Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

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.

Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of OVCF patients with suspected or confirmed COVID-19, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of patients with OVCF diagnosed with COVID-19, the authors jointly develop this expert consensus. The consensus systematically recommends the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures based on the different types and epidemic prevention and control requirements.

Objective:To investigate the clinical efficacy of locking proximal femur plates (LPFP) revision and artificial hip joint revision after failure of proximal femoral nail antirotation (PFNA) internal fixation in elderly patients with intertrochanteric fracture.Methods:A retrospective case control study was conducted on the clinical data of 43 patients with PFNA internal fixation failure in the elderly admitted to Henan Provincial People's Hospital between March 2014 and October 2018. There were 23 males and 20 females, aged 65-83 years [(71.2±2.0)years]. The course of disease was 60-267 days [(83.1±3.6)days]. According to Evans classification, there were 11 patients with type II fractures, 13 with type III and 19 with type IV. There were 23 patients in artificial hip joint revision group and 20 patients in LPFP revision group. The operation time, intraoperative blood loss, postoperative hospitalization time, total hospitalization time, Harris score and complications were recorded and evaluated in two groups.Results:All patients were followed up for 12-28 months, with an average of 13.6 months. Between artificial joint revision group and LPFP revision group, the operation time and intraoperative blood loss were similar ( P>0.05), but there were significant difference in postoperative hospitalization time [(7.1±3.2)days vs. (13.2±2.9)days] and total hospitalization time [(10.2±2.8)days vs. (16.4±3.4)days] ( P<0.05). In artificial joint revision group, the Harris hip score was (21.1±3.7)points preoperatively, and was respective (70.7±4.8)points, (74.6±4.1)points, (78.6±3.3)points, (82.9±5.2)points, (83.8±5.8)points and (84.9±6.4)points at postoperative 1, 2, 3, 6, 9, 12 months. In LPFP revision group, the Harris score was (21.7±3.2)points preoperatively, and was respective (59.9±2.1)points, (64.79±3.4)points, (70.1±4.2)points, (73.9±4.2)points, (76.2±6.3)points and (77.9±6.8)points at postoperative 1, 2, 3, 6, 9, 12 months. The Harris score in artificial joint revision group was gradually improved compared with LPFP revision group ( P<0.05). One patient with superficial wound infection occurred in each group, and the wound healed after frequent dressing changes. Distal femoral fractures occurred in one patient of artificial joint revision group and distal femoral fractures in three patients of LPFP revision group, but all patients were healed after being fixed with wire. Conclusion:For elderly patients with PFNA internal fixation failure of intertrochanteric fracture, artificial hip revision has shorter hospital stay and better hip joint function recovery than LPFP internal fixation, although the effect in operation time and intraoperative blood loss are similar.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Objective To investigate the effect of pressure ulcer risk warning system in the pressure ulcer management in patients undergoing thoracolumbar fracture surgery.Methods A retrospective case control study was performed to analyze the clinical data of 120 patients with thoracolumbar fracture who underwent posterior thoracolumbar pedicle screw fixation and intervertebral bone graft fusion surgery at People's Hospital of Henan Province from October 2016 to September 2018.There were 76 males and 44 females,aged 45-80 years [(59.2 ± 7.2) years].A total of 60 patients received treatment and care under the pressure ulcer early warning system (early warning group),while 60 patients were given assessment form for pressure ulcer management (control group).The time of filling in the assessment form,the implementation score of pressure ulcer prevention measures,the incidence of pressure ulcer,visual analogue pain score (VAS) and patient satisfaction were compared between the two groups.Results In the control group and early warning group,the time of filling in the form was (121.5 ± 9.0) minutes and (11.3 ± 2.0) minutes (P ＜ 0.01),the implementation score of pressure ulcer prevention measures was (85.9 ± 3.8) points and (96.0 ± 2.2)points (P ＜ 0.01),and the pressure ulcer incidence was 25％ (15 patients) and 3％ (two patients),respectively (P ＜0.01).In the control group,the preoperative VAS was (7.3 ± 1.3) points,and the VAS at 6 hours,24 hours,48 hours,72 hours after operation were (3.7 ± 1.1) points,(3.2 ± 0.9) points,(2.4 ± 1.0) points,(2.3 ± 0.8) points,respectively.In the early warning group,the preoperative VAS was (7.4 ± 1.3) points,and the VAS at 6 hours,24 hours,48 hours,72 hours after operation were (2.9 ± 0.7) points,(2.4 ± 0.7) points,(1.8 ± 0.7) points,(1.6 ± 0.8) points,respectively.There was no significant difference in preoperative VAS between the two groups (P ＞ 0.05),while significant differences were found between the postoperative VAS (P ＜ 0.01).The satisfaction score in the control group was (94.6 ± 1.4) points,while that of the early warning group was (98.3 ± 1.1) points (P ＜ 0.01).Conclusion For patients undergoing posterior thoracolumbar pedicle screw fixation and intervertebral bone graft fusion surgery,the pressure ulcer risk warning system is convenient and reduces the incidence of pressure ulcer,thus alleviating patients'pain and improving patients' satisfaction.

