Objective To research the effect to the semen quality of the three operation methods of superiority of highly selective varicocele high ligation,transinguinal canal and laparoseopic of renovated polomo management of varicocele.Methods 561 patients in our hospital who charged by infertility had the operation were analyzed retrospectively and were recruited with primary varicocele above grade II for this study.These patients were divided into three group according to three kinds of operation methods of varicocele :group A was treated with highly selective varicocele high ligation and had 300 patients;group B was treated with transinguinal canal operation and had 181 patients; and group C was treated by laparescopic of renovated polomo operation with 80 patients.Through the comparing of the fertility ability of the three operation methods,to evaluate the therapeutic effect of the three methods.Results The increasing rates of the quality of semen in group B was higher than other groups if patients' ages were lower than 30.The increasing rates of the quality of semen in every group was also higher if patients' ages were lower than 30.No difference was found between three groups in natural conception rate (P＞0.05).Conclusion The methods of highly selective varieecele high ligation would be a better choice in the management of patients with primary varicecele because of higher quality of semen.

Objective:To investigate the effects and mechanism of exosomes secreted by human umbilical cord-derived mesenchymal stem cells （hUC-MSCs） in repair of tendon cell injury.Methods:The hUC-MSCs which were stably subcultured were isolated and purified by a tissue block adherent method，and the immunophenotype of hUC-MSCs was detected by flow cytometry. The induction media was employed to induce the differentiation of hUC-MSCs to osteoblasts，chondroblasts and adipocytes，and cell identification was performed subsequently. The secreted exosomes of MSCs （MSCs-exosomes） were extracted using an ultracentrifugation method. The exosomes were detected by Western blot and electron microscopy，and the fusion ability of the exosome membrane was detected by PKH67 staining fluorescence. Forty Wistar rats were divided into tendon injury group （ n = 20） and normal group （ n = 20） according to the random number table. In tendon injury group，the rats were sacrificed with 100 mg/kg pentobarbital sodium one week after Achilles tendon transection，and the injured tendon cells were obtained following digestion of the Achilles tendon. In normal group，the rats were sacrificed without any treatment and the normal tendon cells were obtained concurrently. After the exosomes were co-cultured with tendon cells in vitro for 12，24，48，72 hours，the proliferation of tendon cells was detected by CCK-8 assay. After the tendon cells were treated with hUC-MSCs exosomes for 24 hours，the effects of exosomes on transforming growth factor β （TGF-β），bone morphogenetic protein （BMP），vascular endothelial growth factor （VEGF），fibroblast growth factor （FGF），interleukin（IL）-1β and tumor necrosis factor-α （TNF-α） were detected by Western blot，qPCR and immunofluorescence. Results:The hUC-MSCs were identified and hUC-MSCs-exosomes were isolated successfully. The cultured MSCs were fusiform and positive for Alanine aminopeptidase （CD13），integrin β-1 （CD29），ECTO-5'-nucleotidase （CD73），thymocyte surface antigen （CD90） and endothelin （CD105），but negative for human leukocyte DR antigen （HLA-DR），hematopoietic progenitor cell antigen （CD34） and leukocyte common antigen （CD45）. The exosomes isolated showed a round disc shape and a diameter of 30-100 nm with a depressed internal structure under the electron microscope which was verified via PKH67 staining and the motility-related protein-1 （CD9） and lysosomal associated membrane protein 3 （CD63） were highly expressed. The CCK-8 assay showed the cell viability in tendon injury group was markedly higher than that in normal group at 12 h，24 h，48 h，and 72 h following treatment of tendon cells （ P < 0.01）. The results of qPCR revealed that the mRNA expressions of TGF-β （1.850 ± 0.127），BMP （2.133 ± 0.398），FGF （1.610 ± 0.223） and VEGF （2.207 ± 0.059） in tendon injury group were markedly higher than those in normal group（1.004 ± 0.105，1.007 ± 0.145，1.007 ± 0.140，1.001 ± 0.065，respectively） （ P < 0.05）. However，the mRNA expressions of IL-1β （0.102 ± 0.009） and TNF-α （0.130 ± 0.013） in tendon injury group was markedly lower than those in normal group （1.004 ± 0.113，1.006 ± 0.134） （ P < 0.01）. The results of Western blot were consistent with those of qPCR. Conclusions:The exosomes secreted by hUC-MSCs can promote the growth of tendon cells and repair of tendon cell injury by up-regulating the expression of growth factors TGF-β，BMP，VEGF and FGF，and inhibiting the expression of inflammatory factors IL-1β and TNF-α.

