This study compared outcomes of combined Salter osteotomy, open reduction, and proximal femoral osteotomy in developmental dysplasia of the hip (DDH) children under 3 years versus those aged 3 years or older. This retrospective study analyzed 65 DDH patients (aged 18 months to 6 years) who underwent the combined procedure between January 2010 and December 2020, stratified into < 3 years (n = 34) and ≥ 3 years (n = 31) groups. Evaluated parameters included radiographic measures, functional outcomes, and complications. Multivariable logistic regression adjusted for baseline differences in preoperative acetabular index. At a mean follow‑up of 8 ± 2.5 years, both groups demonstrated significant radiographic improvements (P < 0.001), with the < 3 years group showing superior acetabular index and center‑edge angle changes (P < 0.001). Final Severin grades were excellent/good in all patients, but the younger group had significantly more excellent results (97.1

Abstract Objective To evaluate the clinical and radiographic outcomes of autologous femoral head structural bone grafting in primary total hip arthroplasty (THA) for adult developmental dysplasia of the hip (DDH). Methods A retrospective analysis was conducted on 22 patients (30 hips) with DDH who underwent primary cementless THA utilizing autologous femoral head structural bone grafting between August 2014 and July 2024. Perioperative parameters (operative time, intraoperative blood loss), functional outcomes (Harris Hip Score (HHS)), and radiographic outcomes (vertical and horizontal displacement of the hip rotation center relative to the teardrop, limb length discrepancy (LLD) in unilateral cases, Wiberg center-edge (CE) angle, acetabular component coverage, graft coverage) were quantified. Complications were recorded throughout follow-up. Results The cohort comprised 5 males and 17 females, mean age 51.73 ± 7.66 years (range: 33–63 years), including 14 unilateral (6 left, 8 right) and 8 bilateral cases. Mean follow-up was 62.4 ± 40.45 months (range: 12–120 months). Mean operative time was 130.67 ± 30.92 minutes (range: 85–195 min); mean intraoperative blood loss was 423.33 ± 253.5 mL (range: 100–1400 mL). The mean HHS improved significantly from 47.77 ± 7.16 preoperatively to 91.20 ± 5.24 at final follow-up (P < 0.0001). Significant restoration of the hip center was achieved: vertical distance decreased from 4.55 ± 1.48 cm to 2.78 ± 0.80 cm, horizontal distance decreased from 6.97 ±1.88 cm to 3.44 ± 0.67 cm (both P < 0.0001). Unilateral LLD was reduced from 25.45 ± 14.05 mm to 5.29 ± 2.91 mm (P ＜ 0.0001). The CE angle increased significantly from 11.53 ± 4.70° to 41.90 ± 4.59° (P < 0.0001). Acetabular component coverage was 96–100% (mean 97.80% ± 1.13%); graft coverage was 19–48% (mean 34.34% ± 7.44%). All grafts demonstrated complete consolidation without collapse or resorption. Surgical incisions healed uneventfully. No complications including periprosthetic infection, loosening, dislocation, or thromboembolic events occurred during follow-up. Conclusion In primary THA for adult DDH, autologous femoral head structural bone grafting achieves effective biological reconstruction of the hip center, provides high acetabular component coverage, corrects limb length discrepancy, and significantly restores hip function. The technique demonstrated reliable graft osseointegration and favorable clinical outcomes at early- to mid-term follow-up.

Dexamethasone has shown promising efficacy in alleviating pain and enhancing outcomes undergoing TKA. However, an optimal route of administration, dosage, and treatment duration have not yet been established. This study is to assess the effects of intravenous dexamethasone administration on postoperative pain management and prognosis in patients undergoing TKA. Data were retrieved from PubMed, Embase, the Cochrane Library, and Web of Science to compare the effects of intravenous dexamethasone administration versus non-administration on outcomes following TKA. Primary endpoints included pain scores and morphine consumption. Secondary endpoints comprised walking distance, ROM, patients requiring rescue analgesics and antiemetics, LOS, levels of CRP and IL-6, QoR, and the incidence of adverse events. This meta-analysis included 15 RCTs involving 2,584 patients. The study indicated that intravenous dexamethasone can decrease VAS scores at rest (24 h, 95

