Objective:To investigate the six-degree-of-freedom (6-DOF) kinematic characteristics of the knee joint and changes in plasma inflammatory factors during the acute and non-acute phases following anterior cruciate ligament (ACL) injury, thereby providing clinical evidence for the necessity of early intervention after ACL injury. Methods:Patients with ACL injury admitted between August 2024 and June 2025 were enrolled. A total of 56 patients met the inclusion criteria, including 24 in the acute phase (disease duration<30 days) and 32 in the non-acute phase (disease duration≥30 days). Thirty healthy volunteers served as the control group. No significant difference was observed among the three groups in baseline characteristics ( P>0.05), including age, height, body weight, body mass index, and the proportion of concomitant meniscal injury. All participants underwent gait analysis using the Opti-Knee system to measure 6-DOF kinematic parameters of the knee joint, including flexion/extension angle, internal/external rotation angle, varus/valgus angle, anterior/posterior displacement, medial/lateral displacement, and superior/inferior displacement. The trends across the gait cycle and differences at key time points among the three groups were assessed. Additionally, venous blood samples were collected to measure the levels of inflammatory factors. Finally, correlation analyses were performed on kinematic parameters and inflammatory factors with significant intergroup differences. Results:Gait analysis showed that compared with the control group, the flexion/extension angle decreased and the anterior/posterior displacement increased in both the acute and non-acute phase groups; the varus/valgus angle and internal/external rotation angle also increased in the non-acute phase group; all differences were significant ( P<0.05). However, no significant difference was found in the kinematic parameters between the acute and non-acute phase groups ( P>0.05). No significant difference in the medial/lateral displacemen or superior/inferiordisplacement among the three groups ( P>0.05). The acute and non-acute phase groups exhibited similar change trends in 6-DOF. Compared with the control group, they showed a smaller flexion angle and greater internal rotation angle, valgus angle, and anterior displacement during the gait cycle. At some key time points, the knee joint displayed abnormal patterns including tibial anterior displacement, valgus, and internal rotation. Blood tests revealed that compared with the control group, the levels of interleukin-6 (IL-6), IL-8, IL-1β, and tumor necrosis factor α (TNF-α) significantly increased in both the acute and non-acute phase groups ( P<0.05); and no significant difference was observed between the acute and non-acute phase groups ( P>0.05). Correlation analysis showed that anterior/posterior displacement was positively correlated with IL-6, TNF-α, and IL-1β ( P<0.05); the flexion/extension angle was negatively correlated with IL-6, IL-8, and TNF-α ( P<0.05). Conclusion:After ACL injury, characteristic dynamic knee instability and a pro-inflammatory microenvironment persist simultaneously. This dual mechanical and biological disturbance may constitute the pathological basis for the development and progression of post-traumatic osteoarthritis, underscoring the necessity of early intervention.
Objective:To compare the safety and early effectiveness between conventional manual technique and domestic robot-assisted simultaneous bilateral medial unicompartmental knee arthroplasty (UKA). Methods:Clinical data of 59 patients who underwent simultaneous bilateral UKA and met the selection criteria between January 2023 and June 2024 were retrospectively analyzed. Among them, 30 patients received bilateral UKA via conventional surgery with Oxford mobile-bearing unicompartmental knee prosthesis (conventional group); another 29 patients underwent bilateral UKA with LINK SLED fixed-bearing unicompartmental knee prosthesis assisted by the domestic NATON robotic surgical system (robotic group). Baseline data including gender, age, body mass index, disease duration, Kellgren-Lawrence grade, and preoperative American Knee Society Score (KSS) and Oxford Knee Score (OKS) showed no significant intergroup differences ( P>0.05). Intraoperative and perioperative indicators including operation time, length of hospital stay, perioperative hemoglobin (Hb) drop (preoperative vs immediate postoperative), and incidence of complications were recorded and compared. KSS and OKS scores were adopted to assess knee functional recovery preoperatively, at 3 months postoperatively, and at last follow-up. KSS satisfaction score was used to evaluate patient satisfaction at 3 months postoperatively and at last follow-up. Radiographic measurements of tibial prosthesis varus-valgus angle and the change in joint line height before and after surgery were performed to evaluate the accuracy of prosthesis implantation. Results:The conventional group had significantly shorter operation time than the robotic group ( P<0.05). There was no significant difference in length of hospital stay and perioperative Hb drop between the two groups ( P>0.05), and no patient required blood transfusion. All patients completed follow-up, the follow-up duration was (12.3±2.3) months for the conventional group and (12.1±2.4) months for the robotic group, with no significant difference ( t=0.324 , P=0.752). No severe complication including prosthesis loosening, periprosthetic infection, periprosthetic fracture, deep vein thrombosis of lower extremities, pulmonary embolism, knee stiffness, or knee instability occurred in either group. The tibial prosthesis varus-valgus angle and the change in joint line height in the robotic group were significantly smaller than those in the conventional group ( P<0.05). No significant intergroup difference was observed in patient satisfaction scores at 3 months postoperatively and at last follow-up ( P>0.05). Both KSS and OKS scores significantly improved at 3 months postoperatively and at last follow-up when compared with preoperative scores, with further improvement over time ( P<0.05); no significant intergroup difference in these scores was found at any postoperative time point ( P>0.05). Conclusion:Although robot-assisted simultaneous bilateral UKA requires longer operation time, it achieves comparable early effectiveness and safety to conventional manual simultaneous bilateral UKA, with superior accuracy of prosthesis implantation. The domestic robot-assisted system demonstrates promising clinical application value in simultaneous bilateral UKA.
