ObjectiveConventional strategies for tendon-bone interface (TBI) repair primarily focus on structural healing, often overlooking the essential processes of neural regeneration and proprioceptive recovery required for functional restoration. This review aims to explore the potential of biodegradable magnesium (Mg) alloys and the released magnesium ions (Mg2 +) in establishing a “Mg2 +-Stem Cell-Nerve” axis as a novel strategic foundation for achieving neurotized regeneration at the TBI.MethodsThis review provides a narrative synthesis of the existing literature on the roles of Mg2 + in regulating stem cell functions and promoting neural regeneration. A multidimensional perspective integrating “immunity-metabolism-nerve” interactions was adopted to dissect the underlying synergistic molecular mechanisms. Furthermore, the design of intelligent Mg-based implants predicated on this theory was discussed.ResultsAnalysis of the existing evidence suggests that Mg2 + may act as a pivotal bioactive signal, independently and synergistically regulating stem cell behavior and neural regeneration processes, thereby supporting the proposal of a conceptual “Mg2 +-Stem Cell-Nerve” axis. This proposed axis could theoretically synchronize structural repair and neural re-innervation of the TBI. Based on this mechanism, the design of intelligent Mg-based implants demonstrates significant potential for achieving spatiotemporally precise modulation.ConclusionBiodegradable Mg alloys, through the proposed “Mg2 +-Stem Cell-Nerve” axis, offer a promising paradigm for advancing TBI healing from structural integration toward neurotized functional regeneration. However, clinical translation remains at an early stage, requiring further validation in large-animal models, resolution of degradation control challenges, and rigorous long-term safety and efficacy evaluation. Although the proposed “Mg2 +-Stem Cell-Nerve” axis provides a novel integrative framework, it is important to note that its full sequential and closed-loop operation currently remains a working hypothesis derived from synthesizing fragmented pairwise evidence from disparate model systems, rather than a fully established pathway directly validated in the TBI microenvironment.

Abstract Background Hemiarthroplasty (HA) and total hip arthroplasty (THA) are the primary surgical options for geriatric femoral neck fractures (FNF). Our study balanced heterogeneity in baseline patient conditions and included long-term follow-up data, compared short-term costs and reoperation risks within the 3-year period, aimed to provide evidence for personalized surgical selection. Methods This study enrolled 878 patients aged ≥ 60 years with first-time FNF treated at the Orthopedics Department of a large Grade-Three Class-A Hospital in China (2013.03–2021.12), categorized into HA and THA groups. Collected demographic characteristics and relevant clinical data, and Inverse Probability of Treatment Weighting (IPTW) was applied to adjust for baseline heterogeneity. Primary outcomes encompassed prosthesis-related complications, secondary fractures included contralateral fracture and osteoporotic vertebral compression fracture (OVCF), and short-term costs. Subgroup analyses stratified by age (60–75 vs. ≥ 75 years) and age-adjusted Charlson Comorbidity Index (aCCI < 5 vs. ≥ 5) were conducted to identify high-risk populations. Results The THA group demonstrated significantly higher risks of periprosthetic fracture (OR = 2.43, 95% CI: 1.09–5.41; P = 0.030) and dislocation (OR = 4.27, 95% CI: 1.44–12.66; P = 0.009) compared to the HA, but had a reduced risk of deep vein thrombosis (DVT) (OR = 0.26, 95% CI: 0.11–0.63; P = 0.003). In high-risk subgroups (age ≥ 75 and aCCI ≥ 5), we observed dramatically increased risks of periprosthetic fracture and dislocation, but there were no differences in low-risk subgroups except for DVT. Short-term cost analysis revealed that the THA incurred higher hospitalization expenses [$13,038 ($9,047–$14,795) vs. $9,043 ($8,012–$10,178)]. Conclusion THA carries an elevated risk of mechanical complications within 3 years, especially among patients aged ≥ 75 years or with an aCCI ≥ 5. For these high-risk populations, HA should be prioritized to mitigate catastrophic risks. THA incurs higher short-term medical costs, but it may benefit low-risk patients through long-term functional improvement.

