Objective : To explore the differences in oxidative stress levels between patients with and without non-suicidal self-injury(NSSI) behavior in depressive disorders, and their correlation with depressive symptoms, disease duration, and self-injury frequency. Methods : A total of 95 subjects were included in the study, including 65 patients with depression(patient group). They were divided into NSSI subgroup(31 cases) and Non-NSSI subgroup(34 cases) based on whether they had NSSI. 30 healthy control group cases(HC). Enzyme linked immunosorbent assay(ELISA) was used to detect the levels of superoxide dismutase(SOD), catalase(CAT), malondialdehyde(MDA), glutathione peroxidase(GPX), and oxidized low-density lipoprotein(OxLDL) in the peripheral blood of the subjects. The Hamilton depression rating scale(HAMD-17) was used to assess the patient′s condition, and the Ottawa self-injury inventory(OSI) was used to quantitatively evaluate the self-injury frequency of NSSI group patients. Results : The levels of SOD, CAT,MDA,GPX and OxLDL in the patient group were significantly higher than those in the control group(P<0.05). The levels of SOD, CAT, MDA,GPX and OxLDL in the NSSI subgroup were significantly higher than those in the Non-NSSI subgroup and the control group(P<0.05).The duration of the NSSI subgroup was positively correlated with the levels of SOD,CAT,and MDA(r=0.504,P=0.004; r=0.568,P=0.001; r=0.404,P=0.024),and the HAMD-17 score was positively correlated with the levels of SOD,CAT,and MDA(r=0.573,P=0.001; r=0.577,P=0.001; r=0.477,P=0.007). The frequency of self-injury was positively correlated with the levels of SOD and MDA(r=0.558,P=0.001; r=0.494,P=0.005). Conclusion The OS level of patients with depression is significantly higher than that of the healthy population,and among them,patients with depression accompanied by NSSI have a more significant increase in oxidative stress level. Elevated levels of OS may affect the severity,duration,and frequency of self-injurious behavior in patients with depression accompanied by NSSI.

OBJECTIVE: To investigate the effectiveness of the suture anchor technique without knots for reconstruction of the anterior talofibular ligament (ATFL) combined with the reinforcement of the inferior extensor retinaculum in treating chronic lateral ankle instability (CLAI). METHODS: The clinical data of 31 patients with CLAI who were admitted between August 2017 and December 2023 and met the selection criteria were retrospectively analyzed. There were 18 males and 13 females, with an age range from 20 to 48 years (mean, 34.6 years). All patients had a history of repeated ankle sprain, with a disease duration of 6-18 months (mean, 9.65 months). The anterior drawer test and inversion stress test were positive, and tenderness was present in the ligament area. Stress X-ray films of the ankle joint showed a talar tilt angle of (10.00±2.78)° and an anterior talar displacement of (9.48±1.96) mm on the affected side. MRI revealed discontinuity, tortuosity, or disappearance of the ATFL structure. Preoperatively, the visual analogue scale (VAS) score was 5.2±2.1, and the American Orthopaedic Foot and Ankle Society (AOFAS) score was 62.9±7.1. All patients underwent arthroscopic debridement of the ankle joint followed by reconstruction of the ATFL using the suture anchor technique without knots combined with reinforcement of the inferior extensor retinaculum. Postoperatively, pain and function were assessed using the VAS and AOFAS scores. Stress X-ray films were taken to measure the talar tilt angle and anterior talar displacement to evaluate changes in ankle joint stability. Patient satisfaction was assessed according to the Insall criteria. RESULTS: All 31 surgeries were successfully completed. One case had wound exudation, while the remaining surgical incisions healed by first intention. Two cases experienced numbness on the lateral aspect of the foot, which disappeared within 1 month after operation. All patients were followed up 15-84 months (mean, 47.2 months). No complication such as anchor loosening, recurrent lateral ankle instability, superficial peroneal nerve injury, rejection reaction, or wound infection occurred postoperatively. The anterior drawer test and inversion stress test were negative at 3 months after operation. Stress X-ray films taken at 3 months after operation showed the talar tilt angle of (2.86±1.72)° and the anterior talar displacement of (2.97±1.32) mm, both of which were significantly different from the preoperative values ( t=12.218, P<0.001; t=15.367, P<0.001). At last follow-up, 2 patients had ankle swelling after exercise, which resolved spontaneously with rest; all 31 patients returned to their pre-injury level of sports or had no significant discomfort in daily activities. At last follow-up, 25 patients were pain-free, 4 had mild pain after exercise, and 2 had mild pain after walking more than 2 000 meters. The VAS score was 0.8±0.9 and the AOFAS score was 91.6±4.1, both of which were significantly different from the preoperative scores ( t=10.851, P<0.001; t=-19.514, P<0.001). According to the Insall criteria, 24 patients were rated as excellent, 4 as good, and 3 as fair, with a satisfaction rate of 90.3%. CONCLUSION The suture anchor technique without knots for reconstruction of the ATFL combined with reinforcement of the inferior extensor retinaculum provides satisfactory short- and mid-term effectiveness in treating CLAI.
