Objective To investigate the clinical effect of pedicle screw fixation in the treatment of fracture and dislocation of atlantoaxial spine via posterior approach .Methods 19 patients with fracture and dislocation of atlantoaxial spine in this hospital from June 2011 to December 2013 were selected and treated with open reduction and pedicle screw fixation via posterior approach . The X‐radiographs were postoperatively re‐examined at regular time for understanding the correction of fracture and dislocation and implant fusion results ,the neurological functions were evaluated according to the Japanese Orthopaedic Association(JOA) scores . Results All cases got bony fusion without the occurrence of internal fixation loosening ,broken screw or broken rod .The JOA score was improved from preoperative (7 .35 ± 2 .39) points to postoperative (13 .21 ± 2 .53) points (P<0 .05) .Conclusion The posteri‐or atlantoaxial pedicle screw fixation and fusion for treating upper cervical spine injury has satisfactory effect .

BACKGROUND:At present, percutaneous vertebroplasty has been widely used in clinical treatment of osteoporotic vertebral fractures. Considering the limitations of the underlying disease in elderly patients (> 65 years of age) at surgery, the relevant detailed studies have gradualy attracted the attention of clinicians. OBJECTIVE:To compare and analyze the clinical effects of vertebroplasty with bone cement and conventional fracture reduction for elderly osteoporotic thoracolumbar fractures. METHODS:Totaly 24 elderly patients with osteoporotic thoracolumbar fractures were voluntarily divided into bone cement treatment and conservative treatment groups (n=12 per group) and subjected to vertebroplasty with polymethylmethacrylate bone cement and conventional reduction therapy, respectively. RESULTS AND CONCLUSION:Compared with the conservative treatment group, the visual analog scale scores, Oswesty dysfunction index and Cobb angle were significantly reduced in the bone cement treatment group, while the degree of anterior vertebral compression was increased. These results suggest that minimaly invasive spine treatment is conducive to improve the fracture healing and enhance the quality of life in elderly patients with osteoporotic vertebral compression fractures in stable conditions.

Objective:To investigate the value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) parameters combined with T 2WI texture analysis of primary lesions of rectal adenocarcinoma in preoperative prediction of lymph node metastasis with short diameter ≤9 mm. Methods:Retrospective analysis was performed on 115 cases of rectal adenocarcinoma confirmed by surgical pathology in Affiliated Provincial Hospital of Anhui Medical University from June 2015 to October 2020. All patients underwent total mesorectal resection and received conventional rectal MRI and IVIM-DWI scan before surgery. According to the pathological results of lymph node, the patients were divided into lymph node metastatic group ( n=44) and non-metastatic group ( n=71). IVIM-DWI parameters of primary rectal adenocarcinoma were measured including apparent diffusion coefficient (ADC), diffusion coefficient (D), pseudo diffusion coefficient (D *) and perfusion fraction (f). The region of interest (ROI) of the whole lesion of rectal adenocarcinoma was delineated on axial T 2WI; then the ROIs were imported into GE Analysis Kit software to extract 3D texture feature. The differences of IVIM-DWI parameters and texture feature parameters were compared between two groups using independent sample t test or Mann-Whitney U test. The optimal texture feature parameters with independent predictive function were screened by multivariate logistic regression. Then the texture feature model and combined model based IVIM-DWI and texture feature parameters were established. The receiver operating characteristic (ROC) curves were used to evaluate the performances of IVIM-DWI, texture feature parameters, texture feature model and combined model in predicting lymph node metastasis in patients with rectal adenocarcinoma. The area under the ROC curve (AUC) were compared with DeLong test. Results:Among all the IVIM-DWI parameters, the D * and f values of primary rectal adenocarcinoma were significantly different between the lymph node metastasis group and the non-lymph node metastasis group ( Z=3.39, P=0.001, Z=-3.06, P=0.002); no statistical significance was found in the ADC and D values between two groups (both P>0.05). A total of 828 texture feature parameters were obtained based on T 2WI of primary lesion of rectal adenocarcinoma, among which 3 optimal texture feature parameters were selected, including firstorder_Skewness, shape_Sphericity and glcm_Idn. The ROC curve results showed that the AUC of D * and f were 0.689 and 0.670, respectively. The AUC of 3 texture feature parameters were 0.651, 0.628, 0.631, respectively. The AUC of texture feature model and the combined model were 0.775 and 0.803. The AUC of combined model was larger than D *, f and the three texture feature parameters (all P<0.05). Conclusion:IVIM-DWI parameters combined with T 2WI texture feature parameters in primary lesion of rectal adenocarcinoma show good diagnostic efficacy in preoperative prediction of lymph node metastasis with short diameter≤9 mm.

