Objective:To analyze the characteristics of highly cited articles on spine and spinal cord injuries published in Chinese Journal of Trauma (hereinafter referred to as the "Journal") from 1985 to 2024. Methods:All the articles related to spine and spinal cord injuries published in the Journal from 1985 to 2024 were retrieved from the Wanfang Database and the articles with citation frequency ≥15 times were defined as highly cited, with the retrieval cut-off date of April 15, 2025. For articles related to spine and spinal cord injuries, the total publication count, number of cited articles, total citation frequency, average citation frequency per article, number of fund-supported articles were recorded and analyzed. For the highly cited articles among them, the total number of articles, types of literature, distribution periods, number of fund-supported articles, core authors, institution distribution, region distribution, frequency of and key words were also statistically analyzed.Results:From 1985 to 2024, the Journal published 1 182 articles on spinal and spinal cord injuries, of which 993 (84.01%) were cited, with a total citation frequency of 10 739 and an average of 10.81 citations per article. A total of 388 articles (32.83%) were supported by research funds. There were 184 highly cited articles on spinal and spinal cord injuries, with the following characteristics: (1) The most common type of highly cited literature was original articles (150 articles, 81.52%), while consensus and guideline articles achieved the highest average citation rate (44.75 citations per article). (2) The period 2015-2019 had the highest number of highly cited articles, accounting for 33.70%. (3) Fifty-four highly cited articles (29.35%) were supported by research funds, including 19 by national-level funds and 35 by funds of other levels. (4) Among the highly cited articles, 8 (4.35%) were authored by one person, and 176 (95.65%) were co-authored by two or more persons. Sixty-two authors who published ≥3 highly cited articles were identified as core authors. (5) A total of 123 highly cited articles (66.85%) were authored by researchers affiliated with a single institution, whereas 61 articles (33.15%) were the result of inter-institutional collaboration. Fifteen first-author institutions published≥3 highly cited articles. (6) Regions with ≥15 highly cited articles were Zhejiang Province (28 articles), Chongqing Municipality (23 articles), Guangdong Province (18 articles), Shaanxi Province (18 articles), Jiangsu Province (16 articles), and Shanghai Municipality (15 articles). (7) The top five key words in the highly cited articles were "spinal fractures" (71 times), "thoracic vertebrae" (45 times), "lumbar vertebrae" (44 times), "spinal cord injuries" (27 times), and "vertebroplasty" (27 times).Conclusions:Over the 40-year period, original articles constitute the majority of highly cited articles on spine and spinal cord injuries in the Journal, while consensus and guideline articles demonstrate the highest average citation frequency. Nearly 30% of the highly cited articles receive research funding support. Core authors and institutions show a relatively concentrated distribution, with spinal fractures, spinal cord injuries, and vertebroplasty emerging as research hotspots in the field.

