To explore the surgical techniques of spinal endoscopic unilateral laminotomy for bilateral decompression and discectomy (Endo-ULBDD), and evaluate the clinical efficacy, practicability and safety of 360° spinal canal decompression for patients with lumbar spinal stenosis combined with central lumbar disc herniation.

The clinical and imaging data of patients with degenerative lumbar disease who received Endo-ULBDD at the Affiliated Hospital of Qingdao University from October 2020 to March 2023 were retrospectively analyzed. A total of 62 patients were enrolled, including 35 males and 27 females, aged 56-79 years with an average age of (67.47±9.23) years. All patients had grade 3 disc herniation according to MSU classification, and the preoperative dural sac cross-sectional area was (61.50±18.67) mm². The follow-up period ranged from 6 to 24 months, with an average of (14.8±5.1) months. The visual analogue scale (VAS) for low back and leg pain and Oswestry disability index (ODI) were recorded before surgery, on the next day after surgery, at 1 month, 3 months and the final follow-up. The cross-sectional area of dural sac was measured preoperatively and postoperatively to calculate the improvement rate. Operation duration, time to get out of bed after surgery and hospital stay were recorded. The clinical scores before and after decompression were compared and analyzed, and modified MacNab criteria were adopted to assess clinical efficacy at the last follow-up.

All patients completed the operation successfully, with a mean operative time of (106.67±16.43) min. The VAS scores of low back and leg pain as well as ODI were significantly improved at all postoperative time points compared with preoperative values (P<0.05). The improvement rate of postoperative dural sac cross-sectional area was (545.6±79.72)%, and the excellent and good rate was 93.5% based on modified MacNab criteria. Three patients developed numbness in the innervation area of nerve roots after operation, and all symptoms subsided within 3 months. No severe complications such as dural tear or nerve root injury occurred, and no recurrent cases were observed during the follow-up period.

Endo-ULBDD can achieve complete 360° spinal canal decompression and discectomy for patients with lumbar spinal stenosis combined with central lumbar disc herniation, with definite early clinical efficacy and high safety.

To compare the outcomes of O-arm navigation-guided single-position oblique lateral interbody fusion (OLIF) with posterior percutaneous fixation versus posterior decompression and fusion with internal fixation in treating grade Ⅱ lumbar spondylolisthesis.

We retrospectively reviewed 83 consecutive patients (53 men, 30 women; mean age, 66.49±7.36 years) with grade II lumbar spondylolisthesis treated between January 2019 and December 2022. Group A (n=36) underwent single-position OLIF with posterior percutaneous fixation under O-arm navigation, while Group B (n=47) received posterior decompression with instrumented fusion. Comparative parameters included operative duration, intraoperative blood loss, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), time to ambulation, hospitalization length, intervertebral disc space height, slip rate, lumbar lordosis angle, fusion, and complication rates.

All patients successfully completed the operation, with an average follow-up of (23.13±4.55) months. In group A, the average operation time was (138.65±22.38) min, the average intraoperative blood loss was (103.61±27.36) ml, the average time to ambulation was (2.19±0.79) days, and the hospital stay was (5.97±0.72) days. In group B, the average operation time was (121.41±21.19) min, the average intraoperative blood loss was (369.48±54.18) ml, the average time to ambulation was (2.53±0.92) days, and the hospital stay was (6.15±0.67) days. The average intraoperative blood in Group A was significantly lower than that in the control group (P<0.01), while there was no statistically significant difference in the average operation time, time to ambulation and hospital stay between the two groups (all P>0.05). Repeated measures variance analysis of VAS for low back and leg pain at 1 week, 6 months and the final follow-up showed that there was a significant difference between the two groups. And there was an interaction between the group and the time point. The VAS for low back and leg pain at 1 week were significant difference between the two groups (P<0.05). No significant difference of the ODI in the two groups at different time points (all P>0.05). Repeated measures variance analysis of intervertebral space, slip rate and lumbar lordosis angle at 6 months and the final follow-up showed that there was a significant difference between the two groups. There was an interaction between the groups and time points. In terms of intervertebral disc space height, slip rate and lumbar lordosis angle, there were significant differences at 6 months and the final follow-up (all P<0.05). In terms of fusion, 97.22% of group A reached grade I and 2.78% of patients reached grade Ⅱ at the final follow-up, while 82.98% of group B reached grade I and 17.02% reached grade Ⅱ, the difference was statistically significant (P<0.05). The incidence of complications in group B was 25.53% (12/47), which was higher than that in group A (11.11%). However, the difference was not statistically significant (P>0.05).

