The technology in spinal surgery clinical treatment is undergoing revolutionary changes in recent years. Artificial intelligence shows promise in enhancing diagnosis, personalizing treatment, and predicting outcomes. Robotic surgery improves safety and precision but its cost-effectiveness limits widespread use. Augmented reality can enhance screw placement accuracy and efficiency, yet requires refinement in precision and user interaction. Three-dimensional printing, through personalized guides and implants, optimizes surgical procedures, though further clinical studies are needed to validate long-term benefits. New implant designs and materials, facilitated by topological optimization, carbon fiber composite polyetheretherketone, present opportunities for creating anatomically and biomechanically congruent spinal implants. This review analyzes the potential and challenges of these advancements in improving surgical accuracy, reducing complications, and meeting individualized treatment needs, aiming to foster the development of more effective and safer spinal surgical techniques. These technologies collectively offer enhanced precision and patient outcomes, signifying a transformative shift in spinal healthcare.

Robotic joint surgery (RJS) has demonstrated high precision and reproducibility in total hip and knee arthroplasty,the integration of artificial intelligence(AI) has further enhanced the intelligence level of key processes,including surgical planning,registration,surgical manipulator control,and robot autonomy. AI-powered surgical planning improves implant positioning accuracy through deep learning,while AI-powered registration overcomes the limitations of traditional methods in precision and efficiency. Additionally,reinforcement learning and neural networks have optimized surgical manipulator control,improving operational accuracy and human-robot interaction. As AI continues to advance,RJS is expected to make significant strides in automation,multimodal sensing,and human-robot collaboration,driving arthroplasty surgeries toward higher levels of intelligence and individual treatment.

The technology in spinal surgery clinical treatment is undergoing revolutionary changes in recent years. Artificial intelligence shows promise in enhancing diagnosis, personalizing treatment, and predicting outcomes. Robotic surgery improves safety and precision but its cost-effectiveness limits widespread use. Augmented reality can enhance screw placement accuracy and efficiency, yet requires refinement in precision and user interaction. Three-dimensional printing, through personalized guides and implants, optimizes surgical procedures, though further clinical studies are needed to validate long-term benefits. New implant designs and materials, facilitated by topological optimization, carbon fiber composite polyetheretherketone, present opportunities for creating anatomically and biomechanically congruent spinal implants. This review analyzes the potential and challenges of these advancements in improving surgical accuracy, reducing complications, and meeting individualized treatment needs, aiming to foster the development of more effective and safer spinal surgical techniques. These technologies collectively offer enhanced precision and patient outcomes, signifying a transformative shift in spinal healthcare.

Robotic joint surgery (RJS) has demonstrated high precision and reproducibility in total hip and knee arthroplasty,the integration of artificial intelligence(AI) has further enhanced the intelligence level of key processes,including surgical planning,registration,surgical manipulator control,and robot autonomy. AI-powered surgical planning improves implant positioning accuracy through deep learning,while AI-powered registration overcomes the limitations of traditional methods in precision and efficiency. Additionally,reinforcement learning and neural networks have optimized surgical manipulator control,improving operational accuracy and human-robot interaction. As AI continues to advance,RJS is expected to make significant strides in automation,multimodal sensing,and human-robot collaboration,driving arthroplasty surgeries toward higher levels of intelligence and individual treatment.

Objective To explore the effects of extended care on aged patients with hip fracture in island area.Methods Forty-Two aged patients with hip fracture,who accepted operation in Department of Orthopedics,Hainan Branch of Chinese PLA General Hospital from June 2014 to November 2015,were enrolled in this study and averagely divided into test group and control group by random number table.Patients in test group received extended care while patients in control group just.3 months after discharge,the differences Harris hip score and Barthel Index were compared between two groups.Results 3 months after discharge in test group,the scores of Harris score and Barthel index were higher compared those of control group (P <0.05). Conclusions Extended care can effectively improve the rehabilitation of aged hip fracture in island area and contribute to patients′self-care.

Objective To explore the demands of continuing nursing care for discharged patients after artificial joint replacement and to improve the continuing nursing service system for orthopaedics patients post operation.Methods Randomly chose 200 discharged arthroplasty patients from department of orthopaedics in a Certain3-Grade-A Integrate hospital as the subjects, and they were investigated with the self-designed questionnaire on continuing nursing service needing.Results Among 200 patients, bed time (98.0%), balance training (94.0%) and rehabilitation processes (93.0%) were the important contents of extended care. Health education(100.0%), online counseling(90.0%) and telephone hotline(82.0%) were main forms of extended care.And 61.0% of patients want to get professional guidance once a week in first 2 months discharge, and once two weeks in 3 months discharge.Conclusions Discharged patients after artificial joint replacement have high demand of continued nursing care.Nursing staff should support patients not only satisfactory health education in hospital but also relevant rehabilitation guidance after being discharged in order to promote to recovery and improve their life quality.

