Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

Objective:To investigate the application effect of medical sterile gloves-assisted cutting cloth samples in the repair of finger degloving injury.Methods:The clinical data of patients with finger skin and soft tissue degloving defects treated in Jiangnan Hospital Affiliated with Binjiang College of Zhejiang University of Traditional Chinese Medicine from April 2015 to December 2021 were analyzed retrospectively. Medical sterile gloves were used to make cloth samples of finger defects, and then the dorsal foot flap or toenail flap was cut according to the cloth samples to repair finger defects. The survival of flaps and the appearance of the fingers’ body were observed after surgery, and the patients’ satisfaction was investigated. The finger function was evaluated by the trial standard of upper limb function evaluation of the Hand Surgery Society of Chinese Medical Association.Results:A total of 12 patients with 13 fingers were enrolled. There were 9 males (10 fingers) and 3 females (3 fingers), aged 17-54, average of 37-year-old. There were 5 cases (5 fingers) in the left hand and 7 cases (8 fingers) in the right hand, all with unilateral finger injury. The size of the dorsal flaps and great toenail flaps harvested were appropriate, ranging from 5.5 cm×4.5 cm to 10.5 cm×5.8 cm. After surgery, all patients were regularly followed up for 3-15 months, an average of 7 months. All the dorsal flap and great toenail flap of the foot after surgery survived, and the appearance of the finger body was not bloated. All patients were very satisfied with the appearance and function of the hand, and the finger function was evaluated as excellent in 7 cases and good in 5 cases.Conclusion:The application of sterile gloves-assisted cutting cloth samples for the treatment of finger degloving injury can simplify the procedure, reduce donor damage, make up for the lack as much as needed, and the repaired fingers can obtain better shape and function.

Objective:To investigate the application effect of medical sterile gloves-assisted cutting cloth samples in the repair of finger degloving injury.Methods:The clinical data of patients with finger skin and soft tissue degloving defects treated in Jiangnan Hospital Affiliated with Binjiang College of Zhejiang University of Traditional Chinese Medicine from April 2015 to December 2021 were analyzed retrospectively. Medical sterile gloves were used to make cloth samples of finger defects, and then the dorsal foot flap or toenail flap was cut according to the cloth samples to repair finger defects. The survival of flaps and the appearance of the fingers’ body were observed after surgery, and the patients’ satisfaction was investigated. The finger function was evaluated by the trial standard of upper limb function evaluation of the Hand Surgery Society of Chinese Medical Association.Results:A total of 12 patients with 13 fingers were enrolled. There were 9 males (10 fingers) and 3 females (3 fingers), aged 17-54, average of 37-year-old. There were 5 cases (5 fingers) in the left hand and 7 cases (8 fingers) in the right hand, all with unilateral finger injury. The size of the dorsal flaps and great toenail flaps harvested were appropriate, ranging from 5.5 cm×4.5 cm to 10.5 cm×5.8 cm. After surgery, all patients were regularly followed up for 3-15 months, an average of 7 months. All the dorsal flap and great toenail flap of the foot after surgery survived, and the appearance of the finger body was not bloated. All patients were very satisfied with the appearance and function of the hand, and the finger function was evaluated as excellent in 7 cases and good in 5 cases.Conclusion:The application of sterile gloves-assisted cutting cloth samples for the treatment of finger degloving injury can simplify the procedure, reduce donor damage, make up for the lack as much as needed, and the repaired fingers can obtain better shape and function.

Objective:To explore the surgical method and therapeutic effect of repairing soft tissue defect of digit-tip with single subcutaneous pedicle V-Y advancing flap combined with skin grafting.Methods:From August 2013 to December 2020, 25 soft tissue defects of digit-tip were repaired by a single subcutaneous pedicle V-Y advancing flap combined with pedicle skin grafting. The area of the defects was 0.8 cm× 0.8 cm to 1.6 cm× 1.4 cm. The flaps were harvested from palm or lateral side of the wound and the area of flap was 0.5 cm×1.0 cm to 0.8 cm×2.5 cm. In order to make the flap transfer to a further distance, the subcutaneous fibre connection of the flap was cut-off during the operation. At the same time, cut off 1 side of subcutaneous pedicle. Finally, the advanced distance of the flap reached 0.5-1.2 cm. After the flap harvested, the medium thickness skin was removed for graft to close the donor site from the wrist striations. After the surgery, follow-up visits were conducted regularly by outpatient clinic, or via telephone or WeChat review or by home visit. Throughout the follow-up, the flap appearance, sensation and recovery of the function of digital joint were observed, together with the patient satisfaction. Results:After the surgery, the postoperative follow-up lasted for 4 months to 8 years. All 25 flaps and skin grafts were survived in first stage wound healing. The flaps and skin grafting areas had excellent texture. The fingerprint had been reconstructed with good appearance. The TPD was 4-9 mm, the functions of digital joint recovered well, and there was no complain about a discomfort at the donor site. According to the evaluation standard of Michigan hand function questionnaire, all 25 patients were very satisfied with the overall appearance and function of the hand. According to Total Angle of Motion (TAM) evaluation standard, finger mobility was excellent in all 25 patients.Conclusion:Subcutaneous V-Y advancing flap combined with skin grafting is an ideal method for repairing soft tissue defect of digit-tip. The surgery characterises a simple flap cutting, less traumatic damage, long advancing distance of flap and good repair effect.