O-arm navigation-guided single-position OLIF with posterior fixation offers distinct advantages over posterior approaches in blood loss, early pain relief, slip reduction, lumbar segmental alignment restoration, and fusion rate. This minimally invasive strategy represents a viable alternative for grade Ⅱ lumbar spondylolisthesis management.

To investigate the application value of Unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) in the treatment of 98 cases of obesity-related single-segment degenerative lumbar disease, compared with Minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF).

A total of 98 obese patients with single segment degenerative lumbar disease admitted to Guangdong second traditional Chinese medicine hospital from January 2022 to January 2024 were selected for a prospective randomized controlled study. They were randomly divided into UBE-TLIF group and MIS-TLIF group using randomised numerical table method, 49 cases in each group. The perioperative conditions of the two groups were compared, as well as the visual analog scale (VAS) scores for waist and leg pain, lumbar lordotic angle (LL), disc height (DH), and Oswestry Disability Index (ODI) scores before surgery, and at 1 month and 6 months after surgery. The functional prognosis at 6 months after surgery and the incidence of postoperative complications were statistically analyzed.

All 98 patients were followed up for a complete period of 6 months postoperatively, with a follow-up rate of 100%. The total follow-up duration ranged from 6 to 29 months, with an average of (19.96±2.87) months. There were 56 males and 42 females, with an average age of 46.95±3.98 years. In the UBE-TLIF group, the intraoperative blood loss, postoperative drainage volume, and hospital stay were (249.68±31.59) ml, (94.23±18.55) ml, and (5.69±1.65) days, respectively, which were lower than those in the MIS-TLIF group [(327.95±28.11) ml, (123.61±20.39) ml, and (7.58±1.43) days], the operation time was (155.27±14.00) minutes, which was longer than that in the MIS-TLIF group [(136.39±11.94) minutes] (P<0.05). One month postoperatively, the VAS scores for low back pain and leg pain in the UBE-TLIF group were (2.00±0.51) and (1.78±0.48), respectively, both of which were lower than those in the MIS-TLIF group [(2.61±0.43) and (2.45±0.56)] (P<0.05). There were no significant differences in ODI, DH, and LL between the UBE-TLIF group and the MIS-TLIF group at 1 month and 6 months after surgery (P>0.05). The excellent and good rate of functional prognosis in the UBE-TLIF group at six months postoperatively was 95.92%, which was not significantly different from that in the MIS-TLIF group (91.84%) (P>0.05). The total incidence of complications in the UBE-TLIF group was 2.04%, which was not significantly different from that in the MIS-TLIF group (4.08%) (P>0.05).

The treatment of single-segment degenerative lumbar disease in obese patients using UBE-TLIF and MIS-TLIF procedures can achieve good efficacy and high safety. UBE-TLIF has the advantages of minimal intraoperative trauma, rapid postoperative recovery, and improved early pain relief. However, its surgical time is longer, and clinicians can choose the appropriate procedure based on specific circumstances.

To investigate the clinical efficacy of ORIF for treating humeral head split fractures.

A retrospective analysis was conducted on seven patients with humeral head split fractures involving >20% of the articular surface, with displacement of >2 mm or angulation of >20°, who were treated between July 2017 and February 2023. All patients underwent ORIF. Fracture exposure was achieved via a superior two-thirds subscapularis tenotomy and an interval approach between the supraspinatus and infraspinatus muscles. The articular fracture fragments were fixed with countersunk screws, followed by definitive fixation using a locking plate. Postoperative follow-up averaged 33.4 months. Functional outcomes were assessed using the Constant and ASES (American Shoulder and Elbow Surgeons) scores. Complications were recorded.

