Introduction:Accurate pedicle puncture technique is very important for vertebroplasty. With the development of technology, the entry point and sagittal direction of the needle can be visually determined under the standard anteroposterior fluoroscopy. However, the needle’s horizontal direction usually requires the needle to be drilled into the pedicle first and then judged by both anteroposterior and lateral fluoroscopy, which is called the "Judge after drill (JAD)" method. In this study, a "Drill after judge(DAJ)" method was designed and its application value was evaluated. Methods: By adding a sliding metal marker on the calibrated needle,the shadow segment of a partial needle with the needle tip and the same length of the pedicle was obtained in the anteroposterior view. The end point of the reverse isometric extension line of this shadow segment represents the needle tip’s position when it just crosses the whole pedicle. After adjusting and judging that this position was near to the inner edge of the pedicle shadow, the needle was drilled into the pedicle. A total of 128 patients were enrolled in this prospective trial, 67 in the DAJ group and 61 in the JAD group. Results : The success rate of first puncture in the DAJ group (88.0%) was higher than that in the CAJ group (16.7%). The puncture times, fluoroscopy times and puncture time(min) in the DAJ group (1.12±0.33,5.61±1.37,5.20±1.94)were less than those in the CAJ group(2.33±0.87,12.72±3.04,11.18±3.07).The differences were all statistically significant (P<0.05). Conclusion: The CAJ method can further improve the minimally invasive technique of pedicle puncture.

To evaluate the efficacy and safety of selective genicular artery embolization (GAE) combined with platelet-rich plasma (PRP) in the treatment of knee osteoarthritis (KOA). 30 patients diagnosed with knee osteoarthritis with moderate to severe knee pain were prospective enrolled and divided into two groups according to random principle. The visual analogue scale (VAS) and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were used to evaluate the clinical outcomes within and between groups. Knee joint fluid was extracted from patients before and after treatment to detect the changes of various inflammatory indicators. Our study finally completed 30 effective cases. The total effective rate of combined treatment group was higher than that of PRP treatment group. Preoperative VAS score and WOMAC score were not significantly different among all treatment groups (P>0.05), but 1 week, 1 month, 3 months and 6 months after treatment, the scores of combined treatment group were lower than those of PRP treatment group, and the differences were statistically significant (P<0.05). The expressions of IL-1β and TNF-α in joint fluid of GAE+PRP combined treatment group were significantly decreased compared with those before treatment, and the difference was statistically significant (P<0.05). No major surgery-related adverse events occurred in all patients. Selective genicular artery embolization combined with platelet-rich plasma can significantly improve the pain and function of KOA patients, effectively improve intra-articular inflammation, and delay the progression of knee osteoarthritis disease. The combination therapy adds a safe and feasible option to the stepwise treatment strategy for knee osteoarthritis.

PURPOSE: To evaluation effect of our perforator flap course based on cadaver and surgery based learning.MATERIALS-METHODS: 40 senior doctor who have demand of perforator flap learning was recruit every year for 6 years. A cadaver and surgery based perforator flap course was practiced for 1 week every year. The questionnaire about the their perforator flap practice cases and effect was send half year after they took part in the course. Total 240 participates’s data were collected and analyzed. RESULTS: The perforator flap rates increase significantly after participates took part in the course. The successful rate also increase significantly. After the training, 100% of student think the training is useful, it has the necessity to popularize this perforator flap training course. The gender, education background, the title level of doctor,resident training year do not have significant difference. CONCLUSION: It is necessary and meaningful for this perforator flap course based on cadaver and surgery based to popularize. The web-teach will be a convenient way to expand its participants.

This study aims to explore the therapeutic effect and clinical significance of minimally invasive ceramic rod technology in the treatment of early ischemic necrosis of the femoral head. Thirty patients diagnosed with femoral head necrosis and treated with minimally invasive ceramic rods were selected, including 20 cases in stage IIa and 10 cases in stage IIb. Calculate the patient's surgical time, intraoperative blood loss, perioperative complications, postoperative follow-up, analyze imaging data, VAS, and Harris score. The average surgical time was (40.80±5.75) minutes, the surgical bleeding volume was 20-50 mL, and there was no blood transfusion during or after the surgery. The average hospital stay was 7.5 days, and there were no postoperative complications such as wound infection, nerve injury, subtrochanteric fracture, or vascular embolism. All incisions in the patients were healed in the first stage. The average follow-up period after surgery was 12.3 months. Referring to Harris score, the excellent and good rate was 92.6%. There was a statistically significant difference (P<0.05) between VAS score and Harris score before and 3 months after surgery, as well as 3 months and 6 months after surgery; The X-ray of the hip joint shows stable performance, with no significant progression of femoral head necrosis. The use of tricalcium phosphate porous bioceramic rod minimally invasive technology for the treatment of early avascular necrosis of the femoral head has a short surgical time, minimal trauma, can improve clinical symptoms and prevent its progression, and the therapeutic effect is satisfactory.

