Introduction Neutrophils play a key role in host immune defense. At present, neutrophils in chronic bone infections exhibit significant heterogeneity but functional alterations that remain poorly understood.Materials and Methods A rat model of chronic bone infection induced by Methicillin-Resistant Staphylococcus Aureus (MRSA) was established. Bone marrow cells were analyzed using scRNA-seq with Gene Ontology (GO) and pathway enrichment analysis. Differentially Expressed Genes (DEGs) were identified to assess neutrophil dysfunction, validated by immunofluorescence staining and ROS quantification.Results MRSA-induced chronic bone infection was confirmed by Gram and H&E staining, which showed bacterial colonization and inflammation. Neutrophils from infected rats showed downregulated immune-related genes (e.g., Clec7a, Ccr5) and upregulated immunosuppressive factors (e.g., Nfkbia, IL10ra). Enrichment analysis showed that immune responses and neutrophil functions were inhibited. Immunofluorescence showed neutrophil polarization towards N2 phenotype and reduced Reactive Oxygen Species (ROS) production in the infection group.Discussion This study established a rat model of MRSA-induced chronic bone infection and identified 7 neutrophil subsets via scRNA-seq analysis, with the NeuP2ry10 subset showing the most significant changes. Neutrophils displayed decreased chemotaxis, phagocytosis, and ROS production, along with elevated anti-inflammatory gene expression, suggesting functional suppression and a shift toward an immunosuppressive state.Conclusion Chronic bone infection drives neutrophil polarization toward an N2 anti-inflammatory phenotype, reducing antimicrobial capacity and promoting infection persistence. Targeting neutrophil function may offer new therapeutic strategies for chronic bone infection.

BACKGROUND:The femoral pin tracker in robotic-assisted total knee arthroplasty (TKA) can be placed intraincisionally or extraincisionally. The purpose of our study was to determine the impact of these placement methods on soft-tissue tension in the knee joint. METHODS:A total of 132 patients undergoing robotic-assisted TKA were prospectively enrolled; of those, 80 were randomized to receive an intraincisional or extraincisional femoral pin tracker during surgery. Soft-tissue tension in the medial and lateral compartments of the knee joint was measured using a sensor before and after the removal of the pin tracker. Measurements were performed at 10°, 45°, 90°, and 120° of knee flexion. Changes in knee joint soft-tissue tension from before to after the removal of the pin tracker were compared between the 2 groups. RESULTS:Our trial included 80 patients (mean age, 66.98 ± 38.48 years; 24% male; 100% Han Chinese). The intraincisional group demonstrated significantly greater changes in soft-tissue tension in the medial compartment of the knee at 10° (p < 0.001), 45° (p = 0.028), and 90° (p = 0.046) of knee flexion compared with the extraincisional group. No significant between-group differences were found in the changes in tension in the medial compartment at 120° of knee flexion (p > 0.05) or in the lateral compartment at any angle (p > 0.05). CONCLUSIONS:Intraincisional placement of the femoral pin tracker may influence soft-tissue tension in the medial compartment of the knee. Surgeons should be aware of these differences when performing soft-tissue balancing before the removal of the femoral pin tracker. LEVEL OF EVIDENCE:Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Aims:We developed a novel unicompartmental pressure sensor to measure intraoperative medial compartment pressureduring robotic arm-assisted unicompartmental knee arthroplasty (UKA) and conventional jig-based UKA in order to assess the effect and impact of soft-tissue balance. Methods:This retrospective study evaluated 80 patients who underwent medial compartment UKA at our institution between November 2022 and June 2023, including 40 patients in conventional jig-based (mobile bearing) UKA and 40 patients in robotic arm-assisted (fixed bearing) UKA. After intraoperative soft-tissue balancing, the medial compartment pressure at 10°, 45°, and 90° of knee flexion was measured using a new unicompartmental pressure sensor. The knee range of motion (ROM), Numerical Rating Scale, and American Knee Society scores were recorded at three months and one year of follow-up. Results:Conventional jig-based UKA did not achieve consistent medial compartment pressures at 10°, 45°, and 90° of knee flexion (p < 0.001), whereas robotic arm-assisted UKA achieved more balanced pressures at these angles (p-values between 10° vs 45°, 10° vs 90°, and 45° vs 90° were 0.132, 0.378, and > 0.999, respectively). In addition, robotic arm-assisted UKA showed better outcome scores and ROM at three months, but no significant clinical differences at the one-year follow-up. Conclusion:Intraoperative pressure measurements using the novel unicompartmental pressure sensor showed that robotic arm-assisted UKA was able to achieve more consistent pressure in the medial compartment than conventional jig-based UKA, which may improve early postoperative rehabilitation.

