Osteoarthritis (OA) is one of the leading causes of joint dysfunction and disability in the elderly, posing serious social problems and a huge socio-economic burden. Existing pharmacological treatments have significant drawbacks, and searching for an effective pharmacological intervention is an urgent priority. Recent studies have demonstrated the chondroprotective, anabolic, and anti-catabolic properties of avocado–soybean unsaponifiable (ASU), a natural plant extract made from avocado and soybean oils, consisting of the remainder of the saponified portion of the product that cannot be made into soap. The main components of ASU are phytosterols, beta-sitosterol, canola stanols, and soya stanols, which are rapidly incorporated into cells. Studies have confirmed the anti-inflammatory, antioxidant, and analgesic properties of phytosterols. ASU slows down the progression of OA primarily by inhibiting pathways involved in the development of OA disease. ASU prevents cartilage degradation by inhibiting the release and activity of matrix metalloproteinases and by increasing the tissue inhibition of these catabolic enzymes; ASU is also involved in the inhibition of the activation of nuclear factor κB (NF-κB) which is a transcriptional inhibitor that regulates the inflammatory response of chondrocytes. NF-κB is a transcription factor that regulates the inflammatory response of chondrocytes, and inhibition of the transfer of the transcription factor NF-κB from the cytoplasm to the nucleus regulates the transcription of many pro-inflammatory factors. By appealing to the mechanism of action and thus achieving anti-inflammatory, anti-catabolic, and pro-synthetic effects on cartilage tissues, AUS is clinically responsive to the reduction of acute pain and OA symptom progression. This paper aims to summarize the studies on the use of avocado–soybean unsaponifiable in the pharmacological treatment of osteoarticular.

The purpose of this study was to compare the difference in functional scores and the incidence of complications after TKA between RA and osteoarthritis. The PubMed, MedLine, The Cochrane Library, Embase and Web of Science databases were searched for all clinical studies up to 15 March 2023 comparing outcomes after total knee replacement in patients with RA and OA, with two review authors independently screening the literature. A total of 7,820,115 (knee-counted) cases were included in 34 studies. The results of meta-analysis showed that the scores of the RA group were lower than that of the osteoarthritis group in the postoperative knee joint score [MD=−2.72,95%CI(-5.06,-0.38),P=0.02] and the postoperative knee joint function score [MD=−11.47,95%CI(-16.55,-6.39),P<0.00001], and the difference was statistically significant. The incidence of deep venous thrombosis (OR=0.84,95%CI(0.79,0.90),P<0.00001) and pulmonary embolism (OR=0.84,95%CI(0.78,0.91),P<0.00001) were significantly lower in RA than in osteoarthritis (P<0.00001). Compared with patients with osteoarthritis, patients with rheumatoid arthritis have lower knee society scores and functional scores after total knee arthroplasty, and a higher risk of prosthetic infection, loosening, and revision, but TKA can still effectively reduce pain in RA patients, Improve function and quality of life without increasing the risk of lower extremity venous thrombosis and pulmonary embolism. Therefore, total knee replacement can be used as a treatment option for patients with rheumatoid arthritis who have not responded to conservative treatment. Patients should fully understand the benefits and possible risks of total knee replacement and develop an individualized treatment plan.

