RATIONALE:Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is widely applied for lumbar spine disorders due to reduced surgical trauma and faster recovery. However, postoperative interbody fusion cage migration remains a challenging complication. This report introduces a contralateral intervertebral foramen revision strategy as an alternative solution to correct cage migration without removing the original cage. PATIENT CONCERNS:A 55-year-old Asian female presented with progressive lower back pain, radiating leg pain, and limited mobility 5 weeks after MIS-TLIF. Symptoms significantly affected daily activities and were consistent with neurological compression. DIAGNOSES:Postoperative cage migration with associated nerve compression was confirmed by physical examination and imaging studies, including X-ray, computed tomography, and magnetic resonance imaging. INTERVENTIONS:A revision MIS-TLIF procedure was performed via the contralateral intervertebral foramen. The migrated cage was repositioned using the original cage handle and Kirschner wire, and an additional interbody cage was implanted to enhance segmental stability. This approach avoided removing the original cage and minimized anatomical disruption. OUTCOMES:Neurological symptoms improved immediately after surgery, and postoperative imaging confirmed satisfactory cage correction and stabilization. At the 1-year follow-up, the patient reported no recurrent discomfort, and computed tomography imaging demonstrated stable cage position and interbody fusion. LESSONS:Contralateral intervertebral foramen access in MIS-TLIF revision surgery offers a minimally invasive alternative for cage migration management, avoiding the need for cage removal and reducing operative trauma. This technique may provide a viable option for similar revision scenarios requiring neural decompression and cage repositioning.

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.

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

Osteosarcoma (OS), an aggressive bone tumor, is a substantial threat to the quality of life and survival of affected individuals. Despite recent improvements in OS therapies, the considerable variability and chemotherapy resistance of this cancer necessitate continuous research to discover new treatment targets and biomarkers. Recent epigenetic advances highlight the crucial role of N6-methyladenosine (m6A) methylation in cancer. In OS, m6A methylation has been demonstrated to be a pivotal component in the pathogenesis. This review introduces new findings regarding the association between m6A methylation regulators and OS, and summarizes the potential clinical applications of OS and m6A methylation regulators, including the role of m6A methylation in OS proliferation, growth, apoptosis, and cell migration, invasion, and metastasis; relationship between m6A methylation and OS chemotherapy resistance; and relationship between m6A methylation and OS prognosis. Our review had certain limitations. The interaction between m6A methylation regulators and other oncogenic factors, such as lncRNAs and ncRNAs, is not fully understood. We hope that these potential methods will be translated into clinical applications and effective treatment.

Spinal cord ischemia/reperfusion injury (SCIRI) is a serious disease that leads to the loss of sensory and motor functions and is a common complication after spinal cord injury, spinal cord degeneration or thoracic and abdominal aortic surgery. At present, the spinal cord is mainly protected from ischemic injury through treatment strategies such as hypothermia, surgery and drug assistance, but these intervention measures cannot effectively improve these conditions. SCIRI is a complex process that leads to cell damage and death. Among them, oxidative stress is an important pathological event of ischemia/reperfusion injury. Oxidative stress can initiate multiple inflammatory and apoptotic pathways, triggering a series of destructive events such as inflammatory responses and cell death, further deteriorating the microenvironment at the injured site, and leading to neurological dysfunction. Based on the important role of oxidative stress in SCIRI, we believe that targeted inhibition of oxidative stress responses can effectively reduce secondary injuries caused by trauma, which has a certain positive effect on the rehabilitation and prognosis of patients with SCIRI. This review systematically expounds the spatiotemporal dynamic characteristics of oxidative stress during the SCIRI process and its molecular regulatory network, with a focus on analyzing the multivariate generation mechanism of ROS. To deeply explore the regulatory effects of ROS on pathological processes such as neuronal death, inflammatory response and blood-spinal barrier disruption under SCIRI conditions, as well as its interaction patterns with signaling pathways. In order to form a systematic treatment for SCIRI caused by oxidative stress and promote the recovery of neurological function after injury. This review is helpful for us to understand the effect of oxidative stress on SCIRI and provides a theoretical basis for the treatment of SCIRI based on oxidative stress.

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.

Spinal cord injury (SCI) is a serious, disabling injury to the central nervous system that can lead to motor, sensory, and autonomic dysfunction below the injury plane. SCI can be divided into primary injury and secondary injury according to its pathophysiological process. Primary injury is irreversible in most cases, while secondary injury is a dynamic regulatory process. Secondary injury involves a series of pathological events, such as ischemia, oxidative stress, inflammatory events, apoptotic pathways, and motor dysfunction. Among them, oxidative stress is an important pathological event of secondary injury. Oxidative stress causes a series of destructive events such as lipid peroxidation, DNA damage, inflammation, and cell death, which further worsens the microenvironment of the injured site and leads to neurological dysfunction. The nuclear factor erythrocyte 2–associated factor 2 (Nrf2) is considered to be a key pathway of antioxidative stress and is closely related to the pathological process of SCI. Activation of this pathway can effectively inhibit the oxidative stress process and promote the recovery of nerve function after SCI. Therefore, the Nrf2 pathway may be a potential therapeutic target for SCI. This review deeply analyzed the generation of oxidative stress in SCI, the role and mechanism of Nrf2 as the main regulator of antioxidant stress in SCI, and the influence of cross-talk between Nrf2 and related pathways that may be involved in the pathological regulation of SCI on oxidative stress, and summarized the drugs and other treatment methods based on Nrf2 pathway regulation. The objective of this paper is to provide evidence for the role of Nrf2 activation in SCI and to highlight the important role of Nrf2 in alleviating SCI by elucidating the mechanism, so as to provide a theoretical basis for targeting Nrf2 pathway as a therapy for SCI.