Objective:To compare the safety and early effectiveness between conventional manual technique and domestic robot-assisted simultaneous bilateral medial unicompartmental knee arthroplasty (UKA). Methods:Clinical data of 59 patients who underwent simultaneous bilateral UKA and met the selection criteria between January 2023 and June 2024 were retrospectively analyzed. Among them, 30 patients received bilateral UKA via conventional surgery with Oxford mobile-bearing unicompartmental knee prosthesis (conventional group); another 29 patients underwent bilateral UKA with LINK SLED fixed-bearing unicompartmental knee prosthesis assisted by the domestic NATON robotic surgical system (robotic group). Baseline data including gender, age, body mass index, disease duration, Kellgren-Lawrence grade, and preoperative American Knee Society Score (KSS) and Oxford Knee Score (OKS) showed no significant intergroup differences ( P>0.05). Intraoperative and perioperative indicators including operation time, length of hospital stay, perioperative hemoglobin (Hb) drop (preoperative vs immediate postoperative), and incidence of complications were recorded and compared. KSS and OKS scores were adopted to assess knee functional recovery preoperatively, at 3 months postoperatively, and at last follow-up. KSS satisfaction score was used to evaluate patient satisfaction at 3 months postoperatively and at last follow-up. Radiographic measurements of tibial prosthesis varus-valgus angle and the change in joint line height before and after surgery were performed to evaluate the accuracy of prosthesis implantation. Results:The conventional group had significantly shorter operation time than the robotic group ( P<0.05). There was no significant difference in length of hospital stay and perioperative Hb drop between the two groups ( P>0.05), and no patient required blood transfusion. All patients completed follow-up, the follow-up duration was (12.3±2.3) months for the conventional group and (12.1±2.4) months for the robotic group, with no significant difference ( t=0.324 , P=0.752). No severe complication including prosthesis loosening, periprosthetic infection, periprosthetic fracture, deep vein thrombosis of lower extremities, pulmonary embolism, knee stiffness, or knee instability occurred in either group. The tibial prosthesis varus-valgus angle and the change in joint line height in the robotic group were significantly smaller than those in the conventional group ( P<0.05). No significant intergroup difference was observed in patient satisfaction scores at 3 months postoperatively and at last follow-up ( P>0.05). Both KSS and OKS scores significantly improved at 3 months postoperatively and at last follow-up when compared with preoperative scores, with further improvement over time ( P<0.05); no significant intergroup difference in these scores was found at any postoperative time point ( P>0.05). Conclusion:Although robot-assisted simultaneous bilateral UKA requires longer operation time, it achieves comparable early effectiveness and safety to conventional manual simultaneous bilateral UKA, with superior accuracy of prosthesis implantation. The domestic robot-assisted system demonstrates promising clinical application value in simultaneous bilateral UKA.