Objective:To investigate the effectiveness of a modified double keystone design perforator island flap in repairing large skin and soft tissue defects in the posterior midline lumbar region following extensive excision for Bowen disease. Methods:A retrospective analysis was conducted on the clinical data of 9 patients with Bowen disease in the posterior midline lumbar region admitted between January 2020 and June 2024. There were 4 males and 5 females; ages ranged from 55 to 80 years, with a mean age of 68.9 years. Lesions were located at L 1-5 levels and concentrated near the midline posterior to the spinous processes. And the lesions were confined to the skin and subcutaneous tissue. The size of residual defects following extensive excision ranged from 6.0 cm×5.5 cm to 10.0 cm×8.5 cm. The modified double keystone design perforator island flaps were designed with the defect as the center. Subcutaneous and adipose tissues were dissected without incising the deep fascia, while preserving perforator vessels. The bilateral flaps were advanced toward the midline using V-Y advancement sutures; the size of unilateral flap ranged from 8.5 cm×3.5 cm to 15.0 cm×6.0 cm. The donor sites were directly sutured. Results:Operations were successfully completed in all 9 cases. The operation time ranged from 80 to 100 minutes (mean, 90 minutes); intraoperative blood loss ranged from 20 to 80 mL (mean, 41.1 mL); and the length of hospital stay ranged from 9 to 15 days (mean, 10.4 days). All flaps survived, with only 1 case of mild fat liquefaction at the recipient site. All patients were followed up 9-18 months (mean, 12.4 months). All flaps were similar in texture, thickness, and color to the surrounding skin, with no obvious "cat's ear" deformity observed. The lumbar mobility was normal, with no sensation of tightness or pain. At last follow-up, the subjective satisfaction, as assessed by the visual analogue scale (VAS) score, ranged from 7 to 10, with a mean of 8.7. No tumor recurrence was observed during follow-up. Conclusion:For large defects resulting from extensive resection of Bowen disease in the posterior midline lumbar region, the use of a modified double keystone design perforator island flap offers the advantages of reliable blood supply, uniform tension distribution, no need for skin grafting, and minimal trauma at donor site.
Objective:To investigate the effects of high-concentration of vancomycin and meropenem on the viability and osteogenic differentiation of rat bone marrow mesenchymal stem cells (BMSCs), and to provide experimental evidence for local antibiotic treatment of periprosthetic joint infection (PJI). Methods:Rat BMSCs were cultured with vancomycin and meropenem at different concentrations (10-10 000 μg/mL). A cell counting kit 8 assay was used to assess the effects of the antibiotics on cell viability. The antibiotic concentration at which cell viability began to decrease by more than 50% compared to the control group (cells cultured without antibiotics) after 7 days was selected as the upper concentration limit for subsequent experiments. The lowest concentration at which cell viability significantly decreased compared to the control group after 7 days ( P<0.05) was selected as the lower concentration limit. The cells were then further cultured in osteogenic induction medium. After 7 days, the proportion of late apoptotic cells was measured by flow cytometry, and the protein expression of Runt-related transcription factor 2 (Runx2), osteopontin (OPN), and Osterix (Osx) was detected by Western blot. After 21 days, Alizarin red staining was performed to evaluate the effects of the antibiotics on BMSCs mineralization and osteogenic differentiation. Results:The inhibitory effects of vancomycin and meropenem on BMSCs viability gradually increased with prolonged intervention. After 7 days, the threshold concentration for a significant decrease in BMSCs viability was 500 μg/mL for both antibiotics ( P<0.05). Concentrations of 500, 1 000, and 3 000 μg/mL were selected for subsequent experiments. After 7 days of osteogenic induction, flow cytometry showed that the proportions of late apoptotic cells were significantly higher in the all antibiotics groups than in the control group ( P<0.05). Western blot showed that low-concentration vancomycin (500 μg/mL) promoted Runx2 expression but inhibited OPN and Osx expressions ( P<0.05), whereas high-concentration vancomycin (3 000 μg/mL) inhibited Runx2, OPN, and Osx expressions ( P<0.05). Low-concentration meropenem (500 μg/mL) promoted Runx2, OPN, and Osx expressions ( P<0.05), whereas high-concentration meropenem (3 000 μg/mL) inhibited the expressions of these osteogenesis-related proteins ( P<0.05). After 21 days, the percentage of mineralized area in the 3 000 μg/mL vancomycin and meropenem groups was significantly lower than that in the control group ( P<0.05). Conclusion:High-concentration (3 000 μg/mL) of vancomycin and meropenem administered for more than 7 days may inhibit the viability and osteogenic differentiation of rat BMSCs.
