To assess the impact of soft tissue release (STR) on radiological and clinical outcomes in functional alignment robot-assisted total knee arthroplasty (FA-TKA). This retrospective controlled study enrolled a total of 127 patients who underwent Mako robot-assisted FA-TKA. Based on whether soft tissue release was performed, patients were categorized into an STR group (n = 38) and a non-STR group (n = 89). Radiographic parameters, including the hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), and posterior tibial slope (PTS), were assessed. Knee function was evaluated using the Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) preoperatively and at 3 and 6 months postoperatively. STR was required in 50

Abstract Background Achieving precise reconstruction of both the coronal and sagittal planes is pivotal in total knee arthroplasty (TKA). However, conventional manual TKA (M-TKA) may induce an unintended “coronal-sagittal coupling” effect, where adjustments in one plane inadvertently alter the outcome in the other. This study aimed to quantify this iatrogenic coupling effect in M-TKA and to evaluate the potential benefits of robotic-assisted TKA (R-TKA) in decoupling these two planes and preserving sagittal Combined Flexion (CF). Methods This retrospective study consecutively enrolled 360 patients who underwent primary TKA between October 2023 and October 2025 (199 in the manual group and 161 in the robotic group). Pre- and postoperative coronal and sagittal parameters were measured on standing full-length lower extremity radiographs and standard lateral radiographs. The “Tibial Cutting Guide Varus/Valgus Angle” (TCVA) was defined to quantify the deviation in cutting guide placement. The study adopted a systematic stepwise analysis strategy: initially detecting potential inter-planar coupling via correlation analysis, subsequently identifying independent predictors of sagittal posterior tibial slope using linear regression models, and finally calculating the equivalent rotational mismatch angle driving this coupling from regression coefficients based on stereometric projection principles. Results In the M-TKA group, ΔMPTA showed a significant negative correlation with ΔPTS (r = − 0.209, p = 0.003), an effect not observed in the R-TKA group. TCVA was a significant independent predictor of postoperative PTS in M-TKA, and geometric analysis revealed an equivalent rotational mismatch of approximately 12.4° between the cutting guide rotational axis and the prosthesis placement axis. The CF preservation rate was significantly higher in the R-TKA group than in the M-TKA group (60.9% vs. 22.6%, p < 0.001). Additionally, ΔDFF and ΔPTS showed a significant negative correlation within the R-TKA group, demonstrating a unique intra-sagittal compensatory mechanism. Conclusion Conventional M-TKA exhibits an iatrogenic coronal-sagittal coupling effect, whereby coronal plane correction errors are projected onto the sagittal plane through inherent rotational mismatch and cutting guide tilt, with error magnitude positively correlated with deformity severity. R-TKA effectively decouples these two planes and better preserves the native sagittal geometric alignment through femoral-tibial synergistic adjustment. Level of evidence Level III, a retrospective cohort study.

This study investigates the correlation between femoral component rotational adjustment strategies and coronal alignment parameters in robot-assisted total knee arthroplasty (TKA), and explores differences among Coronal Plane Alignment of the Knee (CPAK) subtypes. A retrospective analysis of 100 patients with varus gonarthrosis who underwent robot-assisted total knee arthroplasty (TKA) was conducted. Intraoperative navigation data quantified medial/lateral flexion-extension gaps, physiological external rotation, and femoral rotational adjustments. Preoperative CT-based 3D reconstruction, CPAK classification (types I/IV/VII), and radiographic parameters (HKA, lateral distal femoral angle [LDFA], medial proximal tibial angle [MPTA]) were analysed using one-way ANOVA and multivariate linear regression to identify predictors of rotational adjustments and subtype differences. Post-adjustment femoral external rotation angles exhibited a unimodal distribution (4.41°±2.28°), with 52

