Objective:To investigate the early clinical outcomes of anterior cervical discectomy and fusion (ACDF) in the treatment of two-segment cervical spondylotic myelopathy (CSM) using a cervical soft endoscopic minimally invasive system.Methods:A retrospective follow-up study was conducted on the medical records of 23 patients with two-segment cervical myelopathy who underwent ACDF using a soft endoscopic cervical spine minimally invasive system at the Third Affiliated Hospital of Southern Medical University between October 2022 and December 2023. The cohort included 15 males and 8 females, aged 37-79 years (58.52±11.77 years). The affected cervical segments included: C 3, 4 and C 4, 5 in 2 cases; C 3, 4 and C 5, 6 in 3 cases; C 4, 5 and C 5, 6 in 10 cases; C 5, 6 and C 6, 7 in 7 cases; and C 4, 5 and C 6, 7 in 1 case. Clinical outcomes were evaluated based on the Japanese Orthopaedic Association (JOA) scores and visual analog scale (VAS) for neck and shoulder pain, assessed preoperatively and at 1 week, 1 month, and 3 months postoperatively. Additional data recorded included incision length, intraoperative blood loss, operative time, postoperative complications, and the presence of prevertebral soft tissue edema. The improvement rate of JOA scores at the final follow-up was also calculated. Results:All patients successfully underwent surgery and completed follow-up, with follow-up durations ranging from 3 to 6 months (4.01±0.98 months). The mean operative time was 80.09±22.66 min (range: 53-127 min), and the mean incision length was 3.25±0.32 cm (range: 3-4 cm). Estimated blood loss ranged from 10 to 100 ml, with a mean of 34.78±24.1 ml. Postoperative drainage ranged from 0 to 80 ml (mean: 23.13±26.1 ml), and postoperative hospitalization durations ranged from 4 to 12 days (6.83±2.59 days). JOA scores improved significantly from a preoperative median of 9.00(8.00, 10.00) to 12.00(11.00, 14.00) at 1 week, 13.00(12.00, 14.00) at 1 month, and 15.00(15.00, 16.00) at 3 months postoperatively (χ 2=220.492, P<0.001). VAS scores for neck and shoulder pain also improved significantly from a preoperative median of 5.00(4.00, 6.00) to 3.00(2.00, 3.00) at 1 week, 2.00(2.00, 3.00) at 1 month, and 2.00(1.00, 2.00) at 3 months postoperatively (χ 2=170.869, P<0.001). No postoperative complications such as dysphagia, hoarseness, nerve injury, cerebrospinal fluid leakage, or intraspinal hematoma were observed. Imaging revealed no significant prevertebral soft tissue edema. At the final follow-up, the improvement rate of JOA scores resulted in 14 cases rated as excellent and 9 as good. Conclusions:ACDF using a cervical soft endoscopic minimally invasive system demonstrates satisfactory clinical outcomes for the treatment of two-segment CSM. This technique reduces the incidence of common complications associated with both open and traditional endoscopic surgeries.

