BACKGROUND:With changing lifestyles and aging,sagittal spinal imbalance has become a common orthopedic issue significantly affecting knee and pelvic function.Understanding the impact of sagittal spinal imbalance and its compensatory mechanisms is crucial for improving the clinical management of chronic pain.OBJECTIVE:To evaluate the alignment of the spine-pelvis-lower extremities using whole-body EOS imaging,analyze the correlation between spinal sagittal imbalance and knee joint parameters,and explore their compensatory mechanisms.METHODS:A total of 71 patients with chronic low back pain or patellofemoral pain who visited Department of Orthopedics,First Affiliated Hospital of Soochow University between January 1,2021 and December 31,2023 were included.Radiographic measurements were performed using whole-body EOS to determine pelvic tilt,pelvic incidence,lumbar lordosis,sagittal vertical axis,global tilt,hip-knee-angle,knee flexion angle,lateral distal femoral angle,and medial proximal tibial angle.Patients were classified into normal group(pelvic incidence-lumbar lordosis＜10°),compensated group(10°＜pelvic incidence-lumbar lordosis＜20°),and decompensated group(pelvic incidence-lumbar lordosis＞20°)based on the SRS-Schwab spinal deformity classification according to pelvic incidence-lumbar lordosis difference.The differences in radiographic parameters among the groups were analyzed.The differences in American Knee Society Knee Score and Oswestry Disability Index scores were compared among each group.Patients were divided into chronic low back pain group and non-chronic low back pain group,patellofemoral pain group and non-patellofemoral pain group based on clinical symptoms,and the relationship between radiographic parameter differences and clinical symptoms was analyzed.RESULTS AND CONCLUSION:(1)When pelvic incidence-lumbar lordosis was less than 20°,lateral distal femoral angle and medial proximal tibial angle tended to stabilize.When pelvic incidence-lumbar lordosis was greater than 20°,it showed a linear correlation with lateral distal femoral angle and medial proximal tibial angle,with lateral distal femoral angle increasing and medial proximal tibial angle decreasing with increasing pelvic incidence-lumbar lordosis values.(2)Compared with the normal group,the compensated group had significantly increased pelvic tilt(P＜0.01),while knee joint parameters hip-knee-angle and knee flexion angle showed no significant differences;the decompensated group showed significant increases in pelvic tilt(P＜0.01),and decreases in hip-knee-angle,and knee flexion angle(P＜0.01).Compared with the compensated group,the decompensated group showed a significant decrease in hip-knee-angle(P＜0.05),but had no significant differences in pelvic tilt and knee flexion angle.(3)Compared with the non-patellofemoral pain group,patients with patellofemoral pain had significant decreases in spinal lumbar lordosis,lateral distal femoral angle,and medial proximal tibial angle(P＜0.05)and a significant increase in pelvic incidence-lumbar lordosis(P＜0.05).(4)Patients with low back pain had significant differences in radiographic parameters compared with the non-chronic low back pain group(P＜0.05).(5)Compared with the normal group,both the compensated and decompensated groups showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P＜0.05).Compared with the compensated group,the decompensated group showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P＜0.05).(6)Pelvic incidence-lumbar lordosis values increased with age and were higher in females compared with males.(7)This study systematically reveals the spine and lower limbs play an important role in disease progression and clinical symptoms.Associated symptoms low back pain and patellofemoral pain are related to the stability of the spine-pelvis-lower extremity alignment.Furthermore,spinal sagittal imbalance is more severe in elderly and female patients.

