Objective:To develop a preoperative CT image segmentation algorithm based on artificial intelligence deep learning technology for total hip arthroplasty (THA) revision surgery, and to verify and preliminarily apply it.Methods:A total of 706 revision cases with clear CT data from April 2019 to October 2022 in Chinese PLA General Hospital were retrospectively analyzed, including 520 males, aged 58.45±18.13 years, and 186 females, aged 52.23±16.23 years. All of them were unilateral, and there were 402 hips on the left and 304 hips on the right. The transformer_unet convolutional neural network was constructed and trained using Tensorflow 1.15 to achieve intelligent segmentation of the revision THA CT images. Based on the developed three-dimensional planning system of total hip arthroplasty, an intelligent planning system for revision hip arthroplasty was preliminarily constructed. Dice overlap coefficient (DOC), average surface distance (ASD) and Hausdorff distance (HD) parameters were used to evaluate the segmentation accuracy of transformer_unet, full convolution network (FCN), 2D U-shaped Net and Deeplab v3 +, and segmentation time was used to evaluate the segmentation efficiency of these networks.Results:Compared with the FCN, 2D U-Net, and Deeplab v3+ learning curves, the transformer_unet network could achieve better training effect with less training amount.The DOC of transformer_unet was 95%±4%, the HD was 3.35±1.03 mm, and the ASD was 1.38±0.02 mm; FCN was 94%±4%, 4.83±1.90 mm, 1.42±0.03 mm; 2D U-Net was 93%±5%, 5.27±2.20 mm, and 1.46±0.02 mm, respectively. Deeplab v3+ was 92%±4%, 6.12±1.84 mm, 1.52±0.03 mm, respectively. The transformer_unet coefficients were better than those of the other three convolutional neural networks, and the differences were statistically significant (all P<0.05). The segmentation time of transformer_unet was 0.031±0.001 s, FCN was 0.038±0.002 s, 2D U-Net was 0.042±0.001 s, Deeplab v3+ was 0.048±0.002 s. The segmentation time of transformer_unet was less than that of the other three convolutional neural networks, and the difference was statistically significant ( P<0.05). Based on the results of previous studies, an artificial intelligence assisted preoperative planning system for THA revision surgery was initially constructed. Conclusion:Compared with FCN, 2D U-Net and Deeplab v3+, the transformer_unet convolutional neural network can complete the segmentation of the revision THA CT image more accurately and efficiently, which is expected to provide technical support for preoperative planning and surgical robots.

Objective:To explore the impact of robot assisted total hip arthroplasty (THA) on the accuracy of prosthesis placement and its clinical efficacy.Methods:A total of 432 patients (549 hips) who underwent robot-assisted primary THA for various diseases of the hip in the Department of Orthopaedics of the Fourth Medical Center of the PLA General Hospital from August 2018 to October 2022 was retrospectively analyzed. There were 174 male and 258 female with an average age of 54.2±12.7 years old and body mass index (BMI) of 23.2±4.3 kg/m 2. There were 301 left hips and 248 right hips. All patients were operated under general anesthesia using the standard posterior lateral surgical approach to THA. The Harris hip score (HHS), forgotten joint score (FJS), the Western Ontario and McMaster University (WOMAC) osteoarthritis index and patient satisfaction were used to evaluate the clinical outcomes. The anterior inclination, abduction angle, lower extremity discrepancy and the position of the center of rotation (COR) of the hip joint were radiographically accessed preoperatively, intraoperatively and postoperatively. The composition ratio of the acetabular cup in the safe zone was also calculated. Results:Five hundred and forty-nine consecutive hips (432 patients) underwent robotic-assisted THA with a mean follow-up of 23.6±16.2 months. The mean operative time was 86.2±35.4 min, and the mean blood loss was 236.7±94.5 ml. At the last follow-up, the mean HHS score for this group was 91.4±15.4, the WOMAC score was 8.4±6.5, the FJS score was 77.4±23.4, and the satisfaction score was 9.1±2.7 points. The mean postoperative measurement of acetabular cup anteversion was 21.2°±4.8° and abduction was 40.8°±4.3°. About 93.7% (511 patients) had an acetabular cup within the safety zone of ±10° of the target angle, and 84.6% (464 patients) had an acetabular cup within the safety zone of ±5° of the target angle. A total of 4 complications occurred. Acute periprosthesis infection happened in a case of developmental dysplasia of the hip (DDH) and was cured by DAIR (debridement, antibiotics, irrigation, retention of prosthesis). One case of thigh pain of unknown reason was treated with a revision operation, during which no loosening or malposition of the prosthesis was found. After replacing the femoral head component no pain was complained by the patient. One case of hematoma and nerve compression was considered to be caused by blood vessels injury when a titanium cable was used to fix the distal femoral fracture during the surgery. The nerve injury returned to normal within 1 month. One case of dislocation happened immediately after surgery and was revised by replacing a different head. The patient was fully recovered. In addition to software and mechanical failures of the robot itself, complex hip joint diseases would be a risk factor for the termination of robot assisted surgery due to the occurrence of adverse events related to robots in 16 hips. Considering the existence of a certain termination rate in robot assisted surgery, sufficient preparation should be made when applying robot assisted technology in complex hip joint diseases.Conclusion:In robotic-assisted THA, preoperative planning can be achieved with precise and reproducible acetabular cup positions, significantly increasing the chance of locating the acetabular cups in the safety zone, and obtaining satisfactory results in restoring COR and leg length.

