For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

Objective:To investigate the early clinical characteristics of elderly patients with severe burns and the risk factors on prognosis.Methods:This study was a retrospective case series study. Clinical data of 124 elderly patients with severe burns who met the inclusion criteria and were admitted to the 12 hospitals from January 2015 to December 2020 were collected, including 4 patients from the Fourth People's Hospital of Dalian, 5 patients from Fujian Medical University Union Hospital, 22 patients from Guangzhou Red Cross Hospital of Jinan University, 5 patients from Heilongjiang Provincial Hospital, 27 patients from the First Affiliated Hospital of Naval Medical University, 9 patients from the First Affiliated Hospital of Nanchang University, 10 patients from Affiliated Hospital of Nantong University, 9 patients from Tongren Hospital of Wuhan University & Wuhan Third Hospital, 12 patients from the 924 th Hospital of PLA, 6 patients from Zhangjiagang First People's Hospital, 4 patients from Taizhou Hospital of Zhejiang Province, and 11 patients from Zhengzhou First People's Hospital. The patients' overall clinical characteristics, such as gender, age, body mass index, total burn area, full-thickness burn area, inhalation injury, causative factors, whether combined with underlying medical diseases, and admission time after injury were recorded. According to the survival outcome within 28 days after injury, the patients were divided into survival group (89 cases) and death group (35 cases). The following data of patients were compared between the two groups, including the basic data and injuries (the same as the overall clinical characteristics ahead); the coagulation indexes within the first 24 hours of injury such as prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time, D-dimer, fibrinogen degradation product (FDP), international normalized ratio (INR), and fibrinogen; the blood routine indexes within the first 24 hours of injury such as white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, monocyte count, red blood cell count, hemoglobin, and hematocrit; the organ function indexes within the first 24 hours of injury such as direct bilirubin, total bilirubin, urea, serum creatinine, aspartate aminotransferase, alanine aminotransferase, total protein, albumin, globulin, blood glucose, triglyceride, total cholesterol, alkaline phosphatase, creatine kinase, electrolyte indexes (potassium, sodium, chlorine, calcium, magnesium, and phosphorus in blood), uric acid, myoglobin, and brain natriuretic peptide; the infection and blood gas indexes within the first 24 hours of injury such as procalcitonin, C-reactive protein, pH value, oxygenation index, base excess, and lactate; treatment such as whether conducted with mechanical ventilation, whether conducted with continuous renal replacement therapy, whether conducted with anticoagulation therapy, whether applied with vasoactive drugs, and fluid resuscitation. The analysis was conducted to screen the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns. Results:Among 124 patients, there were 82 males and 42 females, aged 60-97 years, with body mass index of 23.44 (21.09, 25.95) kg/m 2, total burn area of 54.00% (42.00%, 75.00%) total body surface area (TBSA), and full-thickness burn area of 25.00% (10.00%, 40.00%) TBSA. The patients were mainly combined with moderate to severe inhalation injury and caused by flame burns. There were 43 cases with underlying medical diseases. The majority of patients were admitted to the hospital within 8 hours after injury. There were statistically significant differences between patients in the 2 groups in terms of age, total burn area, full-thickness burn area, and inhalation injury, and PT, APTT, D-dimer, FDP, INR, white blood cell count, platelet count, urea, serum creatinine, blood glucose, blood sodium, uric acid, myoglobin, and urine volume within the first 24 hours of injury (with Z values of 2.37, 5.49, 5.26, 5.97, 2.18, 1.95, 2.68, 2.68, 2.51, 2.82, 2.14, 3.40, 5.31, 3.41, 2.35, 3.81, 2.16, and -3.82, respectively, P<0.05); there were statistically significant differences between two groups of patients in whether conducted with mechanical ventilation and whether applied with vasoactive drugs (with χ2 values of 9.44 and 28.50, respectively, P<0.05). Age, total burn area, full-thickness burn area, serum creatinine within the first 24 hours of injury, and APTT within the first 24 hours of injury were the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns (with odds ratios of 1.17, 1.10, 1.10, 1.09, and 1.27, 95% confidence intervals of 1.03-1.40, 1.04-1.21, 1.05-1.19, 1.05-1.17, and 1.07-1.69, respectively, P<0.05). Conclusions:The elderly patients with severe burns had the injuries mainly from flame burns, often accompanied by moderate to severe inhalation injury and enhanced inflammatory response, elevated blood glucose levels, activated fibrinolysis, and impaired organ function in the early stage, which are associated with their prognosis. Age, total burn area, full-thickness burn area, and serum creatinine and APTT within the first 24 hours of injury are the independent risk factors for death within 28 days after injury in this population.

