Objective To compare the short-term effects of myocapsular flap repair through minimal posterior approach in Hip arthroplasty with traditional posterior approach in hip arthroplasty in elderly femoral neck fractures. Methods From August 2007 to may 2009, a total of 126 femoral neck fracture patients were randomly divided into two groups, with 63 patients treated with myocapsular flap repair through minimal posterior approach (the modified group), and 63 patients treated with traditional posterior approach (the traditional group). Fifty-eight patients underwent the first-ever total hip replacement and 68 patients underwent artificial double-acting femoral head replacement. Eighty-four cases were inserted with cemented implants and 42 cases with uncemented. Data of incision length, operation time, blood loss volume, drainage amount, blood transfusion volumes were recorded separately. Postoperative complications related to the surgery and hip joint function were also documented. Function of hip joint was scored with Harris scale. All data were statistically analyzed. Results Five patients died within 1 year of surgery, and 4 patients dropped out. All the remained 117 patients were followed up for 12 - 24 months. There were no significant difference in age, type of fracture and artificial the incision length in the modified group was significantly shorter than that in the traditional group([ 10. 5 ± 2. 4 ]cm vs [ 17. 2 ± 3.6 ] cm, t = 3. 012, P = 0. 004). The average operating time was significantly shorter in the modified group compared to the traditional group (t = 2. 455, P = 0. 038). Blood loss, drainage amount, blood transfusion volumes in the modified group were less than those in the traditional group( t = 3.211,2. 986 and 3. 352 ,Ps ＜ 0. 01, respectively). Conclusion Myocapsular flap repair through minimal posterior approach in Hip arthroplasty is a reasonable, mini invasive technique for hip replacement in older with a less blood loss and shorter operating time.fractures

Objective To summarize the experience of aortic root surgery in Stanford A aortic dissection operations.Methods From January 2005 to September 2010, the clinical data of 59 patients with Stanford A aortic dissection was analyzed. There were 43 men and 16 women , ranging in age from 21 to 74 years old, duration of disease varied from 16 hours to 27 days. Among the group, 31 complicated by aortic valve incompetence, 12 Marfan syndrome, 9 single lower limb blood supply dysfunction, 6 right coronary artery involvement. All cases received aortic root surgery under deep hypothermic circulatory arrest. Bentall procedure was performed in 31 patients, Wheat procedure in 15 patients and David procedure in 13 patients.Results The time of cardiopulmonary bypass in the group was 149 to 204 min with an average of ( 171 ± 19) min,and the cross clamp time was 81 to 122 min with an average of (104 ±13) min, and the arrest time was 30 to 47 min with an average of (39 ±7) min. There was 1 case of operative death, which was treated on an emergency basis. Postoperative complications occurred in 20 cases. 17 cases experienced temporary mental dysfunction, 2 cases were infected with MRS A, 1 of which died from MODS, 1 case of single lower limb blood supply dysfunction remained after the first operation and recovered by reoperation (bilateral femoral bypass operation) . All cases were reexamined before discharge, postoperative mean LVEF was (56. 3 ±3.4)% (ranged 51% -62%), aortic annular diameter varied from 22 mm to 27 mm, aortic sinus diameter range from 23 mm to 31mm. 51 patients were followed up, with a mean follow-up time of (24.9 ± 17.2) months (ranged 2-54 months). 54 patients of Stanford A aortic dissection survived well with normal lives and activities. Four non cardiac deaths, one was chronic renal failure, the others were brain hemorrhage. Conclusion Prognosis and operative security of Stanford A aortic dissection patients can be significantly improved by individualized aortic root surgery.