Objective:To compare the efficacy of active warming versus conventional warming during the perioperative period of robotic-assisted total hip arthroplasty (THA) for femoral neck fracture in elderly patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 312 elderly patients with femoral neck fracture who underwent robot-assisted THA at Second Affiliated Hospital of Xi ′an Jiaotong University from January 2024 to January 2025, including 196 males and 116 females, aged 65-89 years [(77.0±7.3)years]. Among them, 156 patients received standardized thermal management (active warming group), involving the administration of pre-warmed intravenous fluids and use of an inflatable warming blanket preoperatively, combined application of a forced-air warming system and warmed fluids intraoperatively, and transfer to a temperature-controlled ward combined with a foot circulatory compression device postoperatively. The other 156 patients received conventional warming with cotton quilts (conventional warming group), involving no administration of pre-warmed intravenous fluids preoperatively, use of warmed fluids intraoperatively, and transfer to a standard ward without the use of a foot circulatory compression device postoperatively. Core body temperature was compared between the two groups at 30 minutes preoperatively, 30 minutes intraoperatively, immediately postoperatively, and at 1 hour, 1 day, 5 days, and 7 days postoperatively. Changes in the coagulation function, including prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), and the inflammatory marker C-reactive protein (CRP) were assessed at 1 day preoperatively and at 1, 5, and 7 days postoperatively. Length of hospital stay and incidence of postoperative complications (incision infection, deep vein thrombosis, cardiac complications, and unplanned reoperations) were also recorded. Results:The core body temperature at 30 minutes intraoperatively, immediately postoperatively and at 1 hour postoperatively was (36.77±0.17)℃, (36.29±0.14)℃, and (36.35±0.14)℃ in the active warming group, significantly higher than (36.12±0.27)℃, (35.49±0.25)℃, and (35.67±0.29)℃ in the conventional warming group ( P<0.01). No significant differences in body temperature were observed between the two groups at 30 minutes preoperatively, at 1, 5, or 7 days postoperatively ( P>0.05). At 1 day postoperatively, the PT, TT and APTT were (8.5±1.3)seconds, (10.0±0.9)seconds and (24.8±2.3)seconds, significantly lower than (9.7±1.3)seconds, (12.1±1.5)seconds and (29.2±2.7)seconds in the conventional warming group ( P<0.01). There were no significant differences in PT, TT, APTT or CRP levels between the two groups at 1 day preoperatively or at 5 and 7 days postoperatively ( P>0.05). The CRP level at 1 day postoperatively was (8.0±3.0)mg/L in the active warming group, significantly lower than (13.5±3.2)mg/L in the conventional warming group ( P<0.05). There were no significant differences in CRP between the two groups at 1 day preoperatively or at 5 and 7 days postoperatively ( P>0.05). The average length of hospital stay was (12.2±1.4)days in the active warming group, significantly shorter than (14.9±1.4)days in the conventional warming group ( P<0.01). The perioperative complication rate was 6.4% (10/156) in the active warming group, significantly lower than 17.9% (28/156) in the conventional warming group ( P<0.01). Conclusion:For elderly patients with femoral neck fracture operated via robot-assisted THA, active warming during the perioperative period can more effectively maintain intraoperative normothermia, improve early postoperative coagulation function, reduce inflammatory response, shorten the length of hospital stay, and decrease complication rate when compared with conventional warming.

Objective:To analyze the characteristics of articles published in Chinese Journal of Trauma (hereinafter referred to as the "Journal") from 1985 to 2024, so as to provide insights for further clarifying its academic orientation and improving its quality. Methods:Data of articles published from 1985 to 2024 in the Journal were retrieved and extracted from the Wanfang Database (retrieval cut-off date: April 10, 2025). Statistical analysis was performed on the publication count, total citation frequency, number of cited articles, number of highly cited articles, proportion of fund-supported articles and their citation rate, distribution of article categories, author distribution, and keyword frequency.Results:Over the 40-year period, the Journal published a total of 10 687 articles, with the total citation frequency of 45 242. Among them, 7 497 articles (70.15%) were cited and 389 (3.64%) were highly cited. A total of 2450 articles (22.93%) were supported by research funds, with a citation rate of 80.29%. The clinical researoh column showed the largest number of publications, accounting for 7 996 articles (74.82%). First authors were distributed across 31 provincial-level regions, contributing 5 878 articles and 29 583 total citations. Thirty-five corresponding authors published more than 30 articles each, 17 of whom were from medical institutions in Chongqing Municipality. A total of 20 686 keywords were identified, with the top 5 being "fracture fixation, internal" (421 times), "craniocerebral injury" (395 times), "diagnosis" (359 times), "brain injury" (354 times), "spinal cord injury" (314 times).Conclusion:Over the 40-year period, the Journal has been characterized by a high overall academic influence despite a relatively low proportion of highly impactful publications, a substantial rate of fund-supported articles, a broad geographical distribution of first authors, with the most significant contributions coming from Chongqing Municipality, and a strong academic foundation in specialized disciplines such as orthopedics and neurosurgery.

