Objective:To compare the clinical efficacy of the reamer-irrigator-aspirator (RIA) technique and iliac crest bone grafting (ICBG) in the treatment of adult noninfectious long bone nonunion of the lower extremity, and to evaluate the safety and effectiveness of the RIA technique.Methods:A retrospective review was conducted of 42 adult patients with noninfectious long bone nonunion of the lower extremity treated surgically at Zhengzhou Orthopaedic Hospital from January 2021 to June 2024. The cohort included 33 men and 9 women with a mean age of 47.0±14.4 years (range, 18-62 years). Twenty-three patients had nonunion on the left side and 19 on the right. Initial surgical fixation methods included plate fixation (19 cases), intramedullary nail (16 cases), external fixator (5 cases), and combined plate-and-nail fixation (2 cases). Revision procedures included debridement and freshening of the nonunion ends, revision or adjustment of internal fixation, and autologous bone grafting. Nineteen patients underwent graft harvesting with the RIA technique (RIA group), and 23 received autograft harvested from the iliac crest (iliac group). Baseline and perioperative variables compared between the two groups included sex, age, body-mass index, preoperative comorbidities, anatomical site of the nonunion (tibial or femoral), duration from the index fracture operation to the current revision, operative time, intraoperative blood loss, volume of blood transfusion and rate of perioperative complications, nonunion fracture sites, visual analogue scale (VAS) pain score at the fracture site, donor-site morphology and functional appearance scores, and radiographic union score for tibial fractures (RUST).Results:There was no significant difference in age between the RIA and ICBG groups (45.1±14.1 vs. 48.5±14.7 years, t=0.746, P=0.449). However, intraoperative blood loss was higher in the RIA group [300 (150, 720) ml, Z=-3.072, P=0.002] and the transfusion rate was higher (14/19 vs. 8/23, χ 2=6.313, P=0.012). The harvested bone volume was very similar [40(35, 60) cm 2vs. 40(35, 40) cm 2, Z=-1.077, P=0.281]. All patients were followed for a mean of 16.5±2.8 months (range, 7-40 months). VAS scores at the surgical site showed no significant difference between groups at 3 months (3.2±1.0 vs. 3.3±1.4, t= 4.754, P=0.720) and 6 months (1.6±0.8 vs. 1.8±1.2, t=6.841, P=0.542). Donor-site morphology and functional scores were significantly better in the RIA group at 3 months [14.5(13.0, 15.5) vs. 9.0(7.0, 10.0), Z=-3.748, P<0.001] and 6 months [15.5(15.0, 16.0) vs. 11.0(10.0, 13.0), Z=-3.782, P<0.001]. At 12 months postoperatively, RUST scores did not differ significantly between groups (10.6±1.2 vs. 10.4±1.5, t=0.483, P=0.632). The incidence of perioperative complications was comparable [42%(8/19) vs. 30%(7/23), χ 2=0.617, P=0.432]. Conclusions:Both RIA and ICBG achieved favorable clinical outcomes in the treatment of adult noninfectious lower-extremity long bone nonunion. Although RIA was associated with greater intraoperative blood loss, it resulted in less donor-site morbidity and better cosmetic and functional outcomes. Bone healing capacity and overall complication rates did not differ significantly between the two groups. These findings suggest that the RIA technique is safe and effective for use in the Chinese patient population.