Background:Kashin-Beck disease (KBD) is an endemic osteoarthropathy characterized by growth retardation and progressive joint degeneration. However, its systemic molecular features in peripheral blood remain incompletely understood. Methods:Peripheral blood transcriptomic data from four independent cohorts were analyzed using differential expression analysis and weighted gene co-expression network analysis to identify KBD-associated gene sets. Multiple feature selection strategies and machine learning models were applied to construct and validate a blood-based diagnostic signature across cohorts. Immune cell composition was inferred by computational deconvolution, and transcription factor regulation, pathway enrichment, and genetic association data were integrated for biological interpretation. Results:A four-gene blood signature (C4B, AQP1, HBA2, and ACSL6) was identified, showing stable diagnostic performance across independent blood cohorts and preserved discriminatory capacity in cartilage tissue. Downstream analyses revealed that the diagnostic genes were associated with altered immune cell composition and immune- and metabolism-related pathways in peripheral blood. Conclusions:This study defines a compact and interpretable blood-based transcriptomic signature for KBD and provides insight into its systemic immune-related molecular context, supporting its potential utility for disease identification and mechanistic investigation.

This review systematically examines the mechanisms and recent research progress of magnesium ions in promoting tendon-bone interface repair by regulating stem cell functions. Firstly, the analysis indicates that magnesium ions synergistically regulate stem cell proliferation, migration, and multidirectional differentiation through multiple signaling pathways, while simultaneously promoting angiogenesis and optimizing the immune microenvironment. Subsequently, a summary of existing research findings confirms that magnesium-based biodegradable biomaterials demonstrate favorable tissue repair-promoting effects in animal experiments. Finally, this article proposes that, given the spatiotemporal sequential characteristics of magnesium ion regulation on stem cells and the healing microenvironment, future research should focus on developing novel smart materials capable of precisely controlling magnesium ion release to match the healing process, thereby advancing its clinical translation and precision medicine applications in the field of tendon-bone repair.

Purpose This paper aims to establish an X-ray imaging grading for assessing ankle joints in adult Kashin Beck disease (KBD), and investigate its correlation with clinical grading of hand and ankle pain. Methods The study involved 160 adult KBD patients (a total of 320 ankles) as the case group and 100 matched healthy subjects (a total of 200 ankles) as the control group. Digital Radiographs of bilateral ankle joints were obtained, and the talus trochlea angle was measured according to the radiographs. The X-ray grading of adult KBD ankles was conducted using the Kellgren Lawrence grading as a reference. Correlation analysis was performed to study the relationship between X-ray grading and clinical grading of hand. Result The X-ray imaging of KBD ankle joints was categorized into grade 0-IV, with grade IV further divided into subtypes a, b, c, and d. There was no correlation between ankle X-ray grading and the clinical grading of the hands in patients with KBD (r = 0.208, p = 0.001). There was a significant correlation between X-ray grading and ankle pain (r = 0.610, p = 0.000), but no correlation between ankle pain and the clinical grading of hand (r = 0.101, p = 0.071). Conclusion This study introduced an X-ray grading method for KBD ankles, although it showed no correlation with the clinical grading of the hands. Importantly, a moderate correlation was identified between X-ray grading and ankle pain, but no significant link was established between ankle pain and the clinical grading of hand.