Background: The femoral pin tracker in robotic-assisted total knee arthroplasty (TKA) can be placed intraincisionally or extraincisionally. The purpose of our study was to determine the impact of these placement methods on soft-tissue tension in the knee joint. Methods: A total of 132 patients undergoing robotic-assisted TKA were prospectively enrolled; of those, 80 were randomized to receive an intraincisional or extraincisional femoral pin tracker during surgery. Soft-tissue tension in the medial and lateral compartments of the knee joint was measured using a sensor before and after the removal of the pin tracker. Measurements were performed at 10°, 45°, 90°, and 120° of knee flexion. Changes in knee joint soft-tissue tension from before to after the removal of the pin tracker were compared between the 2 groups. Results: Our trial included 80 patients (mean age, 66.98 ± 38.48 years; 24% male; 100% Han Chinese). The intraincisional group demonstrated significantly greater changes in soft-tissue tension in the medial compartment of the knee at 10° (p < 0.001), 45° (p = 0.028), and 90° (p = 0.046) of knee flexion compared with the extraincisional group. No significant between-group differences were found in the changes in tension in the medial compartment at 120° of knee flexion (p > 0.05) or in the lateral compartment at any angle (p > 0.05). Conclusions: Intraincisional placement of the femoral pin tracker may influence soft-tissue tension in the medial compartment of the knee. Surgeons should be aware of these differences when performing soft-tissue balancing before the removal of the femoral pin tracker. Level of Evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

In medial mobile-bearing unicompartmental knee arthroplasty (MB-UKA), the position of the bearing does not correspond to the planned position which will increasing the risk of bearing dislocation. This study aimed to explore the relationship between the malposition of the femoral and tibial components and the phenomenon of bearing deviation using postoperative radiological measurements. One hundred twenty patients who underwent mobile-bearing uni-compartmental knee arthroplasty (MB-UKA) at our hospital between January and August 2023 were enrolled in this retrospective study. Standard anteroposterior radiographs were obtained postoperatively using C-arm fluoroscopy. A 3D-2D image matching method was used to measure the femoral component varus/valgus angle and internal/external rotation (IR/ER) relative to the tibial component. The bearing position parameters were measured. Patients were divided into varus/valgus and IR/ER groups according to the femoral component varus/valgus and IR/ER angles. The bearing position parameters of each group were compared separately. There were 57 patients in the varus group, 63 in the valgus group, 59 in the IR group, and 61 in the ER group. The distance between the bearing lateral edge and the lateral wall of the tibial component (W-BED) was significantly lower in the varus group than the valgus group (1.9 [0–6.4] vs. 2.8 [0.3–7.7] mm; P < 0.001). No differences were detected in any bearing position parameters. The varus/valgus angle of the femoral component showed a significant negative correlation with the W-BED. The IR/ER angle of the femoral component showed no significant correlation with any of the positional parameters. Implantation of femoral component with varus/valgus angle relative to tibial component can cause the bearing to deviate from the planned position. If the varus/valgus angle exceeds 8° it can cause the bearing to hit or away from the lateral wall of the tibial component, resulting in an increased risk of dislocation of the bearing.

Objective: To evaluate the efficacy of an aseptic elastic repellent tourniquet in the surgical treatment of lower limb injuries in athletes, resembling those commonly seen in military training. Methods: This prospective study involved 72 athletes experiencing lower limb injuries, divided equally into an observation group and a control group. The observation group underwent surgery with the application of a blood expelling tourniquet, while the control group received a traditional pneumatic tourniquet. Metrics compared included operation preparation time, average operation duration, hemostatic effectiveness, hemoglobin levels, and incidence of postoperative complications. Results: The use of the blood expelling tourniquet significantly reduced the operation preparation time in the observation group (P < 0.05). Hemoglobin levels on the first and third days' post-operation were higher in the observation group compared to the control group (P < 0.05). Additionally, the observation group exhibited a lower incidence of skin-related complications such as skin blisters and lower extremity venous thrombosis (P < 0.05). Conclusion: The application of an aseptic elastic repellent tourniquet in surgeries for athletic lower limb injuries offers significant advantages. It not only shortens preparation and surgery times but also minimizes intraoperative bleeding and reduces the risk of postoperative complications, enhancing recovery outcomes. This study supports the use of this tourniquet type in sports medicine, particularly for injuries analogous to those encountered in rigorous training scenarios like military exercises.