Objective:To evaluate the application of the reaming-irrigation-aspirator (RIA) technique in autologous bone grafting for non-union of lower limb fracture.Methods:A retrospective analysis was conducted of the data of 16 patients with non-union of lower limb fracture who had undergone autologous bone grafting using the RIA technique at Department of Lower Limb Orthopaedics Ⅰ, Zhengzhou Orthopaedic Hospital from July 2023 to March 2024. There were 12 males and 4 females with an age of (47.2±14.3) years. Sites of non-union: the femur in 14 cases and the tibia in 2 cases. Initial surgical fixation: intramedullary nail fixation in 5 cases, plate fixation in 10 cases, and intramedullary nail plus plate fixation in 1 case. The time for fracture non-union was (21.0±12.0) months. Intraoperatively, autologous bone reaming was conducted using a drill bit of RIA system, and simultaneous flushing using irrigation fluid. The bone debris carried out by the irrigation fluid was collected into a filtration device through negative pressure aspiration. After the filter was opened to squeeze out congestion, bone paste was taken out for standby. Internal fixation methods were adjusted according to the non-union condition of the fractures. Finally, the bone paste was implanted into bone defects. The time for autologous bone harvest, amount of bone harvested, intraoperative blood loss, postoperative pain at a donor site, fracture healing, functional recovery of a lower limb and occurrence of complications were recorded.Results:In 2 of the 16 patients, fracture of the RIA drill bit occurred when bone marrow was harvested from the tibia, and their operation was completed only after the drill bits were replaced. In the 16 patients, time for bone harvest was (31.4±6.1) min, bone harvest volume (42.6±9.5) mL, and intraoperative blood loss (815.6±238.6) mL. The incisions in this cohort healed primarily after operation, and 4-week follow-up revealed that no patients had pain symptoms at a donor site. The 16 patients were followed up for (8.0±2.0) months after operation. All patients achieved bone union after (4.4±0.5) months. Follow-ups showed that no patients had complications like delayed infection, donor site fracture, or loosening or fracture of an internal fixator. According to the rating scale for lower limb function at the last follow-up, the function of affected limb was evaluated as excellent in 7 cases, as good in 8 cases, and as fair in 1 case.Conclusion:Application of RIA technique for autologous bone grafting to treat non-union of lower limb fracture can lead to fine fracture healing and good lower limb function, but no long-term pain symptoms in the donor area for the patients.

Objective:To compare the impacts of external fixation of different durations on rehabilitation outcomes after open repair of acute Achilles tendon rupture.Methods:A prospective cohort study was conducted to analyze the clinical data of patients with unilateral acute closed Achilles tendon rupture admitted to Peking University Third Hospital from August 2020 to August 2023. Patients were divided into Group A ( n=96), Group B ( n=347), Group C ( n=346), and Group D ( n=105) based on different postoperative immobilization durations (0, 2, 4 and 6 weeks, respectively). After all the patients received identical open repair procedure, Group A was rehabilitated immediately but the other groups were rehabilitated with the same protocol after removal of the external fixation. Four groups were compared in terms of recovery time of one-leg heel-rise height (OHRH), recovery time of light exercise (LE) in brisk walking and jogging and recovery time of range of motion (ROM). Visual analogue scale (VAS) scores were also compared at 2, 4, 6 and 8 weeks postoperatively. Achilles tendon total rupture score (ATRS) and American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores were evaluated at 6, 8, 10, 12, 14 and 16 weeks postoperatively. Complications were recorded. Results:A total of 894 patients including 869 males and 25 females were included, aged 18-60 years [(35.0±6.3)years]. All the patients were followed up for 14-25 months [(19.0±3.0)months]. The recovery time of OHRH in Group A and B was 12.0(12.0, 12.0)weeks and 12.0(10.0, 12.0)weeks, shorter than those in Group C [14.0(14.0, 16.0)weeks] and D [14.0(14.0, 14.0)weeks] ( P<0.05), with no significant difference between Group A and B ( P>0.05) and between Group C and D ( P>0.05). The recovery time of LE in Group A and B was 18.0(18.0, 18.0)weeks and 18.0(16.0, 18.0)weeks, shorter than those in Group C [20.0(20.0, 20.0)weeks] and D [20.0(20.0, 20.0)weeks] ( P<0.05), with no significant difference between Group A and B ( P>0.05) and between Group C and D ( P>0.05). The recovery time of ROM in Group A and B was 6.0(6.0, 6.0)weeks and 6.0(6.0, 6.0)weeks, shorter than those in Group C [8.0(8.0, 10.0)weeks] and D [10.0(10.0, 10.0)weeks)] ( P<0.05), with no significant difference between Group A and B, and between Group