Objective: To investigate the epidemiological features and changing trends of disease burden of spinal cord injury (SCI) in China from 1990 to 2023, conduct decomposition analysis of disease burden changes, and provide evidence for SCI prevention and control.
Methods: Based on the 2023 Global Burden of Disease (GBD) study data, indicators including incidence and years lived with disability (YLDs) were used to analyze the status and changing trends of SCI disease burden in China from 1990 to 2023. The Gupta decomposition framework was applied to quantify the contributions of population growth, population aging, age-specific incidence rate changes, and disease severity changes to YLDs growth.
Results: In 2023, the number of SCI incidence cases in China was 232 700 cases, representing a 43.6% increase compared to 1990. From 1990 to 2023, the age-standardized YLDs rate of SCI decreased, while the age-standardized incidence rate showed an overall upward trend: it increased year by year from 1990 to 2015, declined briefly after 2015, and rose again from 2020. The disease burden of SCI in males was higher than in females. The age distribution of disease burden showed a shift toward older age groups, with incidence rates increasing with age among middle-aged and elderly populations. Falls were the main cause of SCI in China. Compared with 1990, YLDs in males and females increased by 48.58% and 41.72% respectively in 2023. The proportions of male growth attributed to population growth, population aging, age-specific incidence rate changes, and disease severity changes were 22.79%, 22.69%, 34.99%, and -31.88%, while those for females were 23.82%, 26.30%, 21.99%, and -30.40%.
Conclusion: From 1990 to 2023, population aging made a substantial contribution to the growth of SCI disease burden in China. The primary factor driving the growth of SCI disease burden differed by gender. Clinical interventions that mitigate disease severity represent a key strategy for addressing the rapid growth of SCI disease burden.
Objective: To summarize the research progress on the clinical application of lymphaticovenous anastomosis (LVA).
Methods: A comprehensive review of previous literature on LVA was conducted, summarizing the anastomosis sites, techniques, number of anastomoses, and clinical applications, with particular emphasis on the evolution and development of LVA anastomosis sites and techniques.
Results: LVA is a bypass drainage surgery that has undergone multiple stages of development since its inception. Due to individual differences, the location, method, number of anastomoses, and clinical applications are often based on the surgeon's experience, and there is still no unified application scenario.
Conclusion: LVA is a highly promising surgical procedure that can effectively relieve symptoms of early- and mid-stage lymphedema. With the advantages of minimal invasiveness and rapid recovery, it can serve as a first-line surgical option for lymphedema.
Objective: To compare the effectiveness of two single-pin internal fixation techniques-trans-fracture in-out-in Kirschner wire fixation and antegrade elastic stable intramedullary nailing (ESIN) from the radial mid-shaft-in the treatment of distal radial metaphyseal diaphyseal junction (DRMDJ) fractures.
Methods: A retrospective analysis was conducted on 48 pediatric and adolescent male patients with DRMDJ fractures who met the selection criteria and were treated between January 2022 and December 2024. Among them, 27 patients underwent trans-fracture in-out-in Kirschner wire fixation (group A), and 21 patients underwent antegrade ESIN from the radial mid-shaft (group B). There was no significant difference in baseline data between the two groups ( P>0.05), including age, cause of injury, affected side, presence of associated ulnar fracture, time from injury to surgery, or fracture classification. The operation time, intraoperative fluoroscopy frequency, fracture reduction rates on anteroposterior and lateral views, fracture healing time, and postoperative complications were recorded and compared. Clinical efficacy were evaluated at last follow-up using the Gartland-Werley scoring system.
Results: All surgeries were successfully completed. The operation time was shorter in group A than in group B, with a significant difference ( P<0.05). No significant difference was found in the intraoperative fluoroscopy frequency between the two groups ( P>0.05). All patients were followed up, with a follow-up time of (11.81±2.09) months in group A and (12.10±2.74) months in group B, showing no significant difference ( t=-0.389， P=0.699). In group A, 3 patients experienced Kirschner wire irritation to the skin, which resolved after wound care, adjustment of cast fixation, or early pin removal. No complications such as tendon rupture, osteomyelitis, or nonunion occurred in either group. X-ray films taken on the second postoperative day showed that the fracture reduction rates on both anteroposterior and lateral views reached approximately 90% in each group, with no significant difference between groups ( P>0.05). All fractures achieved bony union, and there was no significant difference in healing time between groups ( P>0.05). At last follow-up, according to the Gartland-Werley score, 24 cases were rated as excellent and 3 as good in group A, while 19 cases were excellent and 2 good in group B, yielding an excellent-good rate of 100% in both groups.