Abstract Background: To explore the influence of the new staging and classification system based on the correlation between MRI and pathological features on the collapse, symptoms and function of femoral head necrosis. Methods: This retrospective study included 100 patients (200 hips) who were diagnosed with bilateral ONFH. According to the degree of fibrosis in the necrotic area in a mid-coronal section on hip MRI, the MRI stage of ONFH can be divided into three types. Based on the level of inflammatory response, the MRI classification of ONFH can be divided into two types (S1 and S2), and S2 can be divided into three subtypes (S2a, S2b, S2c). The radiological evaluations were based on plain X-rays and MRI. The data were analysed using SPSS 26.0 statistical software. Results: There was a significant difference in the collapse rate between Type Ⅰ (7.1% ),Type Ⅱ (66.3% ) and Type Ⅲ (92.1%) (P＜0.001). The collapse rate in S1 (11.1%), S2a (66.7%), S2b (85.3%), S2c (77.8%) was significantly different (P＜0.001). There was also a significant difference in pain level and hip function between MRI staging and classification (P＜0.001). The later the stage, the higher the pain level, and similar results in hip functions. With the aggravation of bone marrow edema, the patient’s pain level increases and hip function decreases. Conclusion: Pathological fibrosis and inflammatory response are important factors that influence ONFH collapse and prognosis. The new MRI stage and classification based on pathology is a supplement to the existing stage and classification.

In the original publication [...].

Objective The objective of the study was to compare postoperative patient-reported outcomes and reoperation rates following unicompartmental knee arthroplasty (UKA) between patients with full-thickness cartilage loss (FTCL) and partial-thickness cartilage loss (PTCL). Design Multiple databases, including PubMed, Embase, Cochrane Library, and CNKI, were searched until October 2019 for studies comparing the Oxford Knee Score (OKS), American Knee Society (AKS) score, and reoperation rates between patients with FTCL and PTCL following UKA. Data analysis was performed using Review Manager software. Results A total of 613 UKA cases from 5 retrospective cohort studies were included. The mean difference in postoperative OKSs was significantly higher by 2.92 in FTCL group than in PTCL group (95% confidence interval [CI] = −5.29 to −0.55; P = 0.02). Improvement in OKS was significantly higher by 2.69 in FTCL group than in PTCL group (95% CI = −4.79 to −0.60; P = 0.01). However, the differences in OKSs were not clinically significant. The mean difference in AKS knee scores was similar between the 2 groups (95% CI = −9.14 to −3.34; P = 0.36), whereas the pooled mean difference in AKS function scores was higher by 5.63 in FTCL group than in PTCL group (95% CI = −9.27 to −1.98; P = 0.002), which was clinically relevant. The reoperation rates were statistically higher in PTCL group than in FTCL group (odds ratio = 2.24; 95% CI = 1.15 to 4.38; P = 0.02). Conclusions Patients with FTCL achieved superior postoperative patient-reported outcomes and lower reoperation rates following UKA compared with those with PTCL. Thus, we believe this procedure should only be applied to end-stage medial osteoarthritis of the knee joint.

Background This study explores the impact of subchondral bone plate necrosis on the development of the osteonecrosis of femoral head (ONFH) and its joint collapse. Methods This retrospective study included 76 ONFH patients (89 consecutive hips) with Association for Research on Osseous Circulation stage II who received conservative treatment without surgical intervention. The mean follow-up time was 15.60 ± 12.29 months. ONFH was divided into 2 types (I and II): Type I with a necrotic lesion involving subchondral bone plate and Type II with a necrotic lesion not involving subchondral bone plate. The radiological evaluations were based on plain x-rays. The data were analyzed using SPSS 26.0 statistical software. Results The collapse rate in Type I ONFH was significantly higher than that in Type II ONFH (P < 0.001). The survival time of hips with Type I ONFH was significantly shorter than those with Type II ONFH and with the endpoint of the femoral head collapse (P < 0.001). The collapse rate of Type I in the new classification (80.95%) was higher compared with that of the China-Japan Friendship Hospital (CJFH) classification (63.64%), and the difference was statistically significant (χ 2 = 1.776, P = 0.024). Conclusion Subchondral bone plate necrosis is an important factor that affects ONFH collapse and prognosis. Current classification using subchondral bone plate necrosis is more sensitive for predicting collapse compared with the CJFH classification. Effective treatments should be taken to prevent collapse if ONFH necrotic lesions involve the subchondral bone plate.