Objective:To evaluate the effectiveness and precision of the domestic total hip arthroplasty (THA)-assisted robotic system ROPA through artificial bone experiments. Methods:Robot-assisted THA was performed on 16 artificial bone models (8 left hips and 8 right hips) using the ROPA system. Preoperative CT scans were imported into the ROPA system for three-dimensional reconstruction and preoperative planning. Component size, acetabular cup position (anteversion and abduction angles), and osteotomy parameters (femoral neck osteotomy distance, offset, leg length discrepancy, and acetabular reaming bone volume) were recorded. Intraoperative probe verification accuracy, matching accuracy, remaining reaming distance, and remaining press-fit distance were documented. Postoperative three-dimensional scanning was performed to measure actual parameters, which were compared with planned values to calculate deviations. Results:Osteotomy experiments were successfully completed on all 16 hip models. Component sizes were consistent with the preoperative plan in all 16 hip models. Deviations between actual and planned values were as follows: Anteversion angle was (0.79±1.69)° and abduction angle was (0.19±2.23)°. According to the initial position of acetabular cup, abduction angle was 40° and anteversion angle was 20°. The deviation of acetabular cup anteversion angle was (40.79±1.69)° and abduction angle was (20.19±2.23)°. All acetabular cups were implanted in the Lewinnek safe zone. The femoral neck osteotomy distance was (0.31±0.38) mm, the leg length discrepancy was (0.79±1.16) mm, the hip offset was (0.69±2.21) mm, and the acetabular fossa reaming bone volume was (0.03±0.06) mm, all of which met the acceptance criteria. The probe verification accuracy was (0.18±0.16) mm, the intraoperative registration accuracy was (0.50±0.22) mm, the remaining reaming distance was (-0.19±1.05) mm, and the remaining press-fit distance was (1.88±0.89) mm, all of which were in line with the expected design error range. Conclusion:The domestic THA-assisted robotic system ROPA demonstrated favorable osteotomy accuracy, operational performance, effectiveness, and precision in artificial bone experiments. However, its long-term efficacy still requires further verification through clinical trials.
Objective:To review the role of the mechanosensitive ion channel Piezo1 in osteoarthritis (OA) pathogenesis and summarize recent advances in its clinical transformation as a potential therapeutic target. Methods:The recent domestic and international research literature was reviewed. Recent studies on Piezo1 in chondrocyte injury, inflammation, extracellular matrix degradation, and osteophyte formation were analyzed, along with Piezo1-targeted inhibitors, activators, and modulators. Results:Piezo1 senses abnormal mechanical stress and mediates Ca 2+ influx, activating PI3K/AKT/mTOR and MAPK/ERK signaling pathways, thereby promoting chondrocyte apoptosis, impaired autophagy, and matrix degradation. Preclinical studies suggest that GsMTx4, Piezo1-siRNA, Dooku1, and artemisinin may confer chondroprotective effects, but their specificity, stability, delivery efficiency, and safety require further verification. Conclusion:Piezo1 is a critical link between mechanical stress and OA progression, representing a potential therapeutic target. Future research should focus on elucidating mechanisms, developing highly specific modulators and targeted delivery systems, and conducting rigorous preclinical and clinical studies to promote clinical transformation.
Objective:To summarize the research progress on immune microenvironment imbalance and targeted interventions in osteoarthritis comorbid with diabetes mellitus, so as to provide a reference for the development of disease-modifying therapies and individualized local drug-delivery strategies for this comorbid population. Methods:Relevant domestic and international studies published in recent years were reviewed. Focusing on the "oxidative stress-immune interaction" axis, the major alterations and cellular network characteristics of the immune microenvironment in osteoarthritis comorbid with diabetes mellitus were summarized, with emphasis on microenvironment-targeted intervention strategies, including small-molecule drug repurposing, nanodelivery systems, exosome/nucleic acid-based therapeutics, and injectable biomaterials. Challenges and prospects related to stratified diagnosis and treatment, efficacy endpoints, and long-term safety in clinical translation were also discussed. Results:The core pathological basis of osteoarthritis comorbid with diabetes mellitus involves hyperglycemia-induced oxidative stress and immunometabolic reprogramming. Through mechanisms such as the accumulation of advanced glycation end products, lipotoxicity, mitochondrial dysfunction, and abnormalities in the gut-joint axis, these changes promote persistent synovitis, extracellular matrix degradation, pain sensitization, and structural joint damage. Immune microenvironment imbalance is mainly characterized by pro-inflammatory polarization of synovial macrophages with impaired efferocytosis, T helper 17 cells/regulatory T cells imbalance, reduced immunomodulatory capacity of mesenchymal stem cells and their exosomes, and senescence-associated immune remodeling in bone marrow lesion areas. Based on these mechanisms, targeted intervention strategies, including small-molecule drug repurposing, nanodelivery systems, exosome/nucleic acid-based therapeutics, and injectable biomaterials, have shown promising application prospects. However, their clinical translation still faces challenges, such as insufficient stratified diagnosis and treatment, inadequate efficacy evaluation systems, and limited long-term safety evidence. Conclusion:The development and progression of osteoarthritis comorbid with diabetes mellitus are closely associated with the persistent interplay among metabolic abnormalities, oxidative stress, and immune microenvironment imbalance. Targeted interventions based on modulation of the local joint microenvironment may relieve pain, improve joint function, and delay the progression of structural joint damage, thereby providing new insights into disease-modifying therapy. Future studies should further refine stratified diagnostic and therapeutic strategies, optimize biomarker selection and delivery platform design, and strengthen long-term safety evaluation to facilitate clinical translation of these strategies.