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.

AIM:This study aimed to explore potential risk factors associated with chronic pain after total knee arthroplasty (TKA) and to establish the risk prediction model of chronic postoperative pain (CPSP). METHODS:This study retrospectively analyzed the clinical data of 160 patients who underwent TKA in our hospital between January 2021 and January 2024. Relevant data such as the baseline characteristics, past medical history, CPSP condition, and pain numerical rating scale (NRS) were retrieved from the medical information system. Logistic regression analysis was performed on the risk factors affecting the postoperative CPSP of the patients. The identified risk factors were incorporated to develop a risk-prediction model. RESULTS:Among the 160 patients, 67 (41.88%) had CPSP at or around the operation incision. The NRS pain score was significantly higher in the CPSP group than in the non-CPSP group during exercise preoperative and 3 months post-operation. Furthermore, the CPSP group had a higher NRS score than the non-CPSP group at rest 3 months after the procedure (p < 0.05). We observed that the preoperative NRS score, preoperative hospital for special surgery (HSS) score, postoperative functional training, and postoperative adverse events were the independent factors influencing the occurrence of CPSP after TKA (p < 0.05). Additionally, there was a significant positive correlation between preoperative NRS score, postoperative adverse events, and CPSP pain severity, and a significant negative correlation between preoperative HSS score, postoperative functional training, and CPSP pain severity (p < 0.05). The receiver operating characteristic (ROC) curve had excellent calibration and prediction capabilities for the predictive model of CPSP after TKA, with the area under the curve (AUC) of 0.868 (95% CI: 0.811-0.925). CONCLUSIONS:In this study, the predictive model of CPSP risk for patients after TKA surgery was initially constructed, which can help medical staff predict the risk of CPSP in patients after surgery individually, thereby preventing the occurrence of CPSP.

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.

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.

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.

OBJECTIVE To explore the effect of personalized digital analog assisted acetabular prosthesis precise implantation in hip dysplasia. METHODS From February 2017 to July 2019, 11 patients(12 hips) with hip dysplasia underwent total hip arthroplasty, including 4 males(5 hips) and 7 females(7 hips), aged from 27 to 61 years old, with an average of (46.64±12.93) years old;Crowe classification:8 hips in typeⅠ and 4 hips in typeⅡ. The preoperative thin-layer CT scan was imported into Mimics 10.01 software. The appropriate size and placement angle of acetabular prosthesis were selected through preoperative simulation, and the acetabular bone defect was understood to determine whether structural bone grafting was needed during the operation. The length of both lower limbs, the anteversion angle of acetabular prosthesis, the abduction angle, the height of acetabular rotation center and the horizontal distance of hip joint center before and after the operation were measured, and the postoperative dislocation, bone graft healing and acetabular cup loosening were observed. The hip Harris score was used to evaluate the joint function. RESULTS All patients were followed up for 18 to 30 months with an average of (23.45±3.70) months. There was no prosthesis dislocation, loosening and bone graft healing after operation. One case had numbness in the innervation area due to the traction of sciatic nerve during operation, and was treated with neurotrophic drugs and recovered one month after operation. The length difference of both lower limbs decreased from (31.73±5.98) mm before operation to (4.73±1.90) mm 3 months after operation (t=15.268, P<0.01). The anteversion angle of acetabular cup and acetabulum was (17.45±3.62)°and abduction angle was (40.10 ± 2.30)° after operation. In all cases, the abduction angle and anteversion angle were within the safe range of Lewinek. The height of hip rotation center was (20.64±2.58) mm and the horizontal inward displacement of hip was (33.46±3.61) mm. Harris score increased from (45.36±2.34) before operation to (91.27±2.37) 3 months after operation (P<0.05). CONCLUSION Through preoperative personalized digital analog reconstruction of acetabulum in patients with hip dysplasia, we can better understand the acetabular defect, help to evaluate the size and placement angle of acetabular prosthesis and whether structural bone grafting is needed, and obtain satisfactory clinical curative effect.

Objective:To assess the sustained release of 3D printed nano-β-tricalcium phosphate scaffolds in animals by comparison with controls.Methods:Light-curing 3D printing plus extrusion stacking with high-temperature sintering was used to produce the nano-β-tricalcium phosphate scaffolds. The printed scaffolds were examined for properties by using scanning electron microscopy, X-ray diffraction (XRD) , and biomechanics, and were then implanted subcutaneously in rats to assess the drug release compared with the control group using calcium sulfate scaffolds.Results:The pores in the 3D printed nano-β-tricalcium phosphate scaffold measured around 400 μm in diameter. XRD peaked at 30 degrees. With optimal contour maintained intact, compression test showed that the scaffold had a maximum force tolerance of about 170N, and a maximum compression tolerance of about 5 MPa. The duration of vancomycin sustained-release using this scaffold lasted up to 56 days, with a higher sustained-release concentration compared with the controls.Conclusion:The 3D printed nano-β-tricalcium phosphate scaffolds offer better sustained-release of vancomycin than the medical particles of calcium sulfate, meanwhile with show favorable mechanical strength and consistent porosity.