OBJECTIVE:To explore medium and long term efficacy of oblique lateral interbody fusion (OLIF) in treating lumbar specific infection. METHODS:From October 2017 to January 2021, 24 patients with lumbar specific infection were treated by OLIF combined with vertebral screw internal fixation, including 15 males and 9 females, aged from 27 to 61 years old with an average of (43.0±15.0) years old;the courses of disease ranged from 6 to 24 months with an average of (14.0±7.0) months;7 patients with L2-L3, 12 patients with L3-L4 and 5 patients with L4-L5;19 patients with tuberculosis infection and 5 patients with brucella infection. The amount of intraoperative blood loss, operative time and complications were recorded, and erythrocyte sedimentation rate(ESR), C-reactive protein (CRP), visual analogue scale (VAS), Japanese Orthopaedic Association(JOA) score and American Spinal Injury Association (ASIA) rating were compared before and one month after opertaion. RESULTS:All patients were followed up from 9 to 24 months with an average of (13.0±6.0) months. Operative time was (132.5±21.4) min, and intraoperative blood loss was (227.3±43.1) ml. ESR and CRP were decreased from (82.34±18.62) mmol·h-1 and (53.08±21.84) mg·L-1 before operation to (33.52±17.31) mmol·h-1 and (15.48±8.36) mg·L-1 at one month after operation, respectively (P<0.05). VAS was decreased from (7.52±1.36) before opertaion to (1.74±0.87) at one month after operation (P<0.05). JOA was increased from (17.86±3.95) before operation to (24.72±3.19) at one month after operation (P<0.05). Four patients had neurological symptoms before operation, and were classified to grade D according to ASIA classification, who were recovered to grade E at 1 month after operation. One patient was suffered from psoas major muscle injury after operation, and returned to normal at 3 weeks. One patient was suffered from abdominal distension and difficulty in defecation, and relieved after gastrointestinal decompression and enema. No complications such as abdominal organ injury and poor wound healing occurred in all patients. CONCLUSION:OLIF combined with vertebral screw internal fixation is a new minimally invasive surgical method for the treatment of lumbar specific infection, especially the lesion located on the middle lumbar vertebra. It has advantages of less trauma, short operation time, less blood loss, convenient operation, complete removal of the lesion, safety and effectiveness, and has good medium-and long-term efficacy for lumbar specific infection.

Background Unicompartmental knee arthroplasty (UKA) is an effective treatment method for knee osteoarthritis. With the development and implementation of enhanced recovery after surgery, UKA is now increasingly performed in outpatient surgical centers. However, there is ongoing debate regarding the safety and effectiveness of performing UKA in outpatient settings. Methods The search was performed to retrieve randomized controlled trials and cohort studies on outpatient UKA from PubMed, Cochrane Library, EMbase, CNKI, and WanFangData databases. The search was conducted from the inception of the databases until August 31, 2023. After independent screening, data extraction, and risk of bias evaluation by two researchers, meta-analysis was performed using RevMan 5.4 software. Results A total of eight studies involving 18,411 patients were included. The results showed that the postoperative transfusion rate in the outpatient group was lower than that in the inpatient group [OR = 0.36, 95%CI (0.24, 0.54), p < 0.00001], and the difference was statistically significant. However, there was no significant difference between the two groups in terms of readmission rate, reoperation rate, surgical site infection, and periprosthetic fracture. The differences were not statistically significant. Conclusion Compared to the traditional inpatient route, the blood transfusion rate for single-condyle replacement in the outpatient operation center is lower, and there is no significant difference in readmission rate, reoperation rate, surgical site infection, and periprosthesis fracture. The outpatient approach to UKA is safe, feasible, and highly satisfactory for patients. However, the results have certain limitations, and a rigorous preoperative complication risk assessment can minimize the risk of UKA in outpatient surgery centers. Trial registration PROSPERO number CRD42023405373.

Epidemiological evidence suggests that there is an association between rheumatoid arthritis (RA) and Alzheimer’s disease (AD). However, the causal relationship between RA and AD remains unclear. Therefore, this study aimed to investigate the causal relationship between RA and AD. Using publicly available genome-wide association study datasets, bidirectional two-sample Mendelian randomization (TSMR) was performed using the inverse-variance weighted (IVW), weighted median, MR‒Egger regression, simple mode, and weighted mode methods. The results of MR for the causal effect of RA on AD (IVW, odds ratio [OR] = 0.959, 95