Objective:To analyze the feasibility and clinical efficacy of mirror reconstruction in total hip arthroplasty (THA) assisted by visual treatment solution (VTS) for patients with Crowe type II-III developmental dysplasia of the hip (DDH).Methods:Included in this study were 67 patients (67 hips) with unilateral Crowe type II-III DDH undergoing primary THA from June 2022 to August 2023. According to the reconstruction position of the rotation center, the patients were divided into mirror group and high group. There were 37 patients (37 hips) in the mirror group, reconstructed by referring to the rotation center of contralateral normal hip, with 8 males and 27 females, aged 40.9±16.7 years old and 30 patients (30 hips) in the high group, reconstructed by the "high hip center" strategy, with 7 males and 23 females, aged 38.3±11.1 years old. The radiographic results between the affected hip and the normal hip in 12 months postoperatively and the clinical results before and after the operation were compared.Results:All the operations for patients with Crowe type II-III DDH were completed successfully. The operation time, intraoperative blood loss and the follow-up time in the mirror group were 113.9±22.9 min, 287.8 ±181.6 ml and 12.8±1.8 months, respectively, while those in the high group were 118.0±26.2 min, 293.3±125.8 ml and 13.7±2.3 months respectively without significant difference between the two groups. In 12 months postoperatively the rotation center height, greater trochanter height and femoral offset of 37 hips in the mirror group were 16.1±3.8 mm, 17.7±5.2 mm and 34.4 ±5.1 mm, respectively, which were not significantly different from those of the normal side, while the HHS and WOMAC osteoarthritis index were significantly improved compared to those before operation from 32.3±5.3 and 76.9±5.4 points to 84.3±6.3 and 9.4±2.5 points ( t=-34.222, P<0.001; t=64.486, P<0.001). In the high group, the rotational center height, greater trochanter height and femoral offset of 30 hips were 27.9±3.7 mm, 25.4 ±7.9 mm and 35.4 ±6.2 mm, respectively, which were significantly higher than those in the normal side ( t=-15.706, P<0.001; t=-6.494, P<0.001; t=-2.555, P=0.016), and the HHS and WOMAC osteoarthritis index were significantly improved compared to those before operation from 30.9±4.8 and 78.7±5.3 points to 79.5±4.9 and 13.9±3.3 points ( t=-37.339, P<0.001; t=64.375, P<0.001). The HHS and WOMAC osteoarthritis index in the mirror group significantly improved compared with the high group in 12 months postoperatively ( t=3.404, P=0.001; t=-6.315, P<0.001). The X-ray at last follow-up showed that all prostheses were in a stable position. Conclusion:Compared with the high hip center reconstruction, satisfactory outcomes in terms of functional recovery and radiographic evaluation could be achieved in patients with Crowe type II-III DDH undergoing VTS-assisted THA of mirror reconstruction. The application of mirror reconstruction is expected to achieve the goal of restoring the anatomical structure and function of the primary hip after THA.

