Antifibrinolytic drugs such as tranexamic acid (TXA) and aminocaproic acid (EACA) have been proved could effectively reduce perioperative blood loss in total knee arthroplasty (TKA). The aim of this study is to compare hemostatic effect and drug safety of TXA and EACA in TKA.

A total of 196 patients who underwent unilateral TKA at Xi'an Honghui Hospital were retrospectively analyzed from August 2023 to February 2024. Among them, there were 50 males and 146 females, with an average age of 66.5±7.5 years. According to the different usage of antifibrinolytic drugs, patients were divided into the TXA group (n=98) and the EACA group (n=98). The administration method of drug was intravenous transfusion combined with intra-articular injection. There was no drainage tube placed for each patient after surgery. Hemostatic efficacy of these two drugs were compared by contrasting perioperative blood loss, transfusion rate, and decline of hemoglobin between two groups of patients. Drug safety was also compared by analyzing complications such as wound bleeding, deep vein thrombosis (DVT), pulmonary embolism (PE), and periprosthetic joint infection (PJI). Knee Society Score (KSS), flexion range of knee and visual analog scale (VAS) of two groups were analyzed to compare knee joint function.

A total of 196 patients was followed up for 3 months after surgery. The mean decline of hemoglobin in TXA group was 20.0(12.0, 32.5) g/L, no significant deffierence compared with 25.0(16.8, 34.5)g/L of EACA group (P=0.072). In terms of perioperative blood loss, TXA group was also significantly lower than the EACA group (746.9±490.7 and 918.6±371.4 ml, P=0.012). Perioperative transfusion rate of TXA group was 1. 0%, no significant difference compared to 3.1% in EACA group (P=0.313). The incidence of periprosthetic infection (PJI) and deep vein thrombosis (DVT) in each group of patients was 1.0%. No pulmonary embolism were found in each group during follow-up period. The VAS score of TXA group was 2.0(0.0, 2.0) at last follow-up, which was significantly higher than 2.0(0.0, 2.0) EACA group (P=0.005). There was no significant difference in knee flexion range between TXA group (107.9±12.3)° and EACA group (109.6±11.9)° (P=0.262). The KSS of TXA group was 78.4±15.6 at last follow-up. There was no significant difference compared to 77.9±15.9 of EACA group (P=0.807).

It was found in this study that hemostatic effect of TXA was significantly better than EACA in primary TKA. TXA group had less amount of blood loss and lower transfusion rate. The incidence of complications between these two groups were relatively approximated. Thus, TXA was recommended as preferred anti fibrinolytic drug in perioperative period of TKA.

To investigate the effect of intraoperative placement of intra-articular drainage on postoperative blood loss and functional recovery in computer-navigated total knee arthroplasty (TKA).

A total of 100 patients who underwent primary unilateral computer-navigated TKA at our hospital between October 2022 and December 2023 were included. Patients were divided into a drainage group (50 cases) and a non-drainage group (50 cases) based on whether a negative-pressure drainage tube was placed before wound closure, with all other treatments being identical. All 100 patients were followed up for 10-24 months (mean 15.39±4.46 months). The cohort included 19 males and 81 females, with a mean age of 66.90±6.43 years in the drainage group and 66.04±6.32 years in the non-drainage group. Postoperative blood loss, joint functional indicators, and complications were compared between the two groups, followed by statistical analysis.

① No statistically significant difference was found in hidden blood loss or total blood loss between the two groups (P>0.05). ② Repeated measures ANOVA of knee range of motion (ROM) on postoperative day 3, month 3, and month 6, as well as HSS scores and WOMAC scores preoperatively and at months 3 and 6, revealed no significant intergroup differences and no interaction between group and time points. Significant differences were observed across time points. ③ No statistically significant differences were found in postoperative wound exudation duration, hospital stay, or complication rates (P>0.05). ④ All incisions healed primarily without complications in both groups.

Placement of a drainage tube after computer-navigated TKA has no significant effect on postoperative blood loss, functional recovery of the knee joint, or the incidence of postoperative complications.