BACKGROUND:Tuberculosis is among the most devastating infectious diseases worldwide. Spinal tuberculosis is not easy to detect at an early stage, which without effective treatment often leads to spinal deformity and spinal cord damage which in turn cause complications such as paraplegia and quadriplegia. In this study, we established a model using three concentrations of bacteria and carried out a comprehensive evaluation of the model by imaging, general observations, and histopathological and bacteriological studies. AIM:To establish a rabbit model of spinal tuberculosis and examine the effect on the model's efficacy using different concentrations of Mycobacterium tuberculosis (M. tuberculosis) inoculum. METHODS:New Zealand rabbits were randomly divided into experimental, control and blank groups. The experimental and control animals were sensitized with complete Freund's adjuvant, a hole was drilled beneath the upper endplate of the L6 vertebral body and filled with gelfoam sponge. The experimental group was divided into three subgroups (experimental 1, experimental 2, experimental 3) and infused with M. tuberculosis suspension at various concentrations. The control group was inoculated with saline and the blank group received no treatment. The 12-week post-operative survival rates were 100%, 80% and 30% in the experimental groups inoculated with concentrations of 106, 107 and 108 CFU/mL bacteria, respectively. RESULTS:The survival rate of the control and blank groups was 100%. Vertebral body destruction at 8 weeks in the three experimental groups as determined by X-ray analysis was 33.3%, 62.5% and 66.7%, and by computed tomography (CT) and 3-dimensional CT 44.4%, 75% and 100%, respectively. At 12 weeks, the figures were 44.4%, 75% and 100% by X-ray analysis and 44.4%, 100% and 100% by CT and 3-dimensional CT, respectively. All surviving rabbits of the experimental groups had vertebral destruction. The positive bacterial culture rates were 22.2%, 75% and 66.7%, respectively, in the experimental groups. After being sensitized with complete Freund's adjuvant, large differences were observed in the extent of spinal tuberculosis after inoculation of the rabbits with different concentrations of H37RV standard M. tuberculosis. CONCLUSION:The experimental 1 had a low success rate at establishing an infection. The experimental 3 resulted in high mortality and complication rates. The experimental 2 was optimum for establishing a spinal tuberculosis model based on the high level of symptoms observed and the low rabbit mortality.

Objective:To review the research progress of strontium (Sr) modified β-tricalcium phosphate composite biomaterials (SrTCP) promoting osteogenesis through immune regulation, and provides reference and theoretical support for the further development and research of SrTCP bone repair materials in bone tissue engineering in the future. Methods:The literature about SrTCP promoting osteogenesis through immune regulation at home and abroad in recent years was extensively reviewed, and the preparation methods, immune mechanism and application of promoting osteogenesis were summarized and analyzed. Results:The preparation methods of SrTCP include solid-state reaction sintering method, solution combustion quenching method, direct doping method, ion substitution method, etc. SrTCP has immune regulatory effects, which can play an immune regulatory role in inducing macrophage polarization, inducing angiogenesis and anti oxidative stress to promote osteogenesis. Conclusion:At present, studies have shown that SrTCP can promote bone defect repair through immune regulation. Subsequent studies can start from the control of the optimal repair concentration and release rate of Sr, and further clarify the specific mechanism of SrTCP in promoting angiogenesis and anti oxidative stress, which is helpful to develop new materials for bone defect repair.

髓内高分化骨肉瘤是骨肉瘤中罕见亚型,在所有骨肉瘤类型中仅占1％～2％[1],其最初由Unni等[2]报道.髓内高分化骨肉瘤发病率低而且容易误诊,诊断的主要难点在于低级别髓内高分化骨肉瘤没有表现出骨肉瘤在影像学上特征性表现,病理诊断也很困难,肿瘤细胞异型性极小或者轻度异型,仅存在成纤维细胞间质[3-5].笔者于2020-10-11诊治1例肱骨近端髓内高分化骨肉瘤,切开髓腔取活体组织检查后行肿瘤型假体人工肩关节置换术[6],术后常规化疗,疗效满意,报道如下.