BackgroundOsteoporosis is a foremost public health challenge, especially with the global aging population. Both frailty and osteoporosis share many risk factors, although the relationship between them remains partially explored. This study aims to explore the correlation between varying frailty statuses and osteoporosis incidence.MethodsParticipants from the 2017-2018 NHANES were classified into three groups: frailty, prefrailty, and robust, based on the frailty phenotype. The correlation between frailty and osteoporosis prevalence was assessed using weighted multivariate logistic regression models. Causal relationship was verified by Mendelian randomization using frailty data from the U.K. Biobank and osteoporosis data from the FinnGen database. Proteomic analysis including associated protein screening and functional enrichments was performed based on data from the Icelandic cohort.ResultsThe study group comprised 1814 participants. An increased incidence of osteoporosis was observed in older age and lower body mass index populations. A significant frailty-osteoporosis correlation (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 1.14-1.64; p = 0.001) was indicated both in the crude model and after adjustments (OR: 1.23; 95% CI: 1.01-1.51; p = 0.039). The inverse variance weighting method observed a potential effect of frailty on osteoporosis risk (beta/SE, 0.209/0.099; OR: 1.233; 95% CI: 1.014-1.499; p = 0.036). Thirteen frailty-osteoporosis-associated proteins were found, and proteomic enrichment indicated oxidative stress-related pathways as a hypothesis-generating mechanism of frailty-mediated osteoporosis.ConclusionsOur findings suggest a potential causal association between frailty and osteoporosis, with risk exacerbating with the progression of frailty severity. Frailty potentially impacts the progression of osteoporosis through response to oxidative stress.

Abstract BackgroundTo analyze the curvature characteristics of thetalus trochlea inpeople from Northwest China in different sex and age groups. MethodsComputed tomography scanning data of talus from 61 specimens were collected and constructed as a three-dimensional model by MIMICS software, anteromedial(AM), posteromedial(PM), anterolateral(AL), and posterolateral(PL) edge, anterior edge of medial trochlea, posterior edge of medial trochlea and anterior edge of lateral trochlea were defined according to the anatomical landmarks on trochlear surface. The curvature radii for different areas were measured using the fitting radius and measure module. Results There were significant differences among the talus curvatures in the six areas (F=54.905, P=0.000), and more trends in the analytical results were as follows: PM > PL > MP > AL > MA > AM. The average posterolateral radius from specimens aged >38 years old was larger than that from specimens aged<=38 years (t=-2.303, P =0.038). The talus curvature of the AM for males was significantly larger than that for females (t=4.25, P=0.000), and the curvature of the AL for males was larger than that for females (t=2.629, P =0.010). For observers aged <=38 years, the AM curvature of the right talus in the male group was significantly larger than thatin the female group (P<0.01). In age <=38years group, the MA curvature of right talus in male was significantly larger than in female group(P<0.01), fitting radius of talus for male (21.90±1.97 mm) was significantly greater than female of this(19.57±1.26 mm)(t=6.894, P=000). The average radius of the talus in the male population was larger than that in the female population. Conclusion There was no significant relationship between age and talus curvature in either males or females. The radius of curvature in the posterior area was significantly larger than that in the anterior area. We recommend that this characteristic of the talus trochlea should be considered when designingthe talus component in total ankle replacement (TAR).

To investigate a novel approach for establishing the transverse pedicle angle (TPA) of the lower lumbar spine using preoperative digital radiography (DR). Computed Tomography (CT) datasets of the lower lumbar were reconstructed using MIMICS 17.0 software and then imported into 3-matic software for surgical simulation and anatomical parameter measurement. A mathematical algorithm of TPA based on the Pythagorean theorem was established, and all obtained data were analyzed by SPSS software. The CT dataset from 66 samples was reconstructed as a digital model of the lower lumbar vertebrae (L3-L5), and the AP length/estimated lateral length for L3 between the right and left sides was statistically significant (P = 0.015, P = 0.005). The AP length of the right for L4 was smaller than that of the left after a paired t test was executed (P = 0.006). Both the width of the pedicle and the length of the pedicle (P2C1) were consistent with TPA (L3<L4<L5). There were no significant differences in TAN-TPA and DR-TPA compared with real TPA. The ICCs for the real TPA and DR-TPA within L3 showed good reliability, and the ICCs for the real TPA and DR-TPA within both L4 and L5 showed moderate reliability. Our novel approach can be considered a reliable way to determine the transverse pedicle angle from routine DR, and the width and length of the pedicle within lumbar DR should be considered to determine the length and trajectory of the screw during preoperative planning.