Objective:To elucidate the therapeutic challenges and recent advances in managing Garden type Ⅳ femoral neck fractures in young adults through the perspective of anatomical blood supply, identifying current limitations and proposing future research directions for optimizing clinical treatment strategies. Methods:A comprehensive review of recent domestic and international literature on Garden type Ⅳ femoral neck fractures in young adults was conducted, focusing on the anatomical basis of femoral neck vascularization, innovations in internal fixation techniques, vascular reconstruction methods, and applications of adjunct technologies. Results:The treatment of Garden type Ⅳ femoral neck fractures in young adults has evolved from internal fixation toward an integrated biomechanical and biological approach. The distinct anatomy of the femoral neck and the vulnerability of femoral head perfusion render the management of Garden type Ⅳ fractures particularly challenging in young adults. Enhanced internal fixation systems have significantly improved stability through optimized biomechanical configurations. Vascularized (or muscle-pedicle) bone grafting offers an effective biological reconstruction strategy for high-risk patients. Conclusion:Individualized comprehensive treatment, grounded in the understanding of femoral neck vascular anatomy, is crucial for improving outcomes. Future efforts should integrate intelligent surgical planning and biological therapeutics to further enhance therapeutic efficacy.
Over the past two decades, significant advancements have been achieved in the diagnosis and treatment of sacroiliac joint (SIJ) complex pain. These advances include anatomical studies elucidating the neural innervation mechanisms, research clarifying the impacts of extra-articular factors on SIJ complex pain, and the clinical application of radiofrequency ablation as well as a wide spectrum of minimally invasive surgical techniques. Nevertheless, a unified standardized protocol for the diagnosis and treatment of SIJ complex pain remains to be established. In 2025, the American Academy of Pain Medicine (AAPM) and the American Society of Regional Anesthesia and Pain Medicine (ASRA-PM) convened 27 professional organizations to revise and promulgate multidisciplinary clinical practice guideline for SIJ complex pain. This article conducts a comprehensive interpretation of the aforementioned guideline, compares it with relevant expert consensus documents in China, analyzes the consistencies and divergences in their diagnosis and treatment, and provides a reference for clinical practice.
Objective:To explore the factors influencing the Constant-Murley score at 3 months after arthroscopic rotator cuff repair, and to provide evidence for early identification of patients at risk of poor recovery and for the development of individualized rehabilitation protocols. Methods:Using a convenience sampling method, 146 patients with rotator cuff injury who underwent arthroscopic rotator cuff repair between May 2025 and August 2025 were enrolled. There were 68 males and 78 females, with ages ranging from 41 to 74 years (mean, 56.2 years). At 3 months postoperatively, shoulder function was assessed using the Constant-Murley score, pain intensity was evaluated with the visual analogue scale (VAS) score, exercise adherence was measured with the Orthopedic Patient Functional Exercise Compliance Scale, and active shoulder forward flexion and abduction ranges were recorded. The independent variables included gender, age, body mass index (BMI), affected side, smoking history, alcohol consumption, educational level, acromial type, hypertension, diabetes mellitus, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, as well as postoperative acromiohumeral distance, VAS score, and the Orthopedic Patient Functional Exercise Compliance Scale score. The dependent variable was the 3-month Constant-Murley score. Univariate analysis and multiple linear regression were performed to identify influencing factors associated with the Constant-Murley score. Results:At 3 months postoperatively, the acromiohumeral distance ranged from 6 to 16 mm (mean, 9.19 mm); VAS scores ranged from 0 to 6 (mean, 3.2); Orthopedic Patient Functional Exercise Compliance Scale scores ranged from 20 to 70 (mean, 50.1); Constant-Murley scores ranged from 35 to 100 (mean, 73.7); active forward flexion ranged from 55° to 180° (mean, 128.84°); and active abduction ranged from 25° to 170° (mean, 122.81°). Univariate analysis showed that smoking history, educational level, acromial type, hypertension, diabetes mellitus, BMI, VAS score, and Orthopedic Patient Functional Exercise Compliance Scale score were significantly associated with the 3-month Constant-Murley score ( P<0.05). Multiple linear regression revealed that hypertension, diabetes mellitus, and higher VAS score were independent risk factors for Constant-Murley score ( P<0.05), while a higher BMI and Orthopedic Patient Functional Exercise Compliance Scale score were protective factors for Constant-Murley score ( P<0.05). Conclusion:Overall, shoulder function recovered well at 3 months after rotator cuff repair, but there remains room for further improvement. Clinicians should emphasize perioperative management of patients with comorbid chronic diseases, strengthen pain intervention, and promote exercise adherence in order to optimize early postoperative functional recovery.