Objective:To analyze the accuracy of prosthesis size selection in Naton robot-assisted medial unicondyle knee arthroplasty by comparing the actual prosthesis size used during operation and the preoperative planning. Methods:The clinical data of 100 patients (110 knees) who underwent Naton robot-assisted medial unicondylar knee arthroplasty between June 2023 and July 2024 was retrospectively analyzed, including 47 knees on left side and 63 knees on right side. There were 37 males (40 knees) and 63 females (70 knees) with a mean age of 65.4 years (range, 59-71 years). Body mass index was 22.2-28.6 kg/m 2 (mean, 25.4 kg/m 2). The disease duration ranged from 1 to 8 years (mean, 3.4 years). Preoperative planning was performed by Naton robotic surgical system based on lower limb CT data. The final prosthesis size after osteotomy was recorded and compared with the preoperative plan to analyse whether it was consistent with the preoperative plan, as well as the situation of knee flexion and extension gaps (<0.5 mm, >2.0 mm) corresponding to the different models of prostheses. Results:During operation, 5 patients (5 knees) were treated with traditional UKA due to mechanical arm failure, software obstacles, significant bone amputation bias, or loose reference frame, and were excluded from the final analysis. The remaining 95 patients (105 knees) successfully received Naton robot-assisted surgery, and no related complications occurred. The prosthesis size was consistent with the preoperative plan in 101 knees (96.2%) on the femur side, 100 knees (95.2%) on the tibia side, and 97 knees (92.4%) on both femur and tibia sides. The prosthesis size was inconsistent in 3 cases (2.86%) on the femur side alone, 4 cases (3.81%) on the tibial side alone, and 1 case (0.95%) on both femur and tibial sides. Among the prostheses with different models, the flexion and extension gaps were less than 0.5 mm in 3 knees, the flexion gap was less than 0.5 mm and the extension gap was more than 2.0 mm in 3 knees, and the flexion gap was more than 2.0 mm and the extension gap was less than 0.5 mm in 2 knees. Conclusion:The accuracy of prosthesis size selection for Naton robot-assisted medial unicondylar knee arthroplasty is relatively high.

Study Design A retrospective case report. Objective To report a case who developed deteriorated paraplegia by spontaneous spinal epidural hematoma (SSEH) based on calcification of the ligamentum flavum (CLF) at the T10–11 level, achieved full neurological recovery following posterior percutaneous endoscopic surgery (PPES). Summary of Background Data CLF rarely occurs at the thoracic spine, and the symptom usually progress slowly. SSEH is another rare spinal lesion that might progress rapidly and cause emergent severe spinal cord compression syndrome. Coexistence of SSEH and CLF at the same thoracic level was rarely reported in English literature. Methods A 65-year-old man presented to our hospital with the complaint of sensorimotor loss on the lower limbs and dysfunction of bladder for 1 day after a progressive weakness and numbness of the lower limbs for 3 months. MR examination found a dorsal protruding mass at the T10–11 level, while computed tomography (CT) found the protruding mass contained scattered calcified deposits. The patient was diagnosed with thoracic CLF. Decompression via PPES was carried out to realize bilateral decompression through a unilateral approach. Results During the operation, the protruding mass was found to be composed of SSEH and CLF together. After the operation, the patient's neurological function recovered quickly. One week later, the patient could walk by himself. After 3 months, complete neurological function had recovered. Conclusion SSEH could develop based on CLF at thoracic level and cause serious neurological dysfunction. PPES might be an advisable method to remove CLF and evacuate SSEH with good clinical results.

