Objective:To anatomically study the external bone graft axis from the pedicle (canal) to the endplate designed for compression healing fractures of the anterior vertebral column in freshly dried vertebral specimens from T10 to L5.Methods:Eight groups of freshly dried vertebral specimens from T10 to L5 (128 vertebral bodies and 256 lateral pedicles and lateral vertebral bodies) were used to observe the vertebral axis of the pedicle (canal), the internal sagittal diameter of the pedicle (canal), and the sagittal diameter of the vertebral body, and the position of vertebral pedicle (canal) axis (f-angle) before design of the external bone graft axis from the pedicle (canal) to the endplate of the compression healing vertebral body. (1) The internal sagittal diameter of the pedicle (canal) was divided into 3 segments. The lateral segment of the vertebral plate was wide, the middle segment of the isthmus of the vertebral arch was narrow and the medial segment of the terminal segment of the vertebral arch was wide. The narrow isthmus of the middle arch (canal) was used as a transposition axis in the design of the axis of the bone graft from the vertebral arch (canal) to the endplate of the compression healing vertebral body. (2) The axis of the vertebral body of the pedicle (canal) was located medial to the transposition axis, parallel to the f-angle at 0° as described by Saillant G. (3) The compression degree of the vertebral body was measured at the outer edge of the lateral anterior column, with Ⅰ° for less than 1/4 compression of the anterior column of the vertebral body, Ⅱ° for 1/4 to 2/4, Ⅲ° for 2/4 to 3/4 and Ⅳ° for more than 3/4 of the compression. (4) The f-angle described by Salliant G at the entry end which was corresponding to the endplate of the compression healing vertebral body was used to design the pedicle (canal) to the outer implant axis of the endplate of the compression healing vertebral body.Results:At an f-angle of 8° to 10°, the bone graft axis was aligned with the Ⅱ° compression healing vertebral endplate on the superior endplate side of the vertebral body axis of the arch; at an f-angle of 16° to 18°, the bone graft axis corresponded to the superior endplate of the Ⅰ° compression healing vertebral body. At an f-angle of -10°~-8°, the bone graft axis corresponded to the Ⅲ° compression healing vertebral endplate on the inferior endplate side of the vertebral body axis of the arch; at an f-angle of -18°~-16°, the bone graft axis corresponded to the inferior endplate of the Ⅳ° compression healing vertebral body.Conclusions:The external axis from the pedicle (canal) to the endplate designed in the present anatomic study for compression healing fractures of the anterior vertebral column allows for safe and easy granular bone implantation due to the toughness of the cortical bone around the arch root (canal) in addition to the precise design of the bone graft axis from the pedicle to the endplate from T10 to L5.

Objective:To explore the relationship between the ratio of serum creatinine and cystatin C (Creatinine/Cystatin C, Cr/CysC) and the risk of fracture in diabetic patients, and to provide a basis for evaluating the risk of fracture in diabetic patients.Methods:Prospectively selected 216 patients with type 2 diabetes (T2DM) who were treated in our hospital from Apr. 2019 to Apr. 2021. Among them, they were divided into fracture group (56 cases) and non-fracture group (160 cases) according to whether they were combined with fractures.Collected two groups of baseline data, general clinical data, laboratory, imaging data, use sarcosine oxidase method to detect serum creatinine (Cr) content, use immunoturbidimetric method to determine serum cystatin C (CysC) level, and calculate The ratio of the two, After matching the propensity scores for age, gender, body mass index, diabetes course, etc., multi-factor Logistic regression analysis was used to evaluate the influencing factors of fracture risk in diabetic patients, and the restrictive cubic spline was used to evaluate the relationship between Cr/CysC and diabetic fracture risk. Relationship.Results:After the two groups were matched by propensity scores, 42 groups were successfully matched, and there was no statistically significant difference in baseline data after matching ( P>0.05) ; Compared with the fracture group, the AGEs (129.13±37.51) ng/mL andALP (97.50±23.80) U/L in the fracture group were higher than those in the non-fracture group (108.41±29.33) ng/mL, (84.35±25.66) U/L higher; Cr/CysC (0.87±0.15) , limb skeletal muscle mass (19.58±3.99) kg were higher than those in the non-fracture group (0.99±0.21) , (21.81±4.38) kg low ( P<0.05) ;Multivariate logistic regression analysis showed that the skeletal muscle mass of extremities ( OR=0.865, 95% CI0.761~0.985) and Cr/CysC ( OR=0.048, 95% CI0.002~0.933) were protective factors for diabetes complicated with fractures; ALP ( OR=1.023, 95% CI1.002~1.044) , AGEs ( OR=1.022, 95% CI1.006~1.039) risk factors for diabetes and fracture (all P<0.05) ,Restricted cubic spline showed a significant non-linear relationship between Cr/CysC and diabetic fractures ( P<0.05) . Conclusion:Cr/CysC is related to the occurrence of fractures in diabetic patients and can be used as a potential predictor of the occurrence of diabetic fractures.