Conclusion: Both fixation techniques achieved satisfactory effectiveness. However, the trans-fracture in-out-in Kirschner wire fixation technique is simpler to perform, requires shorter operation time and eliminates the need for implant removal, making it a potentially preferable option for treating this type of fracture.
Objective: To evaluate the early effectiveness of total talar replacement (TTR) with personalized three-dimensional (3D)-printed titanium talus prostheses in the treatment of steroid-induced talar avascular necrosis (TAN).
Methods: The clinical data of 11 patients with steroid-induced TAN who met the selection criteria between June 2022 and June 2024 were retrospectively analyzed. There were 8 males and 3 females with an average age of 51 years ranging from 26 to 67 years. The duration of hormone use ranged from 12 to 36 months, with an average of 19.6 months. The TTR treatment was performed with the personalized 3D-printed titanium alloy talus prosthesis. Radiographic evaluation was performed preoperatively and at last follow-up to assess prosthesis-related conditions, including loosening, subsidence, and adjacent joint degeneration. Clinical outcomes were assessed using the visual analogue scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS), 36-Item Short Form Survey (SF-36) [including physical health score (PCS) and mental health score (MCS)], and ankle range of motion (ROM) to assess functional recovery.
Results: All surgeries were completed successfully. The operation time was 40-60 minutes (mean, 51 minutes), and intraoperative blood loss was 5-20 mL (mean, 10 mL). All incisions healed by first intention without early complications such as infection, skin necrosis, hematoma, neurovascular injury, or deep vein thrombosis. All 11 patients were followed 15-33 months (mean, 22.8 months). One superficial wound infection occurred at 2 weeks postoperatively and resolved after conservative treatment. No prosthetic joint infection, loosening, subsidence, adjacent joint degeneration, or reoperation was observed. At last follow-up, the VAS score, AOFAS ankle-hindfoot score, AOS score, PCS score, and MCS score improved significantly when compared with preoperative ones ( P<0.05), whereas ankle ROM showed no significant difference ( P>0.05).
Conclusion: Personalized 3D-printed titanium talus prostheses effectively relieve pain and improve ankle function and quality of life in patients with steroid-induced TAN, providing a viable joint-preserving treatment option.
Objective: Initiated by the Knee Group of the Chinese Society of Sports Medicine and the Arthroscopy Group of the Chinese Association of Orthopaedic Surgeons, domestic experts in the field were organized to develop a Chinese expert consensus on anterior cruciate ligament (ACL) reconstruction using the over-the-top (OTT) technique, based on the latest clinical practices and research advancements. This consensus aims to standardize and promote the application of this technique in ACL reconstruction.
Methods: The consensus was reached using the modified Delphi method and was completed through two rounds of online questionnaire surveys and one round of face-to-face expert meeting discussions. The consensus was jointly formulated by 43 sports medicine experts from grade Ⅲ class A hospitals across 20 provinces, autonomous regions and municipalities of China. Among them, 7 experts served as guiding experts. The consensus drafting team drafted the first draft of the consensus based on evidence-based evidence and transformed it into questionnaire items. The second draft was revised according to the feedback from the first round of questionnaires and discussed, revised and voted on item by item in face-to-face meetings. Items with an approval rate of ≥85% were recognized as having reached a consensus. The consensus terms were categorized as "strong" (approval rate: 95.0%-100%), "moderate" (approval rate: 90.0%-94.9%), and "basic" (approval rate: 85.0%-89.9%).
Results: All 43 experts completed the entire process and participated in the face-to-face meeting. Ultimately, 9 consensus statements were agreed upon, including 8 highly-consensus items and 1 general consensus item, covering surgical indications, technical key points, and postoperative rehabilitation.
Conclusion: The ACL OTT reconstruction technique does not require the establishment of a femoral tunnel and demonstrates favorable outcomes in adolescent ACL reconstruction and adult ACL revision, making it a viable surgical option for such patients. However, whether OTT reconstruction should be routinely recommended for primary ACL reconstruction in adults requires further clinical research to confirm its standardized application and ensure clinical efficacy.
Objective: To compare the effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) and unilateral biportal endoscopy (UBE) discectomy in the treatment of far lateral lumbar disc herniation (FLLDH).
Methods: A retrospective analysis was conducted on the clinical data of 60 patients with FLLDH, who were admitted between September 2021 and September 2024 and met the selection criteria, including 30 cases treated with PTED and 30 cases with UBE discectomy. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, body mass index, responsible segment, preoperative visual analogue scale (VAS) scores for low back/leg pain, and modified Oswestry disability index (ODI). The operation time, incision length, intraoperative blood loss, and length of hospital stay in two groups were recorded. The VAS score was used to evaluate the severity of low back and leg pain, and the ODI was employed to assess the spinal functional status. X-ray films combined with CT three-dimensional reconstruction and MRI were performed to confirm the nerve decompression effect and soft tissue repair status.