Humans ; Male ; Adult ; Female ; Joint Instability/surgery* ; Lateral Ligament, Ankle/surgery* ; Retrospective Studies ; Middle Aged ; Ankle Joint/diagnostic imaging* ; Young Adult ; Suture Anchors ; Treatment Outcome ; Suture Techniques ; Plastic Surgery Procedures/methods* ; Chronic Disease ; Ankle Injuries/surgery*

Addressing the enduring challenge of evaluating traditional Chinese medicines (TCMs), the integrated evidence chain-based effectiveness evaluation of TCMs (Eff-iEC) has emerged. This paper explored its capacity through a demonstration study that evaluated the effectiveness evidence of six commonly used anti-hepatic fibrosis Chinese patent medicines (CPMs), including Biejiajian Pill (BP), Dahuang Zhechong Pill (DZP), Biejia Ruangan Compound (BRC), Fuzheng Huayu Capsule (FHC), Anluo Huaxian Pill (AHP), and Heluo Shugan Capsule (HSC), using both Eff-iEC and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. The recognition of these CPMs within the TCM academic community was also assessed through their inclusion in relevant medical documents. Results showed that the evidence of BRC and FHC received higher assessments in both Eff-iEC and GRADE system, while the assessments for others varied. Analysis of community recognition revealed that Eff-iEC more accurately reflects the clinical value of these CPMs, exhibiting superior evaluative capabilities. By breaking through the conventional pattern of TCMs effectiveness evaluation, Eff-iEC offers a novel epistemology that better aligns with the clinical realities and reasoning of TCMs, providing a coherent methodology for clinical decision-making, new drug evaluations, and health policy formulation.

Objective:To investigate the feasibility and clinical effect of arthroscopic limited excision of flexor hallucis longus(FHL) tendon sheath combined with open technique of posterior ankle joint capsule for hallucal ganglion cyst(HGC) deriving from the ankle joint.Methods:This is a retrospective case series study. From September 2021 to September 2023, the clinical data of 18 patients (18 feet) with HGC deriving from ankle joint treated by arthroscopic limited excision of FHL tendon sheath combined with posterior ankle capsule opening technique at Department of Orthopedic, Xuzhou Central Hospital were analyzed retrospectively. There were 12 males and 6 females. The age was (49.5±10.7) years (range:32 to 66 years). There were 10 cases on the right side and 8 cases on the left side; 11 cases in fibular, 3 cases in plantar, 2 cases in tibial and 2 cases in tip. There were 8 cases of primary operation and 12 cases of recurrence after resection in other hospital. There were 10 cases with complete skin and soft tissue and 8 cases with ulcer.All patients underwent arthroscopic limited excision of FHL tendon sheath combined with open technique of posterior ankle joint capsule.Clinical evaluations included the American Orthopedic Foot and Ankle Society ankle-hindfoot score(AOFAS-AH), visual analog scale (VAS). The data were compared by paired sample t test and Wilcoxon rank sum test. Results:All cases successfully completed the operation. The operation time was (46.3±8.1) minutes (range:35 to 65 minutes), and the intraoperative blood loss was (6.8±3.1)ml (range:2 to 15 ml). All patients primarily healing without any complications such as infection and skin necrosis. All 18 patients were followed up for (16.3±2.9) months (range:12 to 20 months),and no recurrence. One patient complained of numbness of tibial nerve innervation, and the symptoms disappeared after 3 months of symptomatic treatment with oral mecobalamin. At the last follow-up, the AOFAS-AH significantly improved from 78.9±7.1 (range:65 to 90) preoperatively to 95.8±3.3 (range:89 to 100) postoperatively ( t=9.62, P<0.01). The VAS ( M(IQR)) was reduced from 3(4) preoperatively to 0(1) postoperatively ( Z=-3.75, P<0.01). Conclusions:Arthroscopic limited excision of FHL tendon sheath combined with open technique of posterior ankle joint capsule is an effective and feasible surgery, which realizes accurate and minimally invasive treatment process and good short-term clinical effect.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective:To investigate the risk factors for new adjacent vertebral fracture after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fracture (OVCF) and their predictive efficacy.Methods:A retrospective cohort study was conducted to analyze the clinical data of 476 OVCF patients admitted to The Affiliated Wuxi People′s Hospital of Nanjing Medical University from January 2018 to December 2024, including 74 males and 402 females, aged 49-91 years [71(65, 79)years]. Among them, 397 patients underwent single-level PKP, while 79 received multi-level PKP. Surgical segments involved T 6 in 9 patients, T 7 in 9, T 8 in 14, T 9 in 12, T 10 in 9, T 11 in 50, T 12 in 110, L 1 in 173, L 2 in 77, L 3 in 46, L 4 in 31, and L 5 in 13. The patients were divided into adjacent vertebral fracture group ( n=55) and non-adjacent vertebral fracture group ( n=421) according to whether adjacent vertebral fracture was observed during the follow-up. The following data were collected in both groups: gender, age, body mass index (BMI), bone mineral density T-value, underlying diseases (hypertension, diabetes, coronary heart disease), prior cerebral infarction, history of OVCF, long-term glucocorticoid use, thoracolumbar fracture, number of operated vertebrae, cement injection approach (unilateral or bilateral), mean cement dose, postoperative vertebral height restoration rate, postoperative Cobb angle correction, postoperative thoracolumbar kyphosis angle correction, and cement distribution score. Univariate and multivariate Logistic stepwise regression analysis were performed to assess and identify independent risk factors for adjacent vertebral fracture in OVCF patients after PKP. