Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Lumbar fusion remains a widely used procedure in clinical practice; however, both patients and clinicians often face challenges related to chronic low back pain and adjacent segment degeneration following traditional open lumbar fixation and fusion. Recent studies have demonstrated that these complications are associated with muscle ischemia and denervation caused by intraoperative dissection and traction of the paravertebral muscles. The postoperative mass of the paravertebral muscles has also been proposed as a predictor of surgical outcomes. With advancements in minimally invasive spinal techniques, minimally invasive lumbar fusion has gained increasing clinical application, drawing more attention to its impact on the paravertebral muscles. After lumbar fusion, the paravertebral muscles undergo a series of histopathological and morphological changes. Traditional open lumbar fusion can exacerbate the natural degeneration of paraspinal muscles, manifesting histopathologically as multifidus muscle edema, an increase in opaque fibers, muscle fiber necrosis, and infiltration of fat and connective tissue. Denervation and a reduction in motor units have been observed through electromyography, while imaging has revealed reduced muscle volume and strength. Different lumbar fusion techniques exert varying effects on the paravertebral muscles. Compared to traditional lumbar fusion, approaches such as the paramedian interfascial approach (PIA), multifidus muscle bundle (MMB) approach, minimally invasive transforaminal lumbar fusion (MIS-TLIF), and cortical bone trajectory screw techniques reduce iatrogenic paravertebral muscle injury. Moreover, anterior lumbar interbody fusion, oblique lateral interbody fusion, lateral lumbar interbody fusion, and endoscopic posterolateral transforaminal lumbar interbody fusion can significantly minimize or even prevent paravertebral muscle injury, leading to improved clinical outcomes.

Objective:To investigate the clinical outcomes of anterolateral thigh flap combined with great saphenous vein transplantations for the treatment of extensive elbow soft tissue defects accompanied by brachial artery embolism.Methods:A retrospective case series study was carried out to investigate the clinical data of 19 patients with extensive elbow soft tissue defects accompanied by brachial artery embolism admitted to Fuyang People's Hospital of Anhui Medical University from March 2017 to March 2020. There were 15 males and 4 females，aged 14-59 years［（37.6±14.1）years］. The areas of elbow soft tissue defects ranged from 7 cm×3 cm to 12 cm×5 cm. Before operation，angiography test was performed to confirm brachial artery embolism of the affected upper limb. The length of embolization ranged from 5 to 12 cm［（7.3±1.6）cm］. All patients were treated using the anterolateral thigh flap combined with great saphenous vein transplantation. The operation time and intraoperative blood loss were recorded. Angiography test was re-examined one week after operation. The degree of flap swelling，elbow Broberg-Morrey functional score and scar contracture were evaluated at postoperative 3，6，and 12 months. Healing of donor site and postoperative complications were observed.Results:All patients were followed up for 12-24 months［（18.1±3.0）months］. The operation duration was 3.5-6.4 hours［（4.9±0.8）hours］，with intraoperative blood loss of 200-600 ml［（338.7±101.6）ml］. The blood flow of repaired brachial artery was unobstructed in all patients one week after operation，with all flaps survived. The degree of flap swelling was（0.9±0.3）cm at postoperative 12 months，significantly reduced from that at postoperative 3 and 6 months［（1.2±0.3）cm，（1.1±0.3）cm］（ P<0.05）. The elbow Broberg-Morrey functional score was（87.8±4.8）points，significantly higher than those at postoperative 3 and 6 months［（71.4±7.0）points，（80.2±4.8）points］（ P<0.05）. The rating of elbow function score was excellent in 9 patients，good in 8 and fair in 2 at postoperative 12 months，with the excellent and good rate of 90%. The rate of scar contracture was 63%（12/19）at postoperative 12 months，significantly higher than that at postoperative 3［11%（2/19）］（ P<0.05），while not different from that at postoperative 6 months［42%（8/19）］（ P>0.05）. The donor site was healed in all patients，without complications related to blood vessels or flaps. Conclusions:For extensive elbow soft tissue defect accompanied by brachial artery embolism，the anterolateral thigh flap combined with great saphenous vein transplantations can successfully restore the blood supply of the distal site of the affected limb with a high survival rate of the flap and well recovered limb function，and hence is a feasible method for severe elbow trauma. However，due to various factors such as elbow joint immobilization during perioperative period，scar contracture is prone to occur in the area of the flap.

