Expert consensus on clinical application of absorbable polymer screw in foot and ankle surgery was developed by Foot and Ankle Committee of Orthopedic Branch of Chinese Medical Doctor Association, Foot and Ankle Committee of Sports Medicine Physician Branch of Chinese Medical Doctor Association, Foot and Ankle Group of Orthopedic Branch of Shanghai Medical Associationand, and Foot and Ankle Alliance of National Orthopedic Medical Center of Shanghai Sixth People's Hospital. Based on evidence-based medicine and expert clinical experience, this consensus provides academic guidance for foot and ankle surgeons regarding the clinical use of absorbable polymer screw. The key topics include clinical indications, practical applications, and relevant considerations for absorbable nail rod systems in foot and ankle surgery.
Objective: To analyze deposition of sodium urate in patients with gout, and to explore predictive value of sodium urate deposition for the occurrence of refractory gout (RG) by dual-energy CT imaging technique.
Methods: A retrospective analysis was conducted on basic data of 176 gout patients admitted from March 2023 to June 2025, including 171 males and 5 females, aged from 22 to 71 years old with an average of(43.16±10.82) years old. According to diagnostic criteria, the patients were divided into RG group and non-RG group. There were 92 patients in RG group, including 90 males and 2 females, aged from 24 to 66 years old with an average of (44.62±11.12) years old;there were 84 patients in non-RG group, including 81 males and 3 females, aged from 22 to 71 years old with an average of (41.46±10.31) years old. The courses of hyperuricemia, uric acid and deposition amounts of monosodium urate(MSU) between two groups were compared. Multivariate Logistic regression was used to analyze influencing factors of RG, receiver operating curve (ROC) was plotted, and area under the curve(AUC) was calculated, in order to evaluate predictive value of MSU deposition for RG.
Results: The courses of hypertension and hyperuricemia and deposition amount of MSU between two groups were statistically significant (P<0.05). Logistic analysis reault showed intra-articular MSU deposition[OR=5.402, 95%CI(2.095, 13.933), P<0.01], hypertension[OR=2.724, 95%CI(1.209, 6.134), P<0.05], courses of hyperuricemia [OR=1.122, 95%CI(1.032, 1.219), P<0.01] were independent risk factors for RG. AUC of MSU deposition for predicting RG was 0.824[95%CI(0.763, 0.885), P<0.01], and sensitivity was 63%, specificity was 92.9%, and the optimal cut-off value was 0.410 cm3.
Conclusion: MSU deposition could increase risk of RG, and the amount of MSU deposition in joint cavity could provide a reference for early identification of patients with RG.
Objective: To explore clinical efficacy of external locking plate combined with platelet-rich palasma (PRP) in treating open fractures of tibia and fibula.
Methods: From November 2019 to May 2022, 13 patients with open fractures of tibia and fibula were admitted, including 11 males and 2 females, aged from 20 to 56 years old;6 patients with Gustilo typeⅡand 7 patients with type Ⅲ;all patients were treated with external tibial plate fixation for tibiofibular fractures in emergency department, combined with PRP injection at the fracture ends and wounds. The fracture healing time and complications were observed. The fracture healing was evaluated based on Lane-Sandhu X-ray score, ankle joint function was evaluated by Kofoed score at 3 months after operation and at the latest follow-up, respectively.
Results: All patients were followed up for 6 to 24 months. Thirteen patients met requirements of bony union, and healing time ranged from 8 to 16 weeks. There were no complications such as infection, dislocation or loose fixation after operation. Lane-Sandhu X-ray score increased from 1 to 7 points at 3 months after operation to 10 points at the latest follow-up. Kofoed ankle joint function score increased from 21 to 48 points at 1 month after operation to 63 to 90 points at 3 months after operation, and then increased to 79 to 98 points at the latest follow-up. There were 11 patients got excellent result and 2 good.
Conclusion: External locking plate combined with PRP for the treatment of open tibiofibular fractures could achieve good fracture healing and ankle joint function, and the clinical effect is satisfactory.
Objective: To compare the clinical efficacy of unilateral biportal endoscopic discectomy(UBE) and percutaneous interlaminar endoscopic discectomy(PIED) in the treatment of highly migrated lumbar disc herniation (LDH).