肱骨滑车上孔小骨是一种较为罕见的先天性肘关节发育异常,因报道较少,缺乏组织学特征,容易与肘髌骨、软骨瘤肿瘤及关节游离体等混淆.本文报道1例肱骨滑车上孔小骨患者,并对该病的特征常见鉴别诊断作出了讨论. 1病例资料 患者,男,31岁,因右肘关节疼痛伴伸直受限2年入院.患者于2年前军事训练后出现右肘关节疼痛,后演变为伸直受限,遂就诊于当地医院,行右肘关节正侧位X线检查示:考虑右肘关节滑囊炎,未予治疗.此后症状加重,当地医院予以局部针灸治疗,病情无缓解.后于某部队医院就诊,行右肘关节正侧位X线检查示:右肱骨鹰嘴窝上方结节状骨化影,考虑肘髌骨,保守治疗无效,遂来本院,门诊以"右肘关节鹰嘴窝包块"收住.患者无外伤、手术史,家属均体健.

Purpose Combination of regional anaesthesia technique that is most effective in analgesia and postoperative functional outcome with the fewest complications needs investigation. Interspace between the popliteal artery and the capsule of the posterior knee block (IPACK) has been introduced clinically. We evaluated the efficacy of IPACK in combination with other nerve blocks after total knee arthroplasty. Methods Data were obtained from PubMed, Cochrane Library, Web of Science, and Sciencedirect. Studies that compared outcomes using IPACK combined with other regional nerve blocks after total knee arthroplasty with other analgesic modalities and those which used pain scores or opioid consumption as primary or secondary outcomes were included. Results Seventeen articles (20 trials, 1652 patients) were included. IPACK supplementation significantly reduced rest pain scores after total knee arthroplasty at postoperative hours 8–12(95%CI − 0.85 [− 1.36, − 0.34], I 2 = 94%, p = 0.001), postoperative day 1 (95% CI − 0.49 [− 0.85, − 0.14], I 2 = 87%, p = 0.006), and postoperative day 2 (95% CI − 0.28 [− 0.51, -0.05], I2 = 72%, p = 0.02); there was no significant difference at postoperative day 3 or discharge (95% CI − 0.14 [− 0.33, 0.05], I 2 = 0%, p = 0.14). Combination treatment resulted in reduced dynamic pain scores at postoperative hours 8–12 (95%CI − 0.52 [− 0.92, − 0.12], I 2 = 86%, p = 0.01) and postoperative day 1(95% CI − 0.49 [− 0.87, − 0.11], I 2 = 88%, p = 0.01). There was no difference between postoperative day 2(95% CI − 0.29 [− 0.63, 0.05], I 2 = 80%, p = 0.09), postoperative day 3 or discharge (95% CI − 0.45 [− 0.92, 0.02], I 2 = 83%, p = 0.06). In addition, it strongly reduced postoperative opioid consumption within 24 H (95% CI − 0.76 [− 1.13, − 0.39], I 2 = 85%, p < 0.00001), 24–48 H (95% CI − 0.43 [− 0.85, − 0.01], I 2 = 83%, p = 0.04), and total opioid use (95% CI − 0.64 [− 1.07, − 0.22], I 2 = 86%, p = 0.003). Although IPACK supplementation improved timed up and go test and walking distance at postoperative day 2, there was no statistically significant difference at other time periods or obvious improvement in knee range of motion and quadriceps strength. IPACK block supplementation could shorten the length of stay (LOS) (95% CI − 0.40 [− 0.64, − 0.15], I 2 = 70%, p = 0.001) and improve patient satisfaction (95% CI 0.43 [0.01, 0.84], I 2 = 87%, p = 0.04). Conclusion Based on these results, IPACK supplementation, in addition to standard postoperative analgesia, can be used effectively and safely to relieve early postoperative pain after total knee arthroplasty.

