Objective:To evaluate the feasibility and efficacy of our self-designed intelligent robot-assisted reduction system for fresh subtrochanteric fractures of the femur.Methods:A retrospective cohort study was conducted to include 10 patients with fresh subtrochanteric fracture of the femur who had been admitted to Department of Orthopedic Trauma, Beijing Jishuitan Hospital from January 2024 to July 2024. There were 7 males and 3 females with an age of (45.0±14.3) years and an interval from injury to surgery of (7.9±3.7) d. All the patients were treated by minimally invasive reduction which was assisted by our self-designed intelligent robot, and internal fixation with intramedullary nails. The operation duration, intraoperative reduction duration, intraoperative blood loss, and intraoperative fluoroscopy frequency were recorded. The reduction effect was evaluated by calculating the differences between preoperative planning and postoperative CT reconstruction (i.e., the differences in femoral shaft length and in rotation angle). The hip functional recovery was assessed by Harris hip function Scoring.Results:The mean operation time was 200.0 (161.3, 217.5) min, the reduction time (83.0±35.5) min, the intraoperative blood loss (290.0±110.1) mL, and the intraoperative fluoroscopy 18.5 (9.0, 19.3) times. In all patients, the difference in femoral shaft length was (2.4±1.4) mm, and the difference in rotation angle 5.1°±3.0°. All patients were followed up for (8.2±2.0)months. All the fractures got united at the last follow-up. Their Harris hip function score was (83.3±4.1) points.Conclusion:Our self-designed intelligent robot-assisted reduction system is feasible and effective in the surgery of fresh subtrochanteric fracture of the femur, because the robot system can complete the autonomous planning of reduction approaches before surgery and assist fracture reduction under real-time monitoring with three-dimensional images, leading to fine outcomes.

Objective To discuss the application of Hydrocoil Azur CX(an electrolysis dehydration gel platinum coil)in interventional embolization of pulmonary arteriovenous fistula(PAVF).Methods Three patients with untreated PAVF,who were admitted to the Affiliated Hospital of Qingdao University of China between May 2023 and July 2023,were selected for this study.Interventional embolization of the responsible vessels with Hydrocoil Azur CX and other spring coils was carried out for all 3 patients.Results Multiple PAVF lesions were effectively obstructed in 3 patients.No recanalization occurred during a follow-up period of 6 months.Conclusion The Hydrocoil Azur CX can effectively and permanently embolize the PAVF.

Objective:To evaluate the feasibility and efficacy of our self-designed intelligent robot-assisted reduction system for fresh subtrochanteric fractures of the femur.Methods:A retrospective cohort study was conducted to include 10 patients with fresh subtrochanteric fracture of the femur who had been admitted to Department of Orthopedic Trauma, Beijing Jishuitan Hospital from January 2024 to July 2024. There were 7 males and 3 females with an age of (45.0±14.3) years and an interval from injury to surgery of (7.9±3.7) d. All the patients were treated by minimally invasive reduction which was assisted by our self-designed intelligent robot, and internal fixation with intramedullary nails. The operation duration, intraoperative reduction duration, intraoperative blood loss, and intraoperative fluoroscopy frequency were recorded. The reduction effect was evaluated by calculating the differences between preoperative planning and postoperative CT reconstruction (i.e., the differences in femoral shaft length and in rotation angle). The hip functional recovery was assessed by Harris hip function Scoring.Results:The mean operation time was 200.0 (161.3, 217.5) min, the reduction time (83.0±35.5) min, the intraoperative blood loss (290.0±110.1) mL, and the intraoperative fluoroscopy 18.5 (9.0, 19.3) times. In all patients, the difference in femoral shaft length was (2.4±1.4) mm, and the difference in rotation angle 5.1°±3.0°. All patients were followed up for (8.2±2.0)months. All the fractures got united at the last follow-up. Their Harris hip function score was (83.3±4.1) points.Conclusion:Our self-designed intelligent robot-assisted reduction system is feasible and effective in the surgery of fresh subtrochanteric fracture of the femur, because the robot system can complete the autonomous planning of reduction approaches before surgery and assist fracture reduction under real-time monitoring with three-dimensional images, leading to fine outcomes.