Abstract Background To analyze the curvature characteristics of the talus trochlea in people from northern China in different sex and age groups. Methods Computed tomography scanning data of talus from 61 specimens were collected and constructed as a three-dimensional model by Materialise’s Interactive Medical Image Control System(MIMICS) software, anteromedial(AM), posteromedial(PM), anterolateral(AL), and posterolateral(PL) edge, anterior edge of medial trochlea, posterior edge of medial trochlea and anterior edge of lateral trochlea were defined according to the anatomical landmarks on trochlear surface. The curvature radii for different areas were measured using the fitting radius and measure module. Results There were significant differences among the talus curvatures in the six areas (F = 54.905, P = 0.000), and more trends in the analytical results were as follows: PM > PL > MP > AL > MA > AM. The average PL radius from specimens aged > 38 years old was larger than that from specimens aged < = 38 years (t=-2.303, P = 0.038). The talus curvature of the AM for males was significantly larger than that for females (t = 4.25, P = 0.000), and the curvature of the AL for males was larger than that for females (t = 2.629, P = 0.010). For observers aged < = 38 years, the AM curvature of the right talus in the male group was significantly larger than that in the female group (P < 0.01). In age < = 38years group, the MA curvature of right talus in male was significantly larger than in female group(P < 0.01), fitting radius of talus for male (21.90 ± 1.97 mm) was significantly greater than female of this(19.57 ± 1.26 mm)(t = 6.894, P = 000). The average radius of the talus in the male population was larger than that in the female population. Conclusion There was no significant relationship between age and talus curvature for males and females. The radius of curvature in the posterior area was significantly larger than that in the anterior area. We recommend that this characteristic of the talus trochlea should be considered when designing the talus component in total ankle replacement (TAR).

Objective Open arthrolysis (OA) combined with hinged external fixator (HEF) is a promising surgical option for patients with elbow stiffness. This study aimed to investigate elbow kinematics and function following a combined treatment with OA and HEF in elbow stiffness cases. Methods Patients treated with OA with or without HEF due to elbow stiffness were recruited between August 2017 and July 2019. Elbow flexion‐extension motion and function (Mayo elbow performance scores, MEPS) were recorded and compared between patients with and without HEF during a 1‐year follow‐up period. Additionally, those with HEF were assessed by dual fluoroscopy at week 6 postoperatively. Flexion‐extension and varus‐valgus motions, as well as ligament insertion distances of the anterior medial collateral ligament (AMCL) and lateral ulnar collateral ligament (LUCL), were compared between the surgical and intact sides. Results This study included 42 patients, of which 12 with HEF demonstrated a similar flexion‐extension angle and range of motion (ROM) and MEPS as the other patients. In patients with HEF, the surgical elbows showed limitations in flexion‐extension (maximal flexion, 120.5° ± 5.3° vs 140.4° ± 6.8°; maximal extension, 13.1° ± 6.0° vs 6.4° ± 3.0°; ROM, 107.4° ± 9.9° vs 134.0° ± 6.8°; all P s < 0.01) compared with the contralateral sides. During elbow flexion, a gradual valgus‐to‐varus transition of the ulna, increase in the AMCL insertion distance, and steady change in the LUCL insertion distance were observed, with no significant differences between the bilateral sides. Conclusions Patients treated with OA and HEF demonstrated similar elbow flexion‐extension motion and function to those treated with OA alone. Although the use of HEF could not restore an intact flexion‐extension ROM and might result in some minor but not significant changes in kinematics, it contributed to clinical outcomes comparable to that of the treatment with OA alone.