Osteonecrosis of the femoral head (ONFH) is a common clinical disease with a high disability rate. Injury of bone microvascular endothelial cells (BMECs) caused by glucocorticoid administration is one of the important causes of ONFH, and there is currently a lack of effective clinical treatments. Extracellular vesicles derived from bone stem cells (BMSC-EVs) can prevent ONFH by promoting angiogenesis and can inhibit cell apoptosis by regulating autophagy via the PI3K/Akt/mTOR signaling pathway. The present study aimed to investigate the effect of extracellular vesicles derived from bone marrow stem cells (BMSC) on a glucocorticoid-induced injury of BMECs and possible mechanisms. We found that BMSC-EVs attenuated glucocorticoid-induced viability, angiogenesis capacity injury, and the apoptosis of BMECs. BMSC-EVs increased the LC3 level, but decreased p62 (an autophagy protein receptor) expression, suggesting that BMSC-Exos activated autophagy in glucocorticoid-treated BMECs. The protective effects of BMSC-EVs on the glucocorticoid-induced injury of BMECs was mimicked by a known stimulator of autophagy (rapamycin) and could be enhanced by co-treatment with an autophagy inhibitor (LY294002). BMSC-EVs also suppressed the PI3K/Akt/mTOR signaling pathway, which regulates cell autophagy, in glucocorticoid-treated BMECs. In conclusion, the results indicate that BMSC-EVs prevent the glucocorticoid-induced injury of BMECs by regulating autophagy via the PI3K/Akt/mTOR pathway.

This meta-analysis was designed to assess the effectiveness and safety of extracorporeal shock wave therapy (ESWT) for patients with low back pain (LBP). Pubmed, Embase, Cochrane's library, PEDro (Physiotherapy Evidence Database), China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched until December 2019 to identify studies assessing the effectiveness and safety of EPSW for LBP. The prime outcome is pain intensity measured by Visual Analog Scale (VAS) or numeric rating scale (NRS). Other outcomes included functional status, quality of life, psychological outcomes measured by Oswestry Disability Index (ODI), as well as the adverse events. Mean differences (MD) were calculated for continuous outcomes, while odd ratios (OR) were calculated for binary outcomes. Revman 5.3 software was used for statistical analysis. Five randomized controlled trials (RCTs) were finally included in this meta-analysis. The pooled mean difference in post-treatment pain scores was −2.37 (P ＜0.0001), indicating that post-treatment pain scores was significantly higher by 2.37 in control group than in ESWT group. At a mean follow-up time of 4–6 weeks, the pooled mean difference in ODI scores was −14.10 (P ＜0.00001), indicating that the pooled mean difference of post-treatment ODI scores was 14.10 higher in control group than in ESWT group. The use of ESWT is effective in alleviating pain and improving the general functional state for patients with LBP. However, more evidence was needed to verify its safety.

OBJECTIVE:To review the research progress of subtype H vessels in the occurrence and development of osteonecrosis of the femoral head (ONFH). METHODS:The relevant domestic and foreign literature was extensively reviewed. The histological features, biological mechanism of subtype H vessels involved in promoting of osteogenesis, and the role and application of the subtype H vessels in ONFH were summarized. RESULTS:The subtype H vessel is a newly discovered bone vessel, mainly distributed in metaphysis and subperiosteum, highly expressing endomucin and CD31. The subtype H vessel has a dense arrangement of Runx2 + early osteoprogenitors, collagen type Ⅰα + osteoblast cells, and Osterix + osteoprogenitors that have the ability to induce osteogenesis and angiogenesis. Factors such as platelet-derived growth factor BB, slit guidance ligand 3, hypoxia inducible factor 1α, Notch signaling pathway, and vascular endothelial growth factor are involved in the mechanism of subtype H vessels in promoting osteogenesis. CONCLUSION:Subtype H vessels play an important role in the regulation of angiogenesis and osteogenesis during bone tissue repair and reconstruction. The discovery of subtype H vessels provides new insights into the molecular and cellular mechanisms of osteogenesis and angiogenesis coupling. In the future, new techniques targeting the regulation of subtype H blood vessels may become a promising method for the treatment of ONFH.

