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.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Objective:To explore the correlation between mechanical complications and paraspinal muscle degeneration following posterior single-segment osteotomy corrective surgery for chronic osteoporotic vertebral compression fractures (OVCF).Methods:A retrospective analysis was conducted on 80 patients who underwent surgery between January 2008 and January 2021 at Peking University Third Hospital. These patients, who developed kyphotic deformity following OVCF, included 17 males and 63 females with a mean age of 63.21±8.07 years (range, 47-77 years). Postoperative mechanical complications included proximal junctional kyphosis (PJK), screw loosening, adjacent segment degeneration (ASD), and distal junctional kyphosis or failure. Patients were compared based on the occurrence of mechanical complications in relation to fat infiltration (FI), relative gross cross-sectional area (rGCSA), and relative functional cross-sectional area (rFCSA) of the paraspinal muscles. Binary logistic regression analysis was used to identify risk factors for postoperative complications.Results:Among the 80 patients, 19 developed PJK, while 61 did not. The PJK group exhibited significantly higher paraspinal muscle FI (0.44±0.05) compared to the non-PJK group (0.38±0.10, P<0.05). Screw loosening occurred in 7 cases, with 73 cases remaining stable. Those with screw loosening demonstrated higher paraspinal muscle FI (0.47±0.05) than those without (0.38±0.09, P<0.05). Thirty patients experienced ASD, while 50 did not. The ASD group had higher paraspinal muscle FI (0.45±0.07) and lower rFCSA (0.09±0.03) compared to the non-ASD group (0.36±0.10 and 0.13±0.06, respectively, P<0.05). Logistic regression analysis indicated that paraspinal muscle FI and rFCSA were not independent risk factors for developing ASD. Twenty-three patients experienced distal junctional kyphosis or failure, while 57 did not; those with complications exhibited higher paraspinal muscle FI (0.48±0.08) and lower rGCSA (0.16±0.04) and rFCSA (0.09±0.03) compared to those without complications (0.37±0.09, 0.20±0.09, and 0.13±0.06, respectively, P<0.05). Logistic regression analysis suggested that paraspinal muscle FI, rGCSA, and rFCSA were not independent risk factors for developing distal junctional kyphosis or failure. Conclusion:Mechanical complications following corrective surgery for chronic OVCF-related kyphosis may be associated with increased paraspinal muscle FI. Additionally, the occurrence of ASD and distal junctional kyphosis or failure may correlate with reduced paraspinal muscle rFCSA

Objective:To investigate the clinical efficacy of percutaneous kyphoplasty (PKP) assisted by intuitive visual navigation orthopaedic surgery robot in the treatment of osteoporotic vertebral compression fracture (OVCF).Methods:A retrospective analysis was conducted in Peking University Third Hospital from June 2021 to November 2022, 78 patients with OVCF were treated by the intuitive visual navigation orthopaedic surgery robot or freehand surgery with a "C" arm X-ray machine. According to the method of puncture, they were divided into robot group and freehand group. In the robot group, there were 36 cases, including 7 males and 29 females, aged 74.50±5.87 years, 32 cases of single vertebral fractures, 4 cases of double vertebral fractures, 1 case of T 8, 2 cases of T 10, 2 cases of T 11, 11 cases of T 12, 10 cases of L 1, 8 cases of L 2, 2 cases of L 3, 3 cases of L 4, and 1 case of L 5. Bone mineral density T value was -2.94±0.50; In the freehand group, there were 42 cases, including 9 males and 33 females, aged 72.86±8.84 years, 36 cases of single fracture and 6 cases of double fracture, 1 case of T 6, 2 cases of T 7, 3 cases of T 11, 9 cases of T 12, 8 cases of L 1, 9 cases of L 2, 5 cases of L 3, 6 cases of L 4, and 5 cases of L 5. Bone mineral density T value was -3.00±0.50. The effectiveness evaluation indexes of the two groups were compared, which included surgery duration, X-ray fluoroscopy times, hospitalization time, lumbar pain visual analogue scale (VAS), Oswestry disability index (ODI) and height of fractured anterior vertebrae (HFAV). Results:Both groups of patients successfully received surgical treatment. The mean operating time of the robot group was 33.44±2.50 min, which was significantly longer than that of the free hand group, which was 29.69±2.40 min ( t=6.491, P<0.001). Meanwhile, the intraoperative blood loss of the robot group was 3.54±0.89 ml, which was significantly less than that of the freehand group, which was 6.72±1.89 ml ( t=9.110, P<0.001). In terms of radiographic fluoroscopy times, the average of the robot group was 26.81±7.76 times, which was significantly less than the freehand group's 42.61±6.62 times ( t=9.294, P<0.001). The postoperative vertebral front edge height in the free hand group was 18.64±0.32 mm and in the robot group was 18.79±0.36 mm. The difference was not statistically significant ( t=2.673, P=0.067). All patients were followed up for 8.3±2.9 months (range, 6-13 months). The VAS scores of low back pain in the two groups at 1 day and 6 months after operation were significantly improved compared with those before operation ( P<0.05), and there was no significant difference between the two groups in VAS score after operation ( P>0.05). Six months after surgery, the ODI of the free hand group and the robot group were 11.67%±2.13% and 12.11%±2.33%, respectively. The ODI scores of the two groups were significantly lower at 6 months postoperative follow-up than that before surgery, and the postoperative follow-up at all had significant differences compared with that before surgery ( P<0.05), and there was no difference between the two groups in postoperative ODI scores ( P>0.05). No obvious bone cement leakage was found in all patients during operation. Conclusion:Compared with the traditional C-arm X-ray for PKP treatment of OVCF by free hand, intuitive visual navigation orthopedic robot can safely and effectively assist in the completion of the operation process, and has the advantages of less intraoperative blood loss, fewer fluoroscopy times.