This study aims to describe the demographic, radiological and clinical features of the focal sclerosis seen in ‘dreaded black lines’ or radiolucent fracture lines (RFLs) of atypical femoral fractures (AFFs) associated with anti-resorptive therapy. Radiographs of AFFs between 2004 and 2020 were reviewed for appearance and location of lesions, and presence of endosteal or periosteal thickening. We collected demographical data, type and duration of anti-resorptive therapy, and progression to complete fracture or need for prophylactic stabilization. Study cohort was divided based on the presence of RFL, and then subdivided into groups of RFL with or without sclerosis. 100 femurs were reviewed and 17 sclerotic RFLs were observed. Majority of sclerotic RFLs were non-linear in fashion, located at subtrochanteric (41.2%) and proximal diaphyseal (35.3%) regions, and always associated with endosteal or periosteal thickening. All 17 sclerotic RFLs were observed in females with a mean age of 69 years. 16 femurs (94.1%) had a history of bisphosphonate therapy, and the remaining femur only had prior denosumab therapy, with mean duration of therapy of 66 months. 3 femurs (17.6%) progressed to complete fractures, whilst 6 femurs (35.3%) required prophylactic fixation. There was no difference between groups in terms of demographics, anti-resorptive therapy and surgical intervention. Focal sclerosis in RFLs has not been previously described in literature despite occurring in approximately a third of RFLs in this study. Its radiological characteristics draw similarities to sclerosis at fracture ends observed in fracture non-union, and future histological studies can be conducted to establish its clinical implications.

To evaluate the efficacy of minimally invasive vascular intervention combined with femoral head core decompression and bone grafting in the treatment of early avascular necrosis of the femoral head (ANFH). Totally 98 patients with non-traumatic early avascular necrosis of the femoral head, including 32 cases of femoral head core decompression and bone grafting, 38 cases of minimally invasive vascular intervention, and 28 cases of combined treatment. Follow up was conducted until femoral head collapse or more than 3 years, to evaluate the value of the three treatment groups on the mid-term results of ANFH (joint surface collapse>2 mm) and the risk factors for postoperative joint surface collapse.
There was a statistically significant difference in the incidence and duration of joint surface collapse after different treatments (P<0.05). Among them, the incidence of joint surface collapse was lower in combination therapy, with a rate of 29.41% and a collapse time of 24 months. There was a statistically significant difference (P=0.002) in the occurrence of joint surface collapse>2 mm after ARCO stage I and II ANFH head preservation treatment. There was a statistically significant difference (P<0.05) in the postoperative joint collapse of ANFH patients treated with steroid hormones (>2 g/2-3m), heavy alcohol consumption (>100 g/d). ARCO staging is an independent risk factor (P=0.03) for ANFH head saving treatment of joint surface collapse>2 mm. Minimally invasive vascular intervention combined with core decompression and bone grafting has a good prognosis for early ANFH, which can effectively delay the progression of femoral head collapse.

Introduction: Rotational alignment during proximal femur replacement (PFR) or distal femur replacement (DFR), where traditional parameters to guide version are missing due to deficient bone stock, can be challenging. This study hypothesise that Linea Aspera Axis (LAA) can be used as an important intraoperative landmark to aim for better rotation alignment. Methods: 40 CT scans of right femora were evaluated. LAA was compared with femoral neck axis and posterior condylar axis at 40, 50 and 60% of femoral length. Results: Mean anteversion (AV) was found to be 12.50 and mean LAA was 91.30, 91.250 and 87.50 to projected femoral neck axis at 40, 50 and 60% of femoral length respectively. LAA positively correlated with projected femoral AV at each level averaging 12.70, 12.50 and 11.60. The posterior condylar axis to LAA was on average 78.50, 78.70 and 75.80 at levels checked (mean 77.70). Conclusion: Unlike previous studies, this study is able to provide clear guidance on implant rotational orientation in PFR and DFR surgery in relation to Linea Aspera. Conventionally surgeons tend to dial in more AV in relation to a perpendicular to LAA to achieve anteversion in PFR. However this study shows that placing the PFR perpendicular LAA is more likely to achieve correct AV. Similarly in DFRs component is often placed at more external rotation to a perpendicular to LAA. Instead implant should be internally rotated by 100 in relation this perpendicular to achive rotation closest to the trans-epicondylar axis.