Objective:To compare the short-term efficacy between our self-designed intelligent robot-assisted minimally invasive reduction system and conventional freehand reduction assisted by fluoroscopy in the treatment of unstable pelvic fractures by robot or fluoroscopy-assisted internal fixation with percutaneous screws.Methods:A prospective randomized controlled trial was conducted to include eligible 35 patients with unstable pelvic fracture who were admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from December 2021 to October 2022. They were randomized into 2 groups. The observation group[17 cases, 10 males and 7 females with an age of (44.0±17.4) years] was treated with robot-assisted minimally invasive reduction, followed by robot-assisted or fluoroscopic internal fixation with percutaneous screws; the control group[18 cases, 12 males and 6 females with an age of (38.8±15.0) years] was treated with freehand reduction assisted by fluoroscopy, followed by robot-assisted or fluoroscopic internal fixation with percutaneous screws. The 2 groups were compared in terms of operation time, intraoperative bleeding, successful reduction, reduction quality, incidence of surgical complications and postoperative functional scores.Results:The 2 groups were comparable because there were no significant differences in the preoperative general data between them ( P>0.05). The intraoperative fluoroscopy frequency[(32.4±17.5) times] and fluoroscopy time [(19.8±10.4) s] in the observation group were significantly lower or shorter than those in the control group [(60.8±26.6) times and (38.2±16.1) s], and the rate of successful reduction in the observation group was 100.0% (17/17), significantly higher than that in the control group[72.2% (13/18)] ( P<0.05). There was no significant difference between the 2 groups in intraoperative bleeding, operation time, reduction error, excellent and good rate of reduction after operation by Matta scoring, or Majeed functional score at 12 weeks after operation ( P>0.05). Conclusion:In the treatment of unstable pelvic fractures, since our self-designed intelligent robot-assisted minimally invasive reduction system can plan autonomously the reduction paths and accomplish minimally invasive reduction of the fracture with 3D images real-time monitoring, it is advantageous over conventional reduction methods in a higher success rate and less radiation exposure.

Objective:To evaluate a self-designed intelligent robot-assisted minimally invasive reduction system in the reduction of unstable pelvic fractures by a cadaveric anatomic study.Methods:Ten unembalmed cadavers (7 male and 3 female ones) were used in this study. In each cadaveric specimen an unstable pelvic fracture was created in accordance with clinical case models (3 cases of type B1, 4 cases of type B2 and 3 cases of type C1 by the Tile classification). A self-designed intelligent robot-assisted minimally invasive reduction system was used to assist the reduction in the cadaveric models. Intraoperative registration and navigation time, autonomous reduction time, total operation time and reduction error were measured.Results:Effective reduction was completed in 10 bone models with the assistance of our self-designed intelligent robot-assisted minimally invasive reduction system. The time for intraoperative registration and navigation averaged 47.4 min (from 32 to 74 min), the autonomous reduction time 73.9 min (from 48 to 96 min), and the total operation time 121.3 min (from 83 to 170 min). The reduction error averaged 2.02 mm (from 1.67 to 2.62 mm), and the reduction results met the clinical requirements.Conclusion:Our self-designed intelligent robot-assisted minimally invasive reduction system is a new clinical solution for unstable pelvic fractures, showing advantages of agreement with clinical operative procedures, high reduction accuracy and operational feasibility, and reduced radiation exposure compared to a conventional operation.