Objective With the increasing prevalence of osteoarthritis of the hip and knee, total joint replacement, the end-stage treatment, provides pain relief and restoration of function, but is often associated with massive blood loss. Tranexamic acid (TXA) has been reported to reduce perioperative blood loss in hip or knee arthroplasty. However, the optimal dose of TXA administration remains controversial. Therefore, we performed a meta-analysis combining data from 5 trials comparing the efficacy and safety of one fixed dose of 1 g intravenously administered TXA with two doses of 1 g each administered intravenously for hip or knee arthroplasty. Methods PubMed, Medline, Embase, Web of Science, and The Cochrane Library were searched from January 2000 to February 2023. Our meta-analysis included randomized controlled trials and cohort studies comparing the efficacy and safety of different doses of intravenous TXA (IV-TXA) for THA or TKA. The observation endpoints included total blood loss, postoperative hemoglobin drop, blood transfusion rate, length of hospital stay, incidence of deep venous thrombosis (DVT), and incidence of pulmonary embolism (PE). Meta-analysis was performed according to Cochrane's guidelines and PRISMA statement. The Danish RevMan5.3 software was used for data merging. Results Five cohort studies involving 5542 patients met the inclusion criteria. Our meta-analysis showed that the two groups were significantly higher in total blood loss (mean difference (MD) = − 65.60, 95% confidence interval (CI) [− 131.46, 0.26], P = 0.05); blood transfusion rate (risk difference (RD) = 0.00, 95% CI [− 0.01, 0.02], P = 0.55); postoperative hemoglobin (MD = 0.02, 95% CI [− 0.09, 0.13], P = 0.31); postoperative hospital stay days (MD = − 0.13), 95% CI [− 0.35, 0.09], P = 0.25); DVT (RD = 0.00, 95% CI [− 0.00, 0.01], P = 0.67); PE (RD = 0.00, 95% CI [− 0.01, 0.00], P = 0.79). There was some inherent heterogeneity due to variance in sample size across each major study. Conclusion 1 dose of 1 g and 2 doses of 1 g IV-TXA each time have similar effects on reducing blood loss, blood transfusion rate, postoperative hemoglobin level, and postoperative hospital stay after TKA or THA, without increasing the risk of postoperative complications risk. For patients at high risk of thromboembolic events, one dose of 1 g TXA throughout surgery may be preferred. However, higher-quality RCT is needed to explore the optimal protocol dose to recommend the widespread use of TXA in total joint arthroplasty. Trial registration We conducted literature selection, eligibility criteria evaluation, data extraction and analysis on the research program registered in Prospero (CRD42023405387) on March 16, 2023.

目前,临床上腰椎结核的手术治疗多采用经前路、经后路、前后联合入路等[1-2]. 2012 年Silvestre等报道了斜外侧椎间融合术(oblique lateral interbody fusion, OLIF),该术式以手术时间短、出血量少、创伤小等优点已被广泛应用于腰椎退行性变的治疗,并取得满意的疗效[3-4] . 此前作者采用单纯斜外侧椎间融合术联合椎体螺钉治疗腰椎结核,亦取得了满意的随访效果[5] . 但由于当时手术经验欠缺,高位腰椎结核若采用此术式,术中存在第 11、12 肋骨阻挡术区的情况,增加了手术难度,因此未纳入高位腰椎结核患者. 随着手术技术的提高及经验的积累,我院采用改良斜外侧椎间融合术联合椎体螺钉治疗高位腰椎结核,报道如下.

Abstract INTRODUCTION: Observational studies have reported associations between OA and the occurrence of depression/depressive symptoms, but the causal relationship between OA and depression/depressive symptoms remains unclear. Our aim was to assess the causal effect of OA on depression, depressive symptoms using two-sample Mendelian randomisation (MR). METHODS: Two-sample MR was used to investigate the causal effect of OA on depression and depressive symptoms. All data were obtained from a public shared database. Traditional methods are Simple mode, Inverse variance weighted, Weighted median, Mendelian Randomization (MR-Egger), Weighted mode to assess the causal effect of OA on depression. The Pleiotrophy RESidual Sum and Outlier (MR PRESSO) and MR - Egger were used for sensitivity studies. Outlier test was used to determine the effect of outliers. Heterogeneity was calculated using Cochrane's Q statistic and inverse variance-weighted (IVW) in MR - Egger regression, with P < 0.05 indicating the presence of large heterogeneity. RESULTS: Based on the results of IVW and Weighted median, we found a causal relationship between OA and depression,depressive symptoms, and OA increased the (IVW: OR = 1.04, P=0.004) and depressive symptom (IVW: OR = 1.10, P= 0.001) Incidence. There was no horizontal pleiotropy or heterogeneity in the analyses, except for heterogeneity in the analyses of OA and depressive symptoms. CONCLUSION: We explored the causal relationship between OA and depression and depressive symptoms by two-sample MR analysis and found that OA increased the incidence of depression and depressive symptoms.