Background： Vertebral fracture (VF) causes pain and deformity. However, their impact on quality of life (QOL) in the general population is unknown. This study aimed to clarify the relationship between VF and QOL in the general population. Materials and Methods: Subjects were participants in a physical examination who underwent a standing whole-spine X-ray. The VF from T4 to L5 was evaluated using the semi-quantitative quadrant (SQ) method, and grade 1 or higher was judged as having a fracture. QOL was evaluated using the SF-12, and deviation scores (<50 was defined as a decrease of QOL) for each subscale were calculated. The group with one or more VF was compared to those without fractures. Wilcoxon test, chi-square test, and Cochran-Armitage test were used for the statistical analysis. Propensity score matching was performed by age and sex and compared with or without VF. Results: Of the 877 patients (325 men, 552 women, mean age 68 years), 469 (53.5%) had one or more VF. In the 656 cases with propensity score matching, the general health perceptions (GH) score of 47.1+/-9.1 in the VF group was significantly lower than that of 48.9;/-8.9 in the no fracture group (p<0.05). In addition, the higher the number of fractures, the more significantly the cases of decreased role physical (RP), GH, and mental health (MH) (p<0,05). Discussion: The results showed that thoracolumbar VF in the general population was associated with lower QOLs. Preventing and treating VF, including secondary fractures, are essential for maintaining QOL in the general population.

A novel steerable PKP for treatment of thoracolumbar osteoporotic vertebral compression fractures:a study of the clinical efficacy and safety
Introduction:To explore the clinical efficacy and safety of a novel steerable percutaneous balloon kyphoplasty (S-PKP) for treatment of thoracolumbar osteoporotic vertebral compression fractures (OVCFs). Methods: From April 2022 to April 2023, a total of 29 patients(32 vertebrae) with thoracolumbar OVCFs were treated with a novel steerable percutaneous balloon kyphoplasty (S-PKP). All patients underwent S-PKP procedure using a unipedicular approach. Introduced the novel steerable curved bone expander from the puncture side, expansion and bending to the contralateral side then inserted and inflated the curved balloon tamp. After vertebral body reduction, the bone cement was injected into the vertebral body. Clinical efficacy of S-PKP treatment was evaluated by kyphotic Cobb’s angle, ODI and VAS score. Bone cement leakage and postoperative complications were also observed.Results:The anterior vertebral body height of the fractured vertebrae, Cobb’s angle was a significant improvement between pre-operative and post-operative values without spinal cord or nerve root injury. The VAS was 8.2±0.3 at pre-operative, 2.1±0.5 at post-operative, 1.8±0.3 at final follow-up; and the ODI was 86.3±2.2 at pre-operative, 32.1±2.9 at post-operative, 27.1±2.3 at final follow-up. There was statistically significant improvement in the VAS and ODI at the post-operative assessment compared with the pre-operative assessment. Asymptomatic leakage was seen in 3 vertebrae. Conclusion:The novel S-PKP technology is a safe and efficient way for the treatment of thoracolumbar OVCFs.

Background: Osseointegration can be an effective method of prosthetics for short and defective limb amputation stumps. However, the problem of postoperative complications is relevant and requires further study, especially in patients who suffered in the course of hostilities. Aim: To investigate early postoperative complications after the first stage of osseointegration with the OPRA (Integrum) system in patients who lost limbs due to combat trauma. Materials and methods:
A total of 27 patients were operated on, 30 operations were performed. All patients were men, military personnel who took part in the russian-Ukrainian war. The reasons for amputations were analyzed: traumatic, secondary due to tourniquet syndrome, secondary due to unsatisfactory results of reconstructive operations. Results: Early postoperative complications occurred in 5 (18.5%) patients. Septic complications were observed in 3 patients (11.1%): revisions of postoperative wounds were performed in 2 patients, drainage of purulent hematoma was performed in 1 patient. Antibiotics were prescribed according to the sensitivity of the microflora. There was no need to remove the implants.
In 1 patient (3.7%) marginal necrosis of the skin in the area of the postoperative wound was observed. In 1 patient (3.7%) there was an allergic reaction to an antiseptic in the form of flucten around the postoperative wound. Conclusion: Among the early postoperative complications, septic ones dominated. Although this type of complication has been effectively treated without removal of implants, improvement of preventive measures is currently relevant.