Objective:To investigate the effect of ultrasonic debridement combined with hyperbaric oxygen on bacterial clearance and microcirculation of diabetic foot ulcer wound.Methods:A total of 98 patients with diabetic foot ulcer who received conservative treatment in the Department of Vascular Surgery of Longkou People Hospital were selected as the research subjects and divided into three groups. The Group A (32 cases) received standard treatment; the Group B (30 cases) received standard treatment + hyperbaric oxygen therapy; the Group C (36 cases) received standard treatment + ultrasonic debridement + hyperbaric oxygen therapy. On the day 0, 7, 14, and 21, the changes of wound area were calculated by millimeter graph paper method, and the ulcer healing rates were also calculated. The bacterial clearance rates of ulcer wound were calculated by quantitative bacterial wound culture method. The microcirculation of ulcer wound was measured by Laser Doppler Perfusion Imaging (LDPI). The limb pains before and after treatment were evaluated by limb pain score and intermittent claudication score.Results:After 3 courses of treatment, the transcutaneous oxygen partial pressures and the wound blood flows of the 3 groups were significantly higher than those before treatment, and the percutaneous oxygen partial pressure and wound blood flow of the Group C after treatment were significantly higher than those of the Group A and the Group B, with statistically significant differences ( P<0.05). On the 14th and 21st day after treatment, the ulcer areas of the Group C were significantly lower than those of the Group A and the Group B, and the ulcer healing rate of Group C was significantly higher than those of the Group A and the Group B, with statistically significant differences ( P<0.05). On the 7th, 14th, and 21st day after treatment, the bacterial quantity in the ulcer tissue of the Group C was significantly lower than those in the Group A and the Group B ( P<0.05). After 3 courses of treatment, the scores of intermittent claudication and limb pain in the three groups were significantly lower than those before treatment, and the scores of limb pain and intermittent claudication in the Group C were significantly lower than those in the Group A and the Group B after treatment ( P<0.05). Conclusion:Hyperbaric oxygen combined with ultrasonic debridement can effectively remove bacteria in diabetic foot ulcer wound, promote microcirculation, and help ulcer wound healing. It is worthy of clinical application.

Objective:To investigate the effect of ultrasonic debridement combined with hyperbaric oxygen on bacterial clearance and microcirculation of diabetic foot ulcer wound.Methods:A total of 98 patients with diabetic foot ulcer who received conservative treatment in the Department of Vascular Surgery of Longkou People Hospital were selected as the research subjects and divided into three groups. The Group A (32 cases) received standard treatment; the Group B (30 cases) received standard treatment + hyperbaric oxygen therapy; the Group C (36 cases) received standard treatment + ultrasonic debridement + hyperbaric oxygen therapy. On the day 0, 7, 14, and 21, the changes of wound area were calculated by millimeter graph paper method, and the ulcer healing rates were also calculated. The bacterial clearance rates of ulcer wound were calculated by quantitative bacterial wound culture method. The microcirculation of ulcer wound was measured by Laser Doppler Perfusion Imaging (LDPI). The limb pains before and after treatment were evaluated by limb pain score and intermittent claudication score.Results:After 3 courses of treatment, the transcutaneous oxygen partial pressures and the wound blood flows of the 3 groups were significantly higher than those before treatment, and the percutaneous oxygen partial pressure and wound blood flow of the Group C after treatment were significantly higher than those of the Group A and the Group B, with statistically significant differences ( P<0.05). On the 14th and 21st day after treatment, the ulcer areas of the Group C were significantly lower than those of the Group A and the Group B, and the ulcer healing rate of Group C was significantly higher than those of the Group A and the Group B, with statistically significant differences ( P<0.05). On the 7th, 14th, and 21st day after treatment, the bacterial quantity in the ulcer tissue of the Group C was significantly lower than those in the Group A and the Group B ( P<0.05). After 3 courses of treatment, the scores of intermittent claudication and limb pain in the three groups were significantly lower than those before treatment, and the scores of limb pain and intermittent claudication in the Group C were significantly lower than those in the Group A and the Group B after treatment ( P<0.05). Conclusion:Hyperbaric oxygen combined with ultrasonic debridement can effectively remove bacteria in diabetic foot ulcer wound, promote microcirculation, and help ulcer wound healing. It is worthy of clinical application.