The correct alignment of the knee joint is considered to be one of the most influential factors in determining the long-term prognosis after total knee arthroplasty(TKA). In order to achieve the correct alignment goal, many different alignment concepts and surgical techniques have been established. For example, mechanical alignment(MA), kinematic alignment(KA) and functional alignment(FA) have their own characteristics. MA focuses on achieving neutral alignment of the limbs, parallel and equal bone gaps during stretching and flexion. KA aims to restore the patient 's natural joint line, make the joint level and angle normal and improve the physiological soft tissue balance, and strive to reproduce the normal knee function;among them, functional alignment(FA) developed with robot-assisted surgery technology is a relatively new alignment concept. It not only considers the alignment of the body, but also aims to achieve flexion and extension balance, while respecting the native soft tissue capsule. It not only restores the plane and slope of the in situ joint line accurately during the operation, but also takes into account the balance of soft tissue, which is a better alignment method. Therefore, it is of great significance to correctly construct the lower limb force line of patients, which is helpful to restore knee joint function, relieve pain symptoms and prolong the service life of prosthesi. However, compared with traditional TKA, the operation time of robot-assisted FA-TKA is prolonged, which means that the probability of postoperative infection will be greater. At present, most studies of FA technology report short-term results, and the long-term efficacy of patients is not clear. Therefore, long-term research results are needed to support the application of this technology. Therefore, the author makes a review on the research status of functional alignment.

Objective:To compare the early clinical outcomes between domestic robot-assisted total knee arthroplasty (RA-TKA) and conventional manual total knee arthroplasty (CM-TKA) for patients with primary knee osteoarthritis.Methods:Embase, Pubmed, Web of Science, Zhi.com and Wanfang databases from January 2015 to April 2023 were searched for clinical controlled trials (RCTs) comparing the clinical outcomes between RA-TKA and CM-TKA. After literature screening, quality evaluation and data extraction according to the criteria required, Revman 5.3 software was applied to perform a Meta-analysis of the literature data. The operation time, intraoperative bleeding, hip-knee-ankle angle (HKA), HKA bias value, frontal femoral component (FFC), frontal tibia component (FTC), lateral femoral component (LFC), lateral tibia component (LTC), Knee Society Score (KSS), visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), knee mobility, Hospital for Specialty Surgery (HSS) knee score, length of hospital stay, and rate of complications were compared between the RA-TKA and CM-TKA patients.Results:Eight RCTs and 449 patients were included, with 221 patients in the RA-TKA group and 228 ones in the CM-TKA group. The Meta-analysis showed that the RA-TKA group had significantly longer operation time ( MD=18.41, 95% CI: 11.28 to 25.23, P<0.001), significantly better HKA ( MD=0.41, 95% CI: 0.06 to 0.76, P=0.020), significantly better HKA bias value ( MD=-0.92, 95% CI: -1.25 to -0.60, P<0.001), significantly better FTC ( MD=0.38, 95% CI: 0.08 to 0.67, P=0.010), significantly better LTC ( MD=1.71, 95% CI: 0.94 to 2.48, P<0.001), and significantly better knee mobility ( MD=-2.23, 95% CI: -4.18~-0.27, P=0.030) than the CM-TKA group. However, the differences were not statistically significant between the 2 groups in the intraoperative bleeding, FFC, LFC, KSS, VAS, WOMAC, HSS, length of hospital stay, or rate of complications ( P>0.05). Conclusion:Use of a domestic robot to assist conventional manual TKA can significantly improve the accuracy of prosthesis fixation and reconstruct the alignment of lower limb better, showing potential advantages in promoting functional recovery of the knee for the patients.