Objective:To compare the clinical prognosis of modified and traditional knotless suture bridge technique in treatment of rotator cuff tear under shoulder arthroscopy.Methods:A retrospective case-control study was conducted to analyze 60 patients with rotator cuff tear admitted to Affiliated Hospital of Qingdao University from June 2018 to June 2019，including 19 males and 41 females，aged 32-74 years［（59.3±10.1）years］. There were 26 patients on the left side and 34 patients on the right side，with the body mass index（BMI）of 19.5-32.4 kg/m 2［（25.5±2.6）kg/m 2］，rotator cuff tear of 2.0-3.7 cm［（2.7±0.4）cm］and pain duration of 2-88 days［（26.2±17.1）days］. A total of 31 patients were repaired with a modified knotless suture bridge（modified group）and 29 patients with a traditional knotless suture bridge（traditional group）. Comparison was made between the two groups in aspects of range of motion of shoulder flexion，abduction and external rotation，visual analog scale（VAS），University of California Los Angeles（UCLA）should function score，Constant shoulder function score，retear and complications at postoperative 3 and 12 months. Results:All patients were followed up for 9-15 months［（12.0±1.8）months］. Three months after operation，the two groups showed no significant differences in shoulder range of motion of abduction，flexion，external rotation，UCLA shoulder function score or Constant shoulder function score（ P>0.05）；while VAS was（2.7±1.2）points in modified group，significantly lower than（3.4±1.2）points in traditional group（ P<0.05）. Twelve months after operation，the shoulder range of motion of abduction and flexion in modified group was（146.9±21.4）° and（150.4±16.2）°，significantly higher than that in traditional group［（130.7±27.4）°，（140.6±18.4）°］（ P<0.05）；There was no significant difference in external rotation activity between the two groups（ P>0.05）；VAS，UCLA shoulder function score and Constant shoulder function score［（1.2±0.5）points，（29.5±2.3）points，（80.4±5.4）points，respectively］in modified group were significantly higher than those in traditional group［（1.5±0.5）points，（27.2±2.7）points，（76.3±6.6）points，respectively］（ P<0.05）. Three months after operation，there was no significant difference in the classification of Sugaya between the two groups（ P>0.05）. Twelve months after operation，the classification of Sugaya was significantly different between the two groups（ P<0.05），with no retear in modified group but 3 patients with retear in traditional group. No postoperative complications occurred，such as non-healing，infection or persistent swelling. Conclusion:For patients with rotator cuff tear，the modified knotless suture bridge technique under shoulder arthroscopy has better range of motion and function，more obvious pain relief and a lower rate of retear than the traditional technique.

Objective:To explore the correlation between fibular head height and varus knee osteoarthritis occurrence and severity.Methods:A retrospective analysis was performed on 618 participants (618 knees, 184 males and 434 females, mean age 61.12±10.98 years) who underwent standard weight-bearing full-leg radiographs and were diagnosed as non-knee osteoarthritis or varus knee osteoarthritis from January 2019 to June 2019. Knee osteoarthritis was diagnosed according to Kellgren-Lawrence grading: 0-I grades were diagnosed as non-osteoarthritis, II-IV grades were diagnosed as osteoarthritis. Joint line convergence angle (JLCA), medial proximal tibial angle (MPTA) and hip-knee-ankle angle were measured on X-rays to reflect varus deformity. The fibular head height was defined as the vertical distance from upper edge of fibular head to lateral tibial plateau. Patients were divided into 5 groups according to Kellgren-Lawrence grading. Differences of age, gender, height, weight, body mass index, varus deformity (JLCA, MPTA and hip-knee-ankle angle) between Kellgren-Lawrence 0-IV grades were compared. Ordinal logistic regression was performed to analyze the correlation between fibular head height and Kellgren-Lawrence grades. Pearson's correlation analysis was used for the correlation among fibular head height, JLCA, MPTA and hip-knee-ankle angle, and the main factor of JLCA, MPTA and hip-knee-ankle angle was extracted by factor analysis. Multiple linear regressions were used to analyze the correlation between fibular head height and varus deformity score.Results:There were 68, 66, 97, 98, 289 participants in Kellgren-Lawrence grades 0-IV respectively that was 134 participants were diagnosed as non-osteoarthritis and 484 participants were diagnosed as osteoarthritis. Fibular head height and MPTA showed a decreasing trend ( F=129.076, 24.875; P<0.001) while JLCA and hip-knee-ankle angle showed an increasing trend ( F=414.346, 105.996; P<0.001) with the increase in Kellgren-Lawrence grading. Age, body mass index and fibular head height are influencing factors of Kellgren-Lawrence grading with OR(95%CI) were 1.116(1.093, 1.141), 1.363(1.060, 1.754), 0.617(0.575, 0.662) . Fibular head height was negatively correlated with JLCA and hip-knee-ankle angle ( r=-0.641, -0.478; P<0.001) , respectively, and positively correlated with MPTA ( r=0.320, P<0.001). There were significant correlations between age, fibular head height and the varus deformity score ( β=0.274, -0.457; P<0.001). Conclusion:Fibular head height of patients with varus knee osteoarthritis is lower than that of non-osteoarthritis. In addition to age and body mass index, fibular head height is a risk factor for varus knee osteoarthritis occurrence. The smaller the fibular head height is, the more serious the osteoarthritis severity and varus deformity are.

