To explore the link between preoperative high-sensitivity C-reactive protein to lymphocyte ratio (hs-CLR) and surgical site infection (SSI) following surgery for degenerative lumbar conditions, and to assess hs-CLR's potential as an inflammatory indicator for prediction.

We retrospectively gathered data from 1, 338 patients who had elective lumbar surgery for degenerative lumbar spinal stenosis or spondylolisthesis from 2020 to 2024 at our facility. This included demographics, comorbidities, preoperative lab tests (such as high-sensitivity C-reactive protein [hs-CRP] and lymphocyte count), and perioperative details. SSI was identified using Centers for Disease Control and Prevention (CDC) guidelines, with follow-up lasting at least 12 months. Treating hs-CLR as a continuous factor, we built a restricted cubic spline model in multivariable logistic regression to map the dose-response between hs-CLR and SSI, identifying the turning point. Patients were grouped into low-hs-CLR (<2.40) and high-hs-CLR (≥2.40). We used 1: 1 propensity score matching (PSM) to even out preoperative baselines. Multivariable logistic models were set up for the unmatched group, and conditional ones for the matched, to check the standalone connection between high hs-CLR and SSI.

SSI rate in the group was 3.6% (48/1, 338). Compared to those without SSI, SSI cases showed notably higher BMI, ESR, hs-CRP, FBG, and hs-CLR (all P<0.05). Spline analysis revealed a clear overall tie between preoperative hs-CLR and SSI risk, with a nearly straight upward trend. Using 2.40 as cutoff, unmatched high-hs-CLR had higher SSI odds, with adjusted odds ratio (aOR) of 1.96 (95% CI: 1.07, 3.61). After PSM yielding 386 pairs, high-hs-CLR risk rose further, aOR 3.53 (95% CI: 1.37, 9.08). ROC showed hs-CLR AUC at 0.722, better than CALLY (0.689), CAR (0.678), and NLR (0.547).

Elevated preoperative hs-CLR links strongly to SSI risk post-degenerative lumbar surgery and stands as an independent predictor even after adjusting for standard risks and surgical elements. Calculated from routine preoperative labs, hs-CLR offers a simple tool for risk layering and tailored care in lumbar surgery patients.

To investigate the preventive and alleviating effects of preoperative regular exercise on periprosthetic knee joint infection in mice.

A knee periprosthetic joint infection (PJI) model was established in C57BL/6 male mice. The mice were divided into three groups: a blank control group, a PJI group, and a preoperative regular exercise + PJI group. The preoperative regular exercise + PJI group underwent a 6-week regular treadmill exercise intervention before the PJI model was established. Four weeks postoperatively, the infectious burden of PJI, osteolysis, inflammatory response, and the tissue repair microenvironment were assessed through gross observation, X-ray imaging, Micro-CT analysis, Giemsa staining, histopathological staining (H&E, TRAP, Alcian blue, COL1A1 immunofluorescence), and qPCR detection.

Compared to the PJI group, preoperative regular exercise significantly reduced the severity of PJI and bacterial load, alleviated osteolysis (as evidenced by reduced periosteal reaction, decreased osteoclast numbers, and improved bone microarchitectural parameters such as BMD and BV/TV), decreased the expression levels of pro-inflammatory factors (Il1b, Il6, Tnf, Cxcl15, Myd88, Tlr4), while concurrently upregulating the expression of anti-inflammatory factors (Il4, Il10), and diminished local tissue inflammatory infiltration and the degree of fibrosis.

Preoperative regular exercise can effectively alleviate the severity of periprosthetic joint infection (PJI) in mice by reducing infectious burden, mitigating osteolysis, controlling the inflammatory response, and improving the tissue repair microenvironment. This provides new experimental evidence and potential strategies for the clinical prevention of PJI.

To evaluate the clinical value of a hoof-shaped ultrasonic bone curette in posterior cervical expansive open-door laminoplasty for multilevel cervical spondylotic myelopathy (CSM).

A retrospective cohort analysis was conducted on 150 patients with multilevel cervical spondylotic myelopathy treated at Zhengzhou Orthopedic Hospital from January 2021 to March 2025. Patients were divided into three groups based on surgical instruments used: Group A (hoof-shaped ultrasonic osteotome, n=50), Group B (flap-shaped ultrasonic osteotome, n=48), Group C (high-speed drill, n=52). The cohort included 84 males and 66 females, with a mean age of (53.6±5.4) years. Comparative analysis included intraoperative parameters (laminoplasty time, blood loss), pre- and postoperative 1-week/6-month Japanese Orthopaedic Association (JOA) scores and improvement rates, complication rates, and hinge bone healing rates at 3 months.