C and D ( P>0.05). At 2 weeks postoperatively, the VAS scores were 2.0(1.0, 2.0)points, 2.0(1.0, 2.0)points, and 2.0(1.5, 2.0)points in Group B, C and D, lower than 5.0(5.0, 5.0)points in Group A ( P<0.05), with no significant difference among Group B, C, and D ( P>0.05). At 4 weeks postoperatively, the VAS scores were 1.0(0, 1.0)points, 1.0(0, 1.0)points, and 1.0(0.5, 1.0)points in Group B, C and D, lower than 2.0(1.0, 2.0)points in Group A ( P<0.05), with no significant difference among Group B, C, and D ( P>0.05). At 6 weeks postoperatively, the VAS score was 0(0, 0)points in all the 4 groups, with no significant difference among them ( P>0.05). At 8 weeks postoperatively, the VAS score was 0(0, 0)points, with lower scores in Group A and B than those in Group C and D ( P<0.05) but with no significant difference between Group A and B and between Group C and D ( P>0.05). At 6 weeks postoperatively, the ATRS scores were 52.0(52.0, 53.8)points and 52.0(50.0, 53.0)points in Group A and B, higher than 41.0(38.0, 43.0)points and 19.0(18.0, 20.0)points in Group C and D ( P<0.05), with a higher score in Group C than that in Group D ( P<0.05) but with no significant difference between Group A and B ( P>0.05). At 8 weeks postoperatively, the ATRS scores were 66.0(66.0, 68.0)points in Group A, higher than 63.0(62.0, 64.0)points, 52.0(50.0, 53.0)points, and 39.0(37.0, 40.0)points in Group B, C and D ( P<0.05), with a higher score in Group B than those in Group C and D ( P<0.05) and a higher score in Group C than that in Group D ( P<0.05). At 10 weeks postoperatively, the ATRS score was 75.0(74.0, 76.0)points in Group B, higher than 69.0(69.0, 70.0)points, 72.0(66.0, 74.0)points, and 62.0(58.5, 63.0)points in Group A, C and D ( P<0.05), with higher scores in Group A and C than that in Group D ( P<0.05) but with no significant difference between Group A and C ( P>0.05). At 12 weeks postoperatively, the ATRS score was 84.0(82.0, 85.0)points in Group B, higher than 75.0(75.0, 77.0)points, 79.0(72.0, 81.0)points, and 72.0(71.0, 73.0)points in Group A, C and D ( P<0.05), with higher scores in Group A and C than that in Group D ( P<0.05) but with no significant difference between Group A and C ( P>0.05). At 14 weeks postoperatively, the ATRS score was 87.0(86.0, 87.0)points in Group B, higher than 82.0(82.0, 84.0)points, 83.0(80.0, 85.0)points, and 79.0(77.5, 80.0)points in Group A, C and D ( P<0.05), with higher scores in Group A and C than that in Group D ( P<0.05) but with no significant difference between Group A and C ( P>0.05). At 16 weeks postoperatively, the ATRS scores were 87.0(87.0, 88.0)points and 88.0(87.0, 88.0)points in Group A and B, higher than 86.0(85.0, 87.0)points and 84.0(83.0, 85.0)points in Group C and D ( P<0.05), with a higher score in Group C than that in Group D ( P<0.05) but with no significant difference between Group A and B ( P>0.05). At 6 weeks postoperatively, the AOFAS ankle-hindfoot scores were 94.0(94.0, 95.0)points and 95.0(94.0, 96.0)points in Group A and B, higher than 85.0(83.0, 86.0)points and 74.0(72.0, 75.0)points in Group C and D ( P<0.05), with a higher score in Group C than that in Group D ( P<0.05) but with no significant difference between Group A and B ( P>0.05). At 8 weeks postoperatively, the AOFAS ankle-hindfoot scores were 100.0(99.0, 100.0)points in Group B, higher than 94.0(94.0, 95.0)points, 92.0(90.0, 93.0)points, and 83.0(82.0, 84.0)points in Group A, C and D ( P<0.05), with a higher score in Group A than those in Group C and D ( P<0.05) and a higher score in Group C than that in Group D ( P<0.05). At 10 weeks postoperatively, the AOFAS ankle-hindfoot score was 100.0(100.0, 100.0)points in Group B, higher than 98.0(98.0, 98.0)points, 98.0(96.8, 99.0)points, and 96.0(95.0, 97.0)points in Group A, C and D, with higher scores in Group A and C than that in Group D ( P<0.05) but with no significant difference between Group A and C ( P>0.05). At 12 weeks postoperatively, the AOFAS ankle-hindfoot score was 100.0(100.0, 100.0)points in both Group A and B, with no significant difference between them ( P>0.05), which was higher than 100.0(98.0, 100.0)points and 99.0(98.0, 99.0)points in Group C and D ( P<0.05), with a higher score in Group C than that in Group D ( P<0.05). At 14 and 16 weeks postoperatively, AOFAS ankle-hindfoot score was 100.0(100.0, 100.0)points, with no significant difference among all the groups ( P>0.05). Superficial wound infection occurred in 12 patients [5.2%(5/96) in Group A, 0.6%(2/347) in Group B, 0.6%(2/346) in Group C and 2.9%(3/105) in Group D] ( P<0.01) while rerupture occurred in 16 [9.4%(9/96) in Group A, 1.2% (4/347) in Group B, 0.9%(3/105) in Group C, and 0 patient in Group D] ( P<0.01). Conclusion:For patients with unilateral acute Achilles tendon rupture, two weeks of postoperative external fixation after open repair can shorten the time of returning sports, alleviate pain, and promote functional recovery, without increasing the risk of complications.