Objective:To compare the clinical efficacies of robot-assisted and free-hand long segment screw fixation combined with wedge osteotomy in the treatment of type IV chronic symptomatic osteoporotic thoracolumbar fractures (CSOVCFs).Methods:A retrospective cohort study was conducted to analyze the clinical data of 72 patients with type IV CSOVCFs who were admitted to Honghui Hospital of Xi′an Jiaotong University from May 2019 to December 2021, including 22 males and 46 females; aged 61-82 years [(71.2±12.3)years]. Fracture segments were located at T 11-T 12 in 37 patients and at L 1-L 2 in 31. A total of 32 patients were treated with robot-assisted long segment screw fixation combined with wedge osteotomy (robot group) and 36 with free-hand long segment screw fixation combined with wedge osteotomy (free-hand group). The operation time, intraoperative bleeding volume, dosage of radiation exposure, intraoperative needle adjustment, time of single pedicle screw placement and accuracy of pedicle screw placement were compared between the two groups. The kyphotic Cobb angle, sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar kyphosis (LL), visual analogue scale (VAS) and Oswestry disability index (ODI) were measured preoperatively, at 3 days postoperatively and at the last follow-up. The incidences of facet joint violation, deviation in guide needle placement, cerebrospinal leak and proximal junctional kyphosis (PJK) were observed. Results:All patients were followed up for 12-26 months [(18.2±5.1)months]. The operation time and time of single pedicle screw placement showed no significant differences between the two groups (all P>0.05). The intraoperative bleeding volume was (502.5±58.3)ml in the robot group, less than that in the free-hand group [(690.2±45.9)ml]. The dosage of radiation exposure was (32.6±10.8)μSv in the robot group, lower than that in the free-hand group [(48.6±15.2)μSv]. The intraoperative needle adjustment was (2.1±0.3)times in the robot group, higher than that in the free-hand group [(20.7±5.8)times], and the accuracy of pedicle screw placement was 99.7% in the robot group, less than that in the free-hand group (91.8%) (all P<0.01). Compared with pre-operation, the kyphotic Cobb angle, SVA, TK and LL were significantly improved in both groups at postoperative 3 days and at the last follow-up (all P<0.05). Compared with postoperative 3 days, the kyphotic Cobb angle, SVA and TK were increased at the last follow-up within the two groups, but with no significant differences (all P>0.05). Compared with postoperative 3 days, the LL was decreased within the two groups at the last follow-up, but with no significant differences (all P>0.05). The VAS and ODI in the two groups were significantly lower at postoperative 3 days and at the last follow-up when compared with those before operation (all P<0.05), and both values were significantly lower at the last follow-up than those at postoperative 3 days (all P<0.05). There were no significant differences in the VAS or ODI at all time points between the two groups (all P>0.05). The incidence of facet joint violation in the robot group was 1.6%, markedly lower than that in the free-hand group (9.6%) ( P<0.01). The incidences of deviation in guide needle placement, cerebrospinal leak and PJK showed no differences between the two groups (all P>0.05). Conclusion:For type IV CSOVCFs, the robot-assisted long segment screw fixation combined with wedge osteotomy can better reduce intraoperative blood loss, decrease radiation exposure, improve accuracy of pedicle screw placement, and reduce facet joint violation when compared with free-hand long segment screw fixation combined with wedge osteotomy.