AimThis study aims to quantitatively analyze the changes in local microcirculation in early osteonecrosis of the femoral head (ONFH) by dynamic contrast-enhanced (DCE) MRI and to explore the pathophysiological mechanisms of early ONFH.Patients and MethodsWe selected 49 patients (98 hips) aged 21–59 years who were clinically diagnosed with early ONFH. A total of 77 femoral heads were diagnosed with different degrees of necrosis according to the Association Research Circulation Osseous (ARCO) staging system, and 21 femoral heads were judged to be completely healthy. All patients underwent DCE-MRI scanning. Pseudocolor images and time-signal intensity curves were generated by Tissue 4D processing software. The volume transfer constant (Ktrans), extracellular extravascular space, also known as vascular leakage (Ve), and transfer rate constant (Kep) of healthy and different areas of necrotic femoral heads were measured on perfusion parameter maps. The differences and characteristics of these parameters in healthy and different areas of necrotic femoral heads were analyzed.ResultsThe signal accumulation in healthy femoral heads is lower than that of necrotic femoral heads in pseudocolor images. The time-signal intensity curve of healthy femoral heads is along the horizontal direction, while they all have upward trends for different areas of necrotic femoral heads. The mean value of Ktrans of healthy femoral heads was lower than the integration of necrotic, boundary, and other areas (F = 3.133, P = .036). The Kep value of healthy femoral heads was higher than the integration of lesion areas (F = 6.273, P = .001). The mean Ve value of healthy femoral heads was smaller than that of the lesion areas (F = 3.872, P = .016). The comparisons of parameters between different areas and comparisons among healthy areas and lesion areas showed different results.ConclusionONFH is a complex ischemic lesion caused by changes in local microcirculation. It mainly manifests as increased permeability of the vascular wall, blood stasis in the posterior circulation, high intraosseous pressure in the femoral head, and decreased arterial blood flow. The application of DCE-MRI scanning to quantitatively analyze the visual manifestations of microcirculation after early ONFH is an ideal method to study the microcirculation changes of necrotic femoral heads.

Crowe Ⅳ型髋关节发育不良(developmental dysplasia of the hip,DDH)的全髋关节置换术(total hip arthroplasty,TH A)中,多数患者需要截骨保证复位,目前横行截骨是运用最广泛的术式,但截骨的最佳高度仍存在争议.本文通过建立Crowe Ⅳ型DDH患者的有限元模型,分析了在不同载荷下,不同截骨高度模型的应力分布与位移情况.结果表明:在多项指标下,小转子下0 cm的截骨高度均表现出了较优性能.在不影响假体安放和断端对合情况允许的情况下,推荐在手术中使用0 cm的截骨高度.

ObjectiveThis study aims to report a case of a patient with complete lumbarization (Castellvi-IB) who developed symptomatic calcified disc herniations at L5S1 and lumbarized S1-2 levels and achieved excellent neurological recovery following percutaneous endoscopic interlaminar discectomy (PEID).Summary of Background DataIn 1984, Castellvi et al. classified lumbosacral transitional vertebra (LSTV) into four types. They incorrectly classified I LSTV anomalies as only type I sacralization, not realizing type I lumbarization also belonged to type I LSTV, with the latter exhibiting a well-developed S1-2 disc (lumbosacral transitional disc, LSTD). Patients with type I lumbarization rarely develop calcified disc herniations concomitantly at L5S1 and LSTD levels. PEID has been developed to perform discectomy for neurological decompression at the lumbar region, especially at the lowest level where the higher iliac crest and/or widened transverse process exists.MethodsA 47-year-old male presented to our hospital complaining of an intractable left leg radiating pain for 3 weeks after suffering from chronic radiating pain for 4 years. His physical examination found hyperalgesia at the lateral side of the left calf, decreased dorsal flexion strength of the ankle (grade 4/5), and a positive sign of straight leg raising test at the left side (30°). The preoperational Lumbar JOA (Japanese Orthopaedic Association) score was 12. Image examinations including whole spinal radiograph, MRI, and CT confirmed complete lumbarization (Castellvi-IB) with calcified disc herniations at L5S1 and LSTD levels at the left side. PEID was carried out at two index levels to accomplish decompression via the left approach.ResultsThe patient’s neurological function recovered quickly. One day postoperatively, he began to walk without discomfort. After 3 months, his muscle strength recovered to normal, and after 6 months, the residual dysesthesia at his posterolateral calf disappeared. The follow-up Lumbar JOA score was 26.ConclusionCalcified lumbar disc herniation could develop at two distal levels concomitantly in the case of type I complete lumbarization. This anomaly might be misinterpreted as a normal lumbar sequence by only lumbar MRI. PEID may be an effective procedure to treat such calcified disc herniations in a single visit.

