Objective

To comprehensively investigate the awareness of and willingness to use digital therapeutics (DTx) among orthopedic rehabilitation medical staff, analyze the possible problems in its use, and provide decision-making basis for the development and application of DTx.

Methods

An observational cross-sectional study was used to investigate the awareness of and willingness to use DTx among orthopedic rehabilitation medical staff in four public medical institutions in Beijing via a questionnaire survey, and the results were statistically analyzed.

Results

A total of 381 valid questionnaires were collected, and it was found through statistical analysis that orthopedic rehabilitation medical staff had a relatively low level of awareness of DTx, and there were differences in the level of awareness among orthopedic rehabilitation medical staff with different positions. Orthopaedic rehabilitation therapists were more aware of DTx than orthopaedic nurses and physicians. Most medical staff were optimistic about DTx,and they believed that DTx could improve work efficiency and provide more convenient and flexible health management methods for patients, and were willing to use DTx to manage patients. However, only 21% of participants had used DTx. In addition, 60.89% of participants were concerned about privacy and security issues, 43.83% were concerned about weakening interpersonal relationships with patients, 46.72% were concerned about taking up free time, and only 41.99% were willing to spend more than 30 minutes per day on DTx.

Conclusion

Although most orthopedic rehabilitation medical staff had low awareness and utilization of DTx, and there were differences in the level of awareness of DTx among orthopedic rehabilitation medical staff with different positions, they expressed their support and willingness to try the new rehabilitation mode of orthopedic rehabilitation DTx. Therefore, targeted training and promotion for medical staff with different positions may help to improve their awareness and usage of DTx.

Objective

To make a comparative analysis of the efficacy and complications of transforaminal lumbar interbody fusion (TLIF) with cortical bone trajectory (CBT) fixation versus pedicle screw (PS) fixation in the treatment of lumbar degenerative disease combined with osteoporosis.

Methods

Clinical data of patients with single-segment lumbar degenerative disease combined with osteoporosis treated in the Second Affiliated Hospital of the Air Force Medical University from January 2019 to March 2022 were retrospectively analyzed, and the patients were randomly divided into either a CBT fixation group (n=48) or a PS fixation group (n=53) based on the fixation method used. Patients in the CBT group had a mean age of (66.20±8.45) years old, with 37 male and 32 female cases, while those in the PS group had a mean age of (66.83±7.41) years old, with 36 males and 31 females. The mean followup time was (12.20±3.47) months. Visual analogue scale (VAS) score, Oswestry dysfunction index (ODI),operative time, intraoperative bleeding, postoperative drainage, hospitalization days, imaging findings,and complications were compared between the two groups of patients.

Results

Surgery was successfully completed in both groups. Operation time, intraoperative bleeding, incision length, and postoperative drainage were significantly better in the CBT group than in the PS group (P<0.05), but the difference in hospitalization time between the two groups was not statistically significant (P>0.05). Low back pain and leg pain VAS scores and ODI decreased significantly in both groups after surgery (P<0.05). ODI was lower in the CBT group than in the PS group at 3 months postoperatively (P<0.05), though the difference in low back and leg pain VAS scores and ODI at the final follow-up was not statistically significant (P>0.05). The proportion of patients with interbody fusion at the last follow-up was 45/48 (93.75%) in the CBT group and 49/53 (90.57%)in the PS group, and the difference between the two groups was not statistically significant (P>0.05). The screw loosening rate was better in the CBT group than in the PS group (P<0.05).

Conclusion

Improvement of clinical symptoms after single-segment lumbar TLIF fusion with CBT screw fixation in osteoporotic patients is comparable to that with PS fixation, and lumbar stability is significantly better in the CBT group,making CBT fixation a reasonable method in TLIF for osteoporotic patients.

Objective

To evaluate the safety and therapeutic effectiveness of microscope-assisted minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for treating recurrent lumbar disc herniation (RLDH).

Methods

A retrospective analysis was conducted on 37 patients with recurrent lumbar disc herniation following percutaneous transforaminal endoscopic lumbar discectomy (PELD) treated at Handan Steel Hospital from April 2021 to March 2023. Of these patients, 25 underwent minimally invasive transforaminal lumbar interbody fusion,including 12 males and 13 females, with an average age of (50.4±4.1)years. Another 12 patients underwent microscope-assisted MIS-TLIF, including 5 males and 7 females,with an average age of (50.3±5.0) years. Comparisons were made between the two groups regarding operative time, intraoperative blood loss, incision length, postoperative drainage, hospital stay, and early complications. Preoperative, postoperative 3-month, postoperative 6-month, and last follow-up evaluations included the Visual Analogue Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and 1-year postoperative Bridwell fusion grading.