Objective:To evaluate the efficacy of unilateral puncture techniques in high-viscosity cement percutanueous vertebroplasty (PVP) in treatment of type I chronic symptomatic osteoporotic vertebral compression fracture (CSOVCF).Methods:A retrospective case control study was conducted to analyze the clinical data of 119 patients with type I CSOVCF admitted to Honghui Hospital affiliated to Xi'an Jiaotong University School of Medicine from December 2013 to December 2016. There were 42 males and 77 females, aged 58-95 years [(79.2±15.6)years]. All patients had bone mineral density of -4.5--2.5 SD [(-3.9±0.2)SD] (T score). The fractured segments included L 1-L 2 in 56 patients and L 3-L 5 in 63. All patients were treated by high-viscosity cement PVP with the unilateral puncture of transverse process and superior articular process in unilateral group ( n=60) and by the bilateral puncture approach with the Magerl method in bilaleral group ( n=59). The operation time, cement injection volume, and intraoperative fluoroscopy frequency were recorded. The visual analogue scale (VAS), Oswestry dysfunction index (ODI), anterior height ratio of injured vertebrae and Cobb angle were measured before operation, at postoperative 1 day and at the last follow-up. The adjacent vertebral fracture, cement leakage and other complications were recorded. Results:All patients were followed up for 12-48 months [(24.1±5.6)months]. The operation time in unilateral group [(21.5±6.5)minutes] was significantly shorter than that in bilateral group [(37.8±7.4)minutes] ( P<0.05). The cement injection volume in unilateral group [(4.2±0.7)ml] was less than that in bilateral group [(6.5±1.1)ml]( P<0.05). The intraoperative fluoroscopy frequency in unilateral group [(14.2±3.0)times] was less than that in bilateral group [(31.4±6.4)times] ( P<0.05). Both groups showed significant improvements in VAS, ODI, anterior height ratio of injured vertebrae and Cobb angle at postoperative 1 day and at the last follow-up compared with these before operation ( P<0.05), but there were no significant differences after operation between the two groups ( P>0.05). The incidence of adjacent vertebral fracture was 5%(3/60) in unilateral group and 8% (5/59) in bilaleral group ( P>0.05). Four patients (7%) had cement leakage in unilateral group and 11 patients (19%) in bilateral group ( P<0.05). No complications of wound infection, nerve injury or pulmonary embolism occurred. Conclusion:Compared with Magerl bilateral puncture approach, high-viscosity cement PVP with unilateral puncture of transverse process and superior articular process in treatment of type I CSOVCF has advantages of shorter operation time, less trauma, less radiation exposure and lower cement leakage rate.

Objective:To observe the drainage effects of the venous and arterial perivascular and adventitial connective tissues(PACT)on edema of lower limbs in mice model, and to provide a new understanding of the drainage for the elderly lower extremity edema.Methods:Different doses of fluorescent sodium(FluoNa)were injected into the venous and arterial perivascular connective tissues in the feet and ankles of the lower limbs to create a model of lower extremity edema in mice.Then, at the level of the femoral artery and vein sheath, a stereoscopic fluorescence microscope was used to observe and record the drainage effect of vascular PACT pathways on the edema.Results:By tracking the diffusion and flowing of FluoNa in the interstitial space of ankle and foot, we found that(1)in addition to the local diffusion at the injection site, FluoNa can also flow along the venous and arterial PACT and the interstitial spaces between the corresponding vein and artery.(2)The flowing process along the vascular adventitia included transmission along the vascular long axis, and the long axis-perpendicular diffusion into the vascular peripheral tissue.(3)When low-dose and high-dose FluoNa were administered into the venous adventitia of the lower extremities, the venous PACT imaging was observed.(4)When low-dose and high-dose FluoNa were administered into the arterial adventitia of the lower extremities, the arterial PACT imaging was observed; (5)When low-dose and high-dose of FluoNa were administered into the near the arteriovenous-accompanying blood vessels, not only the venous PACT pathway and the arterial PACT pathway are imaged, but also the interstitial space between the pathway of the accompanying vein and artery was also visualized at the same time; (6)Histological analysis showed that the tissues stained by FluoNa were the venous and arterial adventitia and perivascular connective tissues.Conclusions:The interstitial fluid in lower extremity tissue edema can not only be drained by the venous or arterial PACT pathway, but also be drained through the interstitial space between the accompanying vein and artery when a large amount of the interstitial fluid accumulates.