UKA has been proved to offer good results in treating patients with unicompartmental knee osteoarthritis (OA). However, there is still a controversy about the better fixation mode in UKA procedure between cemented and uncemented prosthesis. Therefore, this meta-analysis was conducted to compare clinical and radiological outcomes of cemented versus uncemented Oxford UKA. The study surmised that uncemented Oxford UKA was associated with shorter operation time, higher function scores, lower revision rate and less radiolucency than cemented Oxford UKA. A meta-analysis to compare postoperative outcomes between cemented and uncemented Oxford UKA wsa conducted. The primary outcomes included Oxford knee score (OKS), revision rate, and incidence of radiolucency. The secondary outcomes included operation time, knee society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM). PubMed, Embase, Web of Science, the Cochrane Library and China national knowledge infrastructure were searched until April, 2020 to identify studies for including. Relevant data were analyzed using RevMan v5.3. We identified nine studies involving 901 patients meeting our inclusion criteria. No significant difference of OKS was found in both groups. Compared with cemented group, uncemented Oxford UKA group was associated with lower revision rate (95 % CI: 0.90 to 3.73; OR = 1.83) and less radiolucent lines (95 % CI: 0.79 to 9.52; OR = 2.75) after following up for at least 2 years. The operation time was significantly shorter by 10.12 min (95 % CI; p < 0.00001) in the uncemented group when compared against the cemented group. The KSS, WOMAC, ROM were not significantly different between two groups. Uncemented Oxford UKA had lower revision rate, shorter operation time and less radiolucent lines than cemented Oxford UKA did. There is still need for more long follow-up clinical trials with high evidence level to determine which method of fixation is of preferable for Oxford UKA in the future. I.

Background: UKA has been proved to offer good results in treating patients with unicompartmental knee osteoarthritis (OA). However, there is still a controversy about the better fixation mode in UKA procedure between cemented and uncemented prosthesis. Therefore, this meta-analysis was conducted to compare clinical and radiological outcomes of cemented versus uncemented Oxford UKA.& nbsp; & nbsp;Hypothesis: The study surmised that uncemented Oxford UKA was associated with shorter operation time, higher function scores, lower revision rate and less radiolucency than cemented Oxford UKA.& nbsp; & nbsp;Methods: A meta-analysis to compare postoperative outcomes between cemented and uncemented Oxford UKA wsa conducted. The primary outcomes included Oxford knee score (OKS), revision rate, and incidence of radiolucency. The secondary outcomes included operation time, knee society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM). PubMed, Embase, Web of Science, the Cochrane Library and China national knowledge infrastructure were searched until April, 2020 to identify studies for including. Relevant data were analyzed using RevMan v5.3.& nbsp; Results: We identified nine studies involving 901 patients meeting our inclusion criteria. No significant difference of OKS was found in both groups. Compared with cemented group, uncemented Oxford UKA group was associated with lower revision rate (95% CI: 0.90 to 3.73; OR = 1.83) and less radiolucent lines (95% CI: 0.79 to 9.52; OR = 2.75) after following up for at least 2 years. The operation time was significantly shorter by 10.12 minutes (95% CI: p < 0.00001) in the uncemented group when compared against the cemented group. The KSS, WOMAC, ROM were not significantly different between two groups.& nbsp; Conclusions: Uncemented Oxford UKA had lower revision rate, shorter operation time and less radiolucent lines than cemented Oxford UKA did. There is still need for more long follow-up clinical trials with high evidence level to determine which method of fixation is of preferable for Oxford UKA in the future. Level of evidence: I.& nbsp; (c) 2021 Elsevier Masson SAS. All rights reserved.

