Objective A retrospective cohort study was conducted to evaluate the short-term clinical efficacy and technical advantages of arthroscopic-assisted uni-portal spinal surgery (AUSS) combined with transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar spondylolisthesis. Methods This study included 73 patients with low-grade degenerative lumbar spondylolisthesis who underwent surgical treatment in September 2023 and December 2024. Among these, 33 patients underwent AUSS–TLIF, and 40 underwent open TLIF. Preoperative and postoperative assessments were conducted using the visual analogue scale for low back pain and leg pain, Oswestry Disability Index, and surgery-related parameters, including operation time, intraoperative blood loss, postoperative drainage volume, slip reduction rate, and length of hospital stay. Additionally, the surgical outcomes and postoperative fusion status were compared between the two groups. Baseline data were collected and analyzed for confounding factors, including body mass index, duration of symptoms, preoperative medication history, and comorbidities (hypertension and diabetes). All patient data were anonymized to protect privacy. Normality and homogeneity of variance tests were performed for measurement data. Repeated measures analysis of variance was used for visual analog scale scores and Oswestry Disability Index values at different time points. Results All 73 patients successfully underwent the surgical procedure and were followed up for 6 months. Preoperative comparisons of visual analog scale scores and Oswestry Disability Index values between the two groups revealed no statistically significant differences ( p > 0.05). Both groups demonstrated significantly reduced visual analog scale scores for low back pain and leg pain as well as significantly lower Oswestry Disability Index values after the surgery. At 6 months postoperatively, there were no significant differences in the visual analog scale scores, Oswestry Disability Index values, or imaging parameters between the two groups ( p > 0.05). The AUSS–TLIF group exhibited significantly lower visual analog scale scores for low back pain at the 3-day and 3-month follow-ups than the open TLIF group ( p < 0.05). However, no difference was observed at the 6-month follow-up ( p > 0.05). Additionally, there were no differences in the visual analog scale scores for leg pain between the two groups at 3 days, 3 months, or 6 months postoperatively ( p > 0.05). At the 3-month follow-up, the Oswestry Disability Index values of the AUSS–TLIF group were significantly lower than those of the OPEN–TLIF group ( p < 0.05), with no significant difference observed at the 6-month follow-up ( p > 0.05). Intraoperative blood loss, postoperative drainage volume, and hospital stay were significantly lower in the AUSS–TLIF group than in the open TLIF group ( p < 0.05). The operation time in the AUSS–TLIF group was longer than that in the open TLIF group, and this difference was statistically significant ( p < 0.05). No significant differences were observed in the slip reduction rate or the total incidence of complications between the two groups ( p > 0.05). At the final follow-up, there were no significant differences in the MacNab criteria or the imaging fusion rate between the two groups ( p > 0.05). The fusion rates were 96.97% (32/33) in the AUSS–TLIF group and 95.00% (38/40) in the open TLIF group. Postoperative analgesic usage was lower in the AUSS–TLIF group (mean 2.5 ± 1.1 administrations) than in the open TLIF group (mean 3.9 ± 1.1 administrations) at the same postoperative times. Conclusion Both AUSS–TLIF and open TLIF can achieve excellent clinical outcomes in the treatment of degenerative lumbar spondylolisthesis. As an endoscopic procedure, AUSS–TLIF offers distinct advantages, such as improved visualization of the surgical field, enhanced surgical maneuverability, reduced paraspinal muscle damage, reduced intraoperative blood loss, and shortened hospitalization duration. Its short-term efficacy surpasses that of open surgery.

