Objective:To assess the clinical outcomes of hip arthroscopy in patients with concurrent femoroacetabular impingement (FAI) and subspine impingement (SSI).Methods:Data were retrospectively reviewed for patients with both FAI and SSI who underwent hip arthroscopy surgery from August 2021 to May 2022. A total of 23 patients (23 hips) followed up for more than 1 year, including 10 males and 13 females, 9 left hips and 14 right hips, with an average age of 31.3±4.6 years (range, 25-45 years). Subspine decompression by anterior inferior spine (AIIS) shaping for SSI was performed during hip arthroscopy in addition to labral repair and bony correction for FAI in the patients with concurrent FAI and SSI. Clinical outcomes were evaluated using preoperative and 1-year postoperative measures: lateral center-edge (LCE) angle, α angle on 45° Dunn view X-rays, maximum hip flexion angle, hip flexion and knee extension strength, visual analogue scale (VAS) for pain, modified Harris Hip Scores (mHHS), and International Hip Outcome Tool-12 (iHOT-12).Results:Of the 23 patients, 20 had type 2 AIIS and 3 had type 3 AIIS. At 1-year follow-up after surgery, there were significant improvements: LCE angle decreased (33.3°±6.1° to 31.7°±4.1°, t=1.076, P=0.288), α angle reduced (63.7°±8.5° to 50.0°±6.6°, t=6.116, P<0.001), hip flexion angle increased (107.4°±6.0° to 120.2°±4.4°, t=8.269, P<0.001), VAS scores decreased (4.0±1.1 to 1.0±1.1, t=9.591, P<0.001), mHHS improved (62.6±4.9 to 87.5±8.1, t=12.700, P<0.001), and iHOT-12 scores rose (51.4±4.9 to 75.7±7.7, t=12.593, P<0.001). There was no significant difference in the strength of hip flexion and knee extension between preoperative and follow-up ( t=0.930, P=0.357 and t=0.050, P=0.960, respectively). There were no reports of traction-related complications (such as skin necrosis and nerve paralysis), severe adverse events (such as femoral neck fractures, deep vein thrombosis in the lower limbs, intra-articular infections, ectopic ossification and hip instability), or the need for revision surgery. Conclusion:Subspine decompression by anterior inferior spine (AIIS) shaping for SSI during conventional hip arthroscopy is safe and effective, enhancing hip function and alleviating pain at 1-year follow-up without significant complications.

Objective:To investigate the efficacy of programmed death receptor-1(PD-1)/ programmed death-ligand 1 (PD-L1) inhibitors in the treatment of recurrent or metastatic cervical cancer and its effect on serum levels of squamous cell carcinoma antigen (SCC-Ag), carcinoembryonic antigen (CEA), and carbohydrate antigen 125 (CA125) in patients.Methods:This study was a retrospective study. Ninety patients with cervical cancer treated at Lishui Municipal Central Hospital between January 2019 and December 2022 were randomly divided into two groups. Forty-five patients in the control group received routine radiotherapy and chemotherapy, while forty-five patients in the observation group received PD-1/PD-L1 inhibitors in addition to the treatment provided to the control group. The effectiveness and safety were compared between the two groups.Results:The effectiveness in the observation group was superior to that in the control group ( P < 0.05). After treatment, the levels of serum tumor markers, including SCC-Ag, CA125, CEA, and human epididymal protein 4, were significantly lower in the observation group compared with the control group ( t = 5.44, 6.20, 14.74, 4.06, all P < 0.001). After treatment, the levels of interferon-γ, interleukin-2, and interleukin-6 in the observation group were significantly lower compared with the control group ( t = 6.24, 8.95, 8.38, all P < 0.001). After treatment, the levels of CD 3+, CD 4+, and CD 4+/CD 8+ in the observation group were significantly higher compared with those in the control group ( t = 8.82, 6.53, 5.27, all P < 0.001). After treatment, the Functional Assessment of Cancer Therapy-Cervix score in the observation group was significantly higher than that in the control group ( t = 4.35, 4.35, 5.17, 5.24, all P < 0.001). The incidence of various adverse reactions in the observation group was significantly lower than that in the control group ( χ2 = 3.85, 3.87, 5.08, 4.44, all P < 0.05). The cumulative survival rate in the observation group was significantly higher than that in the control group [60.00% (27/45) vs. 40.00% (18/45), P < 0.05]. The median survival time in the observation group was significantly longer than that in the control group (365 days vs. 222 days, P < 0.05). Conclusion:PD-1/PD-L1 inhibitors are effective in the treatment of recurrent or metastatic cervical cancer. They can reduce the serum levels of SCC-Ag, CEA, and CA125, prolong the survival time of patients, and improve their quality of life.