Results: All patients successfully underwent operation. In the PTED group, 1 patient experienced intolerable leg pain during the procedure, which was managed with potent analgesics allowing the operation to proceed uneventfully. In the UBE group, 1 patient developed peritoneal effusion postoperatively and required peritoneal puncture drainage. All incisions healed by first intention. The UBE group demonstrated significantly longer operation time and incision length, and more intraoperative blood loss compared to the PTED group ( P<0.05). All patients were followed up for 12 months. After operation, both groups showed significant reductions in VAS scores for low back and leg pain as well as ODI compared to preoperative measurements, with continuous improvement over time. There were significant differences between different time points ( P<0.05) in both groups. The VAS score for low back pain in the UBE group was significantly higher than that in the PTED group at 3 days after operation ( P<0.05); there was no significantly between the two groups in other outcome indicators ( P>0.05). Radiological re-examinations showed that both groups had limited resection of articular processes, adequate spinal canal decompression, good nerve root release, and satisfactory lumbar stability. No patients experienced incomplete decompression or required reoperation during follow-up.
Conclusion: Both PTED and UBE discectomy are effective minimally invasive approaches for FLLDH with confirmed short-term effectiveness. PTED offers advantages in reduced trauma and faster recovery, whereas UBE discectomy provides superior endoscopic visualization with lower nerve root injury risk.
Objective: To investigate whether retrograde tibial intramedullary nail (RTN) fixation can cause postoperative anterior ankle pain in the treatment of distal tibial extra-articular fracture.
Methods: A retrospective analysis was performed for 29 patients with distal tibial extra-articular fractures caused by trauma, who received RTN treatment between January 2021 and December 2023. There were 19 males and 10 females, with an average age of 47.3 years. There were 18 cases of closed fractures and 11 cases of open fractures. The time from injury to hospital admission was 1-5 days, with an average of 3.7 days. The operation time, intraoperative blood loss, bone healing time, time to full weight-bearing, visual analogue scale (VAS) score, Olerud-Molander ankle score (OMAS), and occurrence of anterior ankle pain were recorded.
Results: The operation time was 43-75 minutes (mean, 60.7 minutes); intraoperative blood loss was 50-120 mL (mean, 88.3 mL). All patients were followed up 14-32 months (mean, 24.0 months). All patients achieved fracture healing and the healing time was 3-6 months (mean, 4.5 months). The postoperative full weight-bearing time was 40-63 days (mean, 53.3 days). The VAS scores were 0-5 (mean, 2.0) at 3 months after operation and 0-3 (mean, 1.5) at last follow-up. The OMAS scores were 60-95 (mean, 80.3) at last follow-up and the ankle functions were rated as excellent in 3 cases, good in 24, and fair in 2, with a excellent and good rate of 93.1%. The postoperative anterior ankle pain occurred in 2 patients (6.9%) and relieved after removal of RTN.
Conclusion: RTN treatment for distal tibial extra-articular fractures provides firm fixation, which is beneficial for early postoperative functional exercise and weight-bearing in patients, and has a lower incidence of anterior ankle pain.
Objective: To review the research progress on acid fibroblast growth factor (aFGF) in promoting tissue injury repair and its mechanism of action.
Methods: By searching and reviewing the basic and clinical studies on aFGF published in recent years, the roles of aFGF in tissue injury including full-thickness skin, skin and mucous barrier, bone and nerve fiber were summarized.
Results: As a key member of the FGF family, aFGF exhibits potent mitogenic activity, it can regulate various cells proliferation and migration, accelerate extracellular matrix synthesis, promote angiogenesis and nerve fiber repair, upregulate tight junction protein expression, and therefore exert dual regulatory effects on dermal and epidermal regeneration and repair. It demonstrates promising clinical application for full-thickness healing and skin and mucous barriers repair. Additionally, it mediates the regeneration and differentiation of osteoblasts, cardiomyocytes, and follicle cells, exhibiting potential for repairing multiple tissues and organs. Furthermore, the aFGF's functions in regulating energy metabolism, immune-inflammatory responses, and alleviating aging have revealed in recent years, indicating a broad clinical application.
Conclusion: aFGF is a valuable member of the FGF family. It is widely used in various kinds of wound healing, besides, it also holds promising application in multiple tissue and organ regeneration and repair.
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