BACKGROUND:With changing lifestyles and aging,sagittal spinal imbalance has become a common orthopedic issue significantly affecting knee and pelvic function.Understanding the impact of sagittal spinal imbalance and its compensatory mechanisms is crucial for improving the clinical management of chronic pain.OBJECTIVE:To evaluate the alignment of the spine-pelvis-lower extremities using whole-body EOS imaging,analyze the correlation between spinal sagittal imbalance and knee joint parameters,and explore their compensatory mechanisms.METHODS:A total of 71 patients with chronic low back pain or patellofemoral pain who visited Department of Orthopedics,First Affiliated Hospital of Soochow University between January 1,2021 and December 31,2023 were included.Radiographic measurements were performed using whole-body EOS to determine pelvic tilt,pelvic incidence,lumbar lordosis,sagittal vertical axis,global tilt,hip-knee-angle,knee flexion angle,lateral distal femoral angle,and medial proximal tibial angle.Patients were classified into normal group(pelvic incidence-lumbar lordosis＜10°),compensated group(10°＜pelvic incidence-lumbar lordosis＜20°),and decompensated group(pelvic incidence-lumbar lordosis＞20°)based on the SRS-Schwab spinal deformity classification according to pelvic incidence-lumbar lordosis difference.The differences in radiographic parameters among the groups were analyzed.The differences in American Knee Society Knee Score and Oswestry Disability Index scores were compared among each group.Patients were divided into chronic low back pain group and non-chronic low back pain group,patellofemoral pain group and non-patellofemoral pain group based on clinical symptoms,and the relationship between radiographic parameter differences and clinical symptoms was analyzed.RESULTS AND CONCLUSION:(1)When pelvic incidence-lumbar lordosis was less than 20°,lateral distal femoral angle and medial proximal tibial angle tended to stabilize.When pelvic incidence-lumbar lordosis was greater than 20°,it showed a linear correlation with lateral distal femoral angle and medial proximal tibial angle,with lateral distal femoral angle increasing and medial proximal tibial angle decreasing with increasing pelvic incidence-lumbar lordosis values.(2)Compared with the normal group,the compensated group had significantly increased pelvic tilt(P＜0.01),while knee joint parameters hip-knee-angle and knee flexion angle showed no significant differences;the decompensated group showed significant increases in pelvic tilt(P＜0.01),and decreases in hip-knee-angle,and knee flexion angle(P＜0.01).Compared with the compensated group,the decompensated group showed a significant decrease in hip-knee-angle(P＜0.05),but had no significant differences in pelvic tilt and knee flexion angle.(3)Compared with the non-patellofemoral pain group,patients with patellofemoral pain had significant decreases in spinal lumbar lordosis,lateral distal femoral angle,and medial proximal tibial angle(P＜0.05)and a significant increase in pelvic incidence-lumbar lordosis(P＜0.05).(4)Patients with low back pain had significant differences in radiographic parameters compared with the non-chronic low back pain group(P＜0.05).(5)Compared with the normal group,both the compensated and decompensated groups showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P＜0.05).Compared with the compensated group,the decompensated group showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P＜0.05).(6)Pelvic incidence-lumbar lordosis values increased with age and were higher in females compared with males.(7)This study systematically reveals the spine and lower limbs play an important role in disease progression and clinical symptoms.Associated symptoms low back pain and patellofemoral pain are related to the stability of the spine-pelvis-lower extremity alignment.Furthermore,spinal sagittal imbalance is more severe in elderly and female patients.

Objective To analyze and compare the differences between 3D-printed patient-specific instrumentation(PSI)-assisted medial open-wedge high tibial osteotomy(OWHTO)and conventional medial OWHTO in terms of the postoperative mechanical stability,accuracy of weight-bearing alignment adjustment,and clinical outcomes.Methods Data from patients diagnosed with knee osteoarthritis(KOA)and undergoing OWHTO from Jan.2019 to Jan.2022 were collected.The patients were divided into the conventional method group(23 individuals)and 3D-printed PSI-assisted group(18 individuals)based on the surgical methods.The accuracy of correction between the two methods was evaluated by comparing the preoperatively planned target correction of the hip-knee-ankle(HKA)angle with the postoperative HKA angle difference.The preoperative posterior tibial slope(PTS)and postoperative PTS angle differences were also assessed.The clinical efficacy of the two methods was assessed by collecting and analyzing the Lysholm score,visual analog scale(VAS),and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)of the patients in both the groups prior to surgery and at the 1st,6th,12th,and 24th month postoperatively.The occurrence of postoperative complications in both the groups was analyzed to evaluate the safety of PSI-assisted OWHTO.Results There were no differences in demographic characteristics,preoperative imaging observations,and clinical symptoms between the two groups(P>0.05).With regard to the results of correction accuracy,the postoperative HKA angle difference was 2.7°±1.8° in the conventional OWHTO group and 0.8°±1.1° in the 3D-printed PSI-assisted OWHTO group(P<0.001).The postoperative PTS angle difference was 2.8°±2.2° for conventional OWHTO and 1.7°±1.9° for PSI-assisted OWHTO(P=0.003).In terms of clinical efficacy,the surgical time of the PSI-assisted group was 59.2±14.8 min.This was significantly shorter than that of the conventional method group(87.6±21.4 min)(P=0.019).The Lysholm,VAS,and WOMAC scores of the PSI-assisted group were superior to those of the conventional method group at each postoperative follow-up visit.With regard to postoperative complications,there were four cases(17.3%)in the conventional method group and three(16.7%)in the PSI-assisted group.The statistical difference between the two groups is not significant.Conclusions Compared with the conventional method,3D-printed PSI-assisted OWHTO demonstrated superior accuracy in correcting lower limb alignment,in conjunction with favorable clinical efficacy and safety.This study has provided an effective reference for clinicians in selecting surgical treatment plans.