Objective To explore the influence factor of the stability of L5S1 fusion and the relationship between the stability of sacrum fusion and the clinical outcome for degenerative lumber scoliosis with long-segment fusion.Metheds Fifty patients with degenerative lumber scoliosis who underwent the long-segment fusion from June 2010 to January 2015 were included in this retrospective study.Based on post-operative L5S1 fusion,patients were divided into two groups.There were 15 patients(30％,9 male and 6 female patients) with a failing sacrum fusion whose average age 60±7.6 years (range from 58 to 78 years).6 patients had the situation at T12-S1,7 at L1-S1 and 2 at L2-S1.There were 35 patients (70％,26 male and 9 female patients) with a satisfying sacrum fusion whose average age 58.4±4.8 years (range from 50 to 80 years).Among them,16 were at T12-S1,12 at L1-S1 and 7 at L2-S1 levels.The interbody fusion rate and accuracy of pedicle screws were evaluated by anteroposterior and lateral spine radiographs in standing and CT scanning during the postoperative follow-up.The age,body mass index (BMI),bone mineral density,Cobb's angel,lumbar lordosis (LL),sagittal vertical axis (SVA),thoracic kyphosis (TLK),sacral slope (SS),pelvic inclination (PI) and pelvic tilt (PT) were compared between the 2 groups to analysis the relevant factor of the failing L5S1 fusion.Oswestry disability index (ODI) and visual analogue scale (VAS) were compared between the 2 groups in the postoperative follow-up.Results There were no statistically significant difference between the 2 groups preoperative in the age,BMI,lumbar Cobb angel,LL,SVA,TLK,SS,PI and PT.But there was a significant difference between the bone mineral density of 2 groups.LL were-40.5°± 8.7° vs.-41.2°±7.9°;TLK were 1.7°±7.4° vs.1.8°±6.7°;SS were 32.1°±5.6° vs.32.4°±5.5°;PT were 18.7°±10.5° vs.19.5°± 10.1°;PI were 42.3°±4.4° vs.40.1°±5.2°;SVA were 9.2±3.5 cm vs.9.5±3.1 cm;T value were-2.7±1.1 vs.-1.2±1.4.There were no statistically significant difference between the 2 groups in the ODI and VAS in the postoperative follow-up.Oswestry disability index were 8.2％±5.2％ vs.7.8％±4.5％;VAS value were 3.4±2.6 vs.3.1±2.1.Conclusion The smaller the bone mineral density of the patients with DS,the higher the incidence of the fusion failure L5S1 fusion.And when the failing L5S1 of fusion happened,the clinical outcome will not always be poor.

Objective:To determine the gender and age differences in anatomical parameters of proximal femur in middle-aged and elderly patients with femoral intertrochanteric fracture so as to provide theoretical evidence for development of internal fixation devices.Methods:The clinical and CT data of 375 patients with intertrochanteric fracture were analyzed retrospectively who had been treated at Department of Orthopedics, The First Medical Center, General Hospital of Chinese PLA from September 2009 to March 2017. The patients were divided into 4 age groups. The middle-aged group (from 45 to 59 years old) had 22 cases, 16 males and 6 females; the early elderly group (from 60 to 74 years old) had 87 cases, 37 males and 50 females; the elderly group (from 75 to 89 years old) had 238 cases, 76 males and 162 females; the late elderly group (≥90 years old) had 28 cases, 6 males and 22 females. The anteversion angle of femoral neck, femoral neck-shaft angle, femoral head diameter, femoral neck length, femoral neck offset and femoral neck width were measured on their images. The anatomical parameters of proximal femur were compared between genders in the same age group and between groups of the same gender.Results:There were no significant differences between male and female patients with femoral intertrochanteric fracture in body mass index or AO classification, showing comparability( P>0.05). The anteversion angle of femoral neck (8.33°±5.00°) of the male middle-aged and elderly patients with intertrochanteric fracture was significantly smaller than that of the female ones (11.28°±6.15°), but their femoral head diameter, femoral neck length, femoral neck offset and femoral neck width (49.10 mm±2.48 mm, 99.70 mm±5.22 mm, 7.18 mm±2.20 mm and 39.10 mm±4.92 mm) were significantly larger than those of the female ones (43.46 mm±2.79 mm, 90.00 mm ± 4.75 mm, 6.29 mm±2.07 mm and 33.49 mm±4.87 mm) (all P<0.05). The femoral head diameter, femoral neck length and femoral neck width of the male patients in all the 4 age groups were significantly larger than those of the female ones ( P< 0.05). The anteversion angles of femoral neck of the male patients in the early elderly, elderly and late elderly groups were significantly smaller than those of the female ones ( P< 0.05). The femoral neck offset of male patients in the elderly group was significantly greater than that of female ones ( P< 0.05). There were no statistically significant differences in anteversion angle of femoral neck, femoral neck-shaft angle, femoral head diameter, femoral neck length, femoral neck offset or femoral neck width between groups of the same gender ( P>0.05). Conclusions:Compared with the middle-aged and elderly male patients with femoral intertrochanteric fracture, the middle-aged and elderly female ones have a larger anteversion angle of femoral neck, smaller offset, width and length of femoral neck, and a smaller femoral head diameter. There are no significant age differences in anatomical parameters of the proximal femur in middle-aged and elderly patients with femoral intertrochanteric fracture.