To explore the machine learning model of chronic pain after total knee arthroplasty (TKA) and analyze its influencing factors.

278 patients with knee osteoarthritis who received TKA in our hospital from October 2021 to May 2024 were selected and randomly divided into training set (195 cases) and test set (83 cases) according to the ratio of 7:3. The pain Numerical Rating Scale (NRS) was used to evaluate the pain before surgery and at discharge. The anxiety and depression Scale (HADS) was used to evaluate the emotional status of the patients. The optimal hyperparameters of the training set were obtained by using the 5-fold cross-validation method, and logistic regression (LR), random forest (RF), extreme gradient Lift (XGBoost) and support vector machine (SVM) models were constructed. Validation sets are used for internal validation. Accuracy, sensitivity, specificity, recall rate, F1 value and area under the curve (AUC) were used to evaluate the predictive performance of the models, and the models with the best performance were compared. Shapley additive interpretation (SHAP) algorithm was used to evaluate important risk variables, and the influence of clinical characteristics on the models was analyzed.

Among 278 patients with knee osteoarthritis treated with TKA, 87 case had chronic pain after surgery (31.29%). Compared with the pain-free group, the patients in the training intensive pain group with diabetes mellitus, the proportion of postoperative thrombosis in lower extremity vein, preoperative HADS score, preoperative NRS score and postoperative CRP level were significantly higher (P<0.05). There were no significant differences between the two groups in terms of age, gender, body mass index (BMI), comorbidities of hypertension, coronary heart disease, disease duration, ASA grading, preoperative knee joint tenderness, surgical site, surgical time, length of hospital stay, and NRS score at discharge (P>0.05). The comparison showed that the AUC of LR, RF, SVM and XGBoost models were 0.725, 0.945, 0.780 and 0.884, respectively, all greater than 0.7, and the AUC and accuracy of RF model were the largest, suggesting that the prediction performance of RF model was better than the other three models. In the optimal model, SHAP algorithm was used to find that postoperative CRP, preoperative HADS, preoperative NRS score, postoperative venous thrombosis of lower extremity, and diabetes mellitus were important factors affecting chronic pain after TKA.

All prediction models of chronic pain after TKA based on machine learning algorithm show good prediction performance, among which RF model has the best comprehensive prediction efficiency, and its risk factors have important guiding significance for clinical prevention and treatment of chronic pain.

The proteome represents a key source of therapeutic targets for complex diseases. In this study, we performed a proteome-wide Mendelian randomization (MR) analysis to identify potential protein biomarkers and therapeutic targets for diffuse idiopathic skeletal hyperostosis (DISH).

Protein quantitative trait loci (pQTL) data were obtained from seven genome-wide association studies (GWASs) on plasma proteomics, encompassing 4,853 circulating proteins. Summary-level genetic associations with DISH were derived from the UK Biobank (9,276 cases and 477,069 controls). Proteome-wide MR and Steiger filtering analyses were conducted to evaluate causal relationships between plasma proteins and DISH risk.

Genetically predicted circulating levels of two proteins, CHAD and TMEM190, were found to be significantly associated with the risk of DISH.

This study identifies two plasma proteins associated with DISH susceptibility and provides novel insights into disease etiology and therapeutic targeting. These findings may contribute to the development of biomarkers and potential drugs for early screening and treatment of DISH.

The aim of the study was to compare the effects of unilateral and bilateral approach percutaneous interlaminar laminectomy (PELD) for the treatment of lumbar disc herniation at L₃-S₁ segment, focusing on the assessment of pain relief, functional recovery, postoperative complications, and patient satisfaction, and to analyse its efficacy and safety.

Sixty patients with lumbar disc herniation were included in the study, there were 20 male cases and 40 female cases, aged from 18 to 70 years, with an average age of (48.8±6.1) years, and were divided into unilateral approach group and bilateral approach group according to the surgical approach, with 30 cases in each group. All patients were treated with PELD surgery and followed up for 6 months after surgery. The main assessment indexes included visual analogue score (VAS), Japanese Orthopaedic Association score (JOA), Oswestry dysfunction index (ODI) and postoperative complications.