BACKGROUND:Only a few studies exist that have assessed the efficacy of autologous osteochondral transplantation (AOT) treatment of osteonecrosis (ON) of the knee. The purpose of this study was to clarify the clinical and radiographic results of AOT performed on young patients with postcollapse ON of the knee.METHODS:This retrospective study included 14 young patients (6 men, 8 women, mean age 34.71 ± 5.41 years) with stage III knee ON undergoing AOT surgery. Mean follow-up time was 87 ± 10.23 months. The postoperative clinical and radiological evaluations were based on Hospital for Special Surgery (HSS) scores and plain x-rays. Paired t tests were used for the statistical analysis by SPSS software.RESULTS:Preoperative HSS (mean 66.86 ± 7.49 points) was significantly improved at mean 7 years to a postoperative HSS (mean 87.36 ± 8.63 points) (P < 0.001). The postoperative rangeof motion (ROM; 125.71° ± 4.74°) was not significantly different from the preoperative ROM (126.86° ± 7.13°) (P = 0.626). There was no progression of collapse observed in any knees at the last follow-up. No knees required any reoperations during the follow-up period.CONCLUSION:Fourteen young patients with local ON of the knee were treated by AOT. No progression of bone collapse was seen and clinical improvement sustained at mean 7 years postsurgery. AOT seems to be a safe technique that can give long-term improvement and durability in young ON patients. However, large-sample and high-quality clinical trials are still needed in the future.

目的:探讨强直性脊柱炎(AS)患者人类白细胞抗原B27(HLA-B27)基因和T、B及自然杀伤(NK)淋巴细胞亚群检测的临床价值.方法:收集中日友好医院2018年～2020年间确诊的121例AS患者以及120例健康体检人群外周血样本,检测HLA-B27基因及分型,流式细胞术检测其标记为T、B及NK的淋巴细胞亚群.结果:121例AS患者中HLA-B27基因阳性101例,其中HLA-B2704型58例、HLA-B2705型40例、HLA-B2702型1例、HLA-B2704*HLA-B2705复合杂合子2例.AS组HLA-B27基因阳性率明显高于健康对照组(83.5％vs2.5％,P＜0.01).HLA-B2705型AS组T％、Th％、Th/Ts明显高于HLA-B2704型AS患者(P＜0.01),B1％、NK％显著低于HLA-B2704型AS患者(P＜0.01).101例HLA-B27基因阳性与20例HLA-B27基因阴性AS患者T、B及NK淋巴细胞亚群差异暂无统计学意义(P＞0.05).结论:AS患者淋巴细胞亚群分布异常,免疫功能紊乱,与HLA-B27基因亚型具有相关性.

Background The mobile Oxford unicompartmental knee arthroplasty (UKA) implant has been widely used with an intramedullary guide for femoral preparation. We modified the femoral guide technique based on the tibial cut first and spacer block technique. This study was performed to determine the radiographic accuracy and early clinical outcomes of the extramedullary method. Methods We retrospectively evaluated 50 consecutive patients who underwent UKA using the extramedullary technique. An equal number of patients who underwent UKA with the conventional technique were matched as the control group. Clinical outcomes were evaluated in terms of the operating time, blood loss, range of motion, and Hospital for Special Surgery score. Radiographic accuracy was evaluated by the implant position and alignment in the coronal and sagittal planes. Results The mean follow-up period was 39.76 ± 5.77 months. There were no differences in the postoperative Hospital for Special Surgery score, range of motion, or hip-knee-ankle angle between the two groups. The operating time in the extramedullary group was shorter than that in the conventional group (54.78 ± 7.95 vs. 59.14 ± 10.91 min, respectively; p = 0.025). The drop in hemoglobin after 3 days was only 12.34 ± 4.98 g/L in the extramedullary group which was less than that in the conventional group ( p = 0.001). No significant differences were found in the postoperative coronal and sagittal angles between the two groups. Acceptable radiographic accuracy of the implant alignment and position was achieved in 92% of patients in the extramedullary group and 96% of patients in the conventional group. Conclusions The radiographic and clinical results of the extramedullary technique were comparable with those of the conventional technique with the advantage of no intramedullary interruption, less blood loss, a shorter operating time, and more rapid recovery. As the technique depends on the accurate tibial cut and overall alignment, we do not recommend it to surgeons without high volume experiences. Trial registration Retrospectively registered Level of evidence IV, retrospective study