Abstract Background Pain is the most common symptom of knee osteoarthritis (KOA), with an incidence of 36.8–60.7%, thereby making it a primary cause that impacts patients’ quality of life and forces them to seek medical treatment. However, the KOA pain mechanisms are complex. The resulting joint degeneration provides stimuli to the central nervous system, thus, initiating several plastic changes under pain stimulation. Hence, nerve function changes enhance the responsiveness of neurons to normal or subliminal afferents, resulting in central sensitization. The development of chronic pain is closely related to the reorganization of brain structure and function. However, recent imaging technologies like resting-state functional magnetic resonance imaging (rs-fMRI) can inhibit the non-specific signals caused by cerebrospinal fluid fluctuations better and detect spontaneous human neural activity with accuracy and sensitivity. Therefore, we intend to explore the characteristics of spontaneous neural activity in KOA patients by utilizing rs-fMRI technology in combination with the changes in clinical-related variables. Our findings might help in revealing the neuropathological mechanism of KOA pain from the perspective of central pain sensitization. Methods Being a cross-sectional study, it will include all KOA patients who will be visiting the Joint Diagnosis and Treatment Center of Gansu Provincial Hospital from September 2023 to September 2024 and healthy volunteers with matching gender, age, and education levels as healthy controls. The clinical data, Central Sensitization Scale (CSI), Visual Analogue Scale (VAS), Western Ontario McMaster University Osteoarthritis Index (WOMAC), and radiological indicators of the two groups will be collected. After processing rs-fMRI scan results by image data processing, the fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) will be calculated for both groups. Based on the variance analysis results, the abnormal brain regions will be superimposed as regions of interest (ROI) for assessing whole-brain functional connectivity (FC). Pearson’s correlation analysis will be employed for analyzing the correlation between the fALFF and FC values of abnormal brain regions as well as the clinical data, rating scales, and radiological indicators of KOA patients. Discussion We will use rs-fMRI technology to analyze the abnormal brain function patterns in KOA patients and imaging data to reveal the specific central pain sensitization mechanisms in KOA. Thus, this study aims to provide reliable and comprehensive evidence for clinical practice and determine a reasonable intervention plan for effectively reducing the discomfort and pain of such patients.

Abstract Aims A comparison of joint amnesia in patients undergoing total hip arthroplasty with direct anterior approach (DAA) and posterior approach (PA) was conducted through systematic evaluation. Methods Searched for literature on FJS in patients undergoing DAA and PA THA comparison surgery from the establishment of PubMed, EMbase, Web of Science, Cochrane Library, CBM,Wanfang, and VIP databases to February 13, 2023. After two researchers independently searched, screened literature, extracted data, and evaluated the quality of included studies according to the inclusion criteria, a meta-analysis was conducted using RevMan 5.3. Results A total of 1 RCT and 6 cohort studies were included. Meta-analysis results showed that at 1 month postoperatively [MD = 2.08, 95% CI (0.20, 3.96), P = 0.03], 3 months [MD = 10.08, 95% CI (1.20, 18.96), P = 0.03], and 1 year [MD = 6.74, 95% CI (1.30, 12.19), P = 0.02], DAA total hip arthroplasty had better FJS than PA, but there was no statistical significance in FJS scores between the two groups at 5 years postoperatively [MD = 1.35, 95% CI (-0.58, 3.28), P = 0.17]. Conclusion Current evidence shows that early FJS after THA with DAA is better than PA, and there is no significant difference between the two in long-term follow-up. However, due to the limited number of literatures included in this study, the above conclusions need to be further confirmed by the inclusion of more high-quality studies.