Objective:To compare the minimally invasive transforaminal lumbar interbody fusion (MTLIF) with open transforaminal lumbar interbody fusion (OTLIF) in treatment of lumbar degenerative disease.Methods:Clinical data of 63 patients with single segment lumbar degenerative disease treated in Department of Orthopedics of Beijing Hospital from November 2015 to September 2016 were retrospectively analyzed, among whom 30 cases received MTLIF and 33 cases received OTLIF. The operative time, intraoperative X-ray exposure times, intraoperative blood lose, postoperative drainage,perioperative fever, adjacent segment degeneration, loosening of internal fixation and cage collapse were observed in two groups 4 years after operation, and the visual analog scale (VAS) score of the lower back and the leg, the Oswestry disability index (ODI) score were compared between two groups.Results:The operation time [(191.6±50.5) min] and radiation exposure times [(15.5±6.4) times] in MTLIF group were significantly more than those in OTLIF group [(105.8±23.1) min, (7.2±1.4)times, t=17.210, t=10.850,all P<0.01]. The intraoperative blood loss [(150.4±70.4) ml], postoperative drainage [(90.4±30.7)ml], VAS score (2.4±0.7) and ODI score (24.5±3.7) 2 weeks after surgery in MTLIF group were significantly lower than those in OTLIF group [(250.7±43.9)ml,(216.3±67.8)ml,(4.5±1.6),(30.6±4.6), t=-12.830, t=-14.070, t=-6.890, t=-5.805,all P<0.01]. There were no significant differences in the incidence of fever [1 case(3.3%) vs. 4 cases(12.1%),χ2=-1.661, P=0.20], VAS score[(1.2±0.7) vs. (1.3±0.6), t=-0.628, P=0.53], ODI score[(14.2±2.7) vs. (14.7±2.5), t=-0.756, P=0.45], fusion rate of Bridwell grade Ⅰ [86.7%(26/30) vs. 84.8%(28/33),χ2=0.042, P=0.84] 1 year after surgery; and the adjacent segment degeneration [0 case(0) vs. 1 case(3.0%),χ2=0.924, P=0.34], internal fixation loosening [1 case(3.3%) vs. 1 case(3.0%),χ2=0.005, P= 0.95] and cage collapse 4 years after surgery [1 case(3.3%) vs. 1case(3.0%),χ2=0.005, P=0.95] between MTLIF group and OTLIF group. Conclusion:Compared with OTLIF, MTLIF has longer operation time and more radiation exposure, but it can achieve full decompression, the same fusion rate, less bleeding, less trauma, faster recovery, fewer complications and satisfactory long-term effect.

Objective:To investigate the impact of osteoporosis on clinical outcomes in elderly patients treated with short segment transforaminal lumbar interbody fusion.Methods:From May 2016 to May 2018, elderly patients who had undergone transforaminal lumbar interbody fusion(TLIF)in our hospital were retrospectively analyzed.Based on bone mineral density(BMD), patients were divided into the osteoporosis group(the OP group, n=75, T≤-2.5 in BMD)and the control group(the CO group, n=103, T>-1.0 in BMD). General patient information, clinical data and postoperative follow-up clinical results were compared between the two groups.Results:Eventually 178 cases were enrolled, including 68 with lumbar disc herniation and 110 with lumbar spinal stenosis.Preoperative Visual Analogue Scale(VAS)scores were 7.35±1.30 in the lower back and 7.32±1.30 in the leg for the OP group and 7.35±1.33 and 7.22±1.40, respectively, for the CO group, and there was no significant difference between the two groups( t=0.140 and 0.468, P=0.989 and 0.640). The proportions of cage collapse and internal fixation loosening were 70.7%(53/75)and 37.3%(28/75)in the OP group, which were higher than 22.3%(23/103)and 14.6%(15/103)in the CO group( χ2=41.440 and 12.280, both P=0.000). However, there was no significant difference between the OP group and the CO group in 1-and 2-year postoperative interbody fusion rates(postoperative 1-year rate: 89.3% or 67/75 vs.91.3% or 94/103, χ2=0.187, P=0.666; postoperative 2 year rate: 94.6% or 71/75 vs.95.1% or 98/103), χ2=0.021, P=0.885). There was no significant difference in VAS score and Oswestry disability index(ODI) between the OP group and the CO group at 6 months, 1 year and 2 years after surgery(all P>0.05). Conclusions:Although there are some osteoporosis-related complications such as cage subsidence and screw loosening, short-segment TLIF can still achieve good clinical results in elderly patients with osteoporosis.