Objective:To summarize the perioperative nursing points of percutaneous kyphoplasty (PKP) in elderly patients with osteoporotic vertebral compression fractures assisted by robots, so as to provide reference for orthopedic nursing.Methods:From July 2019 to February 2021, the data of 72 patients undergoing robot-assisted PKP in the spinal surgery of the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed. The perioperative nursing points were summarized, and the nursing experience was summarized. The nursing under the new measures of precise minimally invasive treatment was analyzed and discussed. The length of hospital stay, postoperative ambulation time, complications and satisfaction survey results of patients were collected and recorded. The Numerical Rating Scale(NRS) score, Self-rating Anxiety Scale(SAS) score and Oswestry Disability Index (ODI) score before and after surgery were compared. The correlation analysis of the scores of various factors was combined to comprehensively evaluate the surgical and nursing effects.Results:All patients had no complications related to machine use during and after operation, and their symptoms were improved to varying degrees. Fifty-seven cases of indwelling catheter, catheter time (19.00±14.24) h. The preoperative hospitalization time was (6.16±2.22) d, and the postoperative hospitalization time was (1.94±0.99) d. Postoperative bed time was (16.34±6.81) h. Postoperative nursing satisfaction was (98.55±2.44)%.The postoperative NRS and SAS scores were (1.00±0.55) and (32.06±5.33) points, respectively, which were lower than those before operation (3.51 ± 0.71) and (39.08±8.86) points, and the differences were statistically significant ( t values were 33.976, 8.184, P<0.01). There were statistically significant differences in six indicators of ODI scores before and after surgery, including low back pain, walking, standing, sitting, sleep and self-care ( P<0.01). Correlation analysis showed that there was a strong correlation between the six ODI score factors and the NRS score. The four factors of sitting, walking, low back pain and standing were highly correlated with SAS. Conclusions:The implementation of good perioperative nursing management for patients with PKP assisted by robot can effectively promote the rehabilitation of patients, reduce the incidence of complications and improve patient satisfaction.

Objective:To evaluate the clinical efficacy of percutaneous channel screwing assisted by the robot navigation positioning system combined with pelvic unlocking reduction frame for pelvic fractures.Methods:A retrospective analysis was conducted of the 12 patients with pelvic fracture who had been admitted to Department of Orthopaedics, The First Affiliated Hospital to Anhui Medical University from January to October 2018. They were 7 men and 5 women with an average age of 42.3 years (from 25 to 62 years). The time from injury to operation averaged 5.1 days (from 2 to 10 days). There were 2 cases of type B1, 5 ones of type B2 and 5 ones of type C1 according to the Tile classification. After closed reduction using the pelvic unlocking reduction frame, the orthopedics robot navigation positioning system was used to guide the placement of percutaneous screws. The posterior rings were fixated with sacroiliac screws, and the anterior rings with pubis screws, pubic symphysis screws or external fixation. The placement time for each screw, fluoroscopy frequency, reduction quality, fracture union time, function of the affected hip and complications at the final follow-up were recorded.Results:A total of 25 percutaneous screws were inserted in the 12 patients with a mean fluoroscopic frequency of 4.7 times (from 3 to 8 times) and a mean placement time of 14.9 min (from 12 to 20 min). According to the Matta rating system, the fracture reduction was rated as excellent in 7 cases, as good in 4 and as fair in one. The average follow-up time was 11.3 months (from 6 to 16 months). All fractures healed after an average period of 11.8 weeks (from 10 to 14 weeks). By the Majeed scoring, the pelvic function at the final follow-up was excellent in 8 cases and good in 4. The follow-ups observed no infection, nerve injury, deep vein thrombosis, heterotopic ossification, implant looseningor traumatic arthritis in these patients.Conclusion:Percutaneous channel screwing assisted by the robot navigation positioning system combined with pelvic unlocking reduction frame can reduce operative time and risks and lead to minimal invasion for pelvic fractures.

Facet joint is the important part of spinal biomechanical structures. The damage of facet joint will destroy the stability of spinal motion segments and accelerate the adjacent segments degeneration (ASD). The violation of cranial facet joint based on various screw insertion techniques is a common but easily overlooked factor in clinical application. The reduction of intra-operative cranial facet joint violation is essential for reduction of postoperative ASD. The rates of facet violation are related to screw insertion techniques. The insertion techniques, including robot-assisted guidance, computer-assistant navigation, and cortical bone trajectory, are used successfully well in protecting cranial facet joints, compared with the freehand pedicle screw placement technique, which has been widely utilized in clinical practice. However, the conventional X-ray guided screw insertion technique is associated with a higher rate of facet violation. The main reasons why different techniques lead to various rates of facet violation include various anatomical referenced landmarks during screw insertion, selection of assisted equipment for instruments, and resistance of soft tissues of the spine. In addition, the related risk factors, such as facet angle, screw insertion segments, lumbar degeneration, and learning curve effect, can also affect the rates of facet violation. In the present study, we compared the differences of facet joint violation when using various screw techniques, and summarized the causes of violations and related risk factor. The present review might provide references for surgeons regarding the decrease of cranial facet joint violation, optimization of insertion techniques and reduction of ASD.