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the risk factors′ predictive performance for adjacent vertebral fracture in OVCF patients after PKP. Results:Univariate analysis revealed significant differences in age, bone mineral density T-value, history of OVCF, long-term glucocorticoid use, number of operated vertebrae, and cement distribution score between the two groups ( P<0.05). The multivariate Logistic stepwise regression analysis showed that the bone mineral density T-value ( OR=0.68, 95% CI 0.48, 0.95, P<0.05) and cement distribution score ( OR=0.61, 95% CI 0.49, 0.76, P<0.01) were significantly correlated with new adjacent vertebral fractures after PKP. The ROC curve analysis showed that bone cement distribution score showed better predictive performance (AUC=0.72, 95% CI 0.64, 0.79), compared with bone mineral density T-value (AUC=0.62, 95% CI 0.54, 0.70), while the combined predictive performance of the two factors was the best (AUC=0.75, 95% CI 0.68, 0.81). Conclusions:Bone mineral density T-value and cement distribution score are independent risk factors for new adjacent vertebral fracture in OVCF patients after PKP. The predictive performance of cement distribution score is proved to be good and can be better in combination with bone mineral density T-value.

Acute lateral ankle sprain (ALAS) is one of the most common sport injuries, with high incidence, recurrence and disability rates. Currently, exercise rehabilitation-based non-surgical treatment is the primary management approach for ALAS. However, there remain improper practices such as excessive immobilization or uncontrolled activity, which contribute to recurrent sprains and chronic ankle instability, significantly impairing patients′ athletic function and quality of life. To standardize the non-surgical management of ALAS, improve the cure rates, and reduce the recurrence and disability rates, Chinese Sports Rehabilitation Medicine Training Project of Chinese Medical Association, Foot and Ankle Basics and Orthopedics Group, Orthopedic Branch of Chinese Medical Doctor Association, and Sports Medicine Branch of Jiangsu Medical Association organized relevant experts to formulate Expert consensus on non-surgical treatment for acute lateral ankle sprain ( version 2025), following the principles of scientific vigor, practicality, and innovation. Thirteen recommendations were proposed for standardized treatment protocols across different healing phases, aiming to provide references for standard management of ALAS and improve the therapeutic outcomes.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Objective:To retrospectively analyze the short-term curative effects of various treatment methods for displaced femoral neck fractures in young and healthy elderly individuals aged 65 to 74 years, while also exploring the surgical treatment options available for this population.Methods:A retrospective analysis was conducted on 159 patients with displaced femoral neck fractures(Garden types Ⅲ and Ⅳ)who were treated at Zhengzhou Orthopedic Hospital from July 2019 to June 2021.Among these patients, 75 were male and 84 were female, with ages ranging from 65 to 74 years, and an average age of 69.1±2.9 years.Patients were categorized based on the treatment method received: the total hip arthroplasty(THA)group comprised 77 cases, the hemiarthroplasty(HA)group included 42 cases, and the internal fixation(IF)group contained 40 cases.We compared intraoperative blood loss, operation time, Harris hip joint function scores one-year post-operation, and the incidence of secondary surgeries across the groups.Results:All 159 patients were followed up for a duration of 36 to 60 months(mean 45.1 months)postoperatively.Intraoperative blood loss was recorded as follows: IF group(19.3±7.0 ml), HA group(303.7±33.8 ml, P<0.001), and THA group(453.6±75.6 ml), with statistically significant differences in pairwise comparisons among the three groups(all P<0.001).The operation times were: IF group(40.7±13.1 min), HA group(53.2±7.5 min), and THA group(96.8±23.6 min), again showing statistically significant differences between each pair of groups(all P<0.001).The Harris hip score at one year postoperatively was(82.1±8.0)points, with an excellent and good rate of 82.4%.Specifically, the THA group scored(82.1±8.1)points with an excellent and good rate of 83.1%; the HA group scored(82.3±7.5)points with an excellent and good rate of 83.3%; and the IF group scored(81.8±8.0)points with an excellent and good rate of 80.0%.No statistically significant differences were observed in the excellent and good rates among the three groups(all P>0.05).A chi-square test performed on the overall postoperative complications among the three groups revealed no statistically significant differences( P=0.115). Conclusions:For relatively healthy elderly patients aged 65 to 74 with femoral neck fractures, hip replacement is not the sole treatment option.Treatment plans should be individualized based on patients' health conditions, transcending age limitations, to effectively address the growing challenges posed by femoral neck fractures in an aging society.