Objective:To compare the impacts of external fixation of different durations on rehabilitation outcomes after open repair of acute Achilles tendon rupture.Methods:A prospective cohort study was conducted to analyze the clinical data of patients with unilateral acute closed Achilles tendon rupture admitted to Peking University Third Hospital from August 2020 to August 2023. Patients were divided into Group A ( n=96), Group B ( n=347), Group C ( n=346), and Group D ( n=105) based on different postoperative immobilization durations (0, 2, 4 and 6 weeks, respectively). After all the patients received identical open repair procedure, Group A was rehabilitated immediately but the other groups were rehabilitated with the same protocol after removal of the external fixation. Four groups were compared in terms of recovery time of one-leg heel-rise height (OHRH), recovery time of light exercise (LE) in brisk walking and jogging and recovery time of range of motion (ROM). Visual analogue scale (VAS) scores were also compared at 2, 4, 6 and 8 weeks postoperatively. Achilles tendon total rupture score (ATRS) and American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores were evaluated at 6, 8, 10, 12, 14 and 16 weeks postoperatively. Complications were recorded. Results:A total of 894 patients including 869 males and 25 females were included, aged 18-60 years [(35.0±6.3)years]. All the patients were followed up for 14-25 months [(19.0±3.0)months]. The recovery time of OHRH in Group A and B was 12.0(12.0, 12.0)weeks and 12.0(10.0, 12.0)weeks, shorter than those in Group C [14.0(14.0, 16.0)weeks] and D [14.0(14.0, 14.0)weeks] ( P<0.05), with no significant difference between Group A and B ( P>0.05) and between Group C and D ( P>0.05). The recovery time of LE in Group A and B was 18.0(18.0, 18.0)weeks and 18.0(16.0, 18.0)weeks, shorter than those in Group C [20.0(20.0, 20.0)weeks] and D [20.0(20.0, 20.0)weeks] ( P<0.05), with no significant difference between Group A and B ( P>0.05) and between Group C and D ( P>0.05). The recovery time of ROM in Group A and B was 6.0(6.0, 6.0)weeks and 6.0(6.0, 6.0)weeks, shorter than those in Group C [8.0(8.0, 10.0)weeks] and D [10.0(10.0, 10.0)weeks)] ( P<0.05), with no significant difference between Group A and B, and between Group C and D ( P>0.05). At 2 weeks postoperatively, the VAS scores were 2.0(1.0, 2.0)points, 2.0(1.0, 2.0)points, and 2.0(1.5, 2.0)points in Group B, C and D, lower than 5.0(5.0, 5.0)points in Group A ( P<0.05), with no significant difference among Group B, C, and D ( P>0.05). At 4 weeks postoperatively, the VAS scores were 1.0(0, 1.0)points, 1.0(0, 1.0)points, and 1.0(0.5, 1.0)points in Group B, C and D, lower than 2.0(1.0, 2.0)points in Group A ( P<0.05), with no significant difference among Group B, C, and D ( P>0.05). At 6 weeks postoperatively, the VAS score was 0(0, 0)points in all the 4 groups, with no significant difference among them ( P>0.05). At 8 weeks postoperatively, the VAS score was 0(0, 0)points, with lower scores in Group A and B than those in Group C and D ( P<0.05) but with no significant difference between Group A and B and between Group C and D ( P>0.05). At 6 weeks postoperatively, the ATRS scores were 52.0(52.0, 53.8)points and 52.0(50.0, 53.0)points in Group A and B, higher than 41.0(38.0, 43.0)points and 19.0(18.0, 20.0)points in Group C and D ( P<0.05), with a higher score in Group C than that in Group D ( P<0.05) but with no significant difference between Group A and B ( P>0.05). At 8 weeks postoperatively, the ATRS scores were 66.0(66.0, 68.0)points in Group A, higher than 63.0(62.0, 64.0)points, 52.0(50.0, 