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 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.