Spinal cord injury is a debilitating neurological condition associated with a high of disability rate, leading to impairments in motor, sensory, and autonomic functions. Current early interventions such as decompression and pharmacological treatments show limited efficacy, often resulting in lifelong deficits in sensory, motor, and other functions, which impose a significant burden on patients, their families, and the society. Recently, electromagnetic neuromodulation has emerged as a promising biomedical technology encompassing a variety of invasive and non-invasive techniques such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and epidural electrical stimulation (EES) that effectively promote neurological recovery in patients with spinal cord injury. However, research on electromagnetic neuromodulation in improving functional impairments after spinal cord injury remains limited, with still uncertain clinical outcomes, necessitating further investigation to clarify its underlying mechanisms. To this end, the authors reviewed recent advances in the mechanistic understanding of electromagnetic neuromodulation in the treatment of spinal cord injury, focusing on pain control, motor function recovery, blood pressure regulation, urogenital function improvement, alleviation of respiratory dysfunction, and reduction of limb spasticity, aiming to provide a reference for the clinical application and future development of electromagnetic neuromodulation technology.

Spinal trauma, primarily caused by high-energy external forces, predominantly manifest as vertebral fracture and spinal cord injury. These conditions are characterized by spinal pain, restricted mobility, and sensory and autonomic dysfunction, significantly compromising patients′ quality of life and life expectancy. Current diagnostic and therapeutic practices for spinal fracture remain susceptible to subjective clinical experience, resulting in misdiagnosis, underdiagnosis, and imprecise surgical execution. Similarly, the therapeutic efficacy of spinal cord injury rehabilitation is frequently limited by a lack of personalized treatment protocols. The growing integration of artificial intelligence (AI) in medicine presents novel opportunities to overcome these obstacles. By excelling in image interpretation, data analytics, clinical decision support, and personalized rehabilitation planning, AI has emerged as a prominent focus of modern research. To this end, the authors reviewed the research progress in the application of AI in the diagnosis and treatment of spinal fracture and rehabilitation of spinal cord injury, providing a reference for AI-assisted precision diagnosis and treatment of vertebral fracture and rehabilitation of spinal cord injury.

Prolonged disorders of consciousness (pDoC) represent severe complications following severe traumatic brain injury, imposing substantial burden on both families and the society. Currently, the diagnosis and treatment of pDoC still face challenges, including insufficient assessment accuracy and limited efficacy of arousal therapies. On one hand, innovative approaches such as neuroimaging, electrophysiological techniques, and neuromodulation have provided new directions for the diagnosis and treatment of pDoC, yet standardized diagnostic and therapeutic protocols as well as large-scale clinical evidence remain lacking. On the other hand, standardized management of pDoC requires multidisciplinary collaboration, yet the limited number of specialized arousal centers in China hinders the provision of systematic therapy. The Department of Neurosurgery at West China Hospital, Sichuan University has established a comprehensive pDoC care system through a multidisciplinary team approach. To this end, the authors systematically summarized the clinical exploration and advancements in pDOC arousal therapy by West China Hospital′s neurosurgical team, aiming to provide valuable insights for domestic peers and jointly advance the optimization and advancement of pDoC diagnosis and treatment.

Trauma has been predicted to be the leading cause of mortality among individuals under 45 years old, thus posing profound societal consequences. China′s trauma center system was established rather late and faces multiple challenges, including insufficient provincial-level trauma centers, constrained patient mobility with most critical cases limited to intra-provincial treatment and referrals, unsustainable "small-yet-comprehensive" county-level models, significant disparities in regional trauma care capacity, absence of consolidated provincial trauma centers, and inadequate specialist training programs. These factors collectively compromise the regional trauma care outcomes. To this end, integrating China′s trauma center development situation with Tongji Hospital′s 30-year institutional experience, the authors proposed establishing provincial high-capacity trauma centers for critical injuries, aiming to enhance the regional trauma care performance.