Objective To investigate surgical outcomes of treatment of pilon fractures of Ruedi -Allgower types Ⅱ and Ⅲ by raft screws fixation combined with bone grafting.Methods 21 patients with pilon fractures of Ruedi -Allgower types II and Ⅲ received surgery were selected.They were 15 men and 6 women,23 to 68 years of age(average 38.2 years).16 cases were closed and 5 cases open.12 cases were type II and 9 cases type III.Intervals between injury and operation ranged from 7 to 14 days,with 8.5 days on average.All of them were treated with raft screws fixation by plate type L combined with bone grafting.Results All cases were followed up for an average of 12 months(range from 8 to 30 months).Fractures healed from 16 to 24 weeks,with 18.2 weeks on average.According to the Burwell -Charnley radiological criteria,anatomical reduction was achieved in 17 cases,and fair reduction in 4.According to the Mazur clinical criteria,ankle functions were rated as excellent in 8 cases,good in 10 cases,fair in 2 cases and poor in 1 case.The rate of excellent and good was 85.7%.Conclusion Raft screws fixation combined with bone grafting are effective for the pilon fractures of Ruedi -Allgower types II and Ⅲ,preventing articular surface collapse and leading to anatomic reduction,and has stable fixation and early functional rehabilitation.

Objective To evaluate the clinical outcomes of cemented bipolar femoral head arthroplasty in treatment of intertrochanteric fractures in elderly patients combined with heart,lung,brain and other diseases.Methods The study comprised 23 cases,aged 75-86 years old,treated with cemented bipolar artificial femoral head arthroplasty between January 2005 and October 2013 (replacement group).Evans' classification of the fracture was type Ⅰ in 3 cases,type Ⅱ in 9,type Ⅲ a in 5,type Ⅲ b in 2,type Ⅳ in 3 and reverse intertrochanteric fracture in 1.Additionally,23 cases with the similar physical condition treated with anatomical locking plates were chosen as controls.For comparisons between groups,operation time,amount of bleeding,drainage volume,mean time to extract drainage tub,antibiotics dosage,perioperative complications,complications of lying in bed,fracture complications and Harris score were measured.Results There were no significant differences between replacement and control groups with respect to operation time (52.7 minutes vs 52.0 minutes),amount of bleeding (160.9 ml vs 156.5 ml),drainage volume (162.2 ml vs 158.3 ml),Harris score (73.7 points vs 74.2 points),time to extract drainage tub (69.9 hours vs 68.9 hours) (P ＞ 0.05).Both groups had 5 days of preventive antibiotic usage.Better results were observed in replacement group than in control group concerning mean time of ambulation (8.1 days vs 109.3 days),rate of perioperative complications (19％ vs 59％),rate of bed rest complications (0 vs 36％) and rate of internal fixation complications (0 vs 18％) (P ＜ 0.05).Conclusion Cemented bipolar femoral head arthroplasty is effective to prevent the complications of internal fixation,bed rest as well as perioperation and improve the quality of life during the treatment of intertrochanteric fracture in elder patients with heart,lung,brain and other diseases.

Objective To evaluate the clinical outcome of artificial cervical disc arthroplasty combined with anchoring cervical intervertebral fusion cage (ACIFC) in the treatment of multilevel cervical disc herniation. Methods From October 2011 to September 2013, 0.26 patients with multilevel cervical disc herniation underwent artificial cervical disc arthroplasty combined with ACIFC, there were 10 male and 16 female with age from 32 to 60 years (mean 46.8 years). Two segment were involved in 15 patients, three segment were involved in 11 patients. Neck disability index (NDI) and Japanese Orthopaedic Association (JOA) score were used to evaluate neurofunctional recovery preoperatively and postoperatively. The postoperative stabilization and the range of motion (ROM) of implanted disc and the fusion of cage were observed on dynamic radiograph. Results The average operation time and amount of bleeding were (95±15) min and (100±20) ml respectively. The average postoperative follow-up was 15 months(range 6-20 months). At the end of follow up,the scores of JOA was increased and the scores of NDI was decreased:(9.08±1.72) scores vs. (14.88±1.37) scores, (40.31±4.97) scores vs. (25.23±4.10) scores,there had significant differences (P<0.05). The change of ROM had no significant difference ( P>0.05). Solid fusion was achieved in all levels brought by cage.There was no cage subsidence or displacement. All artificial cervical disc achieved definite stabilization, no intraoperative and postoperative complication was noted. Conclusions Artificial cervical disc arthroplasty combined with ACIFC provides a feasible way for the treatment of multilevel cervical disc herniation. The definite stabilization and maintained ROM can reduce the fusion segments and avoid the increased stress of adjacent segment which can ensure a good preliminary clinical outcome.