ObjectiveTo compare the clinical efficacy and safety of uni-portal non-coaxial spinal endoscopic surgery (UNSES) with unilateral biportal endoscopic technique (UBE) for the treatment of lumbar spinal stenosis (LSS).MethodsWe retrospectively analyzed 195 patients with LSS (96 in the UNSES group and 99 in the UBE group) from January 2022 to December 2023. The two groups were compared regarding operative time, postoperative hemoglobin decrease, incision length, length of hospital stay, complication rate, functional scores (VAS, JOA, ODI), and imaging parameters, including dural sac cross-sectional area (DCSA), lumbar range of motion (ROM), and sagittal translation (ST).ResultsNo significant differences were observed in baseline characteristics between the UNSES and UBE groups. Compared with the UBE group, the UNSES group showed shorter operative time (65.2 ± 8.1 vs. 72.5 ± 9.3 min, P < 0.001), lower hemoglobin decrease (6.2 ± 1.4 vs. 6.8 ± 2.5 g/L, P = 0.039), a smaller incision length (1.8 ± 0.3 vs. 2.5 ± 0.4 cm, P < 0.001), and fewer fluoroscopy exposures (3.1 ± 1.2 vs. 4.5 ± 2.0, P < 0.001). Both groups showed postoperative improvement in pain, functional scores, and DCSA compared with preoperative values (P < 0.05), whereas ROM and ST remained unchanged. No intergroup differences were observed in these parameters or in complication rates at any time point (all P > 0.05).ConclusionAt the 1-year follow-up, UNSES and UBE were associated with comparable clinical and radiographic outcomes in patients with single-segment lumbar spinal stenosis. Compared with UBE, UNSES was associated with differences in several perioperative parameters, including operative time, hemoglobin decrease, incision length, and fluoroscopy exposure. These findings should be interpreted with caution, given the retrospective design and limited follow-up duration.

Osteoporosis represents a major global health challenge with increasing prevalence and substantial healthcare burden. Current diagnostic approaches relying primarily on bone mineral density measurements have limitations for early disease detection and understanding pathophysiological mechanisms. We conducted comprehensive metabolomic analysis of osteoporotic cancellous bone to identify potential metabolic features and explore disease mechanisms. Hip cancellous bone samples from 18 osteoporotic patients and 18 age-matched non-osteoporotic controls were analyzed using dual-platform gas/liquid chromatography-mass spectrometry. Multivariate analysis combined with machine learning approaches identified metabolic patterns distinguishing osteoporotic from non-osteoporotic bone. Untargeted metabolomics of osteoporotic cancellous bone revealed widespread metabolic alterations. Key findings included significant reductions in amino acids (phenylalanine, glutamate, aspartate, lysine, arginine, serine, cystine), polyamines (spermidine), TCA intermediates (citrate, succinate), and purine nucleosides (adenosine, inosine, guanosine, inosine-2′-phosphate), together with decreased phospholipid precursors (phosphorylcholine, choline). In contrast, metabolites such as allantoic acid and inorganic sulfate were elevated. Pathway enrichment implicated amino acid, purine, energy, one-carbon, and phospholipid metabolism, converging on impaired osteoblast function, enhanced osteoclast activity, and oxidative stress. Statistically, inosine-2′-phosphate (AUC = 0.951) Allantoic acid (log2FC: 3.14785) and phenylalanine (log2FC: − 5.3884) showed strong discriminatory potential. This study provides the first comprehensive metabolomic profile of human osteoporotic cancellous bone, highlighting a network of metabolic disturbances that underlie dysregulated bone remodeling. These findings identify amino acid, purine, and phospholipid pathways as potential mechanistic drivers and therapeutic targets in osteoporosis. Metabolites with strong statistical significance warrant further validation and translational investigation.

[This corrects the article DOI: 10.3389/fbioe.2025.1642787.].

Quantitative CT (QCT) is a method of measuring bone mineral density (BMD) of human based on a CT machine,calibrated by QCT body model and analyzed by professional software.Compared with dual-energy X-ray absorptiometry,QCT can not only assess the cortical and cancellous BMD but also exclude the influences of osteophytes and aortic/vascular calcification,thus being capable of accurately reflecting patients' bone mass.In recent years,increasing studies on QCT and osteoporosis (OP) have been carried out,and the application of QCT in the diagnosis of OP,evaluation of vertebral bone conditions,prediction of fracture risks,and assessment of anti-OP treatment is garnering increasing attention from researchers at home and abroad.This article reviews the research progress in this field,aiming to provide a reference for the research on QCT in the diagnosis and treatment of OP.