Objective To study cerebral cortical activation preoperatively and postoperatively in patients with cervical spondylotic myelopathy (CSM), and discuss effect of the surgery on cortical reorganization in functional recovery.Methods 19 cases with CSM intrial group underwent cervical vertebra canal decompression surgery according to clinical routine.Cases in trial group completed clinical assessment using the modified Japanese Orthopaedic Association Scores (mJOA) prior to decompression and 12 months following surgery, and underwent cerebral functional MRI and conventional MRI in the same time.19 controls also carried out cerebral functional MRI and conventional MRI.All subjects performed a finger-tapping paradigm with right hand during processing functional MRI.The imagings and data of trial group were divided into preoperative group and postoperative group in accordance with the time of completed and than analysed.Results The mJOA score of postoperative group was increased significantly (P<0.001).Cortical volume of activation (VOA) of preoperative group was significantly higher than the control group (P<0.05).VOA was lower in the postoperative group, but still significantly higher than the control group (P<0.05).The preoperative group was able to detect and activate the signal only in the left precentral gyrus.The postoperative group was able to detect and activate the signal in the l left postcentral gyrus, the premotor area and the supplementary motor area, and the right cerebral cortex could also detect a small amount of activation signal.Conclusion CSM patients undergo cerebral cortical remodeling, causing sensory and motor function activation areas to expand and shift.The changes of cortical reorganization after cervical vertebra canal decompression surgery are associated with functional recovery.The surgical treatment may promote the compensating cortical reorganization.

Objective To study the relationship between degenerative lumbar spondylolisthesis and degeneration of cartilage endplate by magnetic resonance imaging.Methods The median sagittal scanning of LA/L5 and L5/S1 intervertebral discs of all subjects were performed by magnetic resonance imaging with T2.Measureed the inclination angle of the front half of the endplate and the inclination angle of the posterior half of the endplate,then the ratio of the anterior horn and the posterior horn was calculated as the change rate of the endplate.The differences of the rate of cartilage endplate in the corresponding stage of spondylolisthesis group and normal group were compared.Results In L4 lumbar spondylolisthesis group,both upper and lower endplate of L4/L5 intervertebral disc have significant differences between the lumbar spondylolisthesis group and the normal group (t =11.280,-3.765,P =0.000).In L5 lumbar spondylolisthesis group,there are significant differences between the lumbar spondylolisthesis group and the normal group (t =11.280,-3.765,P =0.000),both upper and lower endplate of L5/S1 intervertebral disc;and significant differences were found among the upper and lower endplates of the L5/S1 (t =4.633,P =0.000).Among all the subjects,between the upper and lower endplate of L4/L5,significant differences were found,too(t =17.377,3.137,2.199,P =0.000,0.005,0.035).In addition to the above,the differences were not statistically significant.Therefore,lumbar spondylolisthesis can lead to degenerative in cartilage endplate of Slippage stage.Conclusion The degree of degeneration of the anterior and the posterior half of the same cartilage endplate is asymmetrical,for example,the degeneration of the posterior half of the upper endplate is worse than that of the anterior half of the plate,but the degeneration of the anterior half of the lower endplate is worse than that of the posterior half endplate.The degenerative degree of cartilage endplate was less affected by lumbar spondylolisthesis in the non slip stage.

Objectives:To evaluate the long-term complications of percutaneous kyphoplasty(PKP) for osteoporotic vertebral compression fractures (OVCF),and to provide evidence for clinical procedure.Methods:Databases including CNK1,CBM,PubMed,The Cochrane Library(lssue 2,2017),Wiley Online Library,ELSEVIER Science Direct(SDOS) were used to collect the randomized controlled trials(RCTs) which compared PKP with conservative treatment in the treatment of OVCF from inception to February 2017.The diagnosis of thoracolumbar vertebral compression fracture was confirmed by X-ray,CT and MRI.The presence of thoracolumbar osteoporotic T which was less than or equal to-2.5,was confirmed by bone mineral density measurement.All the patients were 50 years or older,and disease duration was less than 6 months;postoperative outcomes included at least one of the following indicators:new vertebral fractures,adjacent fractures,serious adverse events,visual analogue score.Cochrane system evaluation manual 5.0.1 was referred to evaluate the quality of the included literatures.Results:Five RCT studies included four English literatures and one Chinese literature.Methodological quality assessment of 4 articles were more than or equal to 4 points,one article scored 3 points.PKP group consisted of 417 cases,conservative treatment group of 458 cases.The results of meta-analysis showed that there was statistical difference in VAS between the two groups after 3 to 6 months' treatment(mean difference=-0.36;95％CI-0.07 to-0.65;P=0.02).However,there was no statistical difference in new vertebral fractures,adjacent fractures or serious adverse events.Conclusions:Application of PKP in OVCF can reduce the patients' long-term (3-6 months) VAS pain score and does not increase the risks of new vertebral fractures,adjacent fractures and serious adverse events.