Background Kashin–Beck disease (KBD) is an endemic deformable bone and joint disease, which affects the quality of life (QOL) of patients. We conducted a cross-sectional study of the QOL of KBD patients by a new KBD quality of life (KBDQOL) questionnaire. Methods A total of 252 KBD patients and 248 OA patients came from Northwest China, and 260 healthy people living in the same area as KBD and osteoarthritis (OA) patients served as the controls. KBDQOL questionnaire was used to evaluate the QOL of all objects. Results The average scores for physical functions, activity limitations, support of society, mental health and general health were significantly lower in KBD patients than that in OA patients and healthy people except for economics. Monofactor analysis showed that age, height, weight status, education level and grade of KBD had a significant effect on KBDQOL score. Multivariate analysis showed that grade of KBD was the influencing factor of physical function score; gender, age, height, grade of KBD and duration of symptoms were the influencing factors of activity restriction score; age and grade of KBD were factors affecting the general health score. Conclusion The QOL of KBD patients was significantly lower than that of OA patients and healthy people. The KBDQOL questionnaire may be a promising tool for assessing the QOL of KBD patients.

目的 测量大骨节病(Kashin-Beck disease,KBD)患者下颈椎椎体的X线参数,明确KBD对下颈椎椎体发育的影响.方法 分别对62例KBD患者(KBD组)及67例正常人(对照组)行颈椎侧位X线片检查,观察颈椎椎体的影像学特征,测量两组C3～7椎体前缘、中份及后缘高及前后径,并进行统计学分析.结果 KBD患者下颈椎椎体上、下面凹凸不平,终板凹陷、硬化.颈C3～7椎体前、后缘高大于中份高,椎体前、后缘高无统计学差异(P＞0.05);KBD组男性C4～6和女性C4～7的椎体中份高小于前、后缘,差异有统计学意义(P＜0.05).对照组男性C4～7及女性C3～7椎体中间高均高于KBD组,差异有统计学意义(P＜0.05).KBD患者男女组间前后径有统计学差异(P＜0.05);对照组男女前后径较KBD组大,差异无统计学意义(P＞0.05).结论 KBD可引起终板软骨凹陷、不平及硬化,导致颈椎中间高度降低,但对颈椎前后径无明显影响.

Materials based on titanium and its alloys are widely used in the medical and dental fields because of their excellent physical properties such as hardness, ductility and elastic modulus, etc. However, because commonly used titanium alloy internal plants do not have antibacterial properties, when these implants are implanted into the human body, there is a certain risk of infection. Such infections are extremely painful for the patient and problematic for the attending physician. In the past, infections of implants were usually treated with systemic antibiotics in combination with thorough debridement or implant replacement. However, these are passive treatments and typically cause huge physical and economic burdens on the patient. Therefore, attempts towards the development of implants with antibacterial functionality have been increasing, with the combination of titanium alloys with antibiotics, antibacterialmetals, and antibacterial peptides being the main research direction. Therefore, this paper will discuss the latest research progress in the preparation of titanium alloys with antibacterial strategies such as combining antibiotics or antimicrobial peptides, adding antimicrobial metals, and the antibacterial properties and biocompatibility of proposed systems are summarised and discussed herein. This review should serve as a reference for further research on antibacterial titanium alloy implants.

目的 通过测量中老年大骨节病(Kashin-Beck disease,KBD)患者下颈椎椎间隙高度,观察椎间隙的影像学形态,明确大骨节病对下颈椎椎间隙高度及形态的影响.方法 纳入2019年8月至2019年12月在甘肃宁县第二人民医院检查的KBD患者(KBD组)92例,其中男38例,女54例;年龄47～70岁,平均(58.89±7.67)岁,以及非KBD人群(对照组)98例,其中男42例,女56例;年龄49～69岁,平均(58.35±7.38)岁.两组人群行颈椎侧位X线片检查,观察下颈椎间隙影像学表现;测量两组C2～7椎间隙前缘、中间及后缘高度,并进行统计学分析.结果 结果显示KBD组男、女C4～7椎间隙中间高度均低于C2～4,差异有统计学意义(P＜0.05).KBD组男、女C2～4椎间隙中间高度低于对照组,但差异无统计学意义(P＞0.05),而C4～7椎间隙中间高度均低于对照组,差异有统计学意义(P＜0.05).KBD组男、女患者C2～4椎间隙中间高度相比,差异有统计学意义(P＜0.05),而两性别C4～7椎间隙中间高度相比,差异无统计学意义(P＞0 05).根据椎间隙的高度及形态X线表现,可分为间隙正常型27例(29.35％)、增宽型11例(11.96％)、狭窄型42例(45.65％)及椭圆型12例(13.04％).其特征性改变为部分椎体终板上下面凹陷、凹凸不平、硬化.结论 KBD并不影响颈椎间盘发育,但KBD患者更倾向于发生椎间盘退变,高度丢失.本研究初步证实KBD与颈椎椎间盘退变发生可能具有一定相关性.