Objective:To investigate the effectiveness of T 1 rhizotomy combined with flexor origin slide for central hand flexion spasticity. Methods:Between July 2023 and June 2025, 10 patients with central spastic flexion deformity and concomitant flexor tendon contracture due to traumatic brain injury, cerebral palsy, or other causes were admitted. All patients were treated with T 1 rhizotomy combined with flexor origin slide. Postoperative assessments included the Modified Ashworth Scale (MAS) for muscle tone, Medical Research Council (MRC) scale for muscle strength, Fugl-Meyer score for upper extremity motor function, and House Functional Classification (HFC) for hand function. Results:All patients successfully completed the operations and were followed up 6-19 months (median, 13 months). During follow-up, patients showed significant relief of hand spasticity and improvement in hand function. At last follow-up, the MAS grade for muscle tone, Fugl-Meyer score for upper extremity motor function, and HFC grade for hand function showed significant improvement compared to preoperative levels ( P<0.05); but there was no significant difference in MRC grade for muscle strength or PRWE score between pre- and post-operation ( P>0.05). Conclusion:T 1 rhizotomy combined with flexor origin slide effectively reduces muscle tone, corrects flexion deformity, and improves hand function, representing an effective surgical strategy for central spastic flexion deformity of the hand.
Limb reconstruction has emerged as a unique and increasingly important discipline in modern medicine. Limb reconstruction refers to the systematic restoration of complex pathological conditions resulting from various injuries or diseases-such as tissue defects, infections, and deformities-using a combination of surgical and non-surgical approaches. Its technical framework is primarily based on microsurgery, the Ilizarov technique, cement-induced membrane technique (Masquelet technique), engineered tissue regeneration, soft tissue balancing and dynamic reconstruction, and modern prosthetics, supplemented by other surgical modalities including internal and external fixation, joint replacement, sports medicine, and wound management. Limb reconstruction surgery employs these techniques to systematically restore the structure, morphology, and function of the limb, representing a critical component of modern surgery. This discipline overcomes the fragmentation inherent in traditional subspecialty care, providing a definitive clinical pathway for limb reconstruction and serving as the last beacon of hope for salvaging damaged limbs.
Objective:To investigate the mechanism of the mechanosensitive ion channel Piezo1 in microglial ferroptosis following spinal cord injury (SCI), and to assess the effects of Piezo1 inhibition on ameliorating the injury microenvironment and promoting neurological functional recovery. Methods:Primary microglia cells were extracted from neonatal 1-2 days C57BL/6 mice and divided into control group, Yoda1 (Piezo1 agonist) group, and Yoda1+GsMTx4 (Piezo1 inhibitor) group. Live/dead cell staining, reactive oxygen species (ROS) fluorescence staining, 5, 5', 6, 6'-tetrachloro-1, 1', 3, 3'-tetraethylbenzimidazolylcarbocyanine iodide (JC-1) mitochondrial membrane potential detection, and transmission electron microscopy were utilized to assess microglial ferroptosis and mitochondrial functional characteristics. SPF female C57BL/6 mice aged 6 to 8 weeks were used to detect the expression of Piezo1 at different time points after SCI by Western blot, and the two time points with no significant change and the most significant change in Piezo1 expression after SCI were selected for subsequent experiments. T 8, T 9 SCI models were established by modified Allen's method, and were divided into sham operation group, injury group, and injury+shPiezo1 group (Piezo1-targeted interfering virus AAV-shPiezo1 was injected in situ to knock down the expression of Piezo1 14 days before modeling). Colocalization of Piezo1 with microglial markers purinergic receptor P2Y12 (P2ry12), and the expressions of glutathione peroxidase 4 (GPX4) and acyl coenzyme A synthetase long chain member 4 (ACSL4) were observed by immunofluorescence staining. Basso Mouse Scale (BMS) score was used to assess hindlimb motor function in mice. The level of ROS was detected by dihydroethidium (DHE) staining; the content of malondialdehyde (MDA) was detected by MDA kit; the levels of tumor necrosis factor α (TNF-α) and interleukin 10 (IL-10) were detected by ELISA assay; the pathological morphology of spinal cord was observed by HE staining. Results:In vitro experiments showed that compared with the control group, the Yoda1 group had typical ultrastructural changes of ferroptosis, such as increased microglial cell death, enhanced ROS fluorescence, mitochondrial membrane potential depolarization, mitochondrial shrinkage and mitochondrial cristae breakage (all P<0.05), while the GsMTx4 group could partially reverse the above effects ( P<0.05). In vivo experiments demonstrated that the expression of Piezo1 in spinal cord tissue was up-regulated sequentially after SCI, and reached the peak on the 7th day after SCI ( P<0.05), and it was mainly localized in P2ry12-positive microglia. Compared with the injury group, in the injury+shPiezo1 group, the expression of ferroptosis core protein GPX4 in microglia was increased, the expression of ACSL4 was decreased, the levels of ROS and MDA in spinal cord tissue were decreased ( P<0.05), the level of pro-inflammatory factor TNF-α was decreased, and the level of anti-inflammatory factor IL-10 was increased ( P<0.05). In addition, the BMS score was significantly higher than that of the injury group ( P<0.05) from the 14th day after operation, and the spinal cord tissue structure was relatively well preserved, and the cavity area was reduced. Conclusion:SCI activates the Piezo1 channel in microglia, triggering mitochondrial dysfunction and mediating cellular ferroptosis, thereby aggravating secondary neuroinflammation. Targeted inhibition of Piezo1 effectively blocks the ferroptosis process, ameliorates the immune microenvironment, and promotes tissue repair and locomotor functional recovery after SCI.