Abstract Background To compare and analyze the therapeutic effect of Proximal Femoral Nail Antirotation and hemiarthroplasty on intertrochanteric fracture. Methods 45 patients with intertrochanteric fractures (17 males and 28 females) admitted to our hospital from January 2016 to January 2018 were collected. The mean age was 84.82 ± 0.73 years. All injuries were caused by falls during daily activities. Patients were divided into two groups according to the surgical method: the first group was the hemiarthroplasty group, referred to as the hemiarthroplasty group, with a total of 22 patients, and the average length of hospital stay was 13.09 ± 5.03 days. According to the improved Evans-Jensen classification [5], there were 1 cases of III, 9 cases of IV, and 12 cases of V12.The second group was the Proximal Femoral Nail Antirotation group, and the average length of hospital stay was 13.09 ± 6.97 days. According to the Evans-Jensen classification, 1 patient was III, 16 patients were IV, and 6 patients were V. Results Intraoperative blood loss was higher in the The Proximal Femoral Nail Antirotation group than in the hemiarthroplasty group(P=0.034).In the postoperative recovery of the two groups, the time from operation to partial weight-bearing of the hemiarthroplasty group was shorter than that of the PFNA group༈p༝0.000༉, and the postoperative HHS of the hemiarthroplasty group was also better than the latter (p ༝0.0005). In terms of total cost during hospitalization, the Hemiarthroplasty group was less than the PFN group(p ༝ 0.017). One year after surgery, the mortality rate increased to 34% in the PNFA group and 9% in the hemiarthroplasty group( P = 0.038), which was statistically significant. Conclusion Hemiarthroplasty for intertrochanteric fractures in the elderly can reduce intraoperative blood loss, achieve early recovery, improve survival rates, and reduce the economic burden on patients

目的:探讨强直性脊柱炎(AS)患者基本特征以及人类白细胞抗原B27(HLA-B27)基因分型检测的临床意义.方法:收集中日友好医院2018年1月～2019年12月间确诊的AS患者资料,对其外周血样本进行核酸提取,荧光定量PCR染料法检测HLA-B27基因及分型.结果:287例AS患者中HLA-B27基因阳性占82.9％;AS家族史患者占16.0％(一级亲属占14.3％,二级亲属占1.7％);伴发葡萄膜炎10.1％.238例HLA-B27基因阳性AS患者中HLA-B2704亚型占55.0％,HLA-B2705亚型42.4％,HLA-B2702亚型0.8％;HLA-B2704*HLA-B2705复合杂合子1.3％,HLA-B2705*HLA-B2708复合杂合子0.4％.男性AS患者就诊年龄、发病年龄显著早于女性AS患者(P＜0.05;P＜0.01).HLA-B27基因阳性AS患者发病年龄显著早于HLA-B27基因阴性AS患者(P＜0.05).HLA-B2705亚型AS患者伴发葡萄膜炎比例显著高于HLA-B2704亚型AS患者(P＜0.05).结论:男性、HLA-B27基因阳性AS患者发病年龄较早,HLA-B2705亚型AS患者更易伴发葡萄膜炎.