The VAS scores of the unilateral approach group at preoperative, 1 week postoperative, 1 month postoperative, 3 months postoperative and 6 months postoperative were (7.1±1.2), (4.3±0.8), (2.2±0.6), (1.6±0.5), and (1.3±0.4), respectively. Those of the bilateral approach group were (7.3±1.2), (4.7±0.9), (2.5±0.7), (2.0±0.6), and (1.7±0.5), respectively. There were statistically significant differences between different groups and time points (F=4.251, P=0.04; F=325.604, P=0.000), and there was an interaction between groups and time points (F=3.201, P=0.015). The JOA scores of the unilateral approach group at preoperative, 1 week postoperative, 1 month postoperative, 3 months postoperative and 6 months postoperative were (12.4±2.1), (16.1±1.6), (18.4±1.4), (20.1±1.3), and (20.8±1.2), respectively. Those of the bilateral approach group were (12.5±2.2), (15.7±1.5), (17.9±1.3), (17.9±1.3), and (20.0±1.1), respectively. There were statistically significant differences between different groups and time points (F=5.128, P=0.128; F=598.354, P=0.000), and there was an interaction between groups and time points (F=15.246, P=0.015). The Oswestry Disability Index of the unilateral approach group at preoperative, 1 week postoperative, 1 month postoperative, 3 months postoperative and 6 months postoperative were (51.8±7.0), (37.5±6.3), (30.2±5.5), (24.5±4.7), and (20.8±4.1), respectively. Those of the bilateral approach group were (52.1±7.3), (39.0±6.5), (31.0±5.8), (26.0±4.9), and (22.1±4.4), respectively. There were statistically significant differences between different groups and time points (F=4.317, P=0.043; F=485.726, P=0.000), and there was an interaction between groups and time points (F=4.128, P=0.003). The infection rate of the bilateral approach group was 13.3%, significantly higher than that of the unilateral approach group (0%) (P<0.05). There was no significant difference between the two groups in terms of postoperative patient satisfaction (P>0.05).

The unilateral approach to PELD surgery was superior to the bilateral approach in reducing pain, improving functional recovery, and reducing postoperative complications, and both groups had higher postoperative patient satisfaction. Unilateral approach as an effective choice for the treatment of lumbar disc herniation at L3-S1 segment has better clinical results.

To evaluate the short-term efficacy of a novel traction therapy bed for patients with lumbar disc herniation.

A single-arm prospective design was used. Patients with LDH attending the spine surgery outpatient department of our hospital from May 2023 to May 2024 were enrolled and all received standardized intervention with the novel traction therapy bed. The Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, and Visual Analog Scale (VAS) score were assessed before treatment, immediately after treatment, and 3 months after treatment. Lumbar MRI was performed for imaging evaluation according to Pfirrmann grade. The primary outcome was the ODI at 3 months post-intervention. All measurement data were analyzed using paired t-tests or Wilcoxon signed-rank tests for non-normal data, and Generalized Estimating Equations (GEE).

A total of 30 LDH patients were included in this study, including 14 males (46,67%) and 16 females (53.33%), with an average age of 46.13±16.38 years. Compared with pre-intervention, ODI and VAS decreased significantly immediately after intervention, while JOA increased significantly (all P<0.001). At the 3-month follow-up, the improvements in ODI and VAS were maintained, and JOA tended to stabilize, the improvement rate of treatment reached 90.00%. GEE results indicated that the time factor had a significant effect on ODI, JOA, and VAS (all P<0.001), and pairwise comparison results were consistent with the above findings.

The novel traction therapy bed can significantly alleviate pain, improve neurological and motor function in LDH patients in the short term, demonstrating certain clinical application value.

To evaluate the effect of headless compression screw technique and mini-plate technique in the treatment of metacarpal and phalangeal fractures.