IntroductionCritical femoral diaphyseal defects exceeding 3 cm present significant challenges in trauma and military orthopedics, particularly in blast injury scenarios requiring rapid rehabilitation.MethodsThe purpose of this experiment was to evaluate the biomechanical in vitro performance of two personalized prostheses (Groups A and B) designed explicitly for critical femoral diaphyseal defects through integrated biomechanical testing and finite element analysis (FEA). Using fourth-generation composite femurs simulating 10 cm defects (n = 16), we compared axial compression, torsion, four-point bending stiffness, and cyclic fatigue performance against intact bones (Group D) and diaphyseal fractures without defects (Group C).ResultsKey findings demonstrate comparable compressive stiffness between prostheses groups (Group A: 764.12±112.63 N/mm; Group B: 693.63±136.31 N/mm) and intact femurs (808.59±18.1 N/mm, p>0.05). The torsional stiffness is comparable between prostheses groups (Group A: 2.28±0.15 Nm/°; Group B: 2.18±0.22 Nm/°) versus diaphyseal fractures without defects (2.01±0.19 Nm/°). The stiffness results comply with mobilization requirements. FEA revealed maximum von Mises stresses in prosthesis fixation systems below the yield strength of Ti6Al4V, with digital image correlation validating the stress distribution patterns. The porous scaffold design achieved optimal modulus (1,132.85 MPa) between cortical and cancellous bone, reducing the “stress shielding” effect. Both prostheses endured 1800 N cyclic loading (100,000 cycles ≈, 13.3 years of physiological use) without structural failure.DiscussionThese customized prostheses address critical military medical needs by enabling immediate weight-bearing, reducing surgical complexity compared to bone transport techniques, and maintaining long-term mechanical integrity. The stiffener design philosophy and additive manufacturing flexibility provide adaptable solutions for complex combat-related trauma, significantly advancing early functional recovery in resource-constrained environments.

This paper established an osteoporotic rabbit model by depopulation and the glucocorticoid method, investigated the weights of bone micro-parameters in macro-mechanics during OP progression, preliminary elucidated micro-mechanisms, and screened out bone turnover markers (BTMs) that have a strong correlation with bone macro-mechanical strength and microscopic spatial structure to provide the theoretical basis for OP and OP fracture. Methods: 64 female White rabbits were chosen and assigned to two groups: one that underwent a sham operation (Sham group, n = 32) and the other that served as an osteoporosis model (OP group, n = 32). At four different postoperative time points (T = 0, 1, 2, and 4 months), respectively. The white rabbits in the Sham group and the OP group were randomly divided into four groups (n = 8) each. Dual-energy X-ray absorptiometry (DXA) was used to determine the lumbar bone mineral density (BMD) at various time intervals (T = 0, 1, 2, and 4 months), and serum BTMs were found using an ELISA test after blood was drawn and the animals were put to death. Axial compression testing and micro-CT were used to assess and characterise the cancellous bone in the lumbar spine specimens. Results: Lumbar BMD, lumbar Lmax, Tb.Th, Tb.N, and BV/TV all steadily declined as OP progressed, while OC, PINP, CTX, and Tb.Sp all gradually rose. All bone microspatial characteristics were strongly linked with Lmax (p = 0.000) according to a person linear correlation analysis, with the best association found between Tb.Th and lumbar Lmax (r = 0.924, p = 0.000). PINP and OC had the strongest connections with lumbar Lmax (r = -0.958, p = 0.000), whereas CTX had the strongest correlation with Tb.Th (r = -0.955, p = 0.000), according to a correlation analysis of serum BTMs with bone strength and sensitive microspatial measures. Conclusion: All lumbar cancellous bone microspatial parameters were correlated with macroscopic mechanical strength during OP progression, with Tb.Th having the strongest correlation. For BTMs, CTX had the strongest correlation with microspatial structure, and PINP and OC had the strongest correlation with macroscopic mechanical strength.