53.0)points, and 39.0(37.0, 40.0)points in Group B, C and D ( P<0.05), with a higher score in Group B than those in Group C and D ( P<0.05) and a higher score in Group C than that in Group D ( P<0.05). At 10 weeks postoperatively, the ATRS score was 75.0(74.0, 76.0)points in Group B, higher than 69.0(69.0, 70.0)points, 72.0(66.0, 74.0)points, and 62.0(58.5, 63.0)points in Group A, C and D ( P<0.05), with higher scores in Group A and C than that in Group D ( P<0.05) but with no significant difference between Group A and C ( P>0.05). At 12 weeks postoperatively, the ATRS score was 84.0(82.0, 85.0)points in Group B, higher than 75.0(75.0, 77.0)points, 79.0(72.0, 81.0)points, and 72.0(71.0, 73.0)points in Group A, C and D ( P<0.05), with higher scores in Group A and C than that in Group D ( P<0.05) but with no significant difference between Group A and C ( P>0.05). At 14 weeks postoperatively, the ATRS score was 87.0(86.0, 87.0)points in Group B, higher than 82.0(82.0, 84.0)points, 83.0(80.0, 85.0)points, and 79.0(77.5, 80.0)points in Group A, C and D ( P<0.05), with higher scores in Group A and C than that in Group D ( P<0.05) but with no significant difference between Group A and C ( P>0.05). At 16 weeks postoperatively, the ATRS scores were 87.0(87.0, 88.0)points and 88.0(87.0, 88.0)points in Group A and B, higher than 86.0(85.0, 87.0)points and 84.0(83.0, 85.0)points in Group C and D ( P<0.05), with a higher score in Group C than that in Group D ( P<0.05) but with no significant difference between Group A and B ( P>0.05). At 6 weeks postoperatively, the AOFAS ankle-hindfoot scores were 94.0(94.0, 95.0)points and 95.0(94.0, 96.0)points in Group A and B, higher than 85.0(83.0, 86.0)points and 74.0(72.0, 75.0)points in Group C and D ( P<0.05), with a higher score in Group C than that in Group D ( P<0.05) but with no significant difference between Group A and B ( P>0.05). At 8 weeks postoperatively, the AOFAS ankle-hindfoot scores were 100.0(99.0, 100.0)points in Group B, higher than 94.0(94.0, 95.0)points, 92.0(90.0, 93.0)points, and 83.0(82.0, 84.0)points in Group A, C and D ( P<0.05), with a higher score in Group A than those in Group C and D ( P<0.05) and a higher score in Group C than that in Group D ( P<0.05). At 10 weeks postoperatively, the AOFAS ankle-hindfoot score was 100.0(100.0, 100.0)points in Group B, higher than 98.0(98.0, 98.0)points, 98.0(96.8, 99.0)points, and 96.0(95.0, 97.0)points in Group A, C and D, with higher scores in Group A and C than that in Group D ( P<0.05) but with no significant difference between Group A and C ( P>0.05). At 12 weeks postoperatively, the AOFAS ankle-hindfoot score was 100.0(100.0, 100.0)points in both Group A and B, with no significant difference between them ( P>0.05), which was higher than 100.0(98.0, 100.0)points and 99.0(98.0, 99.0)points in Group C and D ( P<0.05), with a higher score in Group C than that in Group D ( P<0.05). At 14 and 16 weeks postoperatively, AOFAS ankle-hindfoot score was 100.0(100.0, 100.0)points, with no significant difference among all the groups ( P>0.05). Superficial wound infection occurred in 12 patients [5.2%(5/96) in Group A, 0.6%(2/347) in Group B, 0.6%(2/346) in Group C and 2.9%(3/105) in Group D] ( P<0.01) while rerupture occurred in 16 [9.4%(9/96) in Group A, 1.2% (4/347) in Group B, 0.9%(3/105) in Group C, and 0 patient in Group D] ( P<0.01). Conclusion:For patients with unilateral acute Achilles tendon rupture, two weeks of postoperative external fixation after open repair can shorten the time of returning sports, alleviate pain, and promote functional recovery, without increasing the risk of complications.

