Objective:This study was aimed to investigate the clinical efficacy of unilateral biportal endoscopic spine surgery (UBE)-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system in the treatment of thoracolumbar burst fractures with neurological deficits.Methods:This was a retrospective observational study conducted on 21 patients with thoracolumbar burst fractures and neurological deficits treated with UBE-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system from April 2022 to August 2023. There were 13 males and 8 females, with an average age of 48.48±14.04 years (ranging from 25 to 72 years). Injured segments were T 12 in 2 cases, L 1 in 7 cases, L 2 in 6 cases, L 3 in 3 cases, L 4 in 2 cases, and L 5 in 1 case. According to the AOSpine Thoracolumbar Spine Injury Classification System, there were 14 cases of A3N2, 2 cases of A3N3, 4 cases of A4N2, and 1 case of A4N3. Surgery time, postoperative hospital stays, and complications were recorded. Local Cobb angle, vertebral fragment intrusion area, spinal canal occupation rate, and anterior vertebral height compression rate were measured preoperatively, postoperatively, and at the last follow-up. Screw placement accuracy was assessed using postoperative CT. Neurological function was evaluated using the American Spinal Injury Association (ASIA) grading system, and clinical efficacy was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI). Results:All patients successfully underwent the operation without any conversions to open surgery during the procedure. A total of 105 percutaneous pedicle screws were placed, with an accuracy rate of 96.2%. Internal fixation devices were removed in 18 cases at the last follow-up. The 21 patients were followed up for 18.38±3.66 months (ranging from 12 to 25 months). The surgery time was 150.29±18.84 min (ranging from 111 to 185 min). Postoperative hospital stay was 5.19±1.15 d (ranging from 3 to 7 d). One patient underwent interbody fusion with an autologous iliac crest bone graft and achieved bony fusion at 12 months postoperatively. Preoperative local Cobb angle, anterior vertebral height compression rate, vertebral fragment intrusion area, and spinal canal occupation rate were 22.90°±4.48°, 54.49%±7.53%, 142.90±21.00 mm 2, and 69.91%±7.07%, respectively. Postoperative values improved to 2.57°±1.09°, 5.19%±1.04%, 56.33±11.35 mm 2, and 25.72%±4.24%, with last follow-up values of 3.19°±1.01°, 5.75%±0.92%, 34.90±5.14 mm 2, and 18.25%±2.44% with significant differences ( P<0.05). Preoperatively, all patients were ASIA grade D. Within 48 hours postoperatively, 10 patients improved to grade E, and at the last follow-up, all patients achieved grade E. VAS scores significantly decreased from 8.10±0.92 preoperatively to 3.48±0.59 postoperatively and 1.52±0.73 at the last follow-up ( F=486.032, P<0.001); ODI significantly improved from 58.14%±5.08% preoperatively to 27.20%±2.65% postoperatively and 8.89%±1.19% at the last follow-up ( F=2'001.348, P<0.001). One patient developed a postoperative wound infection, which healed with regular dressing changes. Conclusions:UBE-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system was a safe and effective approach for the treatment of thoracolumbar burst fractures with neurological deficits. This method achieved vertebral reduction, improved neurological function, stabilized spinal alignment, and maximally preserved the integrity of posterior spinal bony and ligamentous structures.

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:In order to reduce the trauma associated with fetal cardiopulmonary bypass(F-CPB), Our team plans to develop a minimally invasive F-CPB through a small incision in the right axilla. The efficacy of this technique will be verified by using a big experimental animal model, thereby laying the foundation for fetal cardiac surgery supported by F-CPB in the future.Methods:Ten pregnant sheep were divided into F-CPB group(n=5) and control group(n=5). After fasting for 24 h, fetal lambs in the F-CPB group underwent a right axillary incision to establish F-CPB running for 1 h; The control group of fetal lambs only expose heart 1 h without F-CPB. Collect blood sample for laboratory test at the CPB vehicle before(T0), 30 min(T1), and 1 h after F-CPB running(T2) for the F-CPB group and through Superior Vena Cava before(T0), 30 min(T1), and 1 h after F-CPB running(T2) for the control group.Results:The blood routine indicators such as RBC, HCT, and Hb in the F-CPB group of fetal lambs decreased significantly during F-CPB, and their distribution showed significant statistical differences compared with the control group( P<0.05). There were no significant statistical differences in blood gas indicators such as pH, PO 2, PCO 2, and lactate concentration between the F-CPB group and the control group( P>0.05). There was no statistically significant difference in the concentration of cTnI in fetal lamb serum at each time point( P>0.05). There were significant statistical differences( P<0.05) in the distribution of fetal lamb Alb, γ-GGT, CK concentration and cholesterol concentration at various time points in the F-CPB group compared with the control group in liver function examination. In addition, the distribution of BUN in fetal lambs showed a significant difference between the two groups( P=0.006). Conclusion:A minimally invasive F-CPB via small incision in the right axilla is safe and feasible. The experimental animal model has demonstrated that this technique has minimal impact on the vital organ functions and internal environment of fetal lambs, thereby laying the foundation for clinical fetal cardiac surgery in the future.