Objective: To compare the short-term clinical outcomes between functional alignment（FA） and restricted kinematic alignment（rKA） used in robot-assisted total knee arthroplasty（RTKA）. Methods: Patients who underwent RTKA for knee osteoarthritis in our hospital from October 2021 to April 2022 were retrospectively analyzed and divided into FA group and rKA group according to the operator and intraoperative knee alignment guidance method. The general data, surgical data, pre and post-operative hip-knee-ankle angle（HKA）, lateral distal femoral angle（LDFA）, proximal medial tibial angle（MPTA）, external rotation angle of the femoral prosthesis, Knee Society score（KSS） of the knee at 3 months postoperatively, and complications were statistically analyzed in both groups. Results: A total of 37 patients（39 knees） were included in this study, there were 19 patients（20 knees） in the FA group and 18 patients（19 knees） in the rKA group. There was no significant difference in average age, body mass index（BMI）, pre and postoperative HKA, LDFA and MPTA between the two groups（P＞0.05）. The external rotation angle of femoral prosthesis was 2.05°±0.41°in the FA group and-1.11°±0.39° in the rKA group, and the difference between the two groups was statistically significant（P＜0.05）.The postoperative Knee Society score-the knee score（KSS-K） and Knee Society score-the function score（KSS-F） were 88.50±1.67 and 88.60±1.14 respectively in the FA group, and 89.47±1.62 and 89.95±1.26 respectively in the rKA group, and no statistical significance was found between the two groups（P＞0.05）. There was no anterior knee pain, patellar maltracking, or other serious complications occurred in either of the groups. Conclusions: The femoral prosthesis of robot-assisted rKA-aligned TKA patients have more internal rotation than that of FA-aligned TKA patients. There is no evidence showed that femoral prosthesis internal rotation has an effect on the occurrence of anterior knee pain and patellar maltracking and knee function. There is no significant difference in short-term outcomes between robot-assisted FA aligned and rKA aligned TKAs.

Background: Sagittal alignment determines the extension and flexion of knee prostheses in total knee arthroplasty (TKA). The definition of the sagittal axes may be different between the Mako TKA system (Stryker) and the conventional manual intramedullary approach. Whether there is any discrepancy between the 2 approaches has not been well studied. Methods: We retrospectively analyzed 60 full-length computed tomographic (CT) scans of the lower extremities of 54 patients. The femur and tibia were modeled by using Mimics (Materialise). The Mako mechanical axes were determined according to the Mako TKA Surgical Guide. The manual intramedullary axes were determined according to the central axis of the tibial proximal and femoral distal medullary cavities. The femoral, tibial, and combined angular discrepancies were measured in the sagittal plane. Results: On the femoral side, the Mako mechanical axis was more likely to be located in an extended position relative to the manual intramedullary axis (56 of 60 knees). The median angular discrepancy was 2.46° (interquartile range [IQR], 1.56° to 3.43° [range, −1.06° to 5.24°]). On the tibial side, the Mako mechanical axis was likely to be located in a flexed position relative to the manual intramedullary axis (57 of 60 knees). The median angular discrepancy was 2.40° (IQR, 1.87° to 2.84° [range, −0.79° to 4.20°]). The angular discrepancy of the femoral-tibial sagittal angle was 4.63° (IQR, 3.71° to 5.64° [range, 1.20° to 9.02°]). Conclusions: Compared with manual TKA, the Mako system is more likely to result in a decreased posterior tibial slope and extension of the femoral prosthesis. It may also influence the evaluation of lower-extremity extension and flexion. When using the Mako system, special attention should be given to these discrepancies. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Robot-assisted surgical systems for performing total knee arthroplasty (TKA) have gained significant attention. This study was designed to compare the surgical outcomes in primary TKA surgery between the recently developed “SkyWalker” robot system and the more commonly used MAKO robot. A total of 75 patients undergoing primary TKA surgery by the same surgical team were included in this study, with 30 patients in the “SkyWalker” group and 45 patients in the “MAKO" group. We documented the osteotomy plan for both robotic systems. The lower limb alignment angles were evaluated by postoperative radiographic assessment. The operation time, estimated blood loss, postoperative hospital stays, and changes in laboratory indexes were collected during hospitalization. In addition, a comparative evaluation of knee functional assessments and complications was conducted during six month and one year follow-ups. There were no significant differences between the two groups in terms of the accuracy of restoring lower limb alignment, estimated blood loss, or operation time. The knee function assessments at six months and one year postoperatively were similar in both groups. Except for day three after surgery, the level of interleukin-6 (IL-6) and the change in IL-6 (∆IL-6) from preoperative baseline were higher in the “SkyWalker” group than in the MAKO group (median: 20.53 vs. 14.17, P=0.050 and median: 17.30 vs. 10.09, P=0.042, respectively). Additionally, one patient from the MAKO group underwent revision surgery at nine months postoperatively due to ongoing periprosthetic discomfort. The newly developed “SkyWalker” robot showed comparable efficacy to the MAKO robot in terms of lower limb alignment accuracy and postoperative six month and one year follow-up of clinically assessed resumption of knee function.