Aneurysmal bone cyst (ABC) is a benign, distending, osteolytic and locally aggressive bone tumor that is mostly associated with trauma. Approximately 1% of bone tumors are ABCs, which are most prevalent in adolescents and are usually detected in the spine and long tubular bones. The diagnosis of ABC mainly relies on histopathology, malignant transformation is rare, and the chance of malignancy increases if there are multiple recurrences. Due to the rarity of reports of malignant transformation of ABCs into osteosarcoma, there is still considerable debate on the appropriate treatment strategy. The current paper presents a case of aneurysmal bone cyst malignant to osteosarcoma and the therapeutic measures to provide expertise for the diagnosis and treatment of ABCs that are malignant to osteosarcoma.

Abstract Purpose Total knee arthroplasty (TKA) in patients with osteoarthritis (OA) are considered to be a successful procedure, but with little being known about outcomes in patients with rheumatoid arthritis (RA). The aim of this study was to compare the outcomes of TKA in patients with RA versus OA. Methods Data were obtained from PubMed, Cochrane Library, EBSCO and Scopus for all available studies comparing the outcomes of THA in RA and OA patients (From January 1, 2000 to October 15, 2022). Outcomes of interest included infection, revision, venous thromboembolism (VTE), mortality, periprosthetic fractures, prosthetic loosening, length of stay, and satisfaction. Two reviewers independently assessed each study for quality and extracted data. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS). Results Twenty-four articles with a total 8,033,554 patients were included in this review. The results found strong evidence for increased risk of overall infection (OR = 1.61, 95% CI, 1.24–2.07; P = 0.0003), deep infection (OR = 2.06, 95% CI, 1.37–3.09; P = 0.0005), VTE (OR = 0.76, 95% CI, 0.61–0.93; P = 0.008), pulmonary embolism (PE) (OR = 0.84, 95% CI, 0.78–0.90; P<0.00001), periprosthetic fractures (OR = 1.87, 95% CI, 1.60–2.17; P<0.00001); and reasonable evidence for increased risk of deep venous thrombosis (DVT) (OR = 0.74, 95% CI, 0.54–0.99; P = 0.05), and length of stay (OR = 0.07, 95% CI, 0.01–0.14; P = 0.03) after TKA in patients with RA versus OA. There were no significant differences in superficial site infection (OR = 0.84,95% CI, 0.47–1.52; P = 0.57), revision (OR = 1.33,95% CI, 0.79–2.23; P = 0.28), mortality (OR = 1.16,95% CI, 0.87–1.55; P = 0.32), and prosthetic loosening (OR = 1.75, 95% CI, 0.56–5.48; P = 0.34) between the groups. Conclusion Our study demonstrated that patients with RA have a higher risk of postoperative infection, VTE, periprosthetic fracture, and lengths of stay, but did not increase revision rate, prosthetic loosening and mortality compared to patients with OA following TKA. In conclusion, despite RA increased incidence of postoperative complications, TKA should continue to be presented as an effective surgical procedure for patients whose conditions are intractable to conservative and medical management of RA.

[目的]介绍终末髋病伴陈旧性股骨粗隆下骨折加长生物柄全髋置换术的手术技术和临床效果.[方法]2021年本科收治1例终末期股骨头坏死合并陈旧性股骨粗隆下骨折患者,采用远端固定型加长生物柄行人工全髋关节置换术(total hip arthroplasty,THA)治疗.全麻后取后外侧入路,二次截骨法取出股骨头,先置换髋臼侧,再暴露股骨粗隆下骨折端,复位后采用钢板及钢丝临时固定骨折端,加长生物柄置入后取出钢板及远端钢丝,近端钢丝加压固定骨折.[结果]患者顺利接受手术,术后影像显示髋关节假体位置良好.术后1周即可扶助行器自行下地活动,左髋关节Harris评分77分,疗效满意.[结论]加长生物柄全髋关节置换术是治疗终末髋病伴陈旧性股骨粗隆下骨折的有效方法.