Objective:The risk factors of PJK (proximal junctional kyphosis) related to AIS (adolescent idiopathic scoliosis) are inconsistent due to heterogeneity in study design, diagnostic criteria, and population. Therefore, the meta-analysis was conducted to investigate the factors affecting PJK after posterior spinal fusion for AIS patients. Methods:We implemented a systematic search to obtain potential literature relevant to PJK in AIS surgery. Then, a meta-analysis was performed to assess the incidence of PJK and its risk factors. Results:We retrieved 542 articles, and 24 articles were included. The PJK incidence was 17.67%. The use of hooks at UIV (upper instrumented vertebrae) (p = 0.001) could prevent PJK. Before surgery, the larger TK (thoracic kyphosis) (p < 0.001), GTK (global thoracic kyphosis) (p < 0.001), and LL (lumbar lordosis) (p < 0.001) were presented in the PJK group. Immediately post-operatively, in the PJK group, the following parameters were higher: TK (p = 0.001), GTK (p < 0.001), LL (p = 0.04), PJA (proximal junctional angle) (p < 0.001), and PJA-RCA (rod contouring angle) (p = 0.001). At the final follow-up, the following parameters were higher in the PJK group: TK (p < 0.001), GTK (p < 0.001), LL (P < 0.001), and PJA (P < 0.001). Sub-group analysis detected that before surgery, the following parameters were larger in the PJK group: TK (p < 0.001), LL (p = 0.005), and PJA (p = 0.03) in Lenke type 5 AIS patients. Immediately post-operatively, in the PJK group, the following parameters were higher: TK (p < 0.001), LL (p = 0.005), and PJA (p < 0.001). At the final follow-up, the following parameters were higher in the PJK group: TK (p < 0.001), LL (p < 0.001), and PJA (p < 0.001). Conclusion:The individuals with larger preoperative TK were more susceptible to PJK, and PJA was mainly influenced by the adjacent segments rather than the whole sagittal alignment. Using hooks or claws at UIV should prevent PJK.

The purpose of this study was to assess the factors affecting caudal screw loosening after spinopelvic fixation for adult patients with spinal deformity. This meta-analysis calculated the weighted mean difference (WMD) and odds ratio (OR) using Review Manager ver. 5.3 (RevMan; Cochrane, London, UK). The loosening group was older than the control group (WMD, 2.17; 95% confidence interval [CI], 0.48-3.87; p=0.01). The S2 alar-iliac (S2AI) could prevent the caudal screw from loosening (OR, 0.43; 95% CI, 0.20-0.94; p=0.03). However, gender distribution (p=0.36), the number of fusion segments (p=0.24), rod breakage (p=0.97), T-score (p=0.10), and proximal junctional kyphosis (p=0.75) demonstrated no difference. Preoperatively, only pelvic incidence (PI) in the loosening group was higher (WMD, 5.08; 95% CI, 2.71-7.45; p<0.01), while thoracic kyphosis (p=0.09), lumbar lordosis (LL) (p=0.69), pelvic tilt (PT) (p=0.31), pelvic incidence minus lumbar lordosis (PI-LL) (p=0.35), sagittal vertical axis (SVA) (p=0.27), and T1 pelvic angle (TPA) demonstrated no difference (p=0.10). PI-LL (WMD, 6.05; 95% CI, 0.96-11.14; p=0.02), PT (WMD, 4.12; 95% CI, 0.99-7.26; p=0.01), TPA (WMD, 4.72; 95% CI, 2.35-7.09; p<0.01), and SVA (WMD, 13.35; 95% CI, 2.83-3.87; p=0.001) were higher in the screw loosening group immediately postoperatively. However, TK (p=0.24) and LL (p=0.44) demonstrated no difference. TPA (WMD, 8.38; 95% CI, 3.30-13.47; p<0.01), PT (WMD, 6.01; 95% CI, 1.47-10.55; p=0.01), and SVA (WMD, 23.13; 95% CI, 12.06-34.21; p<0.01) were higher in the screw loosening group at the final follow-up. However, PI-LL (p=0.17) demonstrated no significant difference. Elderly individuals were more susceptible to the caudal screw loosening, and the S2AI screw might better reduce the caudal screw loosening rate than the iliac screws. The lumbar lordosis and sagittal alignment should be reconstructed properly to prevent the caudal screw from loosening. Measures to block sagittal alignment deterioration could also prevent the caudal screw from loosening.