Objective:To investigate the early clinical outcomes of anterior cervical discectomy and fusion (ACDF) in the treatment of two-segment cervical spondylotic myelopathy (CSM) using a cervical soft endoscopic minimally invasive system.Methods:A retrospective follow-up study was conducted on the medical records of 23 patients with two-segment cervical myelopathy who underwent ACDF using a soft endoscopic cervical spine minimally invasive system at the Third Affiliated Hospital of Southern Medical University between October 2022 and December 2023. The cohort included 15 males and 8 females, aged 37-79 years (58.52±11.77 years). The affected cervical segments included: C 3, 4 and C 4, 5 in 2 cases; C 3, 4 and C 5, 6 in 3 cases; C 4, 5 and C 5, 6 in 10 cases; C 5, 6 and C 6, 7 in 7 cases; and C 4, 5 and C 6, 7 in 1 case. Clinical outcomes were evaluated based on the Japanese Orthopaedic Association (JOA) scores and visual analog scale (VAS) for neck and shoulder pain, assessed preoperatively and at 1 week, 1 month, and 3 months postoperatively. Additional data recorded included incision length, intraoperative blood loss, operative time, postoperative complications, and the presence of prevertebral soft tissue edema. The improvement rate of JOA scores at the final follow-up was also calculated. Results:All patients successfully underwent surgery and completed follow-up, with follow-up durations ranging from 3 to 6 months (4.01±0.98 months). The mean operative time was 80.09±22.66 min (range: 53-127 min), and the mean incision length was 3.25±0.32 cm (range: 3-4 cm). Estimated blood loss ranged from 10 to 100 ml, with a mean of 34.78±24.1 ml. Postoperative drainage ranged from 0 to 80 ml (mean: 23.13±26.1 ml), and postoperative hospitalization durations ranged from 4 to 12 days (6.83±2.59 days). JOA scores improved significantly from a preoperative median of 9.00(8.00, 10.00) to 12.00(11.00, 14.00) at 1 week, 13.00(12.00, 14.00) at 1 month, and 15.00(15.00, 16.00) at 3 months postoperatively (χ 2=220.492, P<0.001). VAS scores for neck and shoulder pain also improved significantly from a preoperative median of 5.00(4.00, 6.00) to 3.00(2.00, 3.00) at 1 week, 2.00(2.00, 3.00) at 1 month, and 2.00(1.00, 2.00) at 3 months postoperatively (χ 2=170.869, P<0.001). No postoperative complications such as dysphagia, hoarseness, nerve injury, cerebrospinal fluid leakage, or intraspinal hematoma were observed. Imaging revealed no significant prevertebral soft tissue edema. At the final follow-up, the improvement rate of JOA scores resulted in 14 cases rated as excellent and 9 as good. Conclusions:ACDF using a cervical soft endoscopic minimally invasive system demonstrates satisfactory clinical outcomes for the treatment of two-segment CSM. This technique reduces the incidence of common complications associated with both open and traditional endoscopic surgeries.

Objective:To compare the biomechanical stability of a novel interlocking intramedullary nail (nIMN) with that of a traditional interlocking intramedullary nail (tIMN) in the treatment of type AO 32-A3 femoral shaft fractures using a finite element analysis.Methods:A healthy adult male volunteer, aged 30 years old and weighing 70 kg, was selected for collection of his CT scan data of the femur. A three-dimensional finite element model of the femur was established using software Mimics 17.0 and Geomagic Studio. After femoral shaft fractures of AO/OTA types 32-A3a, 32-A3b, and 32-A3c were simulated, nIMN and tIMN were assembled respectively. After boundary conditions and material properties of the models were set based on reference literature, 4 load states were simulated: vertical standing, slow walking, fast walking, and descending stairs. The displacements and stress distribution at the femoral fracture ends under the same conditions were compared between nIMN and tIMN schemes of fixation. The stabilities of each fracture model at different fixation schemes and load states were analyzed.Results:In the 4 load states simulated, the displacements of the fracture ends averaged 0.129 mm, and the maximum stresses 111.00 MPa. The smallest displacement and maximum stress (0.014 mm and 29.48 MPa) were found in the vertical standing in the femoral shaft fracture of type 32-A3c fixed with nIMN. The largest displacement and maximum stress (0.325 mm and 242.98 MPa) were found in descending stairs in the femoral shaft fracture of type 32-A3a fixed with tIMN. In femoral shaft fractures of types 32-A3a, 32-A3b, and 32-A3c, regardless of tIMN or nIMN fixation, the displacement and maximum stress increased with the load, with the femoral shaft fracture of type 32-A3a being particularly evident. nIMN fixation resulted in lower displacements and maximum stresses in AO/OTA types 32-A3a, 32-A3b, and 32-A3c than tIMN fixation. Taking descending stairs as an example, the overall maximum stress occurred on the proximal part of the femur and the surrounding area of Adams'arc, with the maximum stress fluctuating between 86.62 and 242.98 MPa. The maximum stress at the fracture end fluctuated between 0.44 and 56.49 MPa. The stress mainly concentrated on the medial part, and decreased from type 32-A3a to type 32-A3b to type 32-A3c.Conclusion:In type AO 32-A3 femoral shaft fractures, nIMN leads to a smaller fracture end displacement and a lower maximum stress than tIMN, indicating better rotational stability.