随着全球人口老龄化日益严重,骨性关节炎、股骨颈骨折等老年人常见的髋关节疾病发病率越来越高.当髋关节病变较严重时,导致关节疼痛,活动功能严重受限,生活难以自理,给患者和家庭带来巨大的痛苦,同时也对医疗资源和社会等造成影响[1-2].全髋关节置换术已被证明是治疗髋关节骨性关节炎以及改善髋关节功能和疼痛的首选治疗方法,是目前公认的治疗髋关节终末期疾病最为有效且成熟的治疗方案[3].

OBJECTIVES:The adjuvant therapy (AT) for biliary tract cancer (BTC) patients after surgery has always been controversial. More therapeutic regimens and high-quality evidence were needed to evaluate AT's survival benefit further. Thus, this study was performed to investigate the efficacy and safety of the 5-fluorouracil (5-FU) regimen in resected BTC patients.METHODS:PubMed, Cochrane Library, Web of Science, and the Embase were systematically searched from inception to Feb.3, 2021, for eligible studies. The pooled analyses were performed using Review Manager, Stata, and SPSS software.RESULTS:A total of 9 trials involving 1339 participants were included in the meta-analysis. Resected BTC patients could significantly benefit from a 5-FU regimen (HR:0.51, 95%CI, 0.38-0.69, P<0.0001), regardless of gallbladder carcinoma (GBC) or cholangiocarcinoma (CCA). Moreover, both adjuvant chemotherapy (HR:0.61, 95%CI, 0.47-0.79, P=0.0003) and chemoradiotherapy (HR:0.35, 95%CI, 0.14-0.83, P=0.02) could significantly improve clinical survival of resected BTC patients than the surgery alone group. In the subgroup analyses, patients with node-positive (P=0.02) or vascular invasion disease (P=0.002) could better benefit from postoperative AT.CONCLUSION:This study provides the latest evidence to support the 5-FU regimen in resected BTC patients regardless of GBC or CCA. Furthermore, high-risk patients are more likely to benefit from it, such as node-positive or vascular invasion disease.

目的 观察经颈静脉直接肝内门体分流术(DIPS)治疗肝硬化顽固性腹腔积液(RA)的效果及其影响因素.方法 回顾性分析45例接受经颈静脉DIPS治疗的肝硬化RA患者,观察手术成功率及手术相关并发症.于DIPS次日开始随访12个月,比较术前与术后3、6、12个月实验室检查(白蛋白、总胆红素、凝血酶原时间、血氨)、门体静脉压力梯度(PSG)、Child-Pugh评分及分级、RA缓解率、肝性脑病(HE)发生率、分流道通畅率和生存率等指标;以单因素及多因素logistic回归分析观察术后3个月RA未缓解的影响因素.结果 DIPS成功率100％.随访期间患者生存率100％.术前与术后3、6、12个月之间,除凝血酶原时间外,其余指标差异均有统计学意义(P均<0.05).术后6、12个月RA缓解率及分流道通畅率均高于术后3个月(P均<0.05),术后3、6与12个月间HE发生率差异无统计学意义(P=0.607).Child-Pugh评分、总胆红素、血氨为DIPS术后3个月RA未缓解的影响因素(P均<0.05),其中Child-Pugh评分为独立影响因素(P<0.05).结论 经颈静脉DIPS治疗肝硬化RA安全、有效;Child-Pugh评分是DIPS术后3个月RA未缓解的独立影响因素.

随着世界人口老龄化的加重,骨质疏松症的预防以及治疗在老年骨折过程中的作用越来越重要.镁离子在各种细胞的生长发育中发挥重要的作用.较低的血清镁浓度通过影响内分泌、成骨细胞的增殖分化、矿化以及炎症因子释放,造成骨质疏松.镁合金作为新型的骨植入材料,因其具有优异的力学性以及可降解性,也成为近几年合金研究的热点,但是由于镁合金存在降解的速度过快以及在降解过程中产生大量的氢气等问题,影响骨折的愈合,因此,改良镁合金的降解速度成为研究者们主要的研究方向,镁在骨质疏松以及骨折的治疗中将会发挥重要的作用.