Objective:To investigate the clinical characteristics and injury mechanisms of lateral segment floating clavicle (LSFC), and to establish a comprehensive classification system for this specific triple injury of the superior shoulder suspensory complex (SSSC), so as to provide a reference for clinical diagnosis and treatment. Methods:A retrospective analysis was performed on 354 patients with midclavicular fractures who underwent surgical treatment between January 2021 and December 2024. Among them, 11 patients met the diagnostic criteria for LSFC, defined as a combination of midclavicular fracture, ipsilateral coracoid process fracture or coracoclavicular ligament rupture, and ipsilateral acromioclavicular ligament rupture, distal clavicular fracture, or acromial fracture. There were 9 males and 2 females, with an age range of 21-53 years (mean, 39.3 years). LSFC was classified into two main types: Type Ⅰ was characterized by coracoclavicular ligament rupture, and type Ⅱ by coracoid process fracture. According to the injury pattern at the acromioclavicular joint-distal clavicle complex, each type was further subdivided into three subtypes: subtype a (acromioclavicular ligament rupture or acromioclavicular joint dislocation), subtype b (distal clavicular fracture), and subtype c (acromial fracture). Of the 11 patients, 4 were classified as type Ⅰa, 5 as type Ⅱa, and 2 as type Ⅱb. All patients underwent open reduction and internal fixation. Missed diagnosis occurred in 3 cases (27.3%), intraoperative revision of the surgical plan was required in 1 case, and postoperative delayed diagnosis was found in 2 cases during follow-up, with 1 patient undergoing reoperation. Results:All 11 LSFC patients were followed up 13-26 months (mean, 17.8 months). Bony union was achieved in all fractures at last follow-up. A total of 7 complications were noted: 3 cases of acromioclavicular joint subluxation, 3 cases of periprosthetic osteolysis around the clavicular hook plate, and 1 case of wire breakage. The incidence of ipsilateral multiple rib fractures in LSFC patients was 45.5% (5/11), which was significantly higher than that in patients with isolated midclavicular fractures (1.7%, 6/343) ( P<0.001). Conclusion:LSFC is mostly caused by high-energy trauma, with a high rate of missed diagnosis and frequent associated injuries. In particular, ipsilateral multiple rib fractures are a highly suggestive sign of LSFC. The classification system proposed in this study summarizes the characteristics of this triple injury of SSSC, which is conducive to improving clinicians' understanding of the injury and reducing the rate of missed diagnosis.