The English databases PubMed, Web of Science and Chinese databases CNKI, VIP and WanFang Data were searched for the clinical trial literatures about the comparison of the fixation effects of headless compression screws and mini-plates after metacarpal and phalangeal fractures from January 2013 to December 2023. At the same time, the magazine catalogue and references were searched manually. The operation time, fracture healing time, excellent postoperative recovery of hand function, postoperative infection andpostoperative tendon adhesion were analyzed by Review Manager 5.4 software.

A total of 9 articles were included in this study, including 2 in English and 7 in Chinese. The operation time (SMD=-1.37, 95% CI: -1.68, -1.06, P<0.01) and fracture healing time (SMD=-1.33, 95% CI: -2.12, -0.54, P<0.01) of the headless compression screw technique were shorter than those of the mini-plate technique, and the postoperative hand function recovery of the headless compression screw technique was better than that of the mini-plate technique (OR=5.39, 95% CI: 2.17, 13.39, P<0.01). In terms of postoperative complications, the incidence of postoperative infection was similar between the two groups (OR=1.28, 95% CI: 0.48, 3.42, P=0.62), but the incidence of postoperative tendon adhesion (OR=0.07, 95% CI: 0.03, 0.20, P<0.01) was significantly less than those of mini-plate technique.

In the treatment of metacarpal and phalangeal fractures, headless compression screw technique is superior to mini-plate technique in operation time, fracture healing time, postoperative hand function recovery and complications for patients with metacarpal and phalangeal fractures with suitable indications, headless compression screw technology can replace minimally invasive plate technology as the first choice.

Fragility fractures of the pelvis (FFP) represent a distinct category of pelvic fractures occurring in the context of osteoporosis and resulting from low-energy trauma. They exhibit significant differences from high-energy traumatic pelvic fractures in terms of pathological mechanisms, clinical presentation, radiographic characteristics, and treatment strategies.Due to their often insidious nature and tendency to be overlooked, FFPs frequently lead to persistent pain, functional impairment, and reduced quality of life. This imposes a substantial burden on aging societies.As China progressively enters an era of population aging, FFPs have increasingly become a central topic within the multidisciplinary domain. This article focuses on the classification of FFPs, diagnostic challenges and strategies, and therapeutic advancements, among other aspects, aiming to review the current status and ongoing challenges in their diagnosis and management.

To systematically review the research progress on biomarkers for delirium risk prediction in hip fracture patients, clarify their concepts, classifications, and clinical application value, and provide a theoretical basis for early identification of high-risk patients and precise intervention.

Relevant studies were systematically searched in databases including PubMed, Cochrane Library, Web of Science, CINAHL, Embase, CNKI, VIP, Wanfang, and CBM, with the search timeframe spanning from database inception to December 31, 2024. Two researchers independently screened the literature, assessed quality, and extracted data, followed by a summarized analysis of the included studies.

A total of 19 studies were included, covering three major categories of biomarkers: 1. Inflammatory markers: Neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), C-reactive protein (CRP), and cytokines (IL-6, TNF-α) were significantly associated with delirium risk; 2. Blood biochemical markers: Serum albumin, serum S100 calcium-binding protein A12 (S100A12), and serum neurofilament light chain protein (NfL) predicted delirium risk by reflecting nutritional status and central nervous system injury; 3. Cerebrospinal fluid markers: Tissue inhibitor of metalloproteinases-1 (TIMP-1) and soluble triggering receptor expressed on myeloid cells 2 (sTREM2) may contribute to delirium onset through neuroinflammatory pathways.

Current evidence supports the predictive value of biomarkers for delirium risk in hip fracture patients, but three major limitations exist: 1. Significant variability in cutoff values across studies (e.g., NLR thresholds); 2. Lack of dynamic monitoring data; 3. Insufficient research on multi-biomarker combined prediction models. Future multicenter prospective studies are recommended to develop combined biomarker prediction models and establish evidence-based clinical guidelines to facilitate the translation of biomarker-based delirium risk prediction into clinical practice.