Methods: A retrospective analysis was conducted on 43 patients with highly migrated LDH who underwent spinal endoscopic surgery between January 2022 and December 2023. In the UBE group 22 patients included 8 males and 14 females, aged 49 to 59 years old with a mean of (54.13±2.07) years old. In the PIED group 21 patients included 11 males and 10 females, aged 49 to 59 years old with a mean of (55.04±2.80) years old. Perioperative parameters including intraoperative blood loss, operative time, and fluoroscopic exposures were compared between groups. Clinical outcomes were assessed using the visual analogue scale (VAS) for pain, Oswestry disability index (ODI), and modified MacNab criteria. Complications during the perioperative period and follow-up were recorded.
Results: In the PIED group, there were 3 cases of nerve injury, 1 case of residual nucleus pulposus, and 1 case of dural injury. In the UBE group, there was 1 case of nerve injury and 1 case of cerebrospinal fluid leakage. No infections or major bleeding occurred in either group. All patients completed surgery and were followed up for at least 12 months. The UBE group had significantly more intraoperative blood loss (39.09±6.10) ml and more fluoroscopic exposures (6.45±0.26) than the PIED group (34.05±5.62) ml and (3.24±0.28) with significant difference (P<0.05). Preoperative VAS and ODI showed no significant differences between two groups (P>0.05). Both groups demonstrated significant improvements in VAS and ODI postoperatively (P<0.001). At the 3rd days postoperatively, the UBE group had a significantly lower leg pain VAS (2.27±0.20) than the PIED gruop(2.95±0.24) with significant difference (P<0.05), but no significant differences were observed at the first or 12th months (P>0.05). No significant differences in ODI were found between two groups during follow-up (P>0.05). At the 1st month postoperatively, according to modified MacNab criteria, 15 patients got excellent results, 4 good, and 2 fair in PIED group;and 18 patients got excellent results, 2 good, and 2 fair in UBE group, with no significant difference between two groups(P>0.05).
Conclusion: Both PIED and UBE are effective surgical methods for treating highly migrated LDH. Compared with PIED, UBE involves slightly longer operative time, more blood loss, and more fluoroscopic exposures, but carries a lower risk of nerve injury.
The minimally invasive decompression technique represents a novel approach for the treatment of lumbar spinal stenosis(LSS). This method minimizes peripheral tissue damage, decreases the incidence of postoperative complications, optimizes the alleviation of nerve root compression, and expedites patient recovery. Therefore, there are various opinions on the minimally invasive decompression surgery technique for the spine both domestically and internationally today. To enable patients to select an appropriate surgical plan with optimal therapeutic outcomes, this article offers a comprehensive analysis of the advantages, disadvantages, and indications of prevalent minimally invasive spinal decompression techniques for the treatment of lumbar spinal stenosis. Additionally, it presents a comparative evaluation of the therapeutic effects associated with various minimally invasive techniques. This analysis aims to furnish a robust theoretical foundation for the clinical application of diverse minimally invasive decompression techniques in managing lumbar spinal stenosis and related conditions.
Lumbar disc herniation refers to a syndrome mainly characterized by low back and leg pain caused by factors such as degeneration of the lumbar intervertebral disc, deterioration of the biomechanical environment, and formation of immune inflammatory reactions, which lead to the protrusion of intradiscal tissue and compression of nerves. In cases of massive migrated lumbar disc herniation, the nucleus pulposus is prolapsed and migrated, often accompanied by severe clinical symptoms and usually requiring surgical treatment. Since the phenomenon of resorption after lumbar disc herniation is discovered and proposed, relevant literature has continuously emerged. Some scholars have indicated that the resorption rate of massive migrated protrusions is higher, but its mechanism has not been fully clarified. This article reviews and summarizes the resorption mechanisms of massive migrated lumbar disc herniation in recent years. The current research contents mainly include immune inflammatory reactions, the formation of blood vessels and lymphatics, matrix metalloproteinases, dehydration, cell autophagy and apoptosis, and tension application. Based on the above mechanism theory of resorption, we believe that in the treatment of massive migrated LDH, inflammatory reactions should be maintained. At the same time, the patient's clinical symptoms should be used as the main surgical evaluation criterion to avoid unnecessary social, economic, and medical burdens caused by overtreatment.
Objective: To compare the biomechanical properties of four internal fixation methods in a lower cervical spine injury model using the finite element method.