Objective:To compare the clinical efficacy of pedicle subtraction osteotomy (PSO) versus vertebroplasty (VP) combined with long segment fixation for nonunion of osteoporotic vertebral fractures with kyphosis.Methods:A retrospective cohort study was conducted to analyze the clinical data of 72 patients with nonunion of osteoporotic vertebral fractures with kyphosis admitted to Jiangnan Hospital affiliated to Zhejiang University of Traditional Chinese Medicine from January 2010 to December 2017. There were 16 males and 56 females, aged 55-84 years [(68.2±5.2)years]. Level of injury was located at T 11 in 3 patients, at T 12 in 19, at L 1 in 31, and at L 2 in 19. According to the American Spinal Injury Association (ASIA) classification, 31 patients were scaled as grade D and 41 grade E. Overall, 51 patients were treated with PSO combined with long segment fixation (PSO group) and 21 patients treated with VP combined with long segment fixation (VP group). The operation time and bleeding volume were compared between the two groups. Before operation, at postoperative 2 weeks and at the last follow-up, the kyphotic Cobb angle, sagittal vertical axis (SVA), thoracic kyphosis (TK) and lumbar kyphosis (LL) were used to evaluate the osteotomy effect, and the visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the degree of pain and lumbar function recovery. The improvement of ASIA grade was observed at the last follow-up. The complications were observed as well. Results:All patients were followed up for 24-46 months [(33.2±5.9)months].The operation time and bleeding volume were more in PSO group than in VP group (all P<0.01). Before operation, the kyphotic Cobb angle, SVA, TK and LL were not significantly different between the two groups (all P>0.05). At postoperative 2 weeks, TK was not significantly different between the two groups ( P>0.05), while PSO group showed significantly decrease of kyphotic Cobb angle and SVA and increase of LL when compared with VP group ( P<0.05 or 0.01). At the last follow-up, the kyphotic Cobb angle, SVA and TK in PSO group were (8.5±1.1)°, (2.6±0.5)cm and (28.8±6.2)°, respectively, significant lower than those in VP group [(14.2±1.5)°, (4.4±0.9)cm and (32.6±5.9)°] (all P<0.05); while the LL was significantly larger in PSO group [(43.1±3.9)°] than in VP group [(36.9±5.3)°] ( P<0.01). Before operation, the VAS and ODI were not significantly different between the two groups (all P>0.05). At postoperative 2 weeks, the VAS and ODI in the two groups were also not significantly different (all P>0.05), but both were greatly decreased from the preoperative level (all P<0.05). At the last follow-up, the VAS and ODI in PSO group were (1.4±0.5)points and 22.5±2.5, significant higher than (1.8±0.6)points and 25.5±5.1 in VP group (all P<0.01). At the last follow-up, the ASIA classification was grade E in all patients. There were 1 patient suffering from dural matter tear and 1 from proximal junctional kyphosis in PSO group. Whereas 3 patients had bone cement leaking and 1 pedicle screw loosening in PVP group. The complication rate was 3.9% (2/51) in PSO group, significant lower than 19.0%(4/21) in VP group ( P<0.05). Conclusion:Compared with VP group in the treatment of osteoporotic vertebral fractures with kyphosis, PSO combined with long segment fixation is much effective in improving kyphosis angle and spinal axial imbalance correction, maintaining vertebral height and spinal axial stability in middle- to long-term, improving pain and dysfunction and minimizing complications, regardless of more operation time and bleeding volume.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Objective:To explore the surgical method and therapeutic effect of repairing thumb pulp defect with pedicled transposition of radial proper palmar digital artery flap of middle finger.Methods:Since June, 2006 to May, 2020, 17 cases(17 fingers) with thumb pulp defect were repaired by pedicled transposition of radial proper palmar digital artery flap of middle finger. The sizes of flap ranged from 1.5 cm × 1.5 cm to 4.2 cm × 2.0 cm. The antegrade pedicled flap of radial proper palmar digital artery of middle finger was used in 2 cases and the retrograde pedicled flap of middle finger was used in 15 cases. After the flap was resected, the donor sites were covered with a medium thickness skin graft transferred from the wrist or elbow. The skin graft did not need to be packed. The dorsal branch of the digital nerve was included in the flap and it was anastomosed with the proper nerve of the injured thumb stump. After 16-22 days of the operation, the pedicles were cut off. The patients were instructed to perform digit function exercise after the pedicle was cut off. After the operation, the patients were included in regularly follow-up through outpatient visit, telephone or WeChat interview. The appearance and sensation of the thumb and finger pulps and the function recovery of the thumb and finger joints were observed through the followed-ups.Results:All 17 flaps and donor site skin grafts survived over 3 to 32 months of follow-up. The flaps achieved good texture and natural appearance. The TPD recovered to 5~11 mm. According to the Michigan Hand Function Questionnaire, all the 17 patients were very satisfied with the overall appearance and function of the hands. According to TAM, the 17 cases were all in excellent.Conclusion:Repairing thumb pulp defect with radial proper palmar digital artery pedicled flap of middle finger, the flap resection is simple, and the donor site is hidden. The appearance and texture of flap is good. It is a safe, effective and good method.