Results

All surgeries were successfully completed. The microscope group had an average operative time of (170.9±8.6) minutes, intraoperative blood loss of (137.8±7.4) ml,postoperative drainage of (87.8±9.3) ml, and postoperative hospital stay of (6.7±1.1) days.There was one case of cerebrospinal fluid leakage during surgery in this group, but no postoperative neurological damage or superficial wound infections were observed. The conventional group had an average operative time of (166.6±8.9) minutes, blood loss of (141.3±6.6) ml, postoperative drainage of (90.4±12.9) ml, and postoperative hospital stay of (7.0±1.1) days, with one case each of intraoperative cerebrospinal fluid leakage and postoperative neurological damage, but no superficial wound infections. There were no statistically significant differences in perioperative and complication-related data between the two groups (P<0.05).There was also no statistically significant difference in lumbar fusion outcomes between the groups (P<0.05).

Conclusion

Microscope-assisted MIS-TLIF as a revision surgery for RLDH is safe and effective, offering clear surgical fields and ease of teaching, which is advantageous and warrant broader clinical application.

Cervical laminoplasty can make the cervical spinal cord drift backward by expanding the area of the bony spinal canal and increasing the effective space of the spinal canal, so as to achieve indirect decompression of the cervical spinal cord and relieve the clinical symptoms. It is a common surgical procedure for the treatment of multilevel cervical spondylotic myelopathy and cervical ossification of the posterior longitudinal ligament. After nearly half a century of development, there has been a variety of improved cervical laminoplasty methods, resulting in positive surgical outcomes and satisfactory long-term results. However, cervical laminoplasty requires partial dissection of the cervical paraspinal muscles, which destroys the cervical bone structure and spinous process-muscle-ligament complex, resulting in partial loss of the function of the posterior column of the cervical spine to transfer and share load. It is difficult to maintain the new cervical sagittal balance after laminoplasty. In order to reduce the load consumption of the posterior cervical muscles, the gravity of the cervical spine moves forward, which accelerates the local cervical sagittal imbalance. This review focuses on the effects of cervical laminoplasty on cervical sagittal alignment and the subsequent compensatory mechanisms, and discusses the prospects for research on the effects of cervical laminoplasty on the whole spine and spinal-pelvic sagittal balance and relevant compensatory mechanisms,with an aim to provide a theoretical basis for the clinical treatment decision in the future.

Objective

To investigate the feasibility and safety of extramedullary reference with anterior femoral condyle pre-osteotomy technique in total knee arthroplasty （TKA）.

Methods

A total of 160 patients with advanced knee osteoarthritis （OA） who underwent primary TKA at Suqian Third Hospital from January 2022 to December 2022 were randomly divided into two groups： A and B. In group A， a new extramedullary reference technique was adopted while in group B， standard intramedullary femoral instruments were used. Excluding cases with a follow-up duration less than 12 months， there were 68 cases in group A and 67 cases in group B. Gender， age， body mass index （BMI）， affected side， preoperative Visual Analogue Scale （VAS） score， preoperative range of motion （ROM）， preoperative Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC）， and preoperative Oxford Knee Score （OKS） were evaluated in the two groups. Operation time， postoperative drainage volume， incidence of notching of anterior femoral cortex， postoperative hip-knee-ankle （HKA）， tibiofemoral angle （TFA）， femoral flexion angle （FFA），posterior tibial slope （PTS）， and proximal tibia medial angle （MPTA）， and postoperative complication rate were compared between the two groups， and VAS score， knee ROM， and WOMAC and OKS at 1， 6， and 12 months after operation were analyzed.

Results

There were no significant differences in gender， age， BMI，sides， preoperative VAS score， preoperative ROM， and preoperative WOMAC and OKS between the two groups （P＞0.05）. The incidence of anterior femoral cortex notching in group A （5.9%） was significantly lower than that of group B （17.9%； P＜0.05）. The postoperative drainage volume of group A ［（248.9±49.8） ml］was significantly less than that of group B ［（378.9±43.7） ml； P＜0.05］. There were no significant differences in operation time， postoperative complication rate， HKA， TFA， FFA， PTS， and MPTA between the two groups （P＞0.05）. The VAS score， ROM， WOMAC， and OKS in group A were significantly better than those of group B at 1 month after operation （P＜0.05）. However， no significant differences were found between the two groups at 6 and 12 months of follow-up （P＞0.05）.