Background Mobile-bearing unicompartmental knee arthroplasty (MB-UKA) is an effective treatment for anteromedial knee osteoarthritis. Meticulous intraoperative soft tissue balancing remains challenging yet consequential for a successful operation. Currently, surgeons rely mostly on their experience during soft tissue balancing, yielding unreproducible results. The purpose of this study was to quantified measure the soft tissue tension of medial compartment and determine if an optimal "target" tension values with the natural state exists. Methods This was an observational study of 24 consecutive patients. All 30 UKAs were performed by a single surgeon. The piezoresistive sensor was custom designed to fit in the medial compartment gap. Contact pressures were measured at 5 angular positions of the knee intraoperatively: 0°, 20°, 45°, 90°, and 110° of flexion. The change in pressure from extension (20° position) and flexion (110° position) was also calculated (E-FPD). Data on age, sex, body mass index, operative side, and bearing size were collected. Outcome measures were measured at baseline and at the 6-month postoperative follow-up; Oxford Knee Score, visual analog scale score, and range of motion were compared to evaluate clinical outcomes. Results There was a significant improvement in patients in all measured outcomes at 6 months from baseline ( P < 0.05). The E-FPD of 14.9 N (8.9, 24.6) was indicative of appropriate soft tissue balancing throughout the functional range of knee motion. Of 30 knees, 22 were 3-mm bearing and 8 were 4- or 5-mm bearing. The pressure data of the 3-mm bearing group was larger than that of the non-3-mm bearing group for each knee flexion degree, but the difference was not statistically significant ( P > 0.05). Conclusions Objective data from sensor output may assist surgeons in decreasing loading variability during MB-UKA. The data suggested that MB-UKA could not accurately restore soft tissue tension to the natural state, which was related to the inability of MB-UKA surgical instruments to fine adjust the bone cut and soft tissue release. Study registration Chinese Clinical Trial Registry ( http://www.chictr.org.cn ): ChiCTR1900024146.

目的 探讨低频(low-frequency,LF)与高频(high-frequency,HF)脊髓刺激(spinal cord stimulation,SCS)对腰部手术失败综合征(failed lumbar surgery syndrome,FLSS)疼痛的影响.方法 根据计算机产生的随机数字表,将58例FLSS患者分为LF组和HF组各29例.对照组给予LF-SCS治疗,观察组给予HF-SCS治疗.观察两组患者入组时(T0)、3个月(T1)、6个月(T2)和12个月(T3)时的VAS评分、疼痛检测评分(pain detect questionnaire,PDQ)、Oswestry功能障碍指数(Oswestry disability index,ODI)、健康调查12条简表(short form 12 questionnaire,SF-12)、睡眠量表(medical outcomes study sleep scale,MOSS)和医院焦虑和抑郁量表(hospital anxiety and depression,HAD).结果 T1、T2、T3时,两组患者腰痛VAS、腿痛VAS、PDQ、ODI、HAD-D、HAD-A评分均显著低于T0时(P<0.05),且HF组上述指标均低于同期LF组(P<0.05).T1、T2、T3时,两组患者SF-12、MOSS评分均高于T0时(P<0.05),且HF组上述指标均高于同期LF组(P<0.05).结论 与LF-SCS相比,HF-SCS治疗FLSS可进一步改善患者疼痛程度,减轻功能障碍,改善生活质量.