OBJECTIVE To establish the high -performance liquid chromatography （HPLC）fingerprint of Compound huiqin granules and analyze it with chemical pattern recognition ，and determine the contents of 8 active components in the granules . METHODS Using puerarin as reference peak ，the fingerprints of 10 batches of Compound huiqin granules were drawn by HPLC method. Similarity Evaluation System for Chromatographic Fingerprint of Traditional Chinese Medicine （2012 edition）was used to evaluate the similarity and identify common peaks ；SPSS 22.0 and SIMCA 14.0 software were used for cluster analysis and principal component analysis . HPLC method was used to determine the contents of 8 active components ，such as chlorogenic acid ， puerarin，3′-methoxypuerarin，daidzin，luteolin-7-O-β-D-glucuronide，isochlorogenic acid A ，and apigenin -7-O-β-D-glucuronide and isochlorogenic acid C . RESULTS There were 26 common peaks in the fingerprints of 10 batches of Compound huiqin granules，the similarity was greater than 0.900，and 11 peaks were identified ，which were gallic acid ，neochlorogenic acid ， chlorogenic acid ，puerarin，3′-methoxypuerarin，daidzin，luteolin-7-O-β-D glucuronide ，isochlorogenic acid A ，apigenin-7-O-β-D- glucuronide，isochlorogenic acid C and daidzein . The results of cluster analysis and principle component analysis showed that 10 batches of Compound huiqin granules could be clustered into 4 categories，in which S 2，S3 and S 6 belonged to one category ，S4， S8，S10 belonged to one category ，S7 belonged to one category ，and S 1，S5，S9 belonged to one category . Average contents of 8 active components were 1.30，17.42，3.51，3.57，0.75，0.41，0.31，0.32 mg/g，respectively. CONCLUSIONS In this study ，the fingerprints and multi -component content determination method of Compound huiqin granules are successfully established ，which can provide a basis for the quality control of the granules .

OBJECTIVETo evaluate the application of tendon-derived stem cells (TDSC) and bone marrow-derived mesenchymal stem cells (BMSC) for patellar tendon injury repair in rat model.

METHODSTDSCs and BMSCs were isolated from patellar tendons or bone marrow of healthy SD rats. The patellar tendon injury model was induced in 60 SD rats, then the animals were divided into 3 groups with 20 in each group: rats in TDSC group received transplantation of TDSC with fibrin glue in defected patellar tendon, rats in BMSC group received BMSC with fibrin glue for transplantation and those in control group received fibrin glue only. The gross morphology, histology and biomechanics of the patellar tendon were examined at 1, 2, 4, 6 and 8 weeks after the treatment.

RESULTSGross observation showed that the tendon defects in TDSC group and BMSC group almost disappeared in week 8, while the boundary of tendon defects in control group was still visible. Histology examination showed that the neo-tendon formation in TDSC group and BMSC group was observed at week 8, while there was no neo-tendon formation in control group. Biomechanics study showed that the ultimate stress and Young Modulus, relative ultimate stress and relative Young Modulus increased with the time going in all groups(all P<0.05); the ultimate stress and Young Modulus, relative ultimate stress and relative Young Modulus of TDSC and BMSC groups were significantly higher than those in control group at week 4, 6 and 8(all P<0.05). There was no difference in ultimate stress and Young Modulus between TDSC group and BMSC group(P>0.05), however, the relative Young Modulus of TDSC group was significantly higher than that in BMSC group at week 8(P<0.05).

CONCLUSIONAllogeneic TDSC and BMSC transplantation facilitates the repair of tendon injury and improves the biomechanics of tendon. TDSC is more suitable for in vivo tendon regeneration than BMSC.

Animals ; Bone Marrow ; Elastic Modulus ; Mesenchymal Stromal Cells ; cytology ; Rats ; Rats, Sprague-Dawley ; Regeneration ; Tendon Injuries ; therapy ; Tendons ; cytology ; Wound Healing

OBJECTIVE To optimize the steaming and processing technology of wine-steamed Taxillus chinensis， and to characterize its quality. METHODS Using the content of avicularin， quercitrin， quercetin and appearance traits as evaluation indicators， the analytic hierarchy process （AHP）-entropy weight method was used to determine the weights of each indicator， and the comprehensive scores of those indicators were used as response values. Box-Behnken response surface method was used to investigate the effects of solid-liquid ratio （g/mL）， soaking time， and steaming time on the processing technology of wine-steamed T. chinensis， optimize the best processing technology， and verify it. Fifteen batches of T. chinensis decoction pieces from different origins were used to prepare wine-steamed T. chinensis using the best processing technology， and their qualities were characterized. RESULTS The optimal processing technology for wine-steamed T. chinensis was to take 100 g of T. chinensis decoction pieces， add 20 mL of yellow wine， seal and moisten for 2 h， steam at normal pressure for 1 h， take out and dry at 50 ℃. The surface of wine-steamed T. chinensis prepared by the optimal processing technology was reddish brown or brownish， and its powder was dark brown， with a hard or brittle texture that was easy to break， and had a slight aroma of alcohol， and an astringent taste. Results of microscopic and thin-layer identification for the stem cross-section of wine-steamed T. chinensis were the same as those of raw T. chinensis. The contents of moisture， total ash and acid-insoluble ash were 3.92%-8.75%， 2.27%-5.08%， and 0.19%-0.82%， respectively； the contents of water-soluble extract were 11.28%-18.56%， and the contents of alcohol-soluble extract were 3.36%-8.58%； the contents of avicularin， quercitrin， and quercetin were 0.22-1.64， 0.26-2.45， and 0.01-0.38 mg/g， respectively. CONCLUSIONS This study successfully optimized the processing technology of wine-steamed T. chinensis and preliminarily characterized its quality， which can provide reference for the standardized processing and establishment of quality standards for wine-steamed T. chinensis decoction mail：wyl@sxtcm.edu.cn pieces.