Objective:To investigate the clinical efficacy and mechanism of atorvastatin and Lipo-prostaglandin E1 (LipoPGE1) combined with hyperbaric oxygen (HBO) in the treatment of diabetic lower extremity vascular disease.Methods:A total of 194 patients with diabetic lower extremity ischemic disease received conservative treatment at the Department of Vascular Surgery of Longkou People’s Hospital from October 2016 to October 2019 were included into a retrospective analysis, who were divided into observation group ( n=102) and control group ( n=92) according to the treatment. The control group was treated with atorvastatin and LipoPGE1 on the basis of conventional symptomatic treatment, while the observation group was treated with HBO on the basis of that of the control group. The peak systolic velocity (Vmax), resistance index (RI), and ankle brachial index (ABI) of popliteal artery, anterior and posterior tibial artery, and dorsalis pedis artery were measured before and after treatment by color Doppler ultrasound. The skin temperature and transcutaneous oxygen partial pressure (TcPO 2) were recorded before and after treatment. The levels of inflammatory factor interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in serum were detected by enzyme-linked immunosorbent assay (ELISA) and that of C-reactive protein (CRP) was detected by fluorescence method. The whole blood high, low, and medium shear rate, plasma viscosity, and fibrinogen (Fib) of the two groups were detected by digital noninvasive hemodynamic detector. Results:After 3 courses of treatment, the skin temperature, TcPO 2, and ABI of the two groups were significantly higher than those before treatment, and the skin temperature, TcPO 2, and ABI of the observation group were significantly higher than those of the control group ( P<0.05). The limb pain score and intermittent claudication score of the two groups were significantly lower than those before treatment; and after treatment, the limb pain score and intermittent claudication score of the observation group were significantly lower than those of the control group ( P < 0.05). The Vmax of popliteal artery, anterior and posterior tibial artery, and dorsalis pedis artery of the two groups were significantly higher than those before treatment, and the RI was significantly lower than that before treatment; and after treatment, the Vmax of popliteal artery, anterior and posterior tibial artery, and dorsalis pedis artery of the observation group were significantly higher than those of the control group, and the RI was significantly lower than that of the control group ( P<0.05). The levels of serum TNF- α, IL-6, and CRP of the two groups were significantly lower than those before treatment; and after treatment, the levels of TNF-α, IL-6, and CRP of the observation group were significantly lower than those of the control group ( P < 0.05). The whole blood high, low, and medium shear rate, plasma viscosity, and Fib of the two groups were significantly lower than those before treatment; and after treatment, those of the observation group were significantly lower than those of the control group, the differences were statistically significant ( P< 0.05). Conclusion:Atorvastatin and LipoPGE1 combined with HBO can significantly improve the clinical symptoms of the patients with diabetic lower extremity vascular disease and restore the damaged neurovascular function, which is mainly achieved by reducing the inflammatory factors and improving the level of hemorheology of the patients with diabetic lower extremity vascular disease.