目的 探讨短时程脊髓电刺激(TSCS)对战士慢性睾丸疼痛(CTP)的临床疗效.方法 回顾性分析中国人民解放军联勤保障部队第九四O医院疼痛科自2020年1月至2021年9月收治的战士 CTP资料,经保守治疗无效后行TSCS植入治疗,植入时间为1～2周.收集患者术前及术后4、8、12、16、20、24周各时间段视觉模拟疼痛量表(VAS)、匹兹堡睡眠质量指数(PSQI)、术后各时间段药物及相应治疗情况,收集患者术后白细胞计数(WBC)、中性粒细胞(NEU)、淋巴细胞计数(LYM),感染检测指标降钙素原(PCT)、白细胞介素6(IL-6)水平及相关不良反应情况,进一步综合评估TSCS治疗效果.结果 所有战士经TSCS治疗后VAS和PSQI均有明显下降(P＜0.05);术后药物使用量均下降,术后4周内疼痛症状改善最明显,在术后12、16、20、24周后仍遗留疼痛患者逐渐减少.治疗过程中无植入部位感染及TSCS脱出等不良反应发生,经综合评估TSCS治疗战士 CTP的有效率为85.00％.结论 TSCS是一种治疗战士 CTP非常安全有效的微创技术,值得临床推广使用.

Diabetes is one of the most common chronic diseases at present, and insulin pen injection therapy plays an important role in the treatment of diabetes. However, the majority of patients might reuse disposable insulin pen needles for various reasons, which leads to related complications. As far as we know, this article is the first to describe a patient whose needle remained in the right upper limb while reusing a disposable insulin injection needle for subcutaneous insulin injection with the non-dominant hand. The patient went to the doctor 1 week later. The needle moved from the lateral area of the proximal upper arm (the injection site) to the posterolateral area of the distal upper arm. The needle was then successfully removed by surgery. The reuse of disposable insulin pen needles might lead to serious complications. It is suggested to strengthen the education of people living with diabetes to help them use insulin pen needles safely.

Abstract Objective: To evaluate the medium-term outcomes of uncemented total hip arthroplasty in patients ≤ 25 years. Methods: A retrospective research was performed on patients ≤ 25 who received uncemented total hip arthroplasty at the Department of Orthopedics of the 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army from January 2009 to December 2018. The clinical evaluation was measured with modified Harris Hip Score, Western Ontario & McMaster Universities Osteoarthritis Index, and Short-Form 36. Postoperative complications (such as infection, revision, dislocation, and incisional healing issues) were recorded. Using pelvic anteroposterior, hip anteroposterior and lateral X-rays, the radiographic outcome was evaluated, including the position of the implants, loosening, bearing-surface wear, osteolysis, and heterotopic ossification. Loosening of the acetabular or femoral component or revision for any reason was defined as failure. Results: At a follow-up of 8.3±2.4 years (range, 3.8 to 12 years), the preoperative modified Harris hip score was 43.5±12.9 (range, 18 to 62) and increased to 88.3 ± 8.8 (range, 72 to 97), and the preoperative postoperative Western Ontario & McMaster Universities Osteoarthritis Index score improved from 43.6±8.4 (range, 33.1 to 62.3) to 11.5 ± 6.8 (range, 2.5 to 25.8). The Physical Component score-SF-36 improved from 48.5 ± 8.6 (range, 36.4 to 61.3) to 81.2 ± 10.3 (range, 60.3 to 97.5), while the Mental Component score-SF-36 increased from 56.6±12.5 (range, 39.4 to 78.6) to 82.6 ± 12.9 (range, 54.7 to 97). The latest X-ray revealed that the position of the implants did not change substantially since the postoperative image. The abduction angle of acetabular cup was 41.8° ± 6.7° (range, 31° to 57°),the anteversion angle of acetabular cup was 18.2° ± 3.6° (range, 9.5° to 25.7°), and the filling ratio was 90.1% ± 3% (range, 85.2%-95.3%). The preoperative leg length discrepancy was 1.8 cm ± 0.8 cm (range, 1 cm to 5 cm) and reduced to 1.4 cm ± 0.5 cm (range, 0.5 cm to 2.5 cm). No considerable loosening, bearing-surface wear, osteolysis, or heterotopic ossification was observed. At the latest follow-up, the overall survival rate of the 49 hips was 98%. Conclusion: For patients with end-stage hip disease under 25 years old, uncemented THA exhibit excellent outcomes, with a high survival rate and fewer complications at medium-term follow-up.