Conclusion

The new extramedullary reference technique with pre-osteotomy of anterior femoral condyle in TKA is safe and effective. Compared with the intramedullary alignment system， the new technique not only reduces postoperative drainage volume and the incidence of nothing of anterior femoral cortex， but it is also associated with more pain relief and better joint function and ROM within 1 month after operation.

Objective

To evaluate the clinical outcomes of surgery using a novel medial and lateral hook locking plate in the treatment of complex tibial plateau fractures.

Methods

From July 2017 to April 2019， 10 cases of complex tibial plateau fractures were treated surgically using a novel medial and lateral hook locking plate.

Results

The 10 patients were followed for 8～12 months， with an average of 9.5 months.The mean time of union was 4.8 months （range， 4～6 months）.At the last follow-up， no unstability occurred， and the mean range of motion of the knee was 0.1° in extension and flexion 123.5° in flexion.The mean Oxford score was 39.7 points， and the mean HSS score was 89.3 points.

Conclusion

Surgical treatment of complex tibial plateau fractures with the novel medial and lateral hook locking plate can not only make internal fixation more suitable in different individuals， but also reduce iatrogenic injuries and medical cost，with satisfactory clinical results.

Objective

To explore the overall knowledge structure， global research status， and development trends of core decompression for femoral head necrosis.Based on cases in our center， the clinical efficacy and value of this surgical technique were verified.

Methods

Relevant literatures on core decompression for osteonecrosis of the femoral head were searched through the Web of Science core collection database， with a time span from database establishment to January 1， 2024.VOSviewer and Scimago software were used to analyze the co authorship status， regional distribution of research results， hot topics， and time zone distribution of research hotspots in the field of core decompression technology in the treatment of osteonecrosis of the femoral head.And we generated a visual knowledge graph.The current status and development trends of hip preservation therapy for necrosis of the femoral head were comprehensively evaluated， and bibliometric results were correlated with the real-world data.A retrospective analysis was conducted on 27 patients with ARCO stage I-IIIA who underwent simple core decompression or core decompression combined with bone grafting in our hospital from October 2017 to June 2023.We compare the visual analog scale （VAS） and Harris hip joint score in patients undergoing unilateral core decompression combined with bone grafting before surgery， 3 months after surgery， and at the last follow-up after surgery.And we evaluate the collapse of the femoral head based on preoperative and postoperative X-ray， and evaluate the situation of reoperation.

Results

This study included 859 academic papers and reviews， with Chinese scholars having the highest total number of publications， followed by American scholars.However， American scholars Mont and Michael A.had the highest number of individual publications （41）， while American scholars Hungerford ds.had the highest number of citations （178.5 per article）.The top 10 research institutions in terms of publication volume have the highest number of Chinese institutions， but the articles published by Sinai Hospital have been cited 101.13 times， which is more recognized by the academic community.Keyword analysis suggests that the current research focus is not limited to the study of core decompression technology itself， but more on the selection of bone grafting materials and the study of cell therapy.Core decompression combined with bone grafting and cell therapy is currently a hot topic.A total of 27 patients with femoral head necrosis were included as the study subjects in this study， with a total of 32 hip joints undergoing core decompression surgery.Among them， 14 hip joints underwent simple core decompression surgery， and 18 hip joints underwent core decompression combined with bone grafting surgery.Among the 14 hip joints that underwent simple core decompression surgery， 7 femoral heads experienced another collapse with a 50%collapse rate， and 6 joints underwent total hip replacement with a 42.86% reoperation rate.Among the 18 hip joints undergoing core decompression and bone grafting surgery， 5 had femoral head collapse， with a collapse rate of 27.78%， and 3 joints underwent total hip replacement with a hip joint reoperation rate of 16.67%.9 patients who underwent unilateral core decompression combined with bone grafting surgery and did not undergo further surgery achieved good clinical efficacy after surgery.The Harris score and VAS score of those patients improved significantly after surgery （P＜0.01）.

Conclusion

Core decompression for necrosis of the femoral head has received attention from the academic community， and China has become a core force in this field with certain advantages.Bone grafting materials and regenerative cell therapy are current research hotspots that have attracted much attention from the academic community.Core decompression combined with bone grafting and cell therapy is an effective treatment for early and mid stage necrosis of the femoral head， which can improve hip preservation rate， delay or even avoid patients undergoing total hip replacement surgery.

