the last follow-up was lower;the range of motion of hip extension and flexion and neck trunk angle on the affected side were smaller(P<0.05).(3)There was no significant difference in the incidence of postoperative complications between the two groups,but the overall incidence of complications in the lateral wall intact group was significantly lower(P<0.05).(4)In summary,after internal fixation of proximal femoral nail antirotation,patients with the intact lateral wall had a relatively better prognosis than those with risk lateral wall.

Objective:To delineate the histomorphological disparities of subchondral bone between hemophilic arthritis (HA) and osteoarthritis (OA) and to explore the mechanisms underpinning aberrant bone remodeling in HA.Methods:Fifteen male HA patients, aged 32.60±7.58 years (range 22-45), who underwent total knee arthroplasty at the Second Affiliated Hospital of Anhui Medical University from January 2021 to June 2023, were included. All patients had hemophilia A and tested negative for coagulation factor VIII antibodies. Simultaneously, fifteen male OA patients, aged 75.67±5.09 years (range 71-87), also underwent arthroplasty. Tibial plateau bones were extracted for micro-CT, which assessed morphological parameters. Histological changes in the subchondral bone plate (SBP) and trabecular bone were evaluated with HE and Safranin O-Fast Green staining. TRAP staining determined osteoclast differentiation levels, and VEGF-A and Osterix immunohistochemistry gauged angiogenesis and osteoblast differentiation.Results:Micro-CT revealed that HA patients had a BV/TV of 25.14%±0.70% (medial) and 22.31%±0.53% (lateral), Conn.D. of 4.20±0.10 1/mm 3 (medial) and 3.27±0.08 1/mm 3 (lateral), BMD of 0.288±0.006 g/cm 3 (medial) and 0.285±0.004 g/cm 3 (lateral), Tb.Th of 0.257±0.008 mm (medial) and 0.206±0.008 mm (lateral), Tb.N of 0.984±0.043 1/mm (medial) and 0.908±0.026 1/mm (lateral), and Tb.Sp of 0.683±0.008 mm (medial) and 0.808±0.010 mm (lateral). These parameters were significantly lower than those in the OA group except for Tb.Sp, which was higher ( P<0.001). Histological staining indicated that the HA group's SBP thickness was 177.43±6.42 μm (medial) and 117.96±5.08 μm (lateral) with significant differences observed ( P<0.001). TRAP staining showed that TRAP + osteoclasts accounted for 33.4%±3.1% (medial) and 25.1%±2.3% (lateral) in HA subchondral bone, again significantly different ( P<0.001). Immunohistochemical staining revealed VEGFA + cells at 34.1%±5.9% (medial) and 25.9%±3.7% (lateral), and Osterix + cells at 14.6%±1.4% (medial) and 5.8%±1.1% (lateral) in HA patients, differing significantly from the OA group ( P<0.001). Conclusion:The HA group exhibited more extensive subchondral bone destruction, thinner trabeculae, a nearly absent tidemark, higher osteoclast differentiation, increased angiogenesis, and reduced osteoblast differentiation, indicating severe osteoporosis, despite thicker SBP. These findings suggest that targeting abnormal bone remodeling and angiogenesis in HA could retard its progression and provide therapeutic benefits.

Objective:To investigate the application of combined distractor in the treatment of refractory distal radius fractures.Methods:From March 2018 to February 2020, the data of 32 patients with refractory distal radius fractures treated with combined distractor-assisted reduction were retrospectively analyzed. The propensity score matching method was used to establish a non-distractor group according to 1∶1 matching, with a total of 32 patients. In the distractor group, there were 15 males and 17 females, age 54.9 ±15.8 years (range, 18-77). According to AO classification, 3 cases were A3, 3 cases were B3, 16 cases were C2, 10 cases were C3. In the non-distractor group, there were 12 males and 20 females, age 59.7±14.8 years, 4 cases were A3, 5 cases were B3, 12 cases were C2 and 11 cases were C3. Main measures: surgical time, radial height, palm inclination, ulnar deviation, range of motion of the wrist, visual analogue scale (VAS), and functional assessment using disability of arm, shoulder and hand (DASH) and modified Mayo wrist score (MMWS).Results:A total of 64 patients were included in this study, and all patients successfully completed the operation and were followed up for 12-54 months, with an average of 17.8 months. The operative time of the distractor group was 91.2±14.6 min, which was significantly lower than that of the non-distractor group 137.6±27.3 min, and the difference was statistically significant ( t=8.48, P<0.001); the radial height in the distractor group 11.5±1.4 mm was significantly higher than that in the non-distractor group 10.6±1.3 mm, and the difference was statistically significant ( t=2.59, P=0.012). At the last follow-up, there were no statistically significant differences in the palm inclination 7.9°±4.4° vs. 7.5°±3.5°, ulnar deviation 23.3°±5.7° vs. 22.3°±4.5°, wrist flexion 63.2°±15.3° vs. 62.6°±11.1°, dorsiflexion 63.5°±10.7° vs. 62.4°±15.2°, pronation 69.2°±11.8° vs. 67.0°±11.0°, supination 73.1°±10.4° vs. 72.0°±8.7°, VAS 0.8±0.5 points vs. 0.9±0.7 points, DASH score 12.9±6.6 points vs. 13.4±7.0 points amd MMWS 84.1±5.8 points vs. 83.5±6.2 points ( P>0.05). One patient in the distractor group had symptoms of extensor muscle irritation, and the symptoms disappeared after the internal fixation was removed; 2 patients in the non-spreader group developed carpal tunnel syndrome, which improved after incision and decompression treatment. Conclusion:For refractory distal radius fractures, the use of combined distractor can achieve better radius height recovery and shorten the operation time, and has a satisfactory postoperative effect.