Objective:To evaluate our self-designed guide device for Kirschner-wire placement in the surgery for paediatric fractures of supracondylar humerus.Methods:A retrospective study was conducted of the 117 children who had been treated for fractures of supracondylar humerus at Department of Orthopedics, The First People's Hospital of Huaian Affiliated to Nanjing Medical University from March 2019 to January 2023. There were 64 boys and 53 girls with an age of (5.8±1.5) years. By the Gartland classification, there were 67 fractures of type Ⅱ and 50 fractures of type Ⅲ. The time from injury to operation averaged (48.5±10.8) hours. The children were divided into 2 groups according to how their Kirschner-wires were placed. In the control group of 58 cases, external percutaneous Kirschner-wire placement was assisted using a syringe needle; in study group of 59 cases, external percutaneous Kirschner-wire placement was assisted using our self-designed guide device for Kirschner-wire placement. The operation time, rate of one-time placement of disposable K-wire, intraoperative fluoroscopy frequency, Baumann angle, carrying angle, fracture healing time, Flynn score of elbow joint function at the final follow-up, and postoperative complications were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The 117 pediatric patients were followed up for (15.3±3.2) months after operation. The operation time [(30.6±4.5) min] and intraoperative fluoroscopy frequency [(15.6±2.1) times] in the study group were significantly less than those in the control group [(40.6±7.3) min and (23.7±4.9) times], while the rate of one-time placement of disposable K-wire in the study group was significantly higher than that in the control group [84.2%(149/177) versus 32.2%(56/174)] ( P<0.05). There were no significant differences in Baumann angle, carrying angle, fracture healing time, or Flynn score of elbow joint function at the final follow-up between the 2 groups ( P>0.05). The incidence of complications in the study group (6.8%, 4/59) was significantly lower than that in the control group (20.7%, 12/58) ( P<0.05). Conclusions:Our self-designed guide device for Kirschner-wire placement is simple and convenient to use. In the surgery for paediatric fractures of supracondylar humerus, it can improve the rate of one-time placement of disposable K-wire, reduce intraoperative fluoroscopy, and decrease the incidence of complications.

Bone organoids can simulate the complex structure and function of the bone tissues, which makes them a frontier technology in organoid researches. Bone organoids show a tremendous potential of applications in bone disease modeling, bone injury repair, and medicine screening. Although advancements have been made so far in constructing bone organoids with functional structures like mineralization, bone marrow, trabecular bone, callus, woven bone, etc, the researches in this field are confronted with numerous challenges such as lack of standardized construction strategies and unified evaluation criteria, which limits their further promotion and application. To standardize researches in bone organoids, the Orthopedic Expert Committee of Geriatric Branch of Chinese Association of Gerontology and Geriatrics, the Youth Osteoporosis Group of Orthopedic Branch of Chinese Medical Association, the Osteoporosis Group of Orthopedic Surgeon Branch of Chinese Medical Doctor Association, and the Osteoporosis Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine organized related experts to formulate Expert consensus on the construction, evaluation, and application of bone organoids ( version 2024) based on an evidence-based approach. A total of 17 recommendations were put forth, aiming to standardize researches and clinical applications of bone organoids and enhance their value in scientific research and clinical practice.

Objective:To explore the clinical value of a trinity strategy for the treatment of multiple orthopedic trauma.Methods:A retrospective case series study was conducted to analyze the clinical data of 1 267 patients with multiple orthopedic trauma admitted to Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the First Affiliated Hospital of Navy Medical University from June 2013 to May 2023, including 862 males and 405 females, aged 18-93 years [(55.2±19.8)years]. Associated injuries included hemorrhagic shock in 632 patients, traumatic wet lung in 274, cranial injuries in 135, abdominal and pelvic bleeding in 116, pneumothorax in 89, urinary injury in 13, and vesical rupture in 8. All the patients were treated with the trinity strategy and the treatment process was divided into the phases of first aid, remodeling, and rehabilitation. The first aid phase focused on stabilizing symptoms and saving lives; the remodeling phase centered on restoring the anatomical structure and alignment; the rehabilitation phase aimed for functional recovery through the integration of both Western and traditional Chinese medicine. The all-cause mortality within 30 days after surgery and fracture healing time were calculated; the excellent and good rates of Constant-Murley shoulder score, Mayo elbow score, Gartland-Werley wrist score, Harris hip score, Hospital for Special Surgery (HSS) knee score and the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at the last follow-up and the overall excellent and good rate of all joint function scores were measured. The short form health survey (SF-36) scores were collected preoperatively and at 6 months postoperatively, including 8 aspects such as physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health. The incidence of postoperative complications was recorded.Results:All the patients were followed up for 6-18 months [(10.2±4.2)months]. The mortality rate during the acute phase (within 30 days after surgery) was 2.37% with 12 deaths due to hemorrhagic shock, 10 due to traumatic brain injury, 6 due to multiple organ dysfunction syndrome (MODS), and 2 due to pulmonary infection. The average fracture healing time averaged 3.8-18 months [(11.5±4.2)months], with 89.49% of the patients having bone union within 12 months after surgery, 8.93% having bone union within 18 months after surgery, and 1.58% undergoing reoperation. For the patients with internal fixation failure and nonunion, the average healing time was extended to (10.2±2.2)months and (13.7±3.3)months respectively. At the last follow-up, the excellent and good rates of Constant-Murley shoulder score, Mayo elbow score, Gartland-Werley wrist score, Harris hip score, HSS knee score, and AOFAS ankle-hindfoot score were 83.93%, 90.24%, 94.12%, 85.57%, 88.46%, and 92.31% respectively, with an overall excellent and good rate of 89.11%. At 6 months after surgery, the SF-36 scores of all the patients in the eight dimensions,including the physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health were (74.4±8.6)points, (44.7±14.4)points, (77.4±10.9)points, (68.4±18.2)points, (72.5±16.0)points, (76.8±8.7)points, (49.9±17.6)points, and (72.8±17.9)points, significantly improved compared with those before operation [(63.4±12.7)points, (30.9±17.4)points, (56.4±18.0)points, (55.4±24.7)points, (53.5±21.0)points, (55.8±24.3)points, (36.9±24.0)points, (58.8±21.6)points] ( P<0.01). Complications of different degrees occurred in 214 patients (16.89%), including lung infections in 118 patients (9.31%), lower extremity deep vein thrombosis in 50(3.95%), pressure injuries in 26(2.05%), internal fixation failure in 12(0.95%), and nonunion in 8(0.63%). Conclusions:The trinity strategy provides whole-process management, personalized treatment, and overall rehabilitation for multiple orthopedic trauma. It can decrease mortality, shorten fracture healing time, improve joint function and quality of life, and reduce the incidence of complications.