Objective:This study was aimed to investigate the clinical efficacy of unilateral biportal endoscopic spine surgery (UBE)-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system in the treatment of thoracolumbar burst fractures with neurological deficits.Methods:This was a retrospective observational study conducted on 21 patients with thoracolumbar burst fractures and neurological deficits treated with UBE-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system from April 2022 to August 2023. There were 13 males and 8 females, with an average age of 48.48±14.04 years (ranging from 25 to 72 years). Injured segments were T 12 in 2 cases, L 1 in 7 cases, L 2 in 6 cases, L 3 in 3 cases, L 4 in 2 cases, and L 5 in 1 case. According to the AOSpine Thoracolumbar Spine Injury Classification System, there were 14 cases of A3N2, 2 cases of A3N3, 4 cases of A4N2, and 1 case of A4N3. Surgery time, postoperative hospital stays, and complications were recorded. Local Cobb angle, vertebral fragment intrusion area, spinal canal occupation rate, and anterior vertebral height compression rate were measured preoperatively, postoperatively, and at the last follow-up. Screw placement accuracy was assessed using postoperative CT. Neurological function was evaluated using the American Spinal Injury Association (ASIA) grading system, and clinical efficacy was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI). Results:All patients successfully underwent the operation without any conversions to open surgery during the procedure. A total of 105 percutaneous pedicle screws were placed, with an accuracy rate of 96.2%. Internal fixation devices were removed in 18 cases at the last follow-up. The 21 patients were followed up for 18.38±3.66 months (ranging from 12 to 25 months). The surgery time was 150.29±18.84 min (ranging from 111 to 185 min). Postoperative hospital stay was 5.19±1.15 d (ranging from 3 to 7 d). One patient underwent interbody fusion with an autologous iliac crest bone graft and achieved bony fusion at 12 months postoperatively. Preoperative local Cobb angle, anterior vertebral height compression rate, vertebral fragment intrusion area, and spinal canal occupation rate were 22.90°±4.48°, 54.49%±7.53%, 142.90±21.00 mm 2, and 69.91%±7.07%, respectively. Postoperative values improved to 2.57°±1.09°, 5.19%±1.04%, 56.33±11.35 mm 2, and 25.72%±4.24%, with last follow-up values of 3.19°±1.01°, 5.75%±0.92%, 34.90±5.14 mm 2, and 18.25%±2.44% with significant differences ( P<0.05). Preoperatively, all patients were ASIA grade D. Within 48 hours postoperatively, 10 patients improved to grade E, and at the last follow-up, all patients achieved grade E. VAS scores significantly decreased from 8.10±0.92 preoperatively to 3.48±0.59 postoperatively and 1.52±0.73 at the last follow-up ( F=486.032, P<0.001); ODI significantly improved from 58.14%±5.08% preoperatively to 27.20%±2.65% postoperatively and 8.89%±1.19% at the last follow-up ( F=2'001.348, P<0.001). One patient developed a postoperative wound infection, which healed with regular dressing changes. Conclusions:UBE-assisted decompression and reduction combined with a percutaneous pedicle screw and rod fixation system was a safe and effective approach for the treatment of thoracolumbar burst fractures with neurological deficits. This method achieved vertebral reduction, improved neurological function, stabilized spinal alignment, and maximally preserved the integrity of posterior spinal bony and ligamentous structures.