Objective:To investigate the clinical efficacy and mechanism of atorvastatin and Lipo-prostaglandin E1 (LipoPGE1) combined with hyperbaric oxygen (HBO) in the treatment of diabetic lower extremity vascular disease.Methods:A total of 194 patients with diabetic lower extremity ischemic disease received conservative treatment at the Department of Vascular Surgery of Longkou People’s Hospital from October 2016 to October 2019 were included into a retrospective analysis, who were divided into observation group ( n=102) and control group ( n=92) according to the treatment. The control group was treated with atorvastatin and LipoPGE1 on the basis of conventional symptomatic treatment, while the observation group was treated with HBO on the basis of that of the control group. The peak systolic velocity (Vmax), resistance index (RI), and ankle brachial index (ABI) of popliteal artery, anterior and posterior tibial artery, and dorsalis pedis artery were measured before and after treatment by color Doppler ultrasound. The skin temperature and transcutaneous oxygen partial pressure (TcPO 2) were recorded before and after treatment. The levels of inflammatory factor interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in serum were detected by enzyme-linked immunosorbent assay (ELISA) and that of C-reactive protein (CRP) was detected by fluorescence method. The whole blood high, low, and medium shear rate, plasma viscosity, and fibrinogen (Fib) of the two groups were detected by digital noninvasive hemodynamic detector. Results:After 3 courses of treatment, the skin temperature, TcPO 2, and ABI of the two groups were significantly higher than those before treatment, and the skin temperature, TcPO 2, and ABI of the observation group were significantly higher than those of the control group ( P<0.05). The limb pain score and intermittent claudication score of the two groups were significantly lower than those before treatment; and after treatment, the limb pain score and intermittent claudication score of the observation group were significantly lower than those of the control group ( P < 0.05). The Vmax of popliteal artery, anterior and posterior tibial artery, and dorsalis pedis artery of the two groups were significantly higher than those before treatment, and the RI was significantly lower than that before treatment; and after treatment, the Vmax of popliteal artery, anterior and posterior tibial artery, and dorsalis pedis artery of the observation group were significantly higher than those of the control group, and the RI was significantly lower than that of the control group ( P<0.05). The levels of serum TNF- α, IL-6, and CRP of the two groups were significantly lower than those before treatment; and after treatment, the levels of TNF-α, IL-6, and CRP of the observation group were significantly lower than those of the control group ( P < 0.05). The whole blood high, low, and medium shear rate, plasma viscosity, and Fib of the two groups were significantly lower than those before treatment; and after treatment, those of the observation group were significantly lower than those of the control group, the differences were statistically significant ( P< 0.05). Conclusion:Atorvastatin and LipoPGE1 combined with HBO can significantly improve the clinical symptoms of the patients with diabetic lower extremity vascular disease and restore the damaged neurovascular function, which is mainly achieved by reducing the inflammatory factors and improving the level of hemorheology of the patients with diabetic lower extremity vascular disease.

Objective To evaluate the safety and efficiency of robot assisted surgery guided by damage control orthopaedics(DCO) in polytraumatised patients with pelvic ring injuries.Methods A retrospective review of the pelvic fracture database was performed.Twenty-six patients who had sustained a pelvic fracture from September 2012 to December 2015 were suitable for robot-assisted minimally invasive internal fixation.They were 17 men and 9 women,aged from 23 to 58 years (average,42.6 years).Their Injury Severity Score(ISS) ranged from 20 to 31 points (average,21.3 years).According to Tile classification,6 cases were type B2,3 type B3,9 type C2 and 8 type C3.Guided by DCO,the vital signs were stabilized by all means and the fractures treated by simple and temporary external fixation before the pelvic and other fractures were managed by the robot-assisted minimally invasive internal fixation.Demographics,times to operating room (TOR),time from acute stabilization to late definitive internal fixation (TAL),time for bone union,type of robot-assisted surgery for major fractures,length of stay (LOS),postoperative complications and mortality were recorded.The outcomes of the pelvis were evaluated at the final follow-up according to the Matta criteria.Results Of the 26 patients,robot-navigated percutaneous screwing was conducted with 23 sacroiliac screws in 19,with 9 ramus pubicus screws in 9,with 6 supraacetabular screws in 4,and with 4 both-column screws in 2 cases.TOR averaged 2.7 times,TAL 5.9 days,LOS at ICU 2.1 days,ICU admission rate 46.2％ (12 of 26),hospital LOS 7.3 days,and time for pelvic bone union 79.0 days.None patients had postoperative complications related to the pelvic fracture and no one died.According to the Matta criteria at the final follow-ups,8 cases were excellent,11 good,5 fair and 2 poor,yielding an excellent and good rate of 73.1％.Conclusion Robot-navigated minimally invasive surgery plus DCO is effective,time saving and safe treatment for polytraumatised patients with pelvic ring injuries.