PURPOSE:Kashin-Beck disease (KBD) is an endemic osteoarthropathy affecting the epiphyseal growth plate of multiple joints in young and adolescent patients. Previous studies have focused on the visible deformed extremities instead of the spinal radiological features, especially the atlantoaxial joint. The aim of this study was to determine the prevalence and radiographic features of atlantoaxial dislocation (AAD) in adult patients with KBD.METHODS:This study was conducted on KBD patients in three typical endemic counties between October 2017 and November 2019. The patients were evaluated by collecting basic information, clinical signs and symptoms. They underwent dynamic cervical radiography, by which AAD was diagnosed. For those patients with confirmed or suspected AAD, computed tomography (CT) imaging was performed to observe the odontoid morphology and degenerative changes in the lateral atlantoaxial joints. Radiographic evaluations were reviewed to determine the prevalence and features of AAD.RESULTS:A total of 39 (14.6%) of 267 KBD patients were diagnosed with AAD. Compared with the non-AAD patients, the detection rate of AAD was associated with a longer disease duration and stage and was not associated with age, sex or BMI. Thirty-two patients had symptoms at the neck or neurological manifestations, while seven had no symptoms. There were three types of morphologies of the odontoid process in AAD patients: separating in 19 cases, hypoplastic in 15 cases and intact in five cases. Anterior dislocation was noted in 29 cases, and posterior dislocation was noted in ten cases. Thirty-four cases were reducible, and five were irreducible. The lateral atlantoaxial joints had different severities of degenerative changes in 17 cases.CONCLUSIONS:This study revealed that the prevalence of AAD was 14.6% in adult KBD patients. The radiographic features of AAD include manifestations of odontoid dysplasia and chronic degenerative changes in atlantoaxial joints. KBD patients with severe stages and longer disease duration were more vulnerable to the occurrence of AAD. We postulate that this atlantoaxial anomaly might originate from chondronecrosis of the epiphyseal growth plate of the odontoid process in young and adolescent individuals. This study may provide a clinical reference to help clinicians screen, prevent and treat AAD in adult patients with KBD.

Kashin-Beck disease is an endemic, chronic and multiple osteoarthropathy, which can involve multiple joints of the whole body, and the disability rate is very high. At present, there are few relevant studies on ankle lesions of adult Kashin-Beck disease, and there are few systematic reports. This paper reviews the clinical manifestations, imaging research, biochemical research and treatment of Kashin-Beck disease ankle arthritis, so as to provide a more systematic basis for the study of Kashin-Beck disease ankle arthritis.