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:In order to reduce the trauma associated with fetal cardiopulmonary bypass(F-CPB), Our team plans to develop a minimally invasive F-CPB through a small incision in the right axilla. The efficacy of this technique will be verified by using a big experimental animal model, thereby laying the foundation for fetal cardiac surgery supported by F-CPB in the future.Methods:Ten pregnant sheep were divided into F-CPB group(n=5) and control group(n=5). After fasting for 24 h, fetal lambs in the F-CPB group underwent a right axillary incision to establish F-CPB running for 1 h; The control group of fetal lambs only expose heart 1 h without F-CPB. Collect blood sample for laboratory test at the CPB vehicle before(T0), 30 min(T1), and 1 h after F-CPB running(T2) for the F-CPB group and through Superior Vena Cava before(T0), 30 min(T1), and 1 h after F-CPB running(T2) for the control group.Results:The blood routine indicators such as RBC, HCT, and Hb in the F-CPB group of fetal lambs decreased significantly during F-CPB, and their distribution showed significant statistical differences compared with the control group( P<0.05). There were no significant statistical differences in blood gas indicators such as pH, PO 2, PCO 2, and lactate concentration between the F-CPB group and the control group( P>0.05). There was no statistically significant difference in the concentration of cTnI in fetal lamb serum at each time point( P>0.05). There were significant statistical differences( P<0.05) in the distribution of fetal lamb Alb, γ-GGT, CK concentration and cholesterol concentration at various time points in the F-CPB group compared with the control group in liver function examination. In addition, the distribution of BUN in fetal lambs showed a significant difference between the two groups( P=0.006). Conclusion:A minimally invasive F-CPB via small incision in the right axilla is safe and feasible. The experimental animal model has demonstrated that this technique has minimal impact on the vital organ functions and internal environment of fetal lambs, thereby laying the foundation for clinical fetal cardiac surgery in the future.

Objective:To investigate the effect of application of problem-based learning (PBL) combined with evidence-based medicine (EBM) in clinical practice teaching of an orthopedic department.Methods:A total of 48 interns who entered Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China from June 2017 to June 2018 were randomly divided into experimental group (the PBL combined with EBM concept teaching group, n = 24) and control group (the traditional teaching group, n = 24). In the experimental group, teachers selected typical cases, designed questions with certain flexibility and complexity, and organized the students to consult the literature, discuss in groups, and report and summarize around the practical problems. In the control group, traditional indoctrination teaching was adopted according to the clinical experience of the teachers. The teaching effect was assessed by a questionnaire survey, a theoretical examination, and a clinical skill examination. The results were analyzed by t-test and Chi-square test using SPSS 16.0 software. Results:The questionnaire survey showed that compared with the control group, the experimental group gave a significantly better evaluation of the teaching methods they received in terms of improving their theoretical knowledge comprehension ability, comprehensive analysis ability, team collaboration awareness, document retrieval and language expression ability, stimulating their learning motivation, and enhancing their scientific thinking and innovation ability ( P < 0.05). Furthermore, compared with the control group, the experimental group had significantly higher mean scores for both the theoretical test (92.42±2.55 vs. 86.17±3.36, P < 0.05) and the clinical skill test (85.79±3.15 vs. 78.88±3.41, P < 0.05). Conclusion:The application of PBL teaching in orthopedic practice, with the concept of EBM throughout the teaching process, has obtained a good effect. It can improve the clinical teaching quality in orthopedics, improve the comprehensive quality of clinical medical students, inspire their active learning enthusiasm, and cultivate their creative thinking, problem construction, comprehensive analysis, literature retrieval, and communication ability.

The unilateral biportal endoscopic technique is defined as posterior unilateral of two small incision with established percutaneous observation channel and endoscopic observation channel in monitoring field. The operation tools were placed within the channel for each operation inside and outside vertebral canal. The characteristics of dual channel intervention make this technology different from coaxial endoscopic technology. This technique has a clear vision for flexible and convenient operation with the advantages of relatively simple surgical instrument requirements. In recent years, the use of unilateral dual channel endoscopic surgery in treating spinal diseases was gradually increasing, especially in the removal of nucleus including lumbar intervertebral disc protrusion and lumbar spinal stenosis disease decompression, and in endoscopic space-occupying lesions such as vertebral fusion and spinal canal between inside and outside. It was also applied in cervical and thoracic diseases with good clinical effects. Its advantages include less surgical trauma and faster recovery process. In addition, it has a large surgical field of vision under the microscope for easy identification of structures and surgery and with relatively gentle learning curve. Thus, it is conducive to beginners' mastery. However, complications such as nerve injury and postoperative lower limb numbness are still frequently reported. Some factors have to be considered, including insufficient understanding of the new technology, the local anatomy of the dual-channel endoscope, the operation of the spinal canal under the microscope. The successful application of the technique in treating various lumbar diseases needs understanding the operation process of the technique and local anatomy under the microscope.