Objective:To investigate the risk factors and their predictive efficacy for early postoperative infection in elderly patients with intertrochanteric femur fracture.Methods:A retrospective cohort study was conducted to analyze the clinical data of 286 elderly patients with intertrochanteric femur fracture admitted to Zhengzhou Orthopedic Hospital between August 2021 and August 2024, including 154 males and 132 females, aged 60-80 years [(72.5±5.8)years]. Fracture involved the left side in 148 patients and the right side in 138 patients. Internal fixation was performed on 214 patients and joint replacement on 72. Based on the occurrence of infection within two weeks postoperatively, the patients were divided into infection group ( n=25) and non-infection group ( n=261). Data were collected from the two groups, including basic information [gender, age, body mass index (BMI), cause of injury, fracture side], admission data (fasting blood glucose, diastolic blood pressure, systolic blood pressure), preoperative data [American Society of Anesthesiologists (ASA) classification, AO classification, serum C-reactive protein (CRP), serum albumin (Alb), serum CRP/Alb ratio, time from injury to surgery], and treatment-related information (surgical type, duration of surgery, intraoperative blood loss, quality of intraoperative reduction, postoperative antibiotic use). Univariate analysis and multivariate Logistic stepwise regression analysis were used to identify independent risk factors for early postoperative infection in elderly patients with intertrochanteric femur fracture. The receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated to evaluate the predictive efficacy of each factor. Results:Univariate analysis showed significant differences between the two groups in fasting blood glucose on admission, preoperative serum CRP, preoperative serum Alb, preoperative serum CRP/Alb ratio, and duration of surgery ( P<0.01). There were no significant differences between the two groups in the remaining variables ( P>0.05). Multivariate Logistic stepwise regression analysis indicated that fasting blood glucose on admission ( OR=2.65, 95% CI 1.32, 5.32, P<0.01), preoperative serum CRP ( OR=1.10, 95% CI 1.04, 1.18, P<0.01), preoperative serum Alb ( OR=0.79, 95% CI 0.70, 0.90, P<0.01), preoperative serum CRP/Alb ( OR=143.78, 95% CI 4.46, 46.77, P<0.01), and duration of surgery ( OR=1.07, 95% CI 1.02, 1.11, P<0.01) were significantly associated with early postoperative infection in elderly patients with intertrochanteric femur fracture. ROC curve analysis showed that the sensitivity and specificity of preoperative serum CRP/Alb in predicting early postoperative infection in elderly patients with intertrochanteric femur fracture were 88.00% and 88.10%, and that the AUC of preoperative serum CRP/Alb prediction was 0.92, significantly greater than the AUC predicted separately by fasting blood glucose at admission, preoperative serum CRP, preoperative serum Alb and duration of surgery (0.76, 0.75, 0.77, 0.76, respectively). The optimal cut-off value for the preoperative serum CRP/Alb ratio was 1.78. Conclusions:Fasting blood glucose on admission, preoperative serum CRP, Alb, CRP/Alb ratio, and duration of surgery are independent risk factors for early postoperative infection in elderly patients with intertrochanteric femur fracture. These factors all possess certain predictive value for early postoperative infection, but the preoperative serum CRP/Alb ratio demonstrates the best predictive efficacy.