Objective:To evaluate the application of the reaming-irrigation-aspirator (RIA) technique in autologous bone grafting for non-union of lower limb fracture.Methods:A retrospective analysis was conducted of the data of 16 patients with non-union of lower limb fracture who had undergone autologous bone grafting using the RIA technique at Department of Lower Limb Orthopaedics Ⅰ, Zhengzhou Orthopaedic Hospital from July 2023 to March 2024. There were 12 males and 4 females with an age of (47.2±14.3) years. Sites of non-union: the femur in 14 cases and the tibia in 2 cases. Initial surgical fixation: intramedullary nail fixation in 5 cases, plate fixation in 10 cases, and intramedullary nail plus plate fixation in 1 case. The time for fracture non-union was (21.0±12.0) months. Intraoperatively, autologous bone reaming was conducted using a drill bit of RIA system, and simultaneous flushing using irrigation fluid. The bone debris carried out by the irrigation fluid was collected into a filtration device through negative pressure aspiration. After the filter was opened to squeeze out congestion, bone paste was taken out for standby. Internal fixation methods were adjusted according to the non-union condition of the fractures. Finally, the bone paste was implanted into bone defects. The time for autologous bone harvest, amount of bone harvested, intraoperative blood loss, postoperative pain at a donor site, fracture healing, functional recovery of a lower limb and occurrence of complications were recorded.Results:In 2 of the 16 patients, fracture of the RIA drill bit occurred when bone marrow was harvested from the tibia, and their operation was completed only after the drill bits were replaced. In the 16 patients, time for bone harvest was (31.4±6.1) min, bone harvest volume (42.6±9.5) mL, and intraoperative blood loss (815.6±238.6) mL. The incisions in this cohort healed primarily after operation, and 4-week follow-up revealed that no patients had pain symptoms at a donor site. The 16 patients were followed up for (8.0±2.0) months after operation. All patients achieved bone union after (4.4±0.5) months. Follow-ups showed that no patients had complications like delayed infection, donor site fracture, or loosening or fracture of an internal fixator. According to the rating scale for lower limb function at the last follow-up, the function of affected limb was evaluated as excellent in 7 cases, as good in 8 cases, and as fair in 1 case.Conclusion:Application of RIA technique for autologous bone grafting to treat non-union of lower limb fracture can lead to fine fracture healing and good lower limb function, but no long-term pain symptoms in the donor area for the patients.

Objective:To compare the clinical efficacy of the reamer-irrigator-aspirator (RIA) technique and iliac crest bone grafting (ICBG) in the treatment of adult noninfectious long bone nonunion of the lower extremity, and to evaluate the safety and effectiveness of the RIA technique.Methods:A retrospective review was conducted of 42 adult patients with noninfectious long bone nonunion of the lower extremity treated surgically at Zhengzhou Orthopaedic Hospital from January 2021 to June 2024. The cohort included 33 men and 9 women with a mean age of 47.0±14.4 years (range, 18-62 years). Twenty-three patients had nonunion on the left side and 19 on the right. Initial surgical fixation methods included plate fixation (19 cases), intramedullary nail (16 cases), external fixator (5 cases), and combined plate-and-nail fixation (2 cases). Revision procedures included debridement and freshening of the nonunion ends, revision or adjustment of internal fixation, and autologous bone grafting. Nineteen patients underwent graft harvesting with the RIA technique (RIA group), and 23 received autograft harvested from the iliac crest (iliac group). Baseline and perioperative variables compared between the two groups included sex, age, body-mass index, preoperative comorbidities, anatomical site of the nonunion (tibial or femoral), duration from the index fracture operation to the current revision, operative time, intraoperative blood loss, volume of blood transfusion and rate of perioperative complications, nonunion fracture sites, visual analogue scale (VAS) pain score at the fracture site, donor-site morphology and functional appearance scores, and radiographic union score for tibial fractures (RUST).Results:There was no significant difference in age between the RIA and ICBG groups (45.1±14.1 vs. 48.5±14.7 years, t=0.746, P=0.449). However, intraoperative blood loss was higher in the RIA group [300 (150, 720) ml, Z=-3.072, P=0.002] and the transfusion rate was higher (14/19 vs. 8/23, χ 2=6.313, P=0.012). The harvested bone volume was very similar [40(35, 60) cm 2vs. 40(35, 40) cm 2, Z=-1.077, P=0.281]. All patients were followed for a mean of 16.5±2.8 months (range, 7-40 months). VAS scores at the surgical site showed no significant difference between groups at 3 months (3.2±1.0 vs. 3.3±1.4, t= 4.754, P=0.720) and 6 months (1.6±0.8 vs. 1.8±1.2, t=6.841, P=0.542). Donor-site morphology and functional scores were significantly better in the RIA group at 3 months [14.5(13.0, 15.5) vs. 9.0(7.0, 10.0), Z=-3.748, P<0.001] and 6 months [15.5(15.0, 16.0) vs. 11.0(10.0, 13.0), Z=-3.782, P<0.001]. At 12 months postoperatively, RUST scores did not differ significantly between groups (10.6±1.2 vs. 10.4±1.5, t=0.483, P=0.632). The incidence of perioperative complications was comparable [42%(8/19) vs. 30%(7/23), χ 2=0.617, P=0.432]. Conclusions:Both RIA and ICBG achieved favorable clinical outcomes in the treatment of adult noninfectious lower-extremity long bone nonunion. Although RIA was associated with greater intraoperative blood loss, it resulted in less donor-site morbidity and better cosmetic and functional outcomes. Bone healing capacity and overall complication rates did not differ significantly between the two groups. These findings suggest that the RIA technique is safe and effective for use in the Chinese patient population.