Objective:To explore the effect of invalid reconstruction of proximal triangular structure on clinical failure of proximal femoral fractures treatment.Methods:A retrospective study of patients with femoral neck or intertrochanteric fractures postoperative failures from January 2013 to December 2018 was performed. Fifty-three patients including 26 males and 27 females (31 intertrochanteric fractures and 22 femoral neck fractures) met the inclusion criteria. The mean age of included patients was 55.13 years (range, 18-94 years). Fixation strategies included plate screws (18 cases), cannulated screws (13 cases) and intramedullary nails (22 cases). Medial side, the lateral side and the upper side were defined according to the law of mechanics based on the proximal femoral structure and statistical analysis of the failure factors of reconstruction of different sides were performed based on the imaging data of postoperative failure cases.Results:Nineteen of 53 patients were without medial side reconstruction, 4 cases without lateral side reconstruction, 21 cases without upper side reconstruction, 2 cases without medial or lateral side reconstruction and 7 cases were without medial or upper side reconstruction. Sixteen cases experienced loss of reduction, and 23 cases suffered from nonunion; excessive movement of fixation occurred in 12 cases, and fixation breakage occurred in 2 cases. Indicated by statistical analysis, it was invalid reconstruction of different sides that lead to surgical failure ( P=0.098). Revision strategy: 5 cases were treated with plate-screw fixation, 1 with steel cable binding, 11 with hip replacement, 3 with internal fixation removal, 6 with intramedullary nail replacement, 21 with triangular reconstruction fixation, and 6 cases had not been followed up successfully. Conclusion:Invalid reconstruction of any side of the proximal triangular structure will cause instability of the proximal structure which can lead to the failure of fracture fixation during the treatment of proximal femoral fractures.

Objective To investigate the impacts of different body posture care in 6 hours after operation in the ankylosing spondylitis ( AS) patients undergoing osteotomy surgery. Methods A total of 92 AS patients who underwent osteotomy surgery with regained consciousness and stable vital signs were randomly divided into experimental and control groups (46 patients of each group). The patients in the experimental group were sent back to ward after operation and they were helped to lie on the left or right side, and the patients in the control group were helped to lie on the back in the 6 hours after operation. Patients′ occurrence of vomiting, dizzy, rate of heart and respiratory, occurrence of stage-I pressure sores and tension vacuole, visual analogue scale ( VAS) of abdominal skin and back incision were observed and recorded. Results The incidence of vomiting, dizziness andⅠperiod pressure ulcer in experimental group were 10. 9%, 6. 5%, 2. 2%, compared with 15. 2%, 4. 3%, 0. 0% in the control group, which had no statistically significant differences (χ2 =0. 383, 0. 212, <0. 001; P >0. 05). Patients′ postoperative mean breathing rate within 6 h after surgery in the experimental group was [(19. 3 ± 3. 4) times/min] comparing with [(20. 4 ± 4. 1) times/min] in the control group, and there was no statistically significant difference (t = 1. 401, P > 0. 05). Patients′ heart rate [(92.5±6.3)times/min]andtheincidenceofabdominaltensionblisters(4.3%)intheexperimentalgroup were significantly lower than that in the control group [(118. 2 ± 7. 8) times/min, 17. 4%] ( t =17. 385,χ2 =4. 039;P<0. 05). There were statistically differences in patient′s abdominal pain and back incision VAS score distribution in two groups(u =2. 022,2.218;P <0. 05). Conclusions After osteotomy surgery, the application of general anesthesia for AS kyphosis, with regaining consciousness and stable vital signs, applying preoperative habits of lateral position in 6 hours after being sent back to ward, can relieve pain, decrease the occurrence of tension vacuole, prompt patients′comfort as well as accelerate recovery.