目的 探讨经颈静脉肝内门体分流术(TIPS)对失代偿期肝硬化患者短期内肝脏体积(LV)的影响.方法 收集2018年4月至2020年2月甘肃省人民医院收治的56例失代偿期肝硬化患者的临床资料,均进行TIPS并采用计算机断层扫描螺旋(CT)测量患者LV.术前和术后1、6、12个月,比较患者的门静脉压力、凝血指标(总胆红素、凝血酶原时间、血清白蛋白、血小板计数)、LV和Child-Pugh评分.结果 术前,56例患者门静脉压力为(31.77±0.83)mmHg,高于术后的(16.64±4.48)mmHg,差异有统计学意义(P<0.05).除血小板计数外,不同时间各指标比较,差异均有统计学意义(P<0.05);进一步两两比较,术后1、6、12个月凝血酶原时间均长于术前,总胆红素和血清白蛋白水平均高于术前,差异均有统计学意义(P<0.05).不同时间LV和Child-Pugh评分比较,差异均有统计学意义(P<0.05);进一步两两比较,术后1个月LV大于术前,术后6、12个月均小于术前,差异均有统计学意义(P<0.05);术后1个月Child-Pugh评分高于术前,差异有统计学意义(P<0.05).术前、术后患者的Child-Pugh分级比较,差异无统计学意义(P>0.05).结论 CT测量LV安全、可行,LV与肝功能有一定的关系,早期对肝硬化患者行TIPS治疗,可减小LV,使肝功能得到改善.

目的 探讨机器人辅助下空心螺钉内固定治疗股骨颈骨折的临床疗效.方法 回顾性分析2019～2021年因股骨颈骨折就诊于甘肃省人民医院并行空心螺钉的39例患者,其中传统方法组22例,机器人辅助组17例.两组患者的一般资料比较,差异无统计学意义.比较两组患者的手术时间、导针放置次数、一次性置钉成功率、术中透视次数、术中出血量、螺钉间的平行度以及Harris关节评分.结果 机器人辅助组和传统方法组的操作时间分别为56.80±20.68min和72.73±25.10min,导针放置次数分别为3.06±0.24次和4.45±1.18次,术中透视次数分别为14.12±1.87次和21.32±4.08次,前后位螺钉的平行度分别为1.68° ±0.44°和2.38° ±0.43°,侧位螺钉的平行度分别为1.88° ±0.51°和2.34° ±0.37°,术中出血量分别为15.00±5.30ml和23.64±8.75ml,两组数据比较,差异有统计学意义.机器人辅助组和传统方法组的Harris评分分别为87.12±2.71分和85.91±4.12分,差异无统计学意义.结论 和传统方法的手术比较,机器人辅助下空心螺钉内固定可以降低术中出血量、提高手术的精度并且可以降低术中因X线而造成的危害.

Objectives This study aimed to evaluate the effect of preoperative biliary drainage (PBD) on outcomes of pancreaticoduodenectomy (PD) in patients with biliary obstruction. Methods We searched PubMed, EMBASE, Cochrane library, and Web of Science from database inception to 11 March 2021. We used the ROBINS-I tool and Cochrane risk of bias tool 2.0 to assess the risk of bias. The data were statistically analyzed using the RevMan software (Version 5.4). Results In all, 43 studies, including 23,076 patients, were analyzed, of which 13,922 patients were treated with PBD and 9154 were treated with no preoperative biliary drainage (NPBD). The morbidity, infection morbidity, and postoperative pancreatic fistulae (POPF) in patients undergoing PBD, were significantly higher than those in patients undergoing NPBD. Further, PBD may lead to a significantly worse 2- and 3-year overall survival (OS) rates. In subgroup meta-analysis, the differences in morbidity, POPF, and OS outcomes lost significance between the PBD and NPBD groups when the mean total serum bilirubin (TSB) concentration was below 15 mg/dl. Conclusions Routine PBD still cannot be recommended because it showed no beneficial effect on postoperative outcomes. However, in patients with < 15 mg/dl TSB concentration, PBD tends to be a better choice.