The number of artificial total hip revision arthroplasties is increasing yearly in China, and >50% of these cases have acetabular defects. Accurately locating and quantifying the bone defect is one of the current challenges of this surgery. Thus, the objective of the present study was to simulate acetabular implantation with the aid of Mimics 17.0 software (Materialise NV) in patients with loosened acetabular prosthesis, to evaluate the 'ideal acetabular center' and the 'actual acetabular center' to guide the choice of prosthesis and surgical method. From January 2017 to June 2021, the present study included 10 hips from 10 patients [seven men (seven hips) and three women (three hips)]. In all patients, the Mimics software was applied to simulate the dislocation of the femoral prosthesis and acetabular prosthesis implantation before surgery; calculate the height difference between the 'ideal acetabular center' and the 'actual acetabular center' to assess the bone defect; confirm the size of the acetabular prosthesis, abduction angle, anteversion angle and bone coverage of the acetabular cup; and measure the intraoperative bleeding and postoperative follow-up Harris score of the hip joint. After statistical analysis, the present study revealed that digital simulation assistance could improve the accuracy of hip revision acetabular prosthesis implantation, reduce postoperative shortening of the affected limb, especially for surgeons with relatively little experience in hip revision surgery, and greatly reduce the occurrence of complications such as hip dislocation because of poor postoperative prosthesis position.

目的 评估优化剂量骨水泥强化椎弓根钉内固定在骨质疏松性腰椎滑脱症经椎间孔腰椎间融合术中应用的可行性和临床效果.方法 纳入自2016-05-2020-07经椎间孔减压腰椎间融合术治疗的43例骨质疏松性腰椎滑脱症,其中21例术中采用优化剂量骨水泥强化椎弓根钉内固定(观察组),22例术中未注入骨水泥强化(对照组).比较观察组与对照组术后椎体复位满意率、椎间融合率、疼痛VAS评分、ODI指数.结果 43例均获得至少12个月随访.观察组术后未发现骨水泥渗漏及骨水泥毒性反应.对照组1例S1椎体内的2枚螺钉松动,非手术治疗后症状缓解.观察组术后滑脱椎体复位满意率、术后12个月椎间融合率高于对照组,术后1个月、3个月、12个月疼痛VAS评分和ODI指数低于对照组,差异有统计学意义(P＜0.05).结论 经椎间孔腰椎间融合治疗骨质疏松性腰椎滑脱症术中采用优化剂量骨水泥强化椎弓根钉内固定能够有效提高即刻稳定性和螺钉把持力,提高滑脱椎体复位满意率和术后椎间融合率,同时术后应用唑来膦酸规范抗骨质疏松治疗有利于患者早期下床活动,减少骨量丢失,降低远期螺钉松动的风险.

Femoral neck fractures are serious consequence of osteoporosis (OP), numbers of people are working on the micro—mechanisms of femoral neck fractures. This study aims to investigate the role and weight of microscopic properties on femoral neck maximum load (Lmax), funding the indicator which effects Lmax most. A total of 115 patients were recruited from January 2018 to December 2020. Femoral neck samples were collected during the total hip replacement surgery. Femoral neck Lmax, micro—structure, micro—mechanical properties, micro—chemical composition were all measured and analyzed. Multiple linear regression analyses were performed to identify significant factors that affected the femoral neck Lmax. The Lmax, cortical bone mineral density (cBMD), cortical bone thickness (Ct. Th), elastic modulus, hardness and collagen cross—linking ratio were all significantly decreased, whereas other parameters were significantly increased during the progression of OP (P < 0.05). In micro—mechanical properties, elastic modulus has the strongest correlation with Lmax (P < 0.05). The cBMD has the strongest association with Lmax in micro—structure (P < 0.05). In micro—chemical composition, crystal size has the strongest correlation with Lmax (P < 0.05). Multiple linear regression analysis showed that elastic modulus was most strongly related to Lmax (β = 0.920, P = 0.000). Compared with other parameters, elastic modulus has the greatest influence on Lmax. Evaluation of microscopic parameters on femoral neck cortical bone can clarify the effects of microscopic properties on Lmax, providing a theoretical basis for the femoral neck OP and fragility fractures.