Objective:To develop a unilateral biportal endoscopic technique and investigate the clinical efficacy of unilateral biportal endoscopic technique in the treatment of lumbar disc herniation and lumbar spinal stenosis.Methods:Between July 2018 and June 2019, 60 patients with lumbar disc herniation or spinal stenosis were treated by unilateral biportal endoscopic technique. According to the inclusion and exclusion criteria, 51 patients were included in the study. There were 25 cases of prolapsed lumbar disc herniation, 26 cases of degenerative lumbar spinal stenosis, all of which were treated with posterior lumbar decompression by unilateral biportal endoscopic laminectomy, and contralateral stealth decompression by unilateral approach was performed on the patients with bilateral stenosis. Endoscopic interbody fusion and percutaneous pedicle screw fixation were performed in 5 patients with instability. Operation time, length of incision, hospital stay and complications were recorded. Visual analogue scale (VAS) for low back pain and leg pain, Oswestry dysfunction index (ODI) and the modified Macnab scale were used to evaluate the clinical efficacy.Results:All operations were completed successfully, and no cases were transferred to open surgery. The operative time was 70.29±19.55 min (44-151 min), while the length of incision was 1.79±0.34 cm (1.4-3.0 cm). Postoperative CT suggested complete decompression with intact contralateral structure. All patients got out of bed 1-3 d after surgery, and the postoperative hospital stay was 3.49±2.76 d (1-14 d). The postoperative follow-up time was 13.59±2.80 months (10-21 months). Forty-six patients returned to work or normal activities within 3 weeks and 5 patients with interbody fusion returned to normal activities within 4 weeks. According to the modified Macnab criteria, the final outcome was excellent in 43 cases, good in 6 cases, and fair in 2 cases. There were 3 cases of dural sac tear during operation and 2 cases of transient numbness of lower limbs after surgery and they all recovered after conservative treatment. The VAS score of low back pain of 26 patients with lumbar spinal stenosis was reduced from 6.69±1.44 before surgery to 3.27±1.43 at postoperative 1 month, 2.69±1.57 at postoperative 3 months, 2.31±1.16 at postoperative 6 months and 2.23±1.28 at the last follow-up, respectively, and the difference was statistically significant ( F=128.534, P<0.005). The VAS scoreof leg pain was reduced from 6.77±1.34 before surgery to 3.27±1.37 at postoperative 1 month, 2.88±1.48 at postoperative 3 months, 2.85±1.52 at postoperative 6 months and 2.54±1.53 at the last follow-up, and the difference was statistically significant ( F=146.951, P<0.005). The ODI score was reduced from 64.18%±8.23% before surgery to 37.53%±4.45% at postoperative 1 month, 27.51%±3.83% at postoperative 3 months, 19.91%±5.27% at postoperative 6 months and 6.84%±2.74% at the last follow-up, and the difference was statistically significant ( F=783.966, P<0.005). The VAS score of low back pain of 25 patients with lumbar disc herniation was reduced from 5.60±1.38 before surgery to 3.04±1.54 at postoperative 1 month, 2.84±1.75 at postoperative 3 months, 3.12±1.86 at postoperative 6 months and 3.44±1.69 at the last follow-up, respectively, and the difference was statistically significant ( F=22.357, P<0.005). The VAS scoreof leg pain was reduced from 5.48±1.45 before surgery to 2.88±1.64 at postoperative 1 month, 2.52±1.83 at postoperative 3 months, 2.76±1.83 at postoperative 6 months and 3.00±1.92 at the last follow-up, and the difference was statistically significant ( F=29.445, P<0.005). The ODI score was reduced from 53.59%±6.87% before surgery to 32.46%±3.78% at postoperative 1 month, 23.39%±2.78% at postoperative 3 months, 16.49%±3.49% at postoperative 6 months and 7.23%±3.15% at the last follow-up, and the difference was statistically significant ( F=790.985, P<0.005). Conclusion:Unilateral biportal endoscopic technique has the advantages of clear and wide field of vision, large operating space, relatively simple surgical instrument need and convenient and flexible operation procedure. It has excellent clinical effects in the treatment of lumbar disc herniation and lumbar spinal stenosis.

The early accurate diagnosis of burn depth is of great significance in determining the corresponding clinical intervention methods and judging the prognosis quality of burn patients. However, the current diagnostic method of burn depth still relies mainly on the empirical subjective judgment of clinicians, with low diagnostic accuracy. Especially for deep partial-thickness burn wounds, the error of early diagnosis is pretty big. In recent years, with the rapid development of artificial intelligence technology, deep learning algorithm combined with image analysis technology can better identify and analyze the information of medical images. This article reviews the research progress of artificial intelligence technology in the diagnosis of burn depth.