Small cell osteosarcoma is a rare subtype of osteosarcoma with a poor prognosis.It is difficult to differentiate small cell osteosarcoma histopathologically from other malignant bone small cell tumors， especially Ewing’s sarcoma， due to their very similar immunohistochemical features.A diagnosis cannot be made by local puncture or biopsy when no tumor-affected bone is obtained， which affects the treatment plan.Therefore， it is of great significance to make a definite diagnosis of small cell osteosarcoma before surgery.This article briefly reviews the clinical， imaging， pathological， therapeutic， and prognostic features of small cell osteosarcoma.

Objective

To investigate the awareness， demand， intention， and preference for digital therapeutics （DTx） in orthopedic rehabilitation patients， so as to better promote the application of DTx in orthopedic rehabilitation in the future.

Methods

An observational cross-sectional study was conducted to investigate the awareness， demand， intention， and preference for DTx among orthopedic rehabilitation outpatients and inpatients in four public medical institutions in Beijing， including rehabilitation medicine department in Grade Ⅲ Level A hospital， rehabilitation specialist hospital， and community rehabilitation center. A self-designed electronic questionnaire was used for survery， and the results were statistically analyzed.

Results

A total of 928 valid questionnaires were obtained. Statistical analysis of the degree of awareness of DTx showed that 80.28% of patients “did not know”； the proportion of patients with “no awareness at all” in people over 50 years old was significantly higher than that of other age groups （P=0.036 ），but the degree of understanding of DTx among people with master’s degree or above was significantly higher than that of other education groups （ P=0.011 ）. Of the 693 patients who had never used DTx， 75.61% were willing to try to use DTx to manage their own health problems， and if used together with medical staff，the percentage of patients willing to use DTx increased to 86.00%. Compared with patients who had not used DTx， the proportion of patients who were willing to spend more than one hour per day on orthopedic rehabilitation training and the proportion of patients who were willing to attend the hospital more than twice a week for rehabilitation treatment were significantly higher in those who had used DTx （P＜0.001）.However， patients who had used DTx were more worried about personal privacy or other security issues（P=0.003） and believed that DTx would weaken their interpersonal relationships with medical staff （P＜0.001）.

Conclusion

Although the awareness of DTx in orthopedic rehabilitation patients needs to be improved，they have high confidence and more expectations for the new mode of DTx than traditional rehabilitation methods. In the future， we should continue to increase the popularization and education of DTx in orthopedic rehabilitation， and improve the DTx products of orthopedic rehabilitation with regard to product design，performance modules， usage methods， and safety guarantees

假性软骨发育不全（pseudoachondroplasia，PSACH）是一种以身材矮小和骨骼畸形为特征的遗传性疾病。目前，成人PSACH患者的代谢紊乱及其伴随疾病尚未受到充分关注。本文报告了一例合并1型糖尿病的成人PSACH患者的临床特征和基因突变类型，并对中国PSACH患者的基因突变位点的临床表现进行了分析和总结。旨在加深临床医生对PSACH的理解，提升其识别与诊断能力，同时关注成年患者的代谢性疾病伴随情况，以实现早期预防和治疗。

In 2016, the World Health Organization updated the classification criteria for myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN), which added the classification of myelodysplastic/myeloproliferative neoplasm with ring sideroblasts and thrombocytosis (MDS/MPN-RS-T). MDS/MPN-RS-T has the dual characteristics of myelodysplasia and myeloproliferation at the same time. Because its incidence rate is extremely low and there are few relevant literature reports, it is very prone to missed diagnosis and misdiagnosis in clinical work, and there is no systematic treatment plan even after diagnosis. This article analyzes and summarizes the relevant reports on the diagnosis and treatment of MDS/MPN-RS-T at home and abroad, with an aim to improve the understanding of this rare disease among clinicians.

Bone tissue has a natural regenerative ability, but serious bone defects require certain clinical interventions. The gold standard for clinical repair of various bone defects is bone grafting; however, there are problems such as limited access to natural bone for therapeutic grafting, concurrent infections, and immune rejection. Artificial bone repair materials avoid the above problems to a certain extent and offer greater potential and prospects for application. Mineralized collagen is one of the most biomimetic bone defect repair materials, with the composition and multilevel structure of natural bone, which not only has the ability to treat bone defects by itself, but also can be compounded with other substances, such as polymers, metal ions, and angiogenic and osteogenic factors, to improve its ability to repair bone defects. This paper focuses on the clinical problems of treating bone defects, and summarizes the application of mineralized collagen and repair materials using it as a matrix for treating different bone defects, with an aim to to provide ideas for using mineralized collagen materials for bone defect repair.