The incidence of osteoporotic fractures has demonstrated a significant upward trend, with osteoporotic thoracolumbar fracture accounting for nearly 50% of all the osteoporotic fractures. Following osteoporotic thoracolumbar fracture, the patients face significantly increased risks of disability and even mortality, severely compromising their quality of life and overall health. In recent years, the proposal and application of the concept of very high risk of fracture in osteoporosis have provided new perspectives for stratified treatment approaches in osteoporosis management. Study results demonstrate that fracture risk stratification-based treatment strategies can maximize clinical benefits for osteoporosis patients. However, osteoporosis management in China faces significant challenges characterized by high disease prevalence yet low awareness, diagnosis, and treatment rates, creating substantial barriers to implementing stratified care. To improve the screening and clinical management of very high fracture-risk patients, the authors reviewed the research progress in the diagnosis and treatment of patients with very high risk of osteoporotic thoracolumbar fracture, aiming to provide evidence-based references for formulating treatment strategies for such patients.

Objective:To evaluate the efficacy of 3D printing technology combined with computer navigation-assisted screw implantation in the treatment of atlantoaxial instability (AAI) complicated by vertebral artery anomalies.Methods:A retrospective case series study was conducted to analyze the clinical data of 23 patients with AAI complicated by vertebral artery anomalies who were admitted to Honghui Hospital of Xi′an Jiaotong University between January 2019 and January 2023, including 10 males and 13 females, aged 19-70 years [(51.0±13.3)years]. Vertebral artery anomalies were categorized into unilateral high-riding vertebral artery with unilateral dominance ( n=14), bilateral high-riding vertebral arteries with unilateral dominance ( n=6), and ponticulus posticus ( n=3). All the patients underwent preoperative planning using a 3D-printed model of the atlantoaxial complex with the vertebral artery, followed by posterior atlantoaxial pedicle screw fixation with computer-assisted navigation. Operative duration and intraoperative blood loss were recorded. The accuracy of pedicle screw placement was assessed at 3 days postoperatively using the Gertzbein-Robbins classification. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were evaluated preoperatively, at 3 days, 3 months postoperatively, and at the last follow-up. Bony fusion was assessed using cervical CT with 3D reconstruction at the last follow-up. Complications were also observed. Results:All the patients were followed up for 12-19 months [(15.1±1.9)months]. The operative duration was 125-167 minutes [(140.6±10.9)minutes] and intraoperative blood loss was 200-600 ml [(295.7±77.8)ml]. At 3 days postoperatively, all the 66 pedicle screws were safely placed, with 60 screws (91%) rated as Gertzbein-Robbins Grade 0 and 6 screws (9%) as Grade 1. At 3 days and 3 months postoperatively, and at the last follow-up, the VAS scores were (4.0±1.0)points, (2.0±0.6)points, and (1.3±0.5)points, and the JOA scores were (14.2±1.2)points, (16.0±0.8)points, and (16.6±0.5)points, both of which were not only significantly improved compared with preoperative (5.6±1.3)points and (12.8±1.5)points, but also further improved over time ( P<0.05). At the last follow-up, 22 patients (96%) achieved satisfactory atlantoaxial bony fusion. No vertebral artery injury, spinal cord or nerve injury, cerebrospinal fluid leakage, or screw loosening were observed in any patients. Conclusion:For patients with AAI complicated by vertebral artery anomalies, 3D printing combined with computer navigation-assisted navigation for atlantoaxial pedicle screw implantation offers multiple advantages, including minimal surgical trauma, high screw placement accuracy, pain relief, neurological function improvement, high fusion rate, and lowered incidence of complications.