Background: Twenty-four-hour urinary free cortisol (UFC) measurement is the initial diagnostic test for Cushing’s syndrome (CS). We compared UFC determination by both direct and extraction immunoassays using Abbott Architect, Siemens Atellica Solution, and Beckman DxI800 with liquid chromatography-tandem mass spectrometry (LC-MS/MS). In addition, we evaluated the value of 24-hr UFC measured by six methods for diagnosing CS. Methods: Residual 24-hr urine samples of 94 CS and 246 non-CS patients were collected.A laboratory-developed LC-MS/MS method was used as reference. UFC was measured by direct assays (D) using Abbott, Siemens, and Beckman platforms and by extraction assays (E) using Siemens and Beckman platforms. Method was compared using Passing–Bablok regression and Bland–Altman plot analyses. Cut-off values for the six assays and corresponding sensitivities and specificities were calculated by ROC analysis. Results: Abbott-D, Beckman-E, Siemens-E, and Siemens-D showed strong correlations with LC-MS/MS (Spearman coefficient r = 0.965, 0.922, 0.922, and 0.897, respectively), while Beckman-D showed weaker correlation (r = 0.755). All immunoassays showed proportionally positive bias. The areas under the curve were 0.975 for Abbott-D, 0.972 for LCMS/MS, 0.966 for Siemens-E, 0.948 for Siemens-D, 0.955 for Beckman-E, and 0.877 for Beckman-D. The cut-off values varied significantly (154.8–1,321.5 nmol/24 hrs). Assay sensitivity and specificity ranged from 76.1% to 93.2% and from 93.0% to 97.1%, respectively. Conclusions Commercially available immunoassays for measuring UFC show different levels of analytical consistency compared to LC-MS/MS. Abbott-D, Siemens-E, and Beckman-E have high diagnostic accuracy for CS.

Objective:To explore the mechanism of acupuncture combined with sand therapy on bone biomechanics and immune function in rabbits with knee osteoarthritis based on G protein coupled signal.Methods:Totally 35 rabbits were randomly divided into normal group, model group, sand therapy group, acupuncture and moxibustion group and combined group, with 7 rabbits in each group. Except for the normal group, all other groups were prepared with knee osteoarthritis models. After 12 h modeling, rabbits in the sand therapy group and the combined group were treated with sand therapy. Rabbits in the acupuncture and moxibustion group and the combined group received acupuncture stimulation intervention therapy. Rabbits in normal group and model group only moved freely. The levels of IgG, IgM and IgA in serum and IL-1β and TNF-α were detected by ELISA method. The biomechanical properties of femur were measured by American Instron universal material experimental machine. The pathological changes of rabbits in each group were observed by HE staining. Protein expression levels of Gαs, cAMP and Gi in rabbit cartilage tissues were detected by Western blot.Results:Compared with model group, the levels of IgG, IgM and IgA increased ( P<0.05)l the levels of IL-1β and TNF-α decreased ( P<0.05); the maximum load, breaking load, structural stiffness and capacity absorption of rabbits in sand therapy group, acupuncture group and combined group increased ( P<0.05); the expressions of Gαs and cAMP protein increased ( P<0.05), while the expression of Gi protein decreased ( P<0.05). Conclusion:Acupuncture combined with sand therapy in the treatment of knee osteoarthritis can effectively improve the bone strength of osteoarthritis, reduce the inflammatory response, balance the expression of G protein and improve the imbalance of immunoglobulin.