Objective To analyze and compare the differences between 3D-printed patient-specific instrumentation(PSI)-assisted medial open-wedge high tibial osteotomy(OWHTO)and conventional medial OWHTO in terms of the postoperative mechanical stability,accuracy of weight-bearing alignment adjustment,and clinical outcomes.Methods Data from patients diagnosed with knee osteoarthritis(KOA)and undergoing OWHTO from Jan.2019 to Jan.2022 were collected.The patients were divided into the conventional method group(23 individuals)and 3D-printed PSI-assisted group(18 individuals)based on the surgical methods.The accuracy of correction between the two methods was evaluated by comparing the preoperatively planned target correction of the hip-knee-ankle(HKA)angle with the postoperative HKA angle difference.The preoperative posterior tibial slope(PTS)and postoperative PTS angle differences were also assessed.The clinical efficacy of the two methods was assessed by collecting and analyzing the Lysholm score,visual analog scale(VAS),and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)of the patients in both the groups prior to surgery and at the 1st,6th,12th,and 24th month postoperatively.The occurrence of postoperative complications in both the groups was analyzed to evaluate the safety of PSI-assisted OWHTO.Results There were no differences in demographic characteristics,preoperative imaging observations,and clinical symptoms between the two groups(P>0.05).With regard to the results of correction accuracy,the postoperative HKA angle difference was 2.7°±1.8° in the conventional OWHTO group and 0.8°±1.1° in the 3D-printed PSI-assisted OWHTO group(P<0.001).The postoperative PTS angle difference was 2.8°±2.2° for conventional OWHTO and 1.7°±1.9° for PSI-assisted OWHTO(P=0.003).In terms of clinical efficacy,the surgical time of the PSI-assisted group was 59.2±14.8 min.This was significantly shorter than that of the conventional method group(87.6±21.4 min)(P=0.019).The Lysholm,VAS,and WOMAC scores of the PSI-assisted group were superior to those of the conventional method group at each postoperative follow-up visit.With regard to postoperative complications,there were four cases(17.3%)in the conventional method group and three(16.7%)in the PSI-assisted group.The statistical difference between the two groups is not significant.Conclusions Compared with the conventional method,3D-printed PSI-assisted OWHTO demonstrated superior accuracy in correcting lower limb alignment,in conjunction with favorable clinical efficacy and safety.This study has provided an effective reference for clinicians in selecting surgical treatment plans.

Objective To explore the sensitivity regulatory mechanism of ziprasidone capsules on prolactin( PRL) and fast insulin( FINS) in male adolescents with episode schizophrenia.Methods According to inclusion and exclusion criteria, 52 adolescent males selected from January 2015 to March 2016 were confirmed the psychiatric treatment of schizophrenia in our hospital, their ages, ziprasidone capsule usage and suffering schizophrenia stage of disease, height, waist circumference, body weight, hip circumference, and in the morning fasting blood glucose, FINS and PRL content were recorded.Mathematical model were used to calculate QUICKIFINS sensitivity index, and in accordance with the classification criteria BMI, 52 male adolescents with schizophrenia were divided into normal group and overweight group.The correlation detection, and anthropometric parameters, PRL and FINS sensitivity parameters were analysed.Results PRL and FINS, QUICKI indicators were not correlated(r=0.153, P >0.05; r=-0.101, P >0.05) statistically significant; ziprasidone capsule dose has a positive correlation with FINS(r =0.376,P <0.05), and QUICKI negative indicators (r=-0.362,P<0.05); waist-hip ratio or fat content ratio has no correlation with FINS, QUICKI indicators, but BMI and FINS has a positive correlation (r=0.389,P<0.05) and QUICKI indicators with negative correlation(r=-0.413,P<0.05);PRL level between normal group and overweight group was not statistically significant, and levels of FINS in overweight group(10.89 ±8.23) mU/L was higher than the normal group(5.79 ±3.18) mU/L, the difference was statistically significant(P <0.05).QUICKI index between the two groups was statistically significant, and the overweight of FINS was sensitivity less than the normal group.Conclusion Ziprasidone capsule has no relationship with PRL and FINS resistance in the treatment of adolescent patients with schizophrenia, while body mass index correlated with FINS resistance, and ziprasidone capsule dose correlated with FINS resistance.

Objective To compare the clinical outcomes of long and short InterTan intramedullary nailing of senior intertrochanteric hip fracture in conjunction with early total care (ETC).Methods In this prospective study, records of 30 elder patients with intertrochanteric fracture hospitalized between January 2011 and September 2013 were included.Using the concept of ETC, the patients were treated with long (long-nail group, n =15) and short InterTan intramedullary nails (shortnail group, n =15) within 72 hours postinjury.The two groups were compared for operation time, intraoperative blood loss, fracture healing time, Harris hip score, time to pre-injury mobilization and hardware failure rate.Results Operation time was (77.25 ± 7.38) minutes in long-nail group versus (72.10 ± 6.90) minutes in short-nail group (P ＜ 0.01).Time to pre-injury mobilization was (7.45 ± 1.61) months in long-nail group versus (8.57 ± 2.18) months in short-nail group (P ＜ 0.05).There were no significant differences between long-and short-nail groups regarding the blood loss [(180.75 ± 38.26)ml vs (178.62 ± 34.79)ml], fracture healing time [(4.82 ± 1.12)months vs (4.76 ± 1.04) months], and Harris hip score [(83.75 ± 1.71) points vs (82.57 ± 2.18) points] (P ＞ 0.05).Conclusions Either long or short InterTan intramedullary nailing combined with ETC is effective in treatment of intertrochanteric hip fracture in the elderly.However patients treated with long nails return to pre-injury mobilization relatively earlier.Long InterTan intramedullary nail system is better for the patients combined with serious osteoporosis.