Cutting efficiency:Group A demonstrated the shortest laminoplasty time [(29.8±5.5) min], significantly shorter than Group B [(38.4±7.9) min] and Group C [(52.7±9.1) min] (P<0.001). Intraoperative blood loss in Group A [(78.6±20.6) ml] was significantly lower than Groups B [(105.8±29.1) ml] and C [(134.6±35.7) ml] (P<0.001). Functional outcomes: Repeated-measures ANOVA showed no significant differences in JOA scores across groups at any time point, with no group-by-time interaction.Significant intragroup improvements were observed in all groups at each follow-up time point.Safety: C5 nerve root palsy rates: Group A (2%, 1/50), Group B (2.1%, 1/48), Group C (3.8%, 2/52) (P=0.582). Dural tear rate: 0% in Groups A/B vs. 7.7% in Group C (P=0.047).No significant differences in postoperative infection or new-onset neck pain (P>0.05). Hinge bone healing at 3 months: Group A (95.2%)>Group B (93.8%)>Group C (84.6%) (P=0.034).

All three instruments effectively performed laminoplasty, but the hoof-shaped ultrasonic osteotome demonstrated superior efficiency and safety compared to flap-shaped ultrasonic osteotomes and high-speed drills.

To compare the effects of ultrasound-guided modified lumbosacral plexus block (MLPB) combined with monitor anesthesia care (MAC)and spinal anesthesia (SA) on perioperative prognosis and inflammatory stress response in elderly patients undergoing hip surgery.

From January 2019 to January 2020, 62 patients aged 65-90 years old, ASA grade Ⅱ or Ⅲ, underwent unilateral hip operation in the Department of Orthopedics of Jiaxing First Hospital. All the recruiters were divided into 2 groups, MLPB group and SA group, according to random number table method. The MLPB group underwent ultrasus-guided modified lumbosacral plexus block before surgery, and 0.375% ropivacaine 30 ml was injected into the lumbosacral plexus and sacral plexus respectively on the surgical side, and intraoperative combined MAC. In SA group, 1.5 ml of 0.375% ropivacaine hydrochloride and 1 ml of sterile water was injected into subarachnoid space for spinal anesthesia. The main outcome measures were theplasma concentrations ofIL-1β, IL-6, and TNF-α at 6 h after surgery. Secondary outcome measures included perioperative hemodynamic changes, resting and moving pain scores at 6h, 12 h, 24 h, 36 h, 48h, and perioperative adverse reactions.

Compared with MLPB group, plasma levels of IL-1β, IL-6 and TNF-α in SA group at 6 h after operation were significantly increased (P<0.05). In SA group, systolic blood pressure, diastolic blood pressure and mean arterial pressure were significantly decreased at the end of anesthesia and 15 minutes after anesthesia (P<0.05). In the SA group, 53.33% of patients experienced at least one episode of severe hypotension, while only 6.45% of patients in the MLPB group experienced significant hypotension (P<0.05). In addition, compared with the MLPB group, patients in the SA group had higher pain scores at resting and moving at 6 and 12 hours after surgery, and the difference was statistically significant. At the same time, the incidence of nausea and vomiting in SA group was significantly increased (P<0.05), and the incidence of other complications was not statistically significant between the two groups.

Ultrasound-guided MLPB combined with MAC can reduce postoperative inflammatory stimulation in elderly patients, and the hemodynamics of patients are stable, the postoperative pain stimulation is reduced, the occurrence of adverse reactions is reduced, and there is a better anesthetic effect in elderly hip surgery.

To establish a prediction model for postoperative complications of intramedullary nail treatment for elderly intertrochanteric fractures and verify its effectiveness.

A retrospective analysis was conducted on the data of 451 patients with intertrochanteric fractures treated with intramedullary nails in our orthopedic department from January 2015 to December 2022. The average age was 81.97±7.91 years, including 129 males and 322 females, 135 patients with A1 type, 225 patients with A2 type, and 91 patients with A3 type. The patients were randomly assigned to a modeling group (338 cases) and a validation group (113 cases) in a 3:1 ratio. Using the modeling group data, logistic regression analysis was used to screen for independent risk factors for postoperative internal fixation complications, and a prediction model was constructed; Using validation group data, we analyzed its predictive performance using the subject work curve, and evaluate its fitting degree using Hosmer Lemeshow fitting toxicity test.

There were a total of 72 cases (15.9%) after surgery, including 16 cases (11 cases of INTERTAN, 5 cases of PFNA), 5 cases (1 case of INTERTAN, 4 cases of PFNA), 2 cases (1 case of INTERTAN, 1 case of PFNA), 17 cases (13 cases of INTERTAN, 4 cases of PFNA), and 32 cases (9 cases of INTERTAN, 24 cases of PFNA) of excessive withdrawal. Multivariate logistic analysis showed that unstable fractures, poor reduction quality, severe osteoporosis, PFNA, and weight-bearing time>4 weeks were independent risk factors for postoperative internal fixation complications (P<0.05). Based on the above indicators, a prediction model was constructed with a modeling group ROC curve area of 0.864, sensitivity and specificity of 0.882 and 0.7, respectively. The model fit was good (χ²=5.094, P=0.747). The area under the ROC curve of the validation group is 0.858, with sensitivity and specificity of 0.810 and 0.804, respectively. The Youden index is 0.614, and the model fits well (χ²=8.110, P=0.423).