Objective:To investigate the effects of external application of Compound Dahuang Powder combined with acupuncture on the synovial ultrastructure, pathological angiogenesis, and Ras/Raf signaling pathway in rheumatoid arthritis rats.Methods:Totally 100 SPF grade SD rats were selected and divided into normal group, model group, acupuncture group, external application group, and combination group according to random number table method, with 20 rats in each group. Except for the normal group, Freund's complete adjuvant was injected into the bilateral plantars to establish a rheumatoid arthritis model. One week after modeling, the acupuncture group received acupuncture at "Yinlingquan (SP9)" and "Sanyinjiao (SP6)" for 30 minutes, with continuous intervention for 6 days and 7 days as one course of treatment, for a total of 3 courses of intervention. The external application group of rats applied compound Dahuang Powder on the right hind foot and ankle joint, 10 g/time, twice a day, for 7 days as one course of treatment, with a total of 3 intervention courses; the combination group received a combined intervention of acupuncture and external application of compound Dahuang Powder. No intervention was performed in the normal group and model group. The levels of TNF-α and IL-1β in serum of rats in each group were detected using enzyme-linked immunosorbent assay. Transmission electron microscopy was used to observe the ultrastructure of synovial cells. HE staining was used to observe the morphology of synovial tissue. Immunohistochemistry was used to detect vascular endothelial growth factor (VEGF) and its receptor VEGFR2 in synovial tissue. Western blot and RT qPCR were used to detect Ras/Raf protein and mRNA in synovial tissue, respectively.Results:Compared with model group, the levels of TNF-α and IL-1β in serum of rats in acupuncture group and external application group decreased ( P<0.05), the expressions of VEGF and VEGFR2 decreased ( P<0.05), and the expressions of Ras and Raf protein and mRNA in acupuncture group and external application group decreased ( P<0.05). Compared with acupuncture group and external application group, the levels of TNF-α and IL-1β in serum of rats in the combination group decreased ( P<0.05), the expressions of VEGF and VEGFR2 decreased ( P<0.05), and the expressions of Ras and Raf protein and mRNA in the combination group decreased ( P<0.05). The results of synovial cell ultrastructure showed that the nuclear membrane of synovial cells in normal group was good, and the nuclear membrane in model group was seriously damaged. The acupuncture group and external application group had different degrees of improvement, and the combination group had the most significant improvement. HE staining results showed that the joint synovial tissue of the normal group was normal, the joint synovial tissue of the model group had a large amount of inflammatory infiltration, the joint synovial injury of the acupuncture group and the external application group was slightly improved, and the pathological injury of the combined group was significantly reduced. Conclusion:The combination of external application of compound Dahuang Powder and acupuncture can regulate angiogenesis related factors, regulate the Ras/Raf signaling pathway, and improve the ultrastructure of synovial cells in rheumatoid arthritis model rats.

Objective:To investigate the optimal serum antibody titer in acute stage for the diagnosis of Mycoplasma pneumoniae (MP) infection by passive agglutination, and to evaluate the clinical diagnostic value of different antibody titers.Methods:A cross-sectional study.Eighty-eight pairs of clinical serum samples were collected from children with MP infection treated at the Department of Pediatrics in Shengjing Hospital of China Medical University from December 2016 to February 2017 and Children′s Hospital of Baotou in November 2019.The four-fold change of the double serum specific antibody titer was used as the gold standard, and the receiver operating characteristic (ROC) curve was plotted.When detecting the single serum in acute stage, different antibody titers were used as positive criteria to evaluate their clinical application value in the diagnosis of MP infection and find the most appropriate serum antibody titer as the diagnostic cut-off value.Results:(1)When the serum specific antibody titer ≥1∶40 was used as the positive criterion, the sensitivity was 72.9%, the area under the ROC curve was 0.817, and the specificity was 87.5%, which might cause overdiagnosis.When the serum specific antibody titer ≥1∶160 was used as the positive criterion, the specificity was 97.5%, the area under the ROC curve was 0.775, and the sensitivity was 52.1%, which might cause missed diagnosis.When the serum specific antibody titer ≥1∶80 was used as the positive criterion, the sensitivity was 60.4%, the specificity was 97.5%, and the area under the ROC curve was 0.823, overall performing better compared with the said two criteria.(2)After the disease lasted at least 5 days, blood samples were collected.About 72.5% of the children had antibodies, and 60.0% of the children had antibody titers ≥1∶80.Conclusions:(1)When the passive agglutination method is used to detect MP infection, antibody titer ≥1∶80 is recommended as the diagnostic standard.However, in clinical practice, the diagnosis of MP infection depends on clinical and other laboratory test results.(2) It is appropriate to collect blood samples on 5-7 days of illness.If MP infection is clinically suspected, and an antibody titer of 1∶40 is also suggestive, it can perform cooperative diagnosis based on molecular biology lab results or retest at a shorter interval.