Objective The superficial zone cells in articular cartilage (SFZCs) have been identified as stem/progenitor chondrocytes and promoted cell self-renewal in the osteoarthritis (OA). Several studies emphasized the involvement of senescence and autophagy in OA. Interleukin-1β (IL-1β) is one of the main inflammatory mediators of OA, and whether it induces senescence and autophagy in SFZCs remains unclear. The present study aimed to investigate autophagy flux, mitochondrial function, and intracellular reactive oxygen species (ROS) that resulted in senescence in SFZCs induced by IL-1β. Methods Using western blotting, reverse transcription-quantitative PCR, immunofluorescence, intracellular ROS detection, mitochondrial staining, and determination of mitochondrial membrane potential, we tested senescence and autophagy markers in SFZCs induced by IL-1β in vitro. The consequences of mitochondrial function and ROS were also studied with IL-1β-induced senescence. Results IL-1β treatment decreased SFZC proliferation, induced SFZC senescence, and reduced SFZCs’ chondrogenic differentiation capacity. Moreover, IL-1β impaired autophagy flux, and the autophagy activator, rapamycin, attenuated the senescence of SFZCs. IL-1β-induced autophagy defect resulted in mitochondrial dysfunction and overproduction of ROS, and autophagy activation notably protected against mitochondrial dysfunction and reduced the levels of ROS. Moreover, antioxidant N-acetylcysteine reversed the senescence of IL-1β in SFZCs. Conclusion IL-1β promotes autophagy impairment and subsequently results in dysfunctional mitochondria and overproduction of ROS, which finally causes SFZC senescence.

目的 探讨聚甲基丙烯酸甲酯(PMMA)骨水泥强化椎弓根螺钉固定联合唑来膦酸治疗骨质疏松性腰椎滑脱的效果.方法 选取2016年5月—2019年7月联勤保障部队第908医院收治的骨质疏松性腰椎滑脱患者15例,对所有患者行经椎间孔入路腰椎椎间融合术,采用P MMA骨水泥强化椎弓根螺钉固定联合唑来膦酸治疗骨质疏松性腰椎滑脱.记录患者术中情况,术后腰椎复位情况,术后腰椎功能[Oswestry功能障碍指数问卷表(ODI)评估]、疼痛情况[视觉模拟评分法(VAS)评估]以及骨质疏松情况.结果 15例患者均顺利完成手术,术中1例患者出现硬脊膜破裂,术中给予修补,术后未出现脑脊液漏;X线及CT检查均未发现明显的椎弓根螺钉松动、切割和融合器下沉现象,椎间植骨融合良好,椎间融合率为93.2％.患者术后VAS评分、ODI评分和骨密度较术前均有明显好转(P<0.05).结论 骨水泥强化椎弓根螺钉固定联合唑来膦酸能有效提高骨质疏松性腰椎滑脱患者的螺钉固定强度,增强把持力和稳定性,提升手术疗效.