Objective:To compare the clinical efficacy between modified open wedge high tibial osteotomy (MOWHTO) versus traditional open wedge high tibial osteotomy (TOWHTO) for varus knee osteoarthritis (KOA).Methods:A retrospective study was conducted to analyze the 50 patients (60 knees) with varus KOA who had received high tibial osteotomy at Department of Sports Medicine, The Affiliated Hospital of Qingdao University between September 2019 and December 2020. The patients were divided into 2 groups according to different ways of osteotomy: a traditional group and a modified group. In the traditional group subjected to TOWHTO, there were 25 cases (30 knees); in the modified group subjected to MOWHTO, there were 25 cases (30 knees). In MOWHTO, the bone block attached to the medial collateral ligament (MCL) of the knee was first chiseled at the MCL insertion before osteotomy to reduce excessive stripping of the MCL in the osteotomy area, and then the bone fragment attached to the MCL was filled into the osteotomy area to increase bone filling and bone coverage after the alignment of the lower limb was corrected. The hip-knee-ankle angle (HKAA), medioproximal tibial angle (MPTA), and joint line convergence angle (JLCA) were measured preoperatively and at 18 months postoperatively in both groups to evaluate correction of the alignment of the lower limb. Fracture healing time, bone loss in the osteotomy area, Hospital for Special Surgery (HSS) knee score and visual analogue scale (VAS) were recorded to evaluate the postoperative efficacy.Results:There was no statistically significant difference between the TOWHTO and MOWHTO groups in the general clinical data before operation, showing comparability ( P>0.05). At 18 months after operation, HKAA was (179.1° ± 1.1°) in the TOWHTO group and (179.3° ± 0.7°) in the MOWHTO group while MPTA was (91.9° ± 0.4°) in the TOWHTO group and (91.9° ± 0.4°) in the MOWHTO group, showing no statistically significant difference between the 2 groups ( P>0.05) but a significant difference between preoperation and postoperation in each group ( P<0.05). At 18 months after operation, JLCA was (1.8° ± 0.4°) in the TOWHTO group, significantly larger than that in the MOWHTO group (1.5° ± 0.4°), HSS score was 81.5 (79.5, 83.0) points in the TOWHTO group, significantly lower than that in the MOWHTO group [85.0 (82.5, 87.5) points], and VAS was 1.8 (1.6, 2.0) points in the TOWHTO group, significantly higher than that in the MOWHTO group [1.5 (1.5, 2.0) points] (all P<0.05). At 18 months after operation, the preoperative JLCA was significantly improved in both groups ( P<0.05). The time required for a fracture healing score higher than 4 points was (3.3 ± 0.6) months in the TOWHTO group and (4.5 ± 0.9) months in the MOWHTO group, and the rate of bone loss in the osteotomy area was 20% in the TOWHTO group (6/30) and 0 (0/30) in the MOWHTO group, both showing a significant difference between the 2 groups ( P<0.05). Conclusions:Both TOWHTO and MOWHTO can effectively treat varus KOA. MOWHTO is more effective in promoting bone healing in the osteotomy area, reducing bone defects in the osteotomy area and improving knee function.