Objective:To investigate the impact of sliding distance of the fmoral neck system (FNS) on the curative efficacy of displaced femoral neck fractures.Methods:A retrospective study was conducted to analyze the clinical data of the 179 patients with displaced femoral neck fracture who had been treated by FNS fixation at Department of Orthopaedics, The Second General Hospital of Fuzhou between September 2019 and September 2023. Based on the FNS sliding distance measured on X-ray films on the day after surgery or one day after surgery, the patients were assigned into 2 groups: a short sliding distance group [sliding distance ≤5 mm, n=55; 35 males, 20 females; median age: 50.0 (34.0, 59.0) years; body mass index (BMI): (24.0±2.4) kg/m 2] and a long sliding distance group [5 mm 0.05). At postoperative 3, 6, and 12 months, the distances of femoral neck shortening in the short sliding distance group [2.5 (0.7, 3.5) mm, 2.6 (0.7, 3.5) mm, and 2.7 (0.7, 3.5) mm] were significantly shorter than those in the long sliding distance group [3.2 (1.3, 5.7) mm, 3.2 (1.3, 7.1) mm, and 3.2 (1.4, 7.1) mm] ( P<0.05). The incidence of moderate-to-severe shortening at one year after surgery in the long sliding distance group [26.6% (33/124)] was significantly higher than that in the short sliding distance group [3.6%(2/55)] ( P<0.05). No significant differences were found between the 2 groups in tip-apex distance, operation time, intraoperative blood loss, fracture reduction quality, fracture healing time, or incidence of complications ( P>0.05). At the last follow-up, the Harris Hip Score in the short sliding distance group [93.5 (88.7, 96.2) points] was significantly higher than that in the long sliding distance group [90.1 (82.9, 94.9) points] ( P<0.05). Conclusion:In the treatment of displaced femoral neck fractures with FSN fixation, compared with those with a long sliding distance, the patients with a short sliding distance demonstrate superior outcomes in postoperative femoral neck shortening and functional recovery of the hip, but no significant difference in the incidence of complications.

Objective:To report the 5-year survival outcomes and recurrence patterns of robotic total gastrectomy (RTG) for locally advanced proximal gastric cancer in order to provide more valuable long-term follow-up results for clinical practice.Methods:This was a prospective, single-arm, open-label clinical trial (FUGES-014; Clinical-Trials.gov, NCT03524287). Patients with locally advanced proximal gastric cancer who underwent RTG at Fujian Medical University Union Hospital from March 5, 2018, to February 10, 2020, were included in the analysis. To evaluate the long-term efficacy of RTG in the most objective manner possible, we performed a propensity score-matched (1∶2) comparative analysis with historical control patients who had undergone laparoscopic total gastrectomy (LTG) from the FUGES-002 study (ClinicalTrials.gov, NCT02333721) in which the 5-year disease-free survival (DFS), 5-year overall survival (OS), and recurrence patterns were compared between the two groups.Results:Prior to matching, there were 48 cases in the RTG group and 263 cases in the LTG group; patients in the LTG group had more advanced cT and pT stages ( P=0.044 and 0.006, respectively) compared to the RTG group. After matching, there were 48 cases in the RTG group and 96 cases in the LTG group; however, no statistically significant differences were observed in the baseline clinical characteristics between the two groups (all P>0.05). Both groups had a median follow-up of 72 months. The 5-year DFS rates were 75.0% (95%CI: 63.7%- 88.3%) in the RTG group and 61.4% (95%CI: 52.5%-72.0%) in the LTG group ( P=0.116). Similarly, the 5-year OS rates were 79.2% (95%CI: 68.5%-91.5%) and 64.6% (95%CI: 55.7%-74.9%) in the RTG and LTG groups, respectively ( P=0.100). Within 5 years after surgery, tumor recurrence occurred in 10 patients (20.8%) in the RTG group and 33 patients (34.4%) in the LTG group ( P=0.124), and peritoneal recurrence was the predominant pattern in both groups (8.3%[4/48] vs. 10.4%[10/96]; risk difference: -0.02, P=0.554). Gastric cancer-related death was the predominant cause of death in both groups (16.7% [8/48] vs. 31.2% [30/96]; risk difference: -0.15, P=0.064). Among patients stratified by different pathological stages, no statistically significant differences were found in DFS, OS, or recurrence rates between the RTG and LTG groups (all P>0.05). Conclusions:We find the long-term oncological outcomes of RTG for locally advanced proximal gastric cancer to be noninferior to those of LTG. RTG should therefore be considered as a valid option for standardized minimally invasive surgery for locally advanced proximal gastric cancer.