Objective:To investigate the incidence and risk factors of preoperative deep vein thrombosis (DVT) in patients with periprosthetic hip fractures. Methods:This retrospective clinical cohort study enrolled 95 patients with periprosthetic hip fractures who met predefined inclusion and exclusion criteria between January 2016 and December 2025. The cohort included 28 males and 67 females, with a mean age of 72.9 years (range, 39-96 years). According to Vancouver classification, there were 1 case of type A, 32 cases of type B1, 59 cases of type B2, 1 case of type B3, and 2 cases of type C. The interval from injury to hospital admission ranged from 1 to 150 days (mean, 10.9 days). All patients received bilateral lower-extremity venous ultrasonography for preoperative DVT screening. Patients were divided into DVT-positive and DVT-negative groups according to ultrasound findings. Univariate analyses were conducted to compare demographic data (age, gender), underlying comorbidities (hypertension, diabetes mellitus, coronary atherosclerotic heart disease, cerebral infarction, etc.), Vancouver fracture type, injury-to-admission interval, and laboratory indicators (prothrombin time, activated partial thromboplastin time, thrombin time, international normalized ratio, D-dimer, fibrinogen, hemoglobin, red blood cell count, hematocrit, platelet count, serum albumin, triglycerides, total cholesterol, apolipoprotein, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol) between the two groups. The risk factors of preoperative DVT in periprosthetic hip fractures were further screened by logistic regression analysis. Results:The overall preoperative prevalence of DVT was 28.42% (27/95) among patients with periprosthetic hip fractures. Subgroup analysis stratified by thrombus location showed 1 case (1.05%) of proximal DVT, 2 cases (2.11%) of distal axial DVT, and 24 cases (25.26%) of calf muscular vein thrombosis. Univariate analysis revealed significant intergroup differences in the prevalence of history of coronary atherosclerotic heart disease and preoperative D-dimer levels between DVT-positive and DVT-negative groups ( P<0.05). Receiver operating characteristic curve analysis was performed to assess the predictive efficacy of preoperative D-dimer for preoperative DVT. The area under the curve was 0.667 (95% CI: 0.545, 0.772) ( P=0.016). The optimal D-dimer cutoff value was 5.26 mg/L, with a sensitivity of 0.667 and specificity of 0.618. Stratified analysis based on this cutoff demonstrated that patients with D-dimer≥5.26 mg/L had a markedly higher incidence of DVT than those with D-dimer<5.26 mg/L [40.91% (18/44) vs. 17.65% (9/51); χ 2=6.283, P=0.012]. logistic regression analysis further verified that history of coronary atherosclerotic heart disease and preoperative D-dimer≥5.26 mg/L were independent risk factors for preoperative DVT ( P<0.05). Conclusion:The incidence of preoperative DVT is considerably high in patients with periprosthetic hip fractures. History of coronary atherosclerotic heart disease and elevated preoperative D-dimer (≥5.26 mg/L) are independent risk factors for preoperative DVT in patients with periprosthetic hip fractures, which should be paid great attention to clinically.
Objective:To study the early- and mid-term effectiveness of closed reduction and bilateral bracing using percutaneous pinning supported by adjacent metacarpal bones and a cemented external fixator for treatment of metacarpal shaft fractures. Methods:Between April 2022 and June 2024, 18 patients with metacarpal shaft fractures were treated with closed reduction and bilateral bracing fixation using percutaneous pinning supported by adjacent metacarpal bones and a cemented external frame. Of these, 16 were male and 2 were female; their ages ranged from 18 to 47 years (mean, 30.6 years). The time from injury to hospital admission ranged from 1 to 6 days (mean, 3.4 days). Fracture sites were the second metacarpal bone in 5 cases, the fifth metacarpal bone in 10 cases, the fourth and fifth metacarpal bones in 2 cases, and the second to fifth metacarpal bones in 1 case. There were 4 cases of transverse fractures, 10 cases of oblique fractures, and 4 cases of comminuted fractures. The frequency of intraoperative fluoroscopy, operation time, length of hospital stay, time to fracture union, and visual analogue scale (VAS) scores for pain at 1 day before operation and 3 days after operation were recorded. At last follow-up, the range of motion of the metacarpophalangeal joint and the grip strength of the affected hand were measured, and the function of the affected hand was assessed according to the criteria for upper limb functional assessment issued by the Chinese Medical Association Hand Surgery Society. Results:The operation time ranged from 38 to 70 minutes (mean, 49.3 minutes); intraoperative fluoroscopy was performed between 4 and 12 times (mean, 6.9 times); and the length of hospital stay ranged from 4 to 9 days (mean, 6.4 days). The VAS score at 3 days after operation was 2 (1, 2), which was significantly lower than the score recorded at 1 day before operation [5 (4, 6)] ( Z=-3.866, P<0.001). Three patients experienced slight leakage at the puncture site, and 2 had mild difficulty in extending joints. All patients were followed up 6-8 months (mean, 7.1 months). Imaging follow-up revealed that all fractures had healed, with a healing time ranging from 48 to 72 days (mean, 62.0 days). At last follow-up, the range of motion of the metacarpophalangeal joint was 78°-90° (mean, 86.1°); grip strength in the affected hand reached 80% to 98% of that in the unaffected hand, with a mean of 91.8%. According to the criteria for upper limb functional assessment issued by the Chinese Medical Association Hand Surgery Society, the function was rated as excellent in 6 cases, good in 10 cases, and fair in 2 cases, with an excellent and good rate of 88.9%. Conclusion:The treatment of metacarpal shaft fractures using closed reduction and bilateral bracing fixation using percutaneous pinning supported by adjacent metacarpal bones and a cemented external frame offers advantages, such as minimal trauma, relatively simple technique, and ease of internal fixation removal. It yields satisfactory early- to mid-term effectiveness; however, strict adherence to surgical indications is required.
With the rapid development of limb reconstruction surgery, which is powered by classic external fixation and Ilizarov techniques, a large number of related terms and professional jargon have been widely used. To promote the standardized development and academic exchanges of this emerging sub-discipline of orthopedics, this article systematically reviews and analyzes the key technologies and terms that are relatively unified and frequently used in the fields of external fixation and limb reconstruction. The aim is to provide standardized terminology references for relevant scholars and clinicians, and to contribute to the construction of the discipline system.