Autologous ozonized blood transfusion(AOBT) is a therapy of re-transfusion of 100-200 mL of autologous blood after shaking and agitation with appropriate amount of oxygen-ozone in vitro. The oxidation of blood through the strong oxidation of ozone can enhance the non-specific immune response of the body, regulate the internal environment and promote health. This therapy has been increasingly applied in clinical practice, while no unified standard for the operation process in terms of ozone concentration, treatment frequency and treatment course had been established. This operation process of AOBT is primarily explored in order to standardize the operation process and ensure its safety and efficacy.

Objective:To investigate the medium to long-term clinical outcomes of arthroscopic treatment for femoral acetabular impingement (FAI) without capsular closure.Methods:A retrospective analysis was performed on 62 patients (63 hips) with FAI who underwent hip arthroscopy in Huashan Hospital Affiliated to Fudan University from February 2015 to June 2018. There were 29 male patients (30 hips) and 33 female patients (33 hips) with an average age of 43.08±8.88 years. Thirty-two surgeries were performed on the left hip, thirty-one on the right, and one patient underwent bilateral surgery. All 62 patients underwent arthroscopic surgery without capsular closure. The preoperative and postoperative final follow-up assessments included the hip outcome score-activity of daily living scale (HOS-ADL), hip outcome score-sport specific subscale (HOS-SSS), Harris hip score (HHS), University of California at Los Angeles (UCLA) score, Non arthritic hip score (NAHS), visual analogue scale (VAS) for pain, and observation of complications.Results:All the patients completed the operation successfully, and the surgical incisions healed well. No complications such as wound infection, local incisional hematoma, local skin redness, lateral femoral cutaneous nerve injury, or perineal crush injury occurred in any one case. All 62 patients were followed up for 71 (60, 100) months. The VAS before surgery was 6 (0, 10) points and 1 (0, 6) point at the last follow-up, with statistical significance ( Z=-6.81, P<0.001). Preoperative scores were as follows: HOS-ADL: 78.03±5.30; HOS-SSS: 59.88±12.51; HHS: 78.98±7.50; UCLA: 2.00 (2.00, 5.00); NAHS: 83.75 (81.25, 97.50). Postoperative final follow-up scores were as follows: HOS-ADL: 94.77±4.79; HOS-SSS: 79.89±9.07; HHS: 90.75±5.59; UCLA: 4.00 (3.00, 6.00); NAHS: 92.50 (88.75, 98.75). At the final follow-up, HOS-ADL ( t=19.10, P<0.001), HOS-SSS ( t=12.29, P<0.001), HHS ( t=11.21, P<0.001), UCLA ( Z=-6.92, P<0.001), and NAHS ( Z=-6.52, P<0.001) showed significant improvement. Until the end of the follow-up period, no patients underwent revision surgery or hip arthroplasty on the treated hip. Conclusion:For patients with FAI without developmental dysplasia of the hip and generalized ligament laxity, arthroscopic treatment without capsular closure yields favorable medium to long-term clinical outcomes.

The anterior cruciate ligament (ACL) injury is a common sports injury that has a significant impact on knee function and patients′ mobility. With the popularity of national fitness campaign in China, the incidence of ACL injury is increasing year by year. Currently, there still lacks clinical standards or guidelines on how to choose appropriate treatment methods, surgical plans and rehabilitation protocols for ACL injury. In order to timely reflect the new treatment concept of ACL injury, standardize its diagnosis and treatment and improve the curative effect, the Sports Medicine Society of Chinese Research Hospital Association and the Editorial Board of Chinese Journal of Trauma organized domestic orthopedic and sports medicine experts to formulate the "clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version)" based on the level of evidence-based medicine and in compliance with the principle of scientificity, practicability and advancement. The present guideline includes 12 recommendations for the diagnosis, treatment and rehabilitation of ACL injury in order to provide guidance and assistance for the clinical diagnosis and treatment of ACL injury in China.