Objective:To investigate the effect and mechanism of injectable photopolymerizable porous gelatin methacrylate anhydride (Porous GelMA)/methacrylated silk fibroin (SilMA) composite hydrogel (PSE) loaded with human umbilical cord mesenchymal stem cell-derived exosomes (hUCMSC-Exos) in promoting knee joint cartilage regeneration.Methods:The porous GelMA solution (60 g/L) was mixed with SilMA solution (200 g/L) at a volume ratio of 6∶1 . The mixture was ultraviolet-irradiated for 30 seconds to form a cured Porous GelMA/SilMA hydrogel (P/S6). The hUCMSC-Exos was isolated via differential centrifugation coupled with ultrafiltration and then was incorporated into the Porous GelMA/SilMA composite solution at 200 μg/ml, followed by ultraviolet irradiation for 30 seconds to generate Exos-loaded PSE. Primary rat chondrocytes (P1) were divided into control group, P/S6 group, and PSE group to characterize the porosity, compressive strength, and sustained exosome release kinetics of PSE hydrogel. Chondrocytes were allocated to control group, interleukin-1β (IL-1β) group, P/S6 group, and PSE group, among which the last three groups were preconditioned with 10 ng/ml IL-1β for 24 hours, and then cultured in complete medium, P/S6 extract and PSE extract for 3 days, respectively, to establish in vitro cartilage defect models, while the control group remained untreated. Western blot and qRT-PCR analysis were conducted to quantify the expression levels of antibody to aggrecan core protein (ACAN), sex-determining region Y-box transcription factor 9 (SOX9), matrix metalloproteinase-13 (MMP13) and collagen type II (COL II). Murine monocyte-macrophage leukemia cells (RAW264.7) were divided into control group, P/S6 group, and PSE group, which were then cultured in complete medium, PSE extract, and PSE extract medium for 3 days, respectively. qRT-PCR was employed to detect the expression levels of recombinant arginase-1 protein (ARG1), mannose receptor (CD206), and inducible nitric oxide synthase (iNOS). Transcriptomic sequencing was used to identify differentially expressed genes during PSE-mediated chondrocyte regeneration, followed by functional enrichment analysis of key signaling pathways. Twenty-four SD rats were selected to establish cartilage defect models and assigned to injury control group, P/S6 group, and PSE group according to the random number table (8 rats per group). The right knee joints of the rats were surgically exposed, and cylindrical osteochondral defects (a diameter of 2.0 mm× a depth of 1.0 mm) were surgically created in the center of the femoral trochlear groove using a drill bit. The injury control group received phosphate-buffered saline, while the P/S6 group and PSE group were injected with corresponding hydrogels followed by photo-crosslinking. Incisions then were closed in layers. At 6 and 10 weeks after injury, specimens were harvested for HE staining and safranin O-fast green staining to evaluate cartilage regeneration and immunohistochemistry staining to quantify the positive area fractions for COL II, MMP13, ARG1, and CD206 in the defect areas. Results:PSE hydrogel exhibited compressive strength matching native cartilage (0.41 MPa), high porosity (85%), and sustained exosome release capacity (cumulative release rate of approximately 85% over 14 days). In chondrocyte repair experiments, compared to the IL-1β group, the PSE group demonstrated significantly upregulated expression of anabolic markers of cartilage (COL II expression increased by 2.1-fold, ACAN by 1.8-fold, and SOX9 by 1.5-fold) ( P<0.01) as well as significantly suppressed expression of catabolic markers (MMP13 expression decreased by 52%) ( P<0.01). In macrophage polarization assays, the PSE group exhibited ARG1 expression increased by 68% when compared to the control group ( P<0.01), thus promoting M2 polarization of macrophages. Transcriptomic analysis revealed that PSE enhanced extracellular matrix (ECM) synthesis by activating the phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) pathway and ECM-receptor interaction pathway, as well as by suppressing inflammation-related gene expression. Histological evaluation in animal experiments revealed regeneration of hyaline cartilage with smooth, continuous surfaces in the defect areas in the PSE group. At 10 weeks after surgery, the neocartilage-positive area in the PSE group was (9.94±0.26)%, significantly larger than (1.67±0.11)% in the injury control group ( P<0.01). Besides, the CD206? M2 macrophage-positive area reached (14.44±0.23)% in the PSE group, significantly larger than (3.41±0.36)% in the injury control group ( P<0.01). Conclusions:The PSE hydrogel successfully engineered in the study can significantly promote regenerative repair of knee cartilage defects through a dual mechanism of enhanced ECM anabolism and remodeled inflammatory microenvironment. The core mechanisms involve specific activation of the PI3K/Akt pathway (boosting chondrocyte proliferation and survival) and ECM-receptor interaction pathway (driving ECM synthesis and assembly) by exosome-loaded PSE, while effectively polarizing macrophages toward an anti-inflammatory M2 phenotype so as to coordinately regulate cartilage ECM metabolism and suppress inflammatory responses.