Objective:To report the 5-year survival outcomes and recurrence patterns of robotic total gastrectomy (RTG) for locally advanced proximal gastric cancer in order to provide more valuable long-term follow-up results for clinical practice.Methods:This was a prospective, single-arm, open-label clinical trial (FUGES-014; Clinical-Trials.gov, NCT03524287). Patients with locally advanced proximal gastric cancer who underwent RTG at Fujian Medical University Union Hospital from March 5, 2018, to February 10, 2020, were included in the analysis. To evaluate the long-term efficacy of RTG in the most objective manner possible, we performed a propensity score-matched (1∶2) comparative analysis with historical control patients who had undergone laparoscopic total gastrectomy (LTG) from the FUGES-002 study (ClinicalTrials.gov, NCT02333721) in which the 5-year disease-free survival (DFS), 5-year overall survival (OS), and recurrence patterns were compared between the two groups.Results:Prior to matching, there were 48 cases in the RTG group and 263 cases in the LTG group; patients in the LTG group had more advanced cT and pT stages ( P=0.044 and 0.006, respectively) compared to the RTG group. After matching, there were 48 cases in the RTG group and 96 cases in the LTG group; however, no statistically significant differences were observed in the baseline clinical characteristics between the two groups (all P>0.05). Both groups had a median follow-up of 72 months. The 5-year DFS rates were 75.0% (95%CI: 63.7%- 88.3%) in the RTG group and 61.4% (95%CI: 52.5%-72.0%) in the LTG group ( P=0.116). Similarly, the 5-year OS rates were 79.2% (95%CI: 68.5%-91.5%) and 64.6% (95%CI: 55.7%-74.9%) in the RTG and LTG groups, respectively ( P=0.100). Within 5 years after surgery, tumor recurrence occurred in 10 patients (20.8%) in the RTG group and 33 patients (34.4%) in the LTG group ( P=0.124), and peritoneal recurrence was the predominant pattern in both groups (8.3%[4/48] vs. 10.4%[10/96]; risk difference: -0.02, P=0.554). Gastric cancer-related death was the predominant cause of death in both groups (16.7% [8/48] vs. 31.2% [30/96]; risk difference: -0.15, P=0.064). Among patients stratified by different pathological stages, no statistically significant differences were found in DFS, OS, or recurrence rates between the RTG and LTG groups (all P>0.05). Conclusions:We find the long-term oncological outcomes of RTG for locally advanced proximal gastric cancer to be noninferior to those of LTG. RTG should therefore be considered as a valid option for standardized minimally invasive surgery for locally advanced proximal gastric cancer.