背景:实验显示双膦酸盐对预防股骨头塌陷起到积极作用,但临床应用结果存在一定争议,且由于系统用药的不良反应较多,近期对局部应用的研究逐渐增多.目的:综述双膦酸盐治疗股骨头缺血性坏死的研究进展.方法:由2位共同第一作者检索PubMed数据库及CNKI中国期刊全文数据库收录的双膦酸盐治疗股骨头缺血性坏死的相关文章,英文检索词为"osteonecrosis of the femoral head,bisphosphonates,systemic therapy,topical therapy,osteogenesis,bone destruction,bone remodeling",中文检索词为"股骨头坏死、双膦酸盐、系统、局部、成骨、破骨、骨重塑",按纳入和排除标准共纳入文献62篇进行归纳总结.结果与结论:双膦酸盐对成骨细胞既有抑制作用也有激活作用,目前存在一定争议.目前研究显示低浓度双膦酸盐可促进成骨细胞的增殖,而高浓度起到抑制作用.长期系统应用双膦酸盐会有下颌骨坏死等不良反应,而局部应用双膦酸盐治疗股骨头缺血性坏死仍停留在实验阶段,且治疗股骨头缺血性坏死的最佳浓度及药效持续时间都尚未确定,在临床应用前仍需进一步的高质量实验研究来阐明.

Secukinumab is a novel IL-17A inhibitor that has been confirmed to be effective for treating PsA and RA. Several studies have demonstrated that secukinumab also provides benefits for AS patients. Thus, we performed a meta-analysis of RCTs to evaluate the short-term efficacy and safety of secukinumab for the management of AS. The PubMed, Medline, Embase, Web of Science, and Cochrane Library databases were searched for RCTs published prior to March 2020 on the treatment of AS with secukinumab. The primary outcome was the ASAS20 response, and the secondary outcomes included the ASAS40 response, ASAS5/6 response, SF-36 PCS score, ASQoL score, and AEs. Dichotomous data were expressed as pooled RRs with 95% CIs, while continuous data were expressed as pooled MDs with 95% CIs. Subgroup analysis was conducted based on whether the AS patients previously underwent treatment with TNFi. A total of 4 RCTs with 1166 patients were included in our meta-analysis. At week 16, secukinumab 150 mg yielded significant improvements in the clinical response and patient-reported outcomes for AS patients. There was no increased risk of AEs. Consistent results were detected in the meta-analysis of secukinumab 75 mg versus a placebo. Furthermore, no significant difference was detected between the secukinumab 75 mg group and secukinumab 150 mg group. We concluded that secukinumab is effective for treating AS and generally well tolerated by AS patients in the short term, regardless of whether they previously underwent TNFi treatment. The superiority of secukinumab 150 mg over secukinumab 75 mg seems to be limited, since no significant difference in any endpoint was detected between the two groups.

The immunologic factors have been implicated in the pathogenesis of osteonecrosis. We aimed to investigate the potential role of immune regulatory cells in the development of osteonecrosis of femoral head (ONFH). Sixty-seven patients diagnosed with ONFH and fifty-eight age-, height-, and weight-matched healthy subjects were included in this retrospective study between September 2015 and September 2018. The flow cytometry was used to test the count, percentage, and ratio of T and B lymphocyte subsets in peripheral blood. The T and B lymphocyte levels were compared among different ARCO stages, CJFH types, and etiology groups. The total lymphocyte count, CD3+T cells, Ts cells (CD3+CD8+), B-1 cell count, and B-1 cells (CD5+CD19+) were significantly higher in the patients with ONFH than those in the control subjects. The percentage of T lymphocytes in the patients with ARCO IV stage was significantly smaller than that in the ONFH patients with ARCO II and III stages. The percentage of inhibitory T lymphocytes in patients with CJFH type L3 was significantly smaller than that in the patients with types L1 and L2. In terms of the different ONFH etiologies, the total lymphocyte count and Ts cells (CD3+CD8+) were significantly lower in the ONFH patients induced by excessive alcohol intake than those in the idiopathic ONFH patients. Our results seem to indicate that immune regulatory cells, such as T and B lymphocytes, play an important role in the pathogenesis of ONFH. The development and progression of ONFH may be associated with immune system imbalance.