OBJECTIVE To optimize the steaming and processing technology of wine-steamed Taxillus chinensis， and to characterize its quality. METHODS Using the content of avicularin， quercitrin， quercetin and appearance traits as evaluation indicators， the analytic hierarchy process （AHP）-entropy weight method was used to determine the weights of each indicator， and the comprehensive scores of those indicators were used as response values. Box-Behnken response surface method was used to investigate the effects of solid-liquid ratio （g/mL）， soaking time， and steaming time on the processing technology of wine-steamed T. chinensis， optimize the best processing technology， and verify it. Fifteen batches of T. chinensis decoction pieces from different origins were used to prepare wine-steamed T. chinensis using the best processing technology， and their qualities were characterized. RESULTS The optimal processing technology for wine-steamed T. chinensis was to take 100 g of T. chinensis decoction pieces， add 20 mL of yellow wine， seal and moisten for 2 h， steam at normal pressure for 1 h， take out and dry at 50 ℃. The surface of wine-steamed T. chinensis prepared by the optimal processing technology was reddish brown or brownish， and its powder was dark brown， with a hard or brittle texture that was easy to break， and had a slight aroma of alcohol， and an astringent taste. Results of microscopic and thin-layer identification for the stem cross-section of wine-steamed T. chinensis were the same as those of raw T. chinensis. The contents of moisture， total ash and acid-insoluble ash were 3.92%-8.75%， 2.27%-5.08%， and 0.19%-0.82%， respectively； the contents of water-soluble extract were 11.28%-18.56%， and the contents of alcohol-soluble extract were 3.36%-8.58%； the contents of avicularin， quercitrin， and quercetin were 0.22-1.64， 0.26-2.45， and 0.01-0.38 mg/g， respectively. CONCLUSIONS This study successfully optimized the processing technology of wine-steamed T. chinensis and preliminarily characterized its quality， which can provide reference for the standardized processing and establishment of quality standards for wine-steamed T. chinensis decoction mail：wyl@sxtcm.edu.cn pieces.

OBJECTIVE：To establish the fingerprint of wine-processed Schisandra chinensis ，and to conduct cluster analysis and principal component analysis. METHODS ：HPLC method was adopted. The determination was performed on Diamonsil C 18（2） column with mobile phased consisted of methanol-water （gradient elution ）at the flow rate of 1 mL/min. The detection wavelength was set at 250 nm，and the column temperature was 30 ℃；the injection volume was 10 μL. With schisandrol A as the reference peak，HPLC fingerprints of 15 batches of samples were drawn and their similarity were evaluated with Similarity Evaluation System of TCM Chromatographic Fingerprint （2012 edition）. The common peaks were determined. Cluster analysis and principal component analysis were performed by using SPSS 22.0 statistical software. RESULTS ：There were 20 common peaks in 15 batches of samples ，and the similarities were 0.983-0.999；a total of 8 common peaks were identified ，namely 5-hydroxymethyl furfural，schisandrol A ，schisandrol B ，schisantherin A ，schisantherin B ，deoxyschizandrin，γ-schizandrin，pseudo-γ-schizandrin. The results of cluster analysis showed that 15 batches of wine-processed S. chinensis could be clustered into 4 categories. Among them，S1-S4 and S 14 were clustered into one category ，S9-S11 were clustered into one category ，S5，S7-S8，S12-S13 were clustered into one category ，and S 6 and S 15 were clustered into one category. The results of principal component analysis showed that the cumulative variance contribution rate of first four principal component s was 85.381％；the classification results were basically consistent with the results of cluster analysis. Compared with S. chinensis ，5-hydroxymethyl furfural was newly found in S. chinensis after wine-processing ，with high content ；but there was no significant difference in the other chromatographic peaks. CONCLUSIONS：The established HPLC fingerprint is simple and easy to operate ，combined with cluster analysis and principal component analysis ，can be used for quality control of wine-processed S. chinensis decoction pieces.