Objective:To evaluate the clinical efficacy of uncemented total hip arthroplasty (THA) in the treatment of end-stage hip disease in young patients under 25 years old.Methods:Patients who were under 25 years of age and received uncemented THA in the Department of Orthopedics of the 940th Hospital of Joint Logistic Support Force of PLA from January 2009 to December 2018 were retrospectively analysed. The exclusion criteria were the patients who were treated with THA for hip tumour or hip infection, less than three years of follow-up, lost in follow-up or with incomplete data. The demographic data of patients were routinely collected and combinations of clinical scores and imaging assessments were used to assess outcomes of the surgery. Following clinical assessment were compared before surgery and at last follow-up after surgery: Harris hip score, Western Ontario & McMaster Universities osteoarthritis index (WOMAC) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Paired sample t test was used for clinical scores. Independent sample t test was used to compare the scores between different liners. Postoperative complications such as infection, revision, dislocation, incisional healing complications, etc. were recorded. Imaging assessment included: pelvic anteroposterior and hip anteroposterior and lateral X-rays for assessment of the position of prosthesis, prosthesis loosening and wear, osteolysis, heterotopic ossification and femoral filling rate. Loosening of acetabular or femoral component or a revision for any reason was defined as failure.Results:A total of 20 patients (27 hips) with a mean age of (21.8±2.3) years were included. There were 16 males (23 hips) and four females (four hips) for 13 left-sided (48.1%) and 14 right-sided (51.9%) uncemented THA. Seven patients underwent bilateral THA and 13 had unilateral THA. Of all patients, the average body mass index (BMI) was (21.3±3.2) kg/m2 and the mean follow-up time was (7.8±2.4) years. During follow-up, one patient had a replacement of prosthetic liner due to infection, and the rest of patients had no THA related complication. Harris score, WOMAC score, the physical component score-SF-36 and the mental component score-SF-36 were significantly improved at the last follow-up compared with the scores before surgery (t=-25.31, 19.47, -10.18, -7.26, all P<0.05). Imaging examinations at the last follow-up showed no significant change in position of prostheses compared with the images right after the surgery, and the range of prosthetic valgus angle was 32° to 58°, at (43±7)° on average. The prosthetic anteversion angle ranged 9° to 26°, on (18±4)° on average. No loosening, wearing, osteolysis or heterotopic ossification occurred. At the final follow-up, an overall survival rate of 96.3% was achieved for the 27 hips.Conclusion:For the patient who are under 25 years of age and with an end-stage hip disease, the uncemented THA can better restore hip functions with a high survival rate, few complication and satisfactory clinical efficacy.

[目的]介绍非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形的手术技术和初步临床效果.[方法]对19例股骨头颈短缩畸形患者采用非股骨短缩截骨全髋置换治疗.手术采用后外侧入路,先切开并松解粘连挛缩的髋关节囊,充分显露髋臼,确定真性髋臼位置并行髋臼成形或再造,安放髋臼假体;适配型号的股骨柄试模置入后安放递增长度的股骨头进行髋关节复位,在保持髋关节张力的情况下触摸髋关节周围挛缩的软组织并依次松解,随后置入适配的股骨柄及股骨头假体,复位髋关节.[结果]19例患者均顺利完成手术.术后均实现髋臼及股骨柄生物性压配与初始稳定,无严重并发症.术后随访6～36个月.术后6个月随访时患者Harris评分为(94.5±4.7)分,临床效果评定:优15例、良4例,优良率100％.术后影像显示所有患者均保持解剖位旋转中心,假体位置良好,术后3个月X线片均示广泛性骨长入,随访期间均未发生脱位、假体柄移位及断裂.[结论]全髋关节置换术不行股骨缩短截骨治疗终末期关节合并股骨头、颈缩短畸形技术可行,短期疗效满意.