BackgroundCombined anesthesia can be a promising option for hip surgery when neuraxial anesthesia is contraindicated. Lumbar and sacral plexus blocks, and femoral nerve and lateral femoral cutaneous (LFC) nerve blocks in combination with general anesthesia (GA) are commonly used in elderly patients undergoing arthroplasty for hip fracture surgery. However, no study has compared these two anesthetic strategies in the perioperative period. MethodsA total of 41 elderly patients scheduled for arthroplasty for hip fracture surgery were randomized into group A (n = 20) and group B (n = 21). Group A received femoral nerve block, LFC nerve blocks, and GA, and group B received lumbar plexus block, sacral plexus block, and GA. Primary outcomes were incidences of hemodynamic events and changes in blood pressure (BP) and heart rate (HR). Secondary outcomes included time and drug consumption, infusion and bleeding volume, eyes opening time after surgery, and postoperative quality recovery rate. ResultsCompared with group B, group A showed a lower incidence of intraoperative hypotension (p < 0.001), higher BP [including mean arterial pressure (MAP), systolic BP (SBP), and diastolic BP (DBP)] following induction (IN), and higher HR from mid-surgery. Time required for nerve blockade (p < 0.001) and ephedrine consumption was significantly shorter in group A (p < 0.001), while sufentanil consumption was higher as compared to group B (p = 0.002). No significant differences in other intraoperative parameters and postoperative quality recovery rate were reported during the observation. ConclusionOur pilot data indicate that compared with lumbar and sacral plexus blocks, femoral nerve and LFC nerve blocks may provide more stable intraoperative hemodynamics and a comparable postoperative recovery for elderly patients undergoing arthroplasty for hip fracture under GA. Further studies with a larger sample size are needed to derive stronger evidence.

目的 通过三维成像技术建立腰4、腰5椎体数字化模型,探索腰椎后路内固定手术过程中椎弓根螺钉的精准植入位置.方法 采集6例腰椎CT平扫图像数据集,用Mimics软件建模后,采用计算机模拟手术植入椎弓根螺钉的方法,比较人字嵴法、Weinstein法、Magerl法确定椎弓根螺钉钉道的可靠性.结果 本研究纳入6例腰椎CT平扫数据集(男性4例,女性2例),年龄平均值42.83岁,腰4椎体右侧Magerl进钉点到真实进钉点的距离显著大于左侧,腰4左侧人字嵴进钉点到真实进钉点距离显著大于Weinstein法及Magerl法(P均<0.001),腰4右侧人字嵴进钉点到真实进钉点距离显著大于Weinstein法(P=0.003);腰4左侧、右侧外展角依次为:真实外展角>Magerl外展角>Weinstein外展角>人字嵴外展角.腰5椎体左侧真-Weinstein、真-人字嵴距离显著大于右侧(P=0.002和P=0.004),腰5椎体右侧Weinstein外展角大于左侧(P=0.003).腰5椎体左侧、右侧人字嵴进钉点到真实进钉点的距离均显著大于Weinstein法及Magerl法(P均<0.001),腰5椎体左侧、右侧Magerl进钉点到真实进钉点的距离均显著大于Weinstein法.腰5椎体左侧及右侧外展角依次为:真实外展角>Magerl外展角>Weinstein外展角>人字嵴外展角.结论 腰4和腰5椎体的Weinstein法及Magerl法进钉点接近真实进钉点,腰4和腰5椎体Weinstein外展角、Magerl外展角均与真实外展角差异较小.因此,建议腰4椎弓根螺钉置钉时首选Weinstein法,腰5椎弓根螺钉置钉时,首选Weinstein法或Magerl法.