Objectives:To investigate the risk factors of cage retropulsion(CR)after posterior lumbar inter-body fusion(PLIF).Methods:Retrospective analysis was made on 17 patients(13 males and 4 females,with an average age of 63.7±9.9 years)who underwent revision surgery due to CR after PLIF in our hospital from September 2017 to September 2021.And the patients were included into the CR group.Another 34 patients without CR were matched in a ratio of 2∶1 according to the same fusion and fixation segments,time of initial surgery(±1 year),gender,and age(±2 years),including 26 males and 8 females,with an average age of 65.2±10.2 years.They were included in the control group.In the CR group,the average number of fixed segments was 1.8±0.8,and the average number of fused segments was 1.5±0.6;The time of CR was 7(0.75-132)months after the first operation;15 patients had single segmental CR and 2 patients had two segmental CR.The lumbar lordosis(LL),pelvic tilt(PT),sacral slope(SS),and pelvic incidence(PI)were measured on full-spine X-ray before operation of the two groups of patients,the disc height(DH)of the diseased segment was mea-sured on lateral lumbar X-ray,and the intervertebral range of motion(ROM)was measured on flexion-exten-sion X-ray.The CT value of lumbar vertebrae was measured in CT examination before operation;The shape of disc was defined through MRI examination.The cage position was measured on X-ray immediately after operation(The ratio of the distance between the marker line of the posterior margin of the cage and the pos-terior upper margin of the lower vertebral body to the length of the upper endplate of the lower vertebra).The paired sample t-test was used for single factor analysis to analyze the data of the two groups,after which,the parameters with statistical significance were analyzed with logistic regression to determine the inde-pendent risk factors of CR.Results:The mean vertebral CT value in the CR group was lower than that in the control group(124.8±39.7 vs 147.7±38.2,P=0.011);The cage position in the CR group was more posterior than that in the control group(0.15±0.09 vs 0.31±0.07,P＜0.001).There was no significant difference between the two groups in LL(40.8°±12.9° vs 42.4°±7.5°,P=0.717),PT(19.6°±7.1° vs 17.1°±6.7°,P=0.356),SS(27.7°±6.5° vs 31.0°±4.3°,P=0.144),PI(44.3°±13.8° vs 44.7°±13.9°,P=0.926),DH(10.1±2.4mm vs 8.8±1.4mm,P=0.066),ROM(4.3°±2.8° vs 4.4°±2.2°,P=0.950),and Pear-shaped intervertebral discs(33.3％vs 21.4％,P=0.40).Logistic regression analysis showed that low vertebral CT value(osteoporosis)(OR=0.975,P=0.043)and cage po-sition(OR=28.393,P=0.003)were the independent risk factors.Conclusions:Osteoporosis and posterior placement of cage are the risk factors for CR after PLIF.

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.