Unstable fractures, poor reduction quality, severe osteoporosis, PFNA, and weight-bearing time>4 weeks are independent risk factors for postoperative internal fixation complications in the treatment of elderly intertrochanteric fractures with intramedullary nails. The predictive model established based on these indicators has good predictive performance.

Closed suction drainage (CSD) is routinely used to reduce postoperative hematoma formation in surgical procedures such as total hip arthroplasty (THA). However, persistent drainage from the drain site often continues after tube removal. This study aimed to investigate whether oblique drain placement can effectively shorten postoperative drain-site drainage duration and promote recovery in patients undergoing THA and similar surgeries.

A retrospective analysis was conducted on 51 patients (21 males, 30 females; mean age 57.9±11.4 years) who underwent simultaneous bilateral primary THA at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between March 2018 and October 2019. Each patient had the same diagnosis in both hips, with one side receiving oblique drain placement and the contralateral side receiving traditional straight drain placement as an internal control. Outcome measures included drainage volume and duration after tube removal, pain scores, hip function assessed by the Harris Hip Score (HHS), and postoperative complications.

No difference was observed in postoperative day 1 drainage volume between the two techniques (168.6±17.3 vs 170.2±18.7 mL, t=0.441, P=0.661). Oblique drain placement significantly shortened the duration of postoperative drainage (2.4±0.6 vs 3.8±0.8 days, t=9.670, P<0.01) and markedly reduced the incidence of drainage lasting >3 days (3/51 vs 31/51, χ²=24.5, P<0.05). At 24, 48, and 72 hours after tube removal, dressing stain areas were significantly smaller in the oblique placement group (all P<0.01). VAS scores differed significantly between groups on postoperative day 3 (5.33±0.74 vs 6.24±0.79, F=5.913, P<0.001). HHS values showed significant differences at postoperative day 3, discharge, and 1 month (e.g., POD3: 51.57±5.63 vs 44.55±4.82, F=6.763, P<0.001). Hematoma thickness on postoperative day 3 did not differ between groups (3.8±2.8 vs 4.1±2.5 mm, t=0.464, P=0.645), and no deep infection or DVT occurred in any patient.

Oblique drain placement can shorten postoperative drainage duration following THA and facilitate early recovery.

To determine the projection range and coordinate parameters of the calcaneal sustentaculum tali on the lateral wall of the calcaneus through anatomical study, providing precise parameters for screw insertion position, angle, and length in clinical calcaneal fracture internal fixation surgery to improve surgical accuracy and safety.

Sixty foot specimens from 30 adult Chinese cadavers collected from January 2021 to December 2021 were selected. A combination of CT three-dimensional reconstruction technology and physical anatomical measurement was used to determine the morphological parameters of the sustentaculum tali and its projection coordinates on the lateral wall of the calcaneus. A coordinate system was established using the Gissane angle apex and posterior joint surface as references, measuring the geometric parameters of the sustentaculum tali projection area, and verifying the clinical application value of the projection area through 2.0mm Kirschner wire simulation of screw insertion pathway.

The mean projection distance of the sustentaculum tali was (34.37±2.61)mm, with a mean projection area length of (20.25±1.80)mm and mean width of (10.19±1.10)mm. The mean anterior inclination angle of the sustentaculum tali was (30.60±4.73)°, and the mean varus angle was (25.29±6.38)°. Physical measurements showed that the projection area of the sustentaculum tali was approximately rectangular, with coordinate parameters highly consistent with CT measurement results (P<0.05). Screw insertion experiments confirmed that screws inserted according to the projection area coordinate parameters could effectively penetrate the sustentaculum tali without causing vascular or neurological injuries.

The projection of the calcaneal sustentaculum tali on the lateral wall of the calcaneus has a relatively fixed anatomical position and geometric morphology. The established coordinate parameter system can provide reliable anatomical basis for clinical calcaneal fracture internal fixation surgery, helping to improve the accuracy and safety of screw insertion and reduce the risk of surgical complications.

Non-specific Low Back Pain (NSLBP) is a common musculoskeletal disorder. Currently, diagnosis relies on subjective evaluations and traditional imaging, which lack objectivity and quantitative precision. Multiple biomechanical assessment technologies, such as surface electromyography, ultrasound, and gait analysis, dynamically monitor and quantitatively analyze NSLBP patients from perspectives of neuromuscular control, movement patterns, and biomechanics. This paper summarizes the research progress of multiple biomechanical assessment in clinical decision-making for NSLBP. It focuses on discussing the application value of each assessment technology and the advantages of multimodal data fusion. It also prospects the future development path driven by artificial intelligence.