目的 探讨采用颈后路内固定植骨融合术治疗寰枢椎脱位的临床疗效.方法 回顾性分析2015年1月至2019年10月陕西省人民医院骨科收治的寰枢椎脱位患者18例,其中男10例,女8例,年龄24～71岁,平均(49.50±13.00)岁.根据术前颈椎动力位片评估、颅骨牵引实验,将18例患者分为寰枢椎不稳(instability)、可复性寰枢椎脱位(reducible dislocation)、不可复性寰枢椎脱位(irreducible dislocation),寰枢椎不稳共6例(33.33％),行经后路寰枢椎椎弓根螺钉固定术;可复性寰枢椎脱位共8例(44.44％),行颈后路寰枢椎内固定植骨融合术;不可复性寰枢椎脱位4例(22.22％),行前路经口寰枢关节松解、后路复位固定融合术.通过术前和末次随访时患者日本骨科学会(Japanese orthopaedic association,JOA)评分及颈椎功能障碍指数(neck disability index,NDI)评估颈脊髓神经功能改善程度及临床疗效.通过术前及术后末次随访影像学检查,比较寰齿前间隙(atlantodental interval,ADI)、寰椎平面脊髓有效空间(space available for the spinal cord,SAC)、斜坡枢椎角(clivus-axial angle,CAA),评估寰枢椎复位及脊髓压迫解除情况.结果 所有18例患者均顺利完成手术,并获得随访,随访时间平均12～48个月,平均(22.40±6.80)个月.16例为经后路寰枢椎椎弓根螺钉固定植骨融合术,2例为枕颈固定融合术.术中无脊髓、神经及椎动脉损伤,无椎弓根劈裂等并发症发生.术后取髂骨区伤口渗液1例,经对症处理后好转.末次随访时,JOA评分为(15.39±1.42)分,较术前(10.22±1.35)分明显升高.NDI评分末次随访为(16.22±7.17)分,较术前(35.72±5.70)分明显降低.ADI由术前(5.53±0.81)mm 降至末次随访时(0.88±0.71)mm,SAC 由术前(7.72±2.24)mm 升至术后(14.56±1.69)mm,CAA由术前(124.11±9.15).升至末次随访时(148.83±5.38)°.以上指标术后与术前相比差异均有统计学意义(P＜0.05).术后影像学随访提示所有患者寰枢椎脱位复位满意,脊髓减压充分.随访中影像学检查示植骨区获得骨性融合,无内固定松动、断裂或拔出等情况出现.结论 根据术前颈椎动力位X线片评估及全麻下颅骨牵引实验,对寰枢椎脱位进行分型,可指导实施相应的手术策略.颈后路内固定植骨融合术治疗寰枢椎脱位可有效复位,改善脊髓压迫症状,临床疗效令人满意.

Abstract Objective To establish a digital model of the ankle joint through 3D imaging technology and explore the preoperative placement of ankle replacement prostheses. Methods Computed tomography images of intact ankle joints from 54 cases in the outpatient and inpatient departments of our hospital were collected; according to the INBONE® total ankle system surgery process, the surgery model and surgical osteotomy were finished using MIMICS based on computer simulation method. The shortest distance was measured between the center point and the anterior, posterior, medial, and lateral, respectively, to ensure the precise position of the ankle replacement prosthesis by digital simulation surgery. The relationship between the two variables was analyzed by bivariate correlation analysis. Results The dataset of this study included 48 cases of the sub‐data set (26 males and 22 females) and included 27 cases of left ankle and 21 cases of right ankle. The average medial malleolar angle was 18.67°± 2.87°, the average amount of bone resection was 12.13 ± 1.86 cm3, the mid‐anterior distance was 1.72 ± 0.19 cm, the mid‐posterior distance was 2.00 ± 0.19 cm, the ratio of mid‐anterior to mid‐posterior was 0.87, the mid‐medial distance was 1.26 ± 0.17 cm, the mid‐lateral distance was 1.19 ± 0.16 cm, and the ratio of mid‐medial to mid‐lateral was 1.06. After osteotomy, the anteroposterior diameter was 3.73 ± 0.32 cm, the transverse diameter was 2.46 ± 0.27 cm, and the ratio of anteroposterior diameter to transverse diameter was 1.53. In the bottom view, the shape after osteotomy is rectangular. The mid‐anterior distance was strongly negatively correlated with age, the mid‐anterior distance and the amount of bone resection, the mid‐medial distance and the amount of bone resection, the mid‐lateral distance and the amount of bone resection, the mid‐lateral distance and the anteroposterior diameter, the anteroposterior diameter and the transverse diameter were all strongly positively correlated. Conclusion The projection point of the lower tibia centerline on the tibial horizontal osteotomy surface is located at a position slightly anterior to the midpoint of the transverse diameter after ankle arthroplasty. The rational positioning of the total ankle replacement is located at both a position slightly anterior to the midpoint of the transverse diameter and midpoint of the anteroposterior diameter, which can be used as a reference method before total ankle arthroplasty surgery.