Methods: Cervical CT data of a 28-year-old healthy adult male were utilized to establish a finite element model of the normal cervical spine and a lower cervical spine three-column injury model. Four internal fixation methods were then applied to the three-column injury model, resulting in four groups:Group A, anterior cervical locked-plate(ACLP) fixation system model(anterior approach);Group B, posterior cervical pedicle screw fixation model (posterior approach);Group C, combined anterior and posterior cervical pedicle screw fixation model; Group D, Novel composite anterior cervical internal fixation model. A 75 N axial compressive load and a 1.0 N·m pure moment were applied to the upper surface of the cervical spine model to simulate flexion, extension, rotation, and lateral bending movements. The intervertebral range of motion(ROM) and stress distribution of the internal fixators under different motion conditions were compared across all models.
Results: Compared with the normal model, the reductions in overall intervertebral ROM for each group under flexion, extension, rotation, and lateral bending were as follows:Group A, 24.04°, 23.12°, 6.24°, and 9.06°;Group B, 24.42°, 24.34°, 6.48°, and 9.20°;Group C, 25.43°, 25.29°, 7.17°, and 9.57°;Group D, 24.75°, 25.5°, 6.71°, and 9.12°. The peak stress values of the internal fixators in each group were:Group A, 53.9 MPa, 79.9 MPa, 61.4 MPa, and 80.3 MPa;Group B, 218.3 MPa, 105.4 MPa, 206.6 MPa, and 186.8 MPa;Group C, 40.8 MPa, 97.2 MPa, 47.1 MPa, and 39.4 MPa;Group D, 93.0 MPa, 144.0 MPa, 64.8 MPa, and 106.3 MPa.
Conclusion: The biomechanical properties of the novel composite anterior cervical internal fixation method are similar to those of the combined anterior-posterior fixation method, and superior to both the anterior cervical ACLP plate-screw fixation and posterior cervical pedicle screw fixation methods.
Objective: To compare the effects of bilateral vertebral puncture guided by an angle-adjustable linear laser auxiliary device versus free-hand bilateral vertebral puncture.
Methods: A retrospective analysis was conducted on the clinical data of 47 patients who underwent thoracolumbar percutaneous kyphoplasty(PKP) from July 2022 to July 2023. All patients received bilateral percutaneous kyphoplasty, among whom 27 cases underwent conventional free-hand puncture (conventional puncture group) and 20 cases underwent puncture guided by a laser auxiliary device (auxiliary puncture group). In the conventional puncture group, there were 11 males and 16 females, with an average age of (69.6±5.1) years and a disease duration of (6.5±3.8) days;the fractured vertebrae were T11-T12 in 13 cases and L1-L2 in 14 cases. In the auxiliary puncture group, there were 7 males and 13 females, with an average age of (70.8±5.6) years and a disease duration of (6.4±3.8) days;the fractured vertebrae were T11-T12 in 7 cases and L1-L2 in 13 cases. The operation time, total blood loss, intraoperative fluoroscopy times, fluoroscopy duration, radiation dose, puncture success rate, and surgical complications were compared between the two groups. The visual analogue scale (VAS) was used to evaluate low back pain before surgery, 2 days after surgery, and 1 year after surgery.
Results: All patients achieved successful puncture, with good postoperative wound healing and no complications. The operation time of the auxiliary puncture group was (12.1±2.6) minutes, which was shorter than that of the conventional puncture group (14.1±2.8) minutes. The total blood loss of the auxiliary puncture group was (228.5±35.8) ml, less than that of the conventional puncture group (257.0±48.3) ml. The fluoroscopy times, fluoroscopy duration, and radiation dose of the auxiliary puncture group were (5.4±1.3) times, (15.9±3.3) seconds, and (159.4±37.4) μSv, respectively, all lower than those of the conventional puncture group (6.4±1.6) times, (18.8±4.6) seconds, (192.2±48.5) μSv, with statistically significant differences(P<0.05). There were no statistically significant differences in low back VAS scores between the two groups before surgery, 2 days after surgery, or 1 year after surgery(P>0.05).
Conclusion: Both laser auxiliary device-guided vertebral puncture and free-hand vertebral puncture have high success rates and similar postoperative curative effects. However, the laser auxiliary device-guided puncture has shorter operation time, less blood loss, and lower radiation hazard.
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