Objective:To explore the repairing effects of 3D-printed nano-β-tricalcium phosphate (β-TCP) scaffolds loaded with vancomycin and bone morphogenetic protein-2 (BMP-2) for seawater -soaked tibial bone defects in rabbits. Methods:A total of 27 male New Zealand White rabbits were assigned to the normal group using a random number table method, with each group consisting of 9 rabbits. The rabbit tibial bone defect model was created using the osteotomy surgical method. Eight hours after operation, the wounds in the control group and seawater group were immersed in seawater for 2 hours, and those in the normal group were not immersed. After an observation period of 5-7 days, no significant redness or purulent discharge was observed in the wound appearance, then debridement was performed followed by corresponding implantations: the control group with gelatin sponges loaded with vancomycin and BMP-2, and the other two groups with 3D-printed nano-β-TCP scaffolds loaded with vancomycin and BMP-2. After filling the bone defects with the respective materials, all groups underwent layer-by-layer suturing of the wound, followed by disinfection with iodine and injection of gentamicin to prevent infection. The affected limbs were then immobilized using a plaster cast. The affected limbs were imaged using anteroposterior X-ray at 4, 8 and 16 weeks after operation, and the repair effects were evaluated using the Lane-Sandhu X-ray scoring system. At 16 weeks after operation, the bone defect tissues were collected for HE staining to observe bone tissue growth.Results:At 4 weeks after operation, the Lane-Sandhu X-ray score in the control group was significantly lower than that in the normal group [(2.8±1.1)points vs. (1.1±0.9)points] ( P<0.05), and that in the seawater group [(2.2±1.0)points] was not significantly different from those in the other two groups (all P>0.05). At 8 weeks after operation, the seawater group [(6.1±0.9)points] and the control group [(2.8±1.0)points] exhibited lower Lane-Sandhu X-ray score compared to the normal group [(8.2±1.0)points] (all P<0.05), and the seawater group showed a higher score compared to the control group ( P<0.05). At 16 weeks after operation, the control group [(3.8±1.0)points] exhibited a lower Lane-Sandhu X-ray score compared to the normal group [(10.0±1.3)points] and the seawater group [(9.3±1.2)points] (all P<0.05), while no significant difference was noted between the latter two ( P>0.05). At 16 weeks after operation, histological observations revealed varying degrees of bone tissue formation in three groups, with the normal group showing the best bone defect repair effect, followed by the seawater group. Conclusion:The 3D-printed nano-β-TCP scaffolds loaded with vancomycin and BMP-2 are effective for the treatment of seawater -soaked bone defects, which can promote bone tissue repair.

目的:探讨采用固定通道下MIS-TLIF联合唑来膦酸治疗骨质疏松性腰椎退变性疾病的临床疗效.方法:选取2019 年10 月—2021 年8 月我院收治的伴有骨质疏松的腰椎退变性疾病患者17 例,经双能X线骨密度仪测定腰椎(L2～4)前后位骨密度,所有患者均行固定通道下MIS-TLIF,术后给予注射唑来膦酸及抗骨质疏松治疗,测量术前、术后骨密度值、Oswestry功能障碍指数、VAS评分、末次随访时采用Bridwell标准评估椎间融合情况.结果:所有患者均获得随访,随访时间12～31(18.94±6.15)个月.患者未发生手术并发症,腰腿痛症状明显改善,术后VAS评分、ODI评分较术前比较明显改善(P<0.01),腰椎骨密度值术前为(0.69±0.48)g/cm2,术后 12 个月(0.83±0.29)g/cm2(P<0.05),融合率93.75%.结论:固定通道下MIS-TLIF治疗骨质疏松性腰椎退变性疾病早期疗效满意,联合唑来磷酸可以有效提高术后椎体强度,降低内固定松动、拔出等风险,提高临床疗效.

With the ageing of the global population, the incidence of osteoporotic vertebral compression fractures (OVCFs) is increasing. To assess the safety and efficacy of O-arm- and guide-device-assisted personalized percutaneous kyphoplasty (PKP) for treating thoracolumbar OVCFs, a total of 38 consecutive thoracolumbar OVCF patients who underwent bilateral PKP assisted with an O-arm and a guide device (O-GD group, n = 16) or traditional fluoroscopy (TF group, n = 22) from January 2020 to December 2021 were retrospectively reviewed, and their epidemiologic, clinical and radiological outcomes were analysed. The operation time was significantly decreased (p < 0.001) in the O-GD group (38.3 ± 12.2 min) compared with the TF group (57.2 ± 9.7 min). The number of intraoperative fluoroscopy exposures was significantly decreased (p < 0.001) in the O-GD group (31.9 ± 4.5) compared with the TF group (46.7 ± 7.2). Intraoperative blood loss was significantly decreased (p = 0.031) in the O-GD group (6.9 ± 2.5 mL) compared with the TF group (9.1 ± 3.3 mL). No significant difference (p = 0.854) in the volume of injected cement was observed between the O-GD group (6.8 ± 1.3 mL) and the TF group (6.7 ± 1.7 mL). Both the clinical and radiological outcomes, including the visual analogue scale score for pain, Oswestry Disability Index and anterior height and local kyphotic angle of the fractured vertebrae, were significantly improved at the postoperative and final follow-up but did not differ between the two groups. The incidence of cement leakage and refracture of the vertebral body was similar in the two groups (p = 0.272; p = 0.871). Our preliminary study demonstrated that O-GD-assisted PKP is a safe and effective procedure that presents a significantly shorter operation time, fewer intraoperative fluoroscopy exposures and less intraoperative blood loss than the TF technique.