Femoroacetabular impingement (FAI) is a common cause of hip pain and limited range of motion among young and middle-aged active adults and athletes. The acetabular labral tear and cartilage damage secondary to FAI may increase the risk of hip osteoarthritis. FAI is characterized by pathologic impact between the femoral headneck junction and the acetabular rim secondary to bony deformity. According to the pathological anatomy leading to impingement, the FAI can be divided into the femoral cam-type deformity (Cam), the acetabular over-coverage deformity (Pincer) and a combination of both. In recent years, arthroscopic osteoplasty of the femoral head-neck junction is the main way to treat the Cam deformity; However, there still remain some controversies about how to perform an adequate and effective arthroscopic femoroplasty. Based on this problem, the present article reviewed the preoperative diagnosis, intraoperative evaluation, surgical techniques and postoperative evaluation of Cam-type FAI to explore how to adequately correct Cam deformity under arthroscopy. In the present study, a total of 1928 related articles were obtained by searching PubMed, Web of Science, Cochrane library, China Knowledge Network, Wanfang Full-text Database and Weipu Science and Technology Journal Database. According to the inclusion and exclusion criteria, 43 papers were finally included. After summarizing the above literatures, it was found that anatomical structures such as Cam deformity, femoral neck anteversion, and acetabular coverage can be evaluated preoperatively by X-ray, three-dimensional CT and MRI. X-ray fluoroscopy and arthroscopic dynamic examination are performed during the femoroplasty to locate the Cam deformity and to determine whether the femoral neck offset radio and the spherical structure of femoral head are corrected, at the same time, it is necessary to consider the overall anatomy of the hip joint to achieve an adequate resection of the Cam deformity and restore the normal mobility of the hip joint.

Objective To assess the bone tunnel area at different times and sites of the tunnel after the anterior cruciate ligament(ACL) reconstruction in rabbits using Micro-CT.Methods Fifteen rabbits were performed ACL reconstruction using semitendinosus tendon autograft and randomly allocated into 3 groups and killed at 3,6,and 12 weeks after the operation.All samples undertook the micro-CT scanning(using SkyScan 1176,Bruker,U.S.A.) and were analyzed the areas of bone tunnels of femur and tibia after the 3-demension image rebuilding.For each tunnel,the area of the entrance,middle and exit of the tunnel were measured 3 times respectively and compared.Results The average area of the femoral tunnel did not change significantly with time,being 4.84 mm2,4.57 mm2 and 4.46 mm2 at 3,6 and 12 weeks after the operation(P=0.99).At the very beginning,the femoral tunnel area at the entrance was the biggest,while that of the middle was the smallest.Six weeks after the operation,significant differences were observed between the femoral tunnel area at the entrance and middle,as well as that between the exit and middle(P=0.0011,P=0.0106);However,12 weeks after the operation,significant differences were observed only between that at the entrance and middle(P=0.0227).The average tibial tunnel area increased significantly at 6 weeks(6.577 mm2) and decreased at 12 weeks(3.103 mm2) after the operation(P=0.0005).Moreover,no significant differences were observed in the average tibial tunnel area at different time points and sites(P＜0.05).At different sites,the average tibial tunnel area expanded at 6 weeks,and then declined at 12 weeks after the operation.Conclusion The bone tunnel area changes with time after the ACL reconstruction,first increasing followed by decreasing in the average tibial tunnel area.The femur and tibial tunnel have significant differences in the tunnel area at different sites,which change differently with time.The bone tunnel expansion after the anterior cruciate ligament reconstruction can be comprehensively measured repeatedly at different sites.

Objective To investigate the effect of arthroscopy-assisted latissimus dorsi transfer (LDT) on posterosuperior massive rotator cuff tear (psMRCT) and analyze factors related to the outcome.Methods A retrospective case cohort study was conducted to analyze 31 patients with psMRCT admitted from January 2013 to December 2015.There were 13 males and 18 females,aged 52-67 years [(58.4 ± 4.5) years].The mean duration of symptoms was (1.9 ± 0.9) years.All patients received arthroscopy assisted LDT combined with rotator cuff repair.Postoperative rehabilitation training was carried out according to the standard procedures.Before operation and at the last follow-up,X-ray films were taken to measure the acromiohumeral talus,and magnetic resonance imaging was obtained to check the integrity of repaired tissue.Visual analog scale (VAS),active range of motions,Constant-Murley score and Fudan University Shoulder Score (FUSS) were measured to assess the shoulder joint function,and complications were documented.Furthermore,subgroup analysis was made according to "concomitant subscapularis tendon tear or not","concomitant pseudoparalysis or not","Goutallier Ⅲ/Ⅳ level fatty infiltration","complete or partial rotator cuff repair",and " Hamada Ⅰ/Ⅱ level acromiohumeral distance".Pearson correlation analysis was performed to detect the relationship of subgroup factors with postoperative Constant-Murley score and FUSS score.Results All patients were followed up for (38.8 ± 13.0) months.No complications including fever,infection,adhesion or neural malfunction were reported.Mean acromiohumeral distance increased from preoperative (5.4 ± 0.9) mm to (7.0 ± 1.0) mm at the last follow-up (P ＜ 0.05).MRI image showed intact fixation of rotator cuff and transferred latissimus dorsi tendon.At the last follow-up,VAS score decreased from preoperative (4.8 ± 1.4)points to (0.6 ± 0.7)points;the active range of motions was restored significantly;the Constant-Murley score improved from (32.9 ± 9.5) points to (67.4 t 6.7) points;the FUSS score increased from (53.3 ± 9.1) points to (85.1 ± 4.8) points (all P ＜ 0.01).Pearson Correlation analysis indicated that,among subgroup factors,only partial rotator cuff repair was significantly inversely associated with ConstantMurley score (P ＜ 0.05) and FUSS score (P ＜0.01),and the Constant-Murley score and FUSS score of patients with complete repair were significantly higher than those of patients with partial repair (P ＜ 0.05 and P ＜ 0.01,respectively).Conclusions For psMRCT,the effect of arthroscopy-assisted LDT is confirmed,which can relieve pain,restore range of motion and improve shoulder function.Preoperative pseudoparalysis,subacapularis tendon tear,Goutallier Ⅳ level fatty infiltration and Hmada Ⅱ level acromiohumeral distance do not significantly influence postoperative outcome.The torn rotator cuff tear should be repaired as possible.