A variety of techniques have been used for treating avascular necrosis of the femoral head (ANFH), but have frequently failed. In this study, we proposed a β-TCP system for the treatment of ANFH by boosting revascularization and bone regeneration. The angio-conductive properties and concurrent osteogenesis of the highly interconnected porous β-TCP scaffold were revealed and quantified through an in vivo model that simulated the ischemic environment of ANFH. Mechanical test and finite element analysis showed that the mechanical loss caused by tissue necrosis and surgery was immediately partially compensated after implantation, and the strength of the operated femoral head was adaptively increased and eventually returned to normal bone, along with continuous material degradation and bone regeneration. For translational application, we further conducted a multi-center open-label clinical trial to assess the efficacy of the β-TCP system in treating ANFH. Two hundred fourteen patients with 246 hips were enrolled for evaluation, and 82.1% of the operated hips survived at a 42.79-month median follow-up. The imaging results, hip function, and pain scores were dramatically improved compared to preoperative levels. ARCO stage Ⅱ disease outperformed stage Ⅲ in terms of clinical effectiveness. Thus, bio-adaptive reconstruction using the β-TCP system is a promising hip-preserving strategy for the treatment of ANFH.

Osteoblastoma is a rare, benign, bone-forming tumor that is frequently observed in the spine and long tubular bones. There are very few reports available on osteoblastoma of the patella. The present study reported an extremely rare case of a 22-year-old male adult who presented with an osteoblastoma of the patella. He was treated via intralesional curettage of the patella with subsequent bone grafting. After the intervention, he made an uneventful recovery with no recurrence after a follow-up of 2 years. Making an accurate diagnosis of osteoblastoma of the patella is challenging and important for determining the correct treatment modality and prognosis, therefore, the present case may be helpful in the diagnosis and treatment of osteoblastoma of the patella.

Abstract Purpose The aim of this study was to compare the clinical outcomes of culture-negative periprosthetic joint infection (CN PJI) with those of culture-positive periprosthetic joint infection (CP PJI). Methods Data were obtained from Embase, Web of Science and EBSCO for all available studies comparing the clinical outcomes of CN PJI with those of CP PJI. The quality of the studies was scored using the Newcastle–Ottawa scale (NOS). Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess clinical outcomes. Subgroup analyses were performed to explain heterogeneity among the included studies. Publication bias was estimated using Begg’s funnel plot. Sensitivity analysis was performed to test the stability of pooled results. Results Thirty studies with 1630 (38.7%) CN PJI and 2577 (61.3%) CP PJI were included in this meta-analysis. The pooled results of the included studies showed that overall failure rate in CN PJI group (19.0%, 309/1630) was significantly lower than that in CP PJI group (23.4%, 604/2577) (OR 0.63, 95% CI 0.47–0.84, P = 0.002). We performed the subgroup analysis based on the surgical strategies, the pooled results of nine studies for patients undergoing debridement, antibiotics and implant retention (DAIR) revealed that failure rate in CN PJI group (22.2%, 53/239) was significantly lower than that in CP PJI group (29.3%, 227/775) (OR 0.62, 95% CI 0.43–0.90, P = 0.01), the pooled results of four studies for patients undergoing one-stage revision revealed that failure rate between CN PJI group (11.5%, 11/96) and CP PJI group (7.6%, 27/355) had no significant difference (OR 1.57, 95% CI 0.75–3.26, P = 0.23), and the pooled results of 19 studies for patients undergoing two-stage revision revealed that failure rate in CN PJI group (16.1%, 171/1062) was significantly lower than that in CP PJI group (20.4%, 206/1010) (OR 0.52, 95% CI 0.34–0.79, P = 0.002). Conclusions CN PJI group had similar or better survival rate when compared with CP PJI group for patients who underwent DAIR, one-stage or two-stage revision. Negative culture was not a worse prognostic factor for PJI.

开放手术治疗跟腱断裂存在诸多术后并发症,如切口感染、跟腱再断裂、伤口愈合不良、腓肠神经损伤、组织粘连等[1].导致骨科手术切口感染的病原菌以铜绿假单胞菌、鲍氏不动杆菌和大肠埃希菌等革兰阴性菌最为常见[2].