目的 探讨采用数字模拟辅助融合髋行人工全髋关节置换术髋臼假体精准植入的疗效.方法 本研究纳入2016年1月至2020年5月联勤保障部队第九○八医院骨科收治的融合髋患者11例(11髋),男7例(7髋),女4例(4髋);年龄28～56岁,平均(42.7±10.7)岁.其中强直性脊柱炎4例,化脓性关节炎3例,类风湿性关节炎3例,创伤1例.各种原因导致髋关节病变距行人工全髋关节置换术(total hip arthroplasty,THA)时间为9～30年,平均(16.5±7.5)年.屈曲强直8髋,屈曲角度13 °～31°,平均(21.8±6.5)°;屈曲内收短缩强直3髋,屈曲角度16°～25 °,平均(20.3±4.5)°.所有病患均应用Mimics 10.01软件术前模拟截骨、髋臼假体植入,确定截骨角度及髋臼假体尺寸,术后测量髋臼前倾角、外展角,记录手术时间、术中出血量及髋关节Harris评分.结果 患者均获得随访,随访时间6～48个月,平均(21.1±12.9)个月.术后未发生假体脱位及感染,1例因术中牵拉致股骨神经不全损伤,出现大腿前侧皮肤麻木,给予营养神经药物治疗,术后3个月恢复.术后臼杯外展角(39.8±3.3)°,前倾角(15.9±2.7)°,所有病例外展角及前倾角均位于Lewinnek安全范围内.术前Harris评分(19.7±2.9)分,术后3个月(47.5±7.36)分,术后6个月提高至(86.1±5.5)分,术前Harris评分与术后3个月、6个月比较差异均有统计学意义(P＜0.05).结论 采用数字化模拟辅助,可以提高融合髋髋臼假体植入的准确率,特别是对融合髋手术经验相对较少的手术医生,可以提高手术成功率,避免术后假体位置不良导致的髋关节脱位等并发症.

目的 探讨骨水泥注入中空侧孔椎弓根钉内固定治疗伴有骨质疏松症的腰椎滑脱的临床疗效.方法 采用骨水泥注入中空侧孔椎弓根钉内固定治疗15例伴有骨质疏松症的腰椎滑脱患者.记录手术时间、术中出血量、住院时间、骨水泥注入量、并发症发生情况、植骨融合情况.比较手术前后腰椎骨密度、疼痛VAS评分.结果 患者均获得随访,时间13～36(19.8±6.3)个月.手术时间105～170(140.6±17.3)min,术中出血量170～800(410.0±133.3)ml,住院时间9～21(15.0±2.8)d;每个中空椎弓根钉内注入骨水泥1～2(1.5±0.3)ml.术后X线片显示滑脱椎体均复位.术中3例发生椎旁骨水泥渗漏;术后均未发生神经、血管损伤等并发症.术后1年疼痛VAS评分、腰椎骨密度均明显优于术前(P<0.05).末次随访时,腰椎X线片显示椎弓根钉无松动、移位、断裂,椎弓根钉周围未见透亮线,均达植骨融合.结论 骨水泥注入中空侧孔椎弓根钉内固定治疗伴有骨质疏松症的腰椎滑脱疗效可靠.