Objective To explore the heme oxygenase-1 (HO-1) content of carbon monoxide (CO) levels and clinical significance of Mycoplasma pneumoniae infection in children.Methods 219 cases of mycoplasma pneumonia from October 2013 to June 2015 in our hospital were divided into two groups,which were non-asthmatic group (156 cases) and wheezing group (63 cases),and the wheezing group were divided into two groups according to the presence or absence of hypoxemia and mild asthmatic group (39 cases) and severe asthmatic group (24 cases).HO-1 content in the blood was measured by enzyme-linked immunosorbent assay,using dual-wavelength spectrophotometric determination of hemoglobin oxygen percentage of broken (COHb％),analysis of the differences between the groups.Results Children with blood COHb content wheezing group were (2.59 ± 0.40)％ and HO-1 levels were (1 813.24 ± 28.34)ng/L and non-respite group were significantly increased,it had significant differences between the two groups (P＜ 0.05).Group of children with severe wheezing COHb content were (3.63 ± 0.45)％ and HO-1 levels were (2 594.34±23.94)ng/L and mild wheezing group were significantly increased,it had significant differences between the two groups (P＜0.05).Positive correlation between blood COHb content and HO-1 levels were significantly (r=0.733,P＜0.05).Conclusion Mycoplasma pneumoniae infection in children with wheezing blood COHb content and HO-1 levels were significantly increased,and with wheezing exacerbation and showed an increasing trend,suggesting that CO and HO-1 may be involved in Mycoplasma pneumoniae infection in children in the pathogenesis of wheezing,should lead to clinical attention.

Objective To discuss the effect of arthroscopic latissimus dorsi transfer with rotator cuff repair for posterosuperior irreparable massive rotator cuff tear (iMRCT).Methods From September 2014 to December 2015,data of 13 iMRCT including 4 male and 9 female who underwent arthroscopic latissimus dorsi transfer with rotator cuff repair were retrospectively analyzed.The age was ranged from 54 to 65,with a mean age of 58.5±4.3.The mean duration of symptom was 2.1±0.6 years.During operation,complete or partial rotator cuff repair was performed,followed by complete repair of injured subscapularis tendon and tenotomy or tenodesis of the long head of biceps tendon.An arc incision was then made in the axillary fossa to harvest latissimus dorsi tendon from its humeral insertion.The tendon was then introduced into subacromial space and fixed at the footprint of greater tuberosity arthroscopically.X-ray and MRI were conducted prior to and one day after the surgery and at the last follow-up.Pain visual analog scale (VAS) and active range of motion in all planes as well as Constant-Murley score and Fudan University shoulder score (FUSS) were documented before the surgery and at the last follow-up.Results All 13 patients accomplished the follow-up,with a duration from 17 to 22 months and a mean period of 19.6±0.9 months.No complications occurred.No re-tear was identified.The mean acromiohumeral distance increased from 5.4± 1.1 mm to 7.0±0.6 mm.The mean VAS decreased from 4.8± 1.3 to 0.5± 0.7.The mean 0° abduction external rotation,90° abduction external rotation,flexion,as well as abduction increased from 17.3°± 10.5°,12.4°±7.8°,89.2°±41.2°,87.3°±40.7° to 41.2°±12.5°,56.5°±16.6°,120.5°±25.1°,and 113.5°±25.4° respectively.Constant-Mur ley score and FUSS increased from 33.5±9.9 and 50.9±7.6 to 62.8±8.1,and 81.7±7.0,respectively.The improvement in all measurements was significant.Condclion For posterosuperior iMRCT,arthroscopic latissimus dorsi transfer with rotator cuff repair can decrease shoulder pain and improve shoulder function.