Objective:To compare the biomechanical stability of a novel interlocking intramedullary nail (nIMN) with that of a traditional interlocking intramedullary nail (tIMN) in the treatment of type AO 32-A3 femoral shaft fractures using a finite element analysis.Methods:A healthy adult male volunteer, aged 30 years old and weighing 70 kg, was selected for collection of his CT scan data of the femur. A three-dimensional finite element model of the femur was established using software Mimics 17.0 and Geomagic Studio. After femoral shaft fractures of AO/OTA types 32-A3a, 32-A3b, and 32-A3c were simulated, nIMN and tIMN were assembled respectively. After boundary conditions and material properties of the models were set based on reference literature, 4 load states were simulated: vertical standing, slow walking, fast walking, and descending stairs. The displacements and stress distribution at the femoral fracture ends under the same conditions were compared between nIMN and tIMN schemes of fixation. The stabilities of each fracture model at different fixation schemes and load states were analyzed.Results:In the 4 load states simulated, the displacements of the fracture ends averaged 0.129 mm, and the maximum stresses 111.00 MPa. The smallest displacement and maximum stress (0.014 mm and 29.48 MPa) were found in the vertical standing in the femoral shaft fracture of type 32-A3c fixed with nIMN. The largest displacement and maximum stress (0.325 mm and 242.98 MPa) were found in descending stairs in the femoral shaft fracture of type 32-A3a fixed with tIMN. In femoral shaft fractures of types 32-A3a, 32-A3b, and 32-A3c, regardless of tIMN or nIMN fixation, the displacement and maximum stress increased with the load, with the femoral shaft fracture of type 32-A3a being particularly evident. nIMN fixation resulted in lower displacements and maximum stresses in AO/OTA types 32-A3a, 32-A3b, and 32-A3c than tIMN fixation. Taking descending stairs as an example, the overall maximum stress occurred on the proximal part of the femur and the surrounding area of Adams'arc, with the maximum stress fluctuating between 86.62 and 242.98 MPa. The maximum stress at the fracture end fluctuated between 0.44 and 56.49 MPa. The stress mainly concentrated on the medial part, and decreased from type 32-A3a to type 32-A3b to type 32-A3c.Conclusion:In type AO 32-A3 femoral shaft fractures, nIMN leads to a smaller fracture end displacement and a lower maximum stress than tIMN, indicating better rotational stability.

Objective:To investigate the impact of sliding distance of the fmoral neck system (FNS) on the curative efficacy of displaced femoral neck fractures.Methods:A retrospective study was conducted to analyze the clinical data of the 179 patients with displaced femoral neck fracture who had been treated by FNS fixation at Department of Orthopaedics, The Second General Hospital of Fuzhou between September 2019 and September 2023. Based on the FNS sliding distance measured on X-ray films on the day after surgery or one day after surgery, the patients were assigned into 2 groups: a short sliding distance group [sliding distance ≤5 mm, n=55; 35 males, 20 females; median age: 50.0 (34.0, 59.0) years; body mass index (BMI): (24.0±2.4) kg/m 2] and a long sliding distance group [5 mm 0.05). At postoperative 3, 6, and 12 months, the distances of femoral neck shortening in the short sliding distance group [2.5 (0.7, 3.5) mm, 2.6 (0.7, 3.5) mm, and 2.7 (0.7, 3.5) mm] were significantly shorter than those in the long sliding distance group [3.2 (1.3, 5.7) mm, 3.2 (1.3, 7.1) mm, and 3.2 (1.4, 7.1) mm] ( P<0.05). The incidence of moderate-to-severe shortening at one year after surgery in the long sliding distance group [26.6% (33/124)] was significantly higher than that in the short sliding distance group [3.6%(2/55)] ( P<0.05). No significant differences were found between the 2 groups in tip-apex distance, operation time, intraoperative blood loss, fracture reduction quality, fracture healing time, or incidence of complications ( P>0.05). At the last follow-up, the Harris Hip Score in the short sliding distance group [93.5 (88.7, 96.2) points] was significantly higher than that in the long sliding distance group [90.1 (82.9, 94.9) points] ( P<0.05). Conclusion:In the treatment of displaced femoral neck fractures with FSN fixation, compared with those with a long sliding distance, the patients with a short sliding distance demonstrate superior outcomes in postoperative femoral neck shortening and functional recovery of the hip, but no significant difference in the incidence of complications.