Background : To determine the swing angle of the intramedullary rod in the canal during medial mobile-bearing unicompartmental knee arthroplasty (UKA), we simulated the intramedullary localization process of mobile-bearing UKA via digital technology and analyzed the swing angle of the intramedullary rod swing in the canal through finite element analysis. Methods : Patients requiring mobile-bearing UKA in our department were prospectively selected. A three-dimensional femur model was established, and intramedullary rods of different lengths were inserted. The swing of the intramedullary rod in the canal was simulated, the angle of the moving rod was obtained, and the anatomic parameters of the femur were measured. Parson's correlation between the swing angle of the intramedullary rod and anatomical parameters of the femur were analyzed. Results : The longer the intramedullary rod, the smaller the swing range; this difference was statistically significant (P<0.05). The maximum swing range of the same intramedullary rod was significantly larger in the sagittal than in the coronal plane (P<0.05). Parson’s correlation analysis indicated that the isthmic diameter and femur length significantly correlated with the 20-cm and 25-cm and 30-cm rod swing ranges, respectively. Conclusion : We proved that the longer the intramedullary rod, the smaller the swing angle in the femoral medullary canal. The femoral medullary canal diameter and femur length affect the swing angle; thus, in patients with a shorter femur length, we recommend 25-cm intramedullary rods.

脊髓型颈椎病(cervical spondylotic myelopathy,CSM)以肢体活动、感觉障碍、麻木等为主要表现,中老年患者居多,大多需手术治疗.颈椎管扩大成形术联合微型钛板固定治疗是CSM创伤较小、疗效确切的手术方法,通过"脊髓漂移"原理进行减压治疗[1].但报道称,术后仍有部分患者因致压物体积过大、脊髓漂移距离过短、术前压迫率过高等影响脊髓功能恢复[2].既往高压氧已被证实用于脊髓损伤、颅脑损伤等具有良好的辅助康复效果,但用于CSM术后康复的报道较少[3].为此,本文比较高压氧对CSM术后功能恢复及弥散张量成像(diffusion tensor imaging,DTI)相关参数的影响,探讨其可能机制,报道如下.

Objective:This retrospective study aims to explore the effect of silver nanoparticles with thermoplastic polyurethane (TPU/NS) on the rehabilitation of diabetic patients with open fracture of lower extremities.Methods:Diabetic patients (n = 98) with open fracture of lower extremities treated in our hospital were analyzed retrospectively from June 2015 to December 2021. TPU/NS nanocomposites were prepared for postoperative treatment of diabetic patients with open fracture of lower extremities. First, the cultured Staphylococcus aureus and Escherichia coli were used to test the antibacterial effect of TPU/NS dressing in vitro. After using TPU/NS dressing (observation group) and traditional dressing (control group), the inflammatory reaction, clinical treatment, functional rehabilitation, and adverse reactions in patients were compared.Results:TPU/NS dressing effectively inhibited the growth of bacteria with a minimum inhibitory concentration of 2 μg/mL. The usage of TPU/NS dressing reduced the inflammatory reaction by reducing positive rate of bacteria after the dressing on the seventh day postoperatively. Besides, the times of dressing, stopping time of wound exudation, wound healing time, length of hospital stay, and VAS score in the observation group were lower than those in the control group; the incidence of adverse reactions after treatment was lower in the observation group as compared with the control group (17.07% vs. 35.09%). Meanwhile, the functional rehabilitation and life quality of patients in the observation group were better TPU/NS dressing treatment.Conclusion:TPU/NS dressing has the function of promoting the postoperative recovery of patients by inhibiting the bacterial infection of the wound, thus improving the limb function and life quality. As a result, there was a tremendous potential to apply the constructed TPU/NS membrane to diabetic patients with open fractures, especially those with soft tissue injury.