Objective:To evaluate the specialty of the clinical features, treatment procedure, clinical outcome, and prognosis in the patients with "sandwich" atlantoaxial dislocation (AAD).Methods:From 2008 to 2018, 160 cases with "sandwich" AAD were retrospectively selected from the case series of AAD in Peking University Third Hospital. The case series had 80 males and 80 females. The mean age at the initial visit was 35.5±14.6 years (range, 5-77). The clinical courses, treatment methodology and prognosis were reviewed. And the surgical approach, posterior fixation segment and the recovery of neurological function were mainly summarized. The atlantodental interval (ADI), the distance by which the odontoid exceeded the Chamberlain line and the cervical-medullary angle were analyzed.Results:The most common symptoms included weakness or numbness of the limbs (67.5%, 108/160), unstable gait (30%, 48/160) and vertigo (20%, 32/160). Among all, 130 cases (81.3%, 130/160) had myelopathy, with the Japanese Orthopaedic Association (JOA) scores from 4 to 16 (mean JOA scores 13.5±2.5). Cranial neuropathy was involved in 20 cases (12.5%). Radiological findings showed brainstem and/or cervical-medullar in 130 cases (81.3%), syringomyelia in 37 cases (23.1%) and Chiari malformation in 30 cases (18.8%). Computed tomography angiography (CTA) was performed in 90 cases, which showed vertebral artery anomalies in 55 cases (61.0%) and excessive medialized internal carotid artery in 5 cases (5.6%). All cases had no spinal cord or vertebral artery injury. The surgery included posterior occipito-cervical fusion (reducible dislocation, 145 cases), and transoral release followed by posterior fusion (irreducible dislocation, 15 cases). Fifty-seven cases were treated using alternative fixation technique. The average follow-up time was 50.5±22.4 months (range, 24 to 120 months). All of 152 cases (95.0%) achieved solid atlantoaxial fusion; there was no obvious osseous fusion formation on postoperative images in 6 cases (3.8%), but no atlantoaxial instability was found on dynamic radiographs; screw loosening happened in 2 patients (1.2%). Nine patients (5.6%) suffered complications, including 4 cases with recurrent dislocation, 2 screw loosening, 2 cases with bulbar paralysis and 1 wound infection. The mean postoperative JOA was 15.1±1.8 (range, 5-17), and the mean neurological improvement rate was 42.9%±33.3% in the patients with myelopathy.Conclusion:"Sandwich" AAD, a subgroup of AAD, has unique clinical features: earlier onset age and more severe myelopathy. The incidence of bone and vascular malformation is higher. So alternative surgical plan and hybrid fixation should be prepared for this subgroup of AAD.

Objective:To systematically evaluate whether the early use of bracing after posterior lumbar fusion has advantages in terms of the improvement of clinical outcomes such as pain, functional disability, fusion rate, and complication rate in patients with lumbar degenerative diseases.Methods:All randomized controlled trials of bracing performed after posterior lumbar fusion in patients with lumbar degenerative diseases were searched in Pubmed, Web of Science, Embase, China national knowledge infrastructure (CNKI) and Wanfang database from January 1990 to May 2022. The data extracted were authors, year of publication, nationality, subject characteristics, sample size, surgical protocol, type and time of bracing, follow-up duration, preoperative and postoperative Oswestry disability index (ODI) and visual analogue scale (VAS), postoperative fusion rate and complication rate. The Cochrane Risk of Bias tool was used to evaluate the risk of bias. The use of fix- or random-effect models was depended on the magnitude of heterogeneity. Data analysis was performed using Stata 17.0 statistical software for meta analysis.Results:A total of five randomized controlled trials were included, all in English, with a total of 362 patients (male 144, female 218). The results of meta-analysis showed that there was no statistically significant difference in the improvement of ODI scores [ MD=1.25, 95% CI(-2.39, 4.88), P=0.501]and VAS scores[ MD=0.21, 95% CI(-0.22, 0.63), P=0.340]between the brace group and the control group after operation. In terms of fusion rate, there was no significant difference between the brace group and the control group[ OR=0.59, 95% CI(0.25, 1.38), P=0.224]. In addition, there was also no significant difference in the incidence of postoperative complications between two groups[ OR=1.12, 95% CI(0.58, 2.15), P=0.735]. Conclusion:The early use of bracing after lumbar fusion has no significant advantages in improving symptoms and functional recovery, fusion rate and surgical complications. The necessity of postoperative bracing after posterior lumbar fusion requires further high-quality research to prove.

Tissue engineered skin is widely used in the treatment of refractory wounds such as severe burn wounds and diabetic wounds. Seed cells and scaffold materials are the key elements for constructing tissue engineered skin. Adipose-derived stem cells have gradually become an important choice of seed cells in tissue engineered skin due to their advantages of low immunogenicity and multi-directional differentiation potential. Scaffold material is a vital part of skin tissue engineering. The modification of single material and preparation of composite materials are becoming the main research directions of the construction of skin tissue engineering scaffolds. This paper introduced the application of various kinds of skin tissue engineering scaffolds loaded with adipose-derived stem cells in wound repair in recent years, and summarized the advantages and disadvantages in using various scaffold materials to the construction of skin tissue engineering scaffolds, in order to provide new ideas for the development of tissue engineered skin loaded with adipose-derived stem cells.