Objective To evaluate the clinical application of open reduction and internal fixation and bone grafting on treatment of pilon fractures of tibia.Methods Forty cases with Pilon fractures of Ⅱ,Ⅲ tibia who underwent open reduction and intemalfixation and bone grafting treatment were selected as our subjects.Those 40 cases were performed follow-up for 8.0-60.0 months,and average was 31.5 months.The ankle joint symptoms and functional Mazur scoring system were used to evaluate the function of ankle joint.Results Of the 40 patients,15 cases were with excellent ankle function,and 19 cases were good,4 cases were poor and 2 cases were worse.The excellent and good rate was 85％ (34/40).Conclusion Open reduction and internal fixation and bone grafting is proved as the effective treatment on Ⅱ,Ⅲ tibia pilon fractures.

Objective To investigate the clinical results in the treatment of developmental dysplasia of the hip (DDH) with one stage open reduction and Salter or Dega osteotomy for “walking age”children .Methods We retrospectively reviewed 16 patients(16 hips)with unilateral hip dislocation who had undergone one‐stage open reduction and Salter or Dega innominate osteotomy in the the“walking age”children .the results were evaluated clinically by McKay′s classification and radiologically by the modified Severin′s classification .Early signs of osteonecrosis were identified by neck widening ,epiphysis fragmentation ,and presence of a metaphyseal growth disturbance line in the first year after the operation .Results After a follow‐up of one year on average ,good clinical and ra‐diographic results were noted in 87 .5% and 81 .25% of the patients ,respectively .Osteonecrosis occurred in 3 hips(18 .75% ) .Con‐clusion One‐stage open reduction and Salter or Dega osteotomy is an effective treatment for developmental dysplasia of the hip in walking age .

Objective To study far femoral malignant bone tumor salvage limb treatment with allogeneic heterotopic half-joint transplantation and the use of GSH nail Methods Eleven cases with far femoral malignant bone tumor were administered tumor resection,transplanted with allogeneic heterotoeic bone half-joint,and fixed with GSH nail Results Nine out of the 11 cases were followed up.None of them had infection,rejection or heterotopic bone fracture.All of them can move with walking after 6 months.The effects of surgery was rated as excellent for 3 cases,fine for 4 cases andbad for 2 cases according to Mankin's rating criteria.Conclusion Salvage limb treatment for bone tumor can improve patients' quality of life.Allogeneic heterotopic bone,with rich source and acceptable joint surface,is a good graft for the treatment of bone defect after bone tumor resection.

Objective To investigate the therapeutic effect of Sky Bone Expander System in the treatment of osteoporotic vertebral body compression fractures in the elderly.MethodsTwenty-five cases (26 vertabrals)with osteoporotic vertebral body compression fractures were treated by Sky Bone Expander System.ResultsAll the 25 cases completed the surgery successfully,with an average operation duration of 35 min (range:30 -60 min).We injected 2.7 -4.5 ml bone cement to each vertebrae with an average of 3.5 ml.No blood vessels and nerves damage or other complications were found.The height of vertebral was restored.ConclusionSky Bone Expander System could effectively treat osteoporotic vertebral body compression fractures in the elderly.The height of vertebral could rebound and kyphosis could be improved.Furthermore,Sky Bone Expander System could relieve pain and reduce the leakage of bone cement

Objective To investigate the experiences of total hip replacement in the treatment of different types of osteoarthritis secondary to acetabular dysplasia, and evaluate its effect. Methods From January 1999 to December 2006, 37 hips in 35 cases with osteoarthritis secondary to acetabular dysplasia undergoing total hip replacement were included in this study. Preoperative Harris score was 30-64 points, with an average score of 45 points. Undergoing total hip replacement with complete release, of soft tissue, original acetabular, and no femoral osteotomy. Crowe Ⅰ , Ⅱ-type acetabular dysplasia chose conventional cementless press-fit prosthesis;Crowe Ⅲ,Ⅳ-type,chose the appropriate trumpet,Zweymüller system cementless acetabular biconical spiral surface and thin and straight SL rectangular hip stems. Results The duration of follow-up ranged from 12 to 60 months (average 24 months). No case appeared dislocation, periprosthetic fractures, femoral nerve and sciatic nerve injury and other complications, no clinical and X-ray findings of prosthesis loosening occurred. Postoperative Harris score was 60-95 points, and average was 85 points. Conclusion Adequate preoperative preparation, intraoperative complete release, is the key of the treatment and restoration of limb length.