Objective To evaluate the curative effect of endovascular treatment for Leriche syndrome.Methods The clinical data of 57 patients with Leriche syndrome,who were admitted to authors' hospital during the period from September 2010 to October 2014,were retrospectively analyzed.The curative effect of percutaneous transluminal angioplasty (PTA) was analyzed.Results Among the 57 patients (65 diseased limbs in total),simple PTA was employed in 2,catheter directed thrombolysis (CDT) with subsequent PTA and stenting in 5,and PTA plus stenting in 50.A total of 97 stents were implanted,the technical success rate was 100％.After the treatment,the ankle brachial index (ABI) increased from preoperative (0.42±0.22) to postoperative (0.83±0.15),the difference between the two data was statistically significant (P＜0.01).Thepatients were followed up for (9.8±2.8) months.The 6-month and 12-month primary patency rates were 95.4％ and 90.7％ respectively,the postoperative secondary patency rate was 96.4％.After the treatment,the symptoms of lower limb ischemia were improved in all patients.During perioperative period,iliac artery rupture due to balloon dilatation occurred in 2 patients,pseudoaneurysm at brachial aaery puncture point in one patient,hematoma at puncture point in 3 patients,cerebral infarction in 2 patients and myocardial infarction in one patient.One patient developed contrast-induced nephropathy and finally died of multiple organ dysfunction syndrome.The perioperative mortality was 1.75％.One patient developed in-stent obstruction in 3 months after two stage treatment,and artificial vascular bypass grafting had to be carried out.Conclusion For the treatment of Leriche syndrome,PTA is safe and reliable,it carries less complications and lower perioperative mortality with satisfactory short-term patency rate.(J Intervent Radiol,2017,26:221-224)

In order to explore the pathogenic characters,diagnosis and treatment of canine leptospirosis,a retrospective analysis of the pathogenetic factor,diagnosis and treatment of three dogs were reported which diagnosed as canine leptospirosis in China Agricultural University Teaching Animal Hospital from August to November,2015.The infected dogs showed symptoms of depressed,jaundice,anorexia and vomiting.Two of them had fever history and contacted the water resource outside before getting ill.All three dogs were confirmed anemia,liver and kidney damage by laboratory examination.They were diagnosed with canine leptospirosis according to the positive results of the Leptospira PCR examination base on urine.During the diagnosis and treatment process,one of them was dead,the rest two recovered after antibiotic and symptomatic therapy.In conclusion,dogs which infected with leptospirosis may have a contact with the infected water before.The Leptospira PCR examination base on urine can be used for the diagnosis method of the disease.As to treatment,the use of penicillin and tetracycline drugs such as doxycycline is recommended.