OBJECTIVE: To investigate the effects of autophagy on osteogenic differentiation of stem cells from the apical papilla (SCAPs) in the presence of tumor necrosis factor- (TNF-) stimulation . METHODS: SCAPs treated with TNF- (0, 5, and 10 ng/mL) with or without 5 mmol/L 3-MA were examined for the expression of autophagy marker LC3-Ⅱ using Western blotting. The cells were transfected with GFP-LC3 plasmid and fluorescence microscopy was used for quantitative analysis of intracellular GFP-LC3; AO staining was used to detect the acidic vesicles in the cells. The cell viability was assessed with CCK-8 assays and the cell apoptosis rate was analyzed using flow cytometry. The cells treated with TNF- or with TNF- and 3-MA were cultured in osteogenic differentiation medium for 3 to 14 days, and real- time PCR was used to detect the mRNA expressions of osteogenesis-related genes (ALP, BSP, and OCN) for evaluating the cell differentiation. RESULTS: TNF- induced activation of autophagy in cultured SCAPs. Pharmacological inhibition of TNF--induced autophagy by 3-MA significantly decreased the cell viability and increased the apoptosis rate of SCAPs ( < 0.05). Compared with the cells treated with TNF- alone, the cells treated with both TNF- and 3-MA exhibited decreased expressions of the ALP and BSP mRNA on days 3, 7 and 14 during osteogenic induction ( < 0.05) and decreased expression of OCN mRNA on days 3 and 7 during the induction ( < 0.05). CONCLUSIONS Autophagy may play an important role during the osteogenic differentiation of SCAPs in the presence of TNF- stimulation.
Autophagy ; drug effects ; physiology ; Cell Differentiation ; drug effects ; physiology ; Cell Survival ; drug effects ; Cells, Cultured ; Dental Papilla ; cytology ; Green Fluorescent Proteins ; Humans ; Osteogenesis ; physiology ; Stem Cells ; drug effects ; physiology ; Transfection ; Tumor Necrosis Factor-alpha ; administration & dosage ; antagonists & inhibitors ; pharmacology

Objective To investigate the effectiveness of open-door laminoplasty with lateral mass screw fusion in the treatment of multisegmental cervical spondylotic myelopathy (CSM)with segmental instability.Methods Forty-one patients with multisegmental cervical spondylotic myelopathy combined with instability underwent open-door laminoplasty with lateral mass screw fusion.The JOA(Japanese Orthopaedic Association)scoring system and Neck Disability Index(NDI) were applied to evaluate neurological function and axial neck/shoulder pain before and after surgery,respectively.In addition,the Ishihara method was used to measure the cervical curvature index(CCI),and spinal cord expansion was calculated with MRI.Results After 43 months of postoperative follow-up,there were significant differences in JOA scores[(7.12±0.91) vs.(14.73± 1.12),t =35.28,P＜0.001],areas of the dural sac at the level of maximum stenosis in MRI[(0.22±0.05)]cm2 vs.(0.62±0.09)cm2,t=14.15,P＜0.001],and NDI scores[(24.46±6.61) vs.(12.90±3.46),t=15.59,P ＜ 0.001],compared with those before treatment.However,there were no significant differences in pre-and post-operation CCI[(10.36±1.69) vs.(10.87±2.05),t=1.11,P＞0.05].Conclusions Open-door laminoplasty with lateral mass screw fusion can improve neurological function and maintain the normal cervical curvature.Therefore,it is effective in the treatment of multisegmental cervical spondylotic myelopathy with segmental instability.