Objective To compare arthroscopic double-row bridging suture and minimally invasive locking plate system in the treatment of simple avulsion fracture of humeral greater tuberosity.Methods A retrospective study was conducted of the 93 patients with avulsion fracture of humeral greater tuberosity who had been treated at Orthopaedic Center,Beijing Luhe Hospital from January 2012 to December 2016.Of them,38 were treated by arthroscopic double-row bridging suture (ADRB) and 55 by open reduction and internal fixation with minimally invasive locking plate system (MIPS).Regular X-ray follow-ups were carried out at 3,6 and 12 months postoperatively and every 6 months afterwards.Surgical time,range of motion (ROM) of the shoulder,American Shoulder and Elbow Surgeons (ASES) score,Visual Analogue Scale (VAS) and complications were recorded preoperatively and at the last follow-up.Results The patients of the arthroscopy and plate groups were comparable because there were no significant differences in the preoperative general data between them (P ＞ 0.05).The average follow-up time for the 93 patients was 35.9months (from 12 to 60 months).The operation time for the arthroscopy group (97.0 ± 20.1 min) was significantly longer than that for the plate group (67.5 ± 19.0 min) (P ＜ 0.05).At the last follow-up,anteflexion lift (152.6° ± 12.9°),abduction lift (154.0° ± 13.5°) and internal rotation angle at 90° (57.7° ±12.2°) in the arthroscopy group were significantly better than those in the plate group (134.9° ± 17.8°,129.5° ± 18.6° and 50.8° ± 12.9°,respectively) (P ＜ 0.05).At the last follow-up,the ASES scores for the arthroscopy and plate groups were 88.5 ± 7.6 and 85.1 ± 11.3,respectively,showing no statistically significant difference (P ＞ 0.05);the VAS scores for the 2 groups were 1.5 ± 1.2 and 2.2 ± 1.5 respectively,showing a statistically significant difference between the 2 groups (P ＜ 0.05).There was no significant difference between the2 groups in improvement of ASES scores (P ＞ 0.05).Ninety fractures healed after 3 months while 3 fractures in the arthroscopy group did after 6 months.In the plate group,7 patients developed shoulder stiffness 3 to 6 months after surgery and 3 ones reported pain during abduction.Conclusions Both ADRB and MIPS are an effective treatment for simple avulsion fracture of humeral greater tuberosity.MIPS fixation needs shorter surgical time while ADRB leads to better postoperative shoulder ROM.

Objective:To explore the feasibility of the AI intelligent reconstruction model based on knee joint magnetic resonance data developed by Nuctech Company Limited for evaluating knee cartilage injury.Methods:Thirty-three patients (a total of forty-one knees) who were hospitalized with severe knee osteoarthritis in Beijing Tsinghua Changgung Hospital from May 2021 to April 2022 were selected. All of them were planned to be performed total knee arthroplasty (TKA) for the treatment of knee osteoarthritis. Fifteen males with an average age of 71±5 years old and twenty six females with an average age of 71±9 years old were included in this study. There were 19 cases of left knee and 22 cases of right knee. Thin layer MRI examination on the patients' knee joints was performed before the surgery, and artificial intelligence model based on the thin layer MRI data of the knee joint was reconstructed. The cartilage part of the model was selected and corrected by Principal Component Analysis (PCA) in order to realize model straightening. The tibial plateau cartilage of knee joint which intercepted during operation was classified according to the International Cartilage Repair Society (ICRS). Finally the results were compared with the ICRS classification results of knee artificial intelligence reconstruction model and artificial recognition of knee joint MRI images.Results:Compared with the grade of cartilage injury intercepted during our operation which was according to the ICRS classification, the sensitivity of artificial intelligence reconstruction model for the diagnosis of cartilage injury with ICRS classification grade four was 93.1%. The specificity of artificial intelligence reconstruction model was 91.4%. The positive predictive value (PPV) of artificial intelligence reconstruction model was 92.2%. And the negative predictive value (NPV) of artificial intelligence reconstruction model was 80.3%. The area under ROC curve (AUC) was 0.92. The ICRS classification consistency between artificial intelligence model and physical inspection results was good with kappa value 0.81 ( P<0.001) . In the aspect of artificial recognition of cartilage injury grading in MRI images, the sensitivity of artificial recognition was 92.10% compared with the manual identification of cartilage injury classification in MRI images. The specificity of artificial recognition was 91.60%. The positive predictive value (PPV) of artificial recognition was 97.20% and the negative predictive value (NPV) of artificial recognition was 78.8%. The kappa value of the cartilage injury classification in MRI images consistency between artificial recognition and manual identification was 0.79 ( P<0.001). Conclusion:Based on the evaluation of cartilage injury by AI reconstruction model of knee joint, the sensitivity and specificity of the diagnosis of ICRS grade IV cartilage injury can be acceptable, but still needs to be improved.