AIM: To investigate the influencing factors of corneal edema after phacoemulsification combined with intraocular lens(IOL)implantation in middle-aged and elderly patients with diabetic cataract, reducing postoperative complications of cataract in such patients.METHODS: A total of 198 middle-aged and elderly patients(226 eyes)with diabetic cataract who underwent phacoemulsification combined with IOL implantation in Zhongxian People's Hospital of Chongqing from August 2021 to June 2023 were retrospectively analyzed, and they were divided into corneal edema group(n=53)and non-corneal edema group(n=173)according to their postoperative corneal edema. Baseline data were collected and compared between the two groups, and the operation-related indexes such as preoperative corneal thickness, endothelial cell density, operation time and effective phaco time were recorded and compared between the two groups. The influencing factors of corneal edema were analyzed by multivariate Logistic model, and the risk nomogram was drawn.RESULTS: The age distribution of patients ≥60 years old in the corneal edema group was significantly higher than that in the non-corneal edema group, the duration of diabetes mellitus in the corneal edema group was significantly longer than that in the non-corneal edema group, and the lens nuclear hardness grade was significantly higher than that in the non-corneal edema group(all P<0.05). The changes in endothelial cell density in the corneal edema group were significantly higher than those in the non-corneal edema group(P<0.05); compared with the non-corneal edema group, the patients in the corneal edema group had a longer operation time and a longer effective phaco time(all P<0.05). Age, duration of diabetes mellitus, lens nuclear stiffness grade, operation time and effective phaco time were the risk factors for corneal edema after surgery(all P<0.05). When the total score of the patient risk nomogram is 150 points, the risk of corneal edema after surgery is about 65%.CONCLUSION: The factors influencing the occurrence of corneal edema after phacoemulsification combined with IOL implantation include age, duration of diabetes, lens nuclear stiffness, operation duration and effective phaco time.

Objective:To investigate the risk factors and prognostic value of the textbook outcome (TO) in patients with advanced gastric cancer (AGC) who underwent neoadjuvant chemotherapy followed by surgical resection.Methods:This is a retrospective cohort study. A total of 253 patients with AGC who underwent neoadjuvant chemotherapy combined with gastrectomy and D2 lymphadenectomy in the Department of Gastric Surgery, Fujian Medical University Union Hospital from January 2010 to December 2019 were retrospectively included. There were 195 males and 58 females, aged (60.3±10.0) years (range: 27 to 75 years). The patients were then divided into the TO group ( n=168) and the non-TO group ( n=85). Multivariate Logistic regression was used to analyze the independent predictors of TO. Univariate and multivariate Cox analysis were used to analyze independent prognosis factors for overall survival (OS) and disease-free survival (DFS). Propensity score matching was performed to balance the TO and non-TO groups, and the Kaplan-Meier method was used to calculate survival rates and draw survival curves. Results:Among the 253 patients, 168 patients (66.4%) achieved TO. The Eastern Cooperative Oncology Group score ( OR=0.488, 95% CI: 0.278 to 0.856, P=0.012) and ypN stage ( OR=0.626, 95% CI:0.488 to 0.805, P<0.01) were independently predictive of TO. Multivariate analysis revealed that TO was an independent risk factor for both OS ( HR=0.662, 95% CI: 0.457 to 0.959, P=0.029) and DFS ( HR=0.687, 95% CI: 0.483 to 0.976, P=0.036). After matching, the 5-year OS rate (42.2% vs. 27.8%) and the 5-year DFS rate (37.5% vs. 27.8%) were significantly higher in the TO group than in the non-TO group (both P<0.05). Furthermore, patients in the non-TO group benefited significantly from postoperative chemotherapy (both P<0.05), but those in the TO group did not (both P>0.05). Conclusion:TO is an independent prognosis factor in patients undergoing neoadjuvant chemotherapy and surgery for AGC and is associated with postoperative chemotherapy benefits.