Objective:To systematically review the research progress of Internal Brace suture tape augmentation technique in the treatment of chronic lateral ankle instability (CLAI), and to provide reference for clinical practice. Methods:The related literatures of Internal Brace suture tape augmentation technique in the treatment of CLAI were extensively reviewed at home and abroad, and the effectiveness was evaluated. Results:Biomechanical studies showed that the Internal Brace suture tape augmentation technique significantly improved the immediate stability of ankle ligaments after repair. Clinical studies have shown that this technique alone or in combination with Broström procedures can achieve good results in the treatment of CLAI, especially in patients with poor ligament stump quality, systemic ligament laxity, revision surgery, and high exercise needs. Conclusion:Internal Brace suture tape augmentation technique is helpful for patients with CLAI to obtain immediate stability, accelerate rehabilitation, and early return to exercise, especially for patients with poor prognostic factors. More high-quality clinical studies are needed for further verification in the future.
Objective:To summarize the current research status of artificial intelligence (AI) in burn diagnosis and treatment, and to anticipate its future development direction. Methods:Research literature on the application of AI in burn diagnosis and treatment both domestically and internationally in recent years was reviewed. The progress of AI application in various stages of burn diagnosis and treatment was summarized, and the challenges in its clinical application were analyzed. Results:AI has demonstrated its value in improving diagnosis and treatment efficiency and prediction accuracy in multiple aspects, including burn wound diagnosis and severity assessment, perioperative decision making and precise intervention, personalized rehabilitation, and prognosis prediction. However, it also faces challenges related to data, models, and clinical translation. Conclusion:AI exhibits significant potential in burn diagnosis and treatment. In the future, it is necessary to address existing challenges such as the scarcity of data, privacy risks, insufficient interpretability, and clinical translation barriers, and promote its application in clinical practice.
Objective:To explore the effects of RAS-selective lethal small molecule 3 (RSL3), Erastin, and tert-butyl hydroperoxide (TBHP) on ferroptosis of rat annulus fibrosus cells (AFCs), and to establish an effective in vitro model of ferroptosis of rat AFCs, providing an experimental basis and theoretical support for the subsequent research on the mechanism of ferroptosis. Methods:AFCs were isolated and cultured from the caudal vertebrae of 6-week-old female Sprague-Dawley rats by enzymatic hydrolysis. The optimal treatment concentrations of RSL3, Erastin, and TBHP (used for establishing an in vitro model of ferroptosis in rat AFCs) were screened by the cell counting kit 8 (CCK-8) method. According to the optimal concentrations of each inducer obtained through screening, rat AFCs were divided into control group, RSL3 group, Erastin group, and TBHP group. The expression levels of ferroptosis-related genes [glutathione peroxidase 4 (GPX4), ferritin heavy chain 1 (FTH1), acyl coenzyme A synthase long chain member 4 (ACSL4), solute carrier family 7, member 11 (SLC7A11), and prostaglandin-endoperoxide synthase 2 (PTGS2)], and cell proliferation-related genes [proliferating cell nuclear antigen (PCNA)] were detected by real-time fluorescence quantitative PCR (RT-qPCR), Western blot, and cell immunofluorescence staining; iron (Fe 2+) content and malondialdehyde (MDA) content kits were used to evaluate iron accumulation and lipid peroxidation. The levels of intracellular lipid droplets (LDs) and reactive oxygen species (ROS) were determined by cell fluorescence staining to evaluate the level of cellular oxidative stress. Results:The optimal concentrations for treating rat AFCs were screened by CCK-8 method and rat AFCs were divided into control group, RSL3 (0.1 μmol/L) group, Erastin (0.5 μmol/L) group, and TBHP (50 μmol/L) group. Both RSL3 group and TBHP group downregulated the mRNA expression levels of GPX4, FTH1, SLC7A11, and PCNA, upregulated the mRNA expression levels of ACSL4 and PTGS2, decreased the protein expression levels of GPX4 and FTH1, and increased the protein expression level of PTGS2 ( P<0.05); simultaneously, increased the intracellular Fe 2+ and MDA contents, LDs and ROS levels ( P<0.05), significantly induced the occurrence of ferroptosis. While the Erastin group upregulated the mRNA expression levels of FTH1, SLC7A11, and PTGS2 ( P<0.05); however, it had no significant effect on the mRNA expression levels of GPX4, ACSL4, and PCNA, nor on the protein expression levels of GPX4, FTH1, and PTGS2 ( P>0.05), although it increased the intracellular MDA content ( P<0.05), but did not significantly change the intracellular Fe 2+ content, LDs and ROS levels ( P>0.05), failed to induce ferroptosis significantly. Conclusion:RSL3 and TBHP are suitable for the establishment of ferroptosis models in rat AFCs, which is helpful for the subsequent study of ferroptosis in intervertebral disc degeneration.