Objective:To analyze retrospectively the risk factors for pulmonary infection after traumatic cervical spinal cord injury.Methods:The 154 patients with a cervical spinal cord injury studied included 120 with a pulmonary infection and 34 uninfected controls. Regressions were evaluated using data on their genders, ages, the cause of injury, affected segments, the neurological level of the injury (NLI), and the presence of a vertebral fracture or dislocation.Results:Age, complete injury, NLI at C 1 to C 4, and an injury-to-treatment time of more than 8 hours were found to be independent risk factors for secondary pulmonary infection. Conclusion:Elderly spinal cord injury patients, with a complete injury, an NLI between C 1 and C 4 or an injury-to-treatment time of more than 8 hours have a higher risk of pulmonary infection.

Objective:To explore the short-term therapeutic outcomes of femoral neck fractures fixated by Femoral Neck System (FNS).Methods:A retrospective analysis was conducted of the 16 patients with femoral neck fracture who had been admitted to the Department of Traumatology & Orthopedics, The Second Affiliated Hospital to Anhui Medical University from January to December 2019. They were 6 males and 10 females, aged from 24 to 69 years (average, 47.5 years). According to the Garden Classification, there were 3 cases of type Ⅱ, 7 cases of type Ⅲ, and 6 cases of type Ⅳ. All the 16 patients were fixated with FNS. Recorded were operation time, frequency of intraoperative fluoroscopy, intraoperative blood loss, quality of postoperative fracture reduction, hospital stay, fracture healing time, and efficacy and complications at the last follow-up.Results:The 16 patients were followed up for 5 to 16 months after operation (average, 9.3 months). According to the Garden indexes, fracture reduction was evaluated as satisfactory in all the 16 patients. The operation time in this group ranged from 25 to 115 min with an average of 41.5 min, the frequency of intraoperative fluoroscopy from 14 to 47 times with an average of 26 times, the intraoperative blood loss from 35 to 210 mL with an average of 76 mL, the hospital stay from 3 to 9 days with an average of 4.6 days, and the fracture healing time from 3 to 6 months with an average of 4.5 months. By the Harris hip scores at the last follow-up, the function of the affected hip was rated as excellent in 10 cases, good in 5 and fair in one. Follow-ups revealed no complications like infection or implant loosening.Conclusions:The FNS is a new type of simple, reliable, safe and minimally invasive internal fixation for the treatment of femoral neck fractures. The plate, bolt, anti-rotation screws and locking screws in FNS can be inserted through a single minimally invasive incision, leading to reliable fixation, limited irritation to the lateral muscular soft tissues, and fine short-term outcomes.

Objective:To evaluate the trauma center model in general hospitals for patients with severe trauma.Methods:The data of 1,248 patients with severe trauma (ISS≥16) were retrospectively analyzed who had been admitted to the trauma centers in 6 Chinese general hospitals from January 2019 through June 2020. They were 987 males and 261 females with an age of 50.4 years ± 15.4 years. Their injuries were caused by a traffic accident in 622 cases, falling from a height in 357 cases, a knife in 62 cases, and others (like a heavy object and fall) in 207 cases. Upon admission, their injury severity scores (ISS) were 24.9±8.5 and their Glasgow coma scores (GCS) 12.6±3.6. They were all treated in a scientific and standard manner by a multidisciplinary team at the trauma center of their specific general hospital. Recorded were deaths within 30 days after admission, 30-day mortality and causes of death.Results:All the patients were treated effectively. 101 deaths occurred within 30 days after admission, yielding a 30-day mortality of 8.1%. The main causes of death were severe craniocerebral injury in 56 cases, hemorrhagic shock in 26 cases, multi-organ failure in 11 cases and others in 8 cases.Conclusions:Establishment of trauma centers in China can make up for the disadvantage of over-division of clinical specialties in large general hospitals which has led to insufficient care for patients with severe trauma and multiple injuries. The trauma centers in general hospitals may be a feasible model to be popularized in treatment of patients with severe trauma and multiple injuries.

The unilateral biportal endoscopic technique is defined as posterior unilateral of two small incision with established percutaneous observation channel and endoscopic observation channel in monitoring field. The operation tools were placed within the channel for each operation inside and outside vertebral canal. The characteristics of dual channel intervention make this technology different from coaxial endoscopic technology. This technique has a clear vision for flexible and convenient operation with the advantages of relatively simple surgical instrument requirements. In recent years, the use of unilateral dual channel endoscopic surgery in treating spinal diseases was gradually increasing, especially in the removal of nucleus including lumbar intervertebral disc protrusion and lumbar spinal stenosis disease decompression, and in endoscopic space-occupying lesions such as vertebral fusion and spinal canal between inside and outside. It was also applied in cervical and thoracic diseases with good clinical effects. Its advantages include less surgical trauma and faster recovery process. In addition, it has a large surgical field of vision under the microscope for easy identification of structures and surgery and with relatively gentle learning curve. Thus, it is conducive to beginners' mastery. However, complications such as nerve injury and postoperative lower limb numbness are still frequently reported. Some factors have to be considered, including insufficient understanding of the new technology, the local anatomy of the dual-channel endoscope, the operation of the spinal canal under the microscope. The successful application of the technique in treating various lumbar diseases needs understanding the operation process of the technique and local anatomy under the microscope.