At the final follow-up, the functional scores were favourable (adjusted Constant score: 75.4±8.6; ASES score: 88.4±7.2). However, abduction strength was significantly weaker on the surgical side than on the non-surgical side (surgical side: 51±5.1 vs. non-surgical side: 79±17; P=0.002). However, no significant difference was found in internal rotation strength (P=0.96). One patient experienced malreduction of the articular surface and one patient developed humeral head osteonecrosis.

Open reduction and internal fixation (ORIF) enables anatomical reduction and stable fixation of humeral head split fractures, providing good mid-term functional outcomes for patients aged under 65 years and potentially reducing the risk of osteonecrosis. However, specific attention to restoring abduction strength is warranted.

To observe the clinical efficacy of musculoskeletal ultrasound (MSUS)-assisted individualized diagnosis and treatment for traumatic frozen shoulder (TFS).

A total of 94 patients with TFS who met the inclusion criteria and were admitted to Lu'an People's Hospital between September 2021 and October 2024 were enrolled. Based on the implementation date (May 2023) of the ultrasound-guided interventional therapy system, patients treated in May 2023 or earlier were assigned to the blind peri-shoulder injection group (Control Group A, n=51), while those treated from June 2023 onwards were assigned to the ultrasound-guided individualized treatment group (Observation Group B, n=43). The control group received traditional blind peri-articular injections combined with a 4-week rehabilitation exercise prescription. The observation group received US-guided peri-articular injections, combined with an individualized rehabilitation exercise prescription of the same intensity and duration. Outcome measures, including the Visual Analogue Scale (VAS) score, Constant-Murley Shoulder Score (CMS), and range of motion (ROM) in various directions (including forward flexion, abduction, external rotation, and internal rotation), were assessed before the initial treatment, and at 4 and 8 weeks post-treatment to evaluate pain and shoulder functional recovery.

Both groups showed significant improvements in VAS scores, CMS scores, and joint ROM at 4 and 8 weeks post-treatment compared to pre-treatment levels (all P<0.001). Intergroup comparisons at each post-treatment time point revealed that the observation group demonstrated superior improvement in all the aforementioned outcome measures compared to the control group (all P<0.05). Furthermore, the incidence of postoperative complications was lower in the observation group than in the control group (4.65% vs 21.57%, P<0.05).

MSUS-assisted individualized diagnosis and treatment for TFS demonstrates significant efficacy, effectively alleviating pain, improving mobility and shoulder function, and exhibiting a high safety profile. It is worthy of widespread clinical application and promotion.

To analyze the effect and complications of superselective vascular intervention combined with core decompression bone grafting in patients with avascular necrosis of femoral head.

A prospective study of 92 patients with ischemic necrosis of the femoral head from January 2020 to January 2023 in the Second Hospital of Handan City was selected by simple random sampling, and the patients were divided into 46 cases in the study group and 46 cases in the control group by random number table method, in which 25 males and 21 females were in the study group, with ages ranging from 40 to 70 years, with a mean of (56.59±6.21) years, and 26 males and 20 females were in the control group, with ages ranging from 42 to 70 years, with a mean of (57.85±6.15) years. The control group was treated with core decompression and bone grafting, and the study group was treated with super-selective vascular intervention combined with core decompression and bone grafting. The results, Harris hip score, complications and quality of life (SF-36 scale) were compared2 years after surgery between the two groups.

The results of rank sum test for hierarchical data showed that the difference in surgical outcomes between the two groups was statistically significant (Z=12.699, P<0.05), and the excellent rate in the study group was higher than that in the control group (84.78% VS 50.00%) (χ²=12.662, P<0.05). The results of repeated measures ANOVA showed that at 2 years postoperatively, compared with the control group [(36.71±3.98) points, (34.28±4.54) points, (3.30±0.96) points, (3.33±0.90) points, and (77.63±8.75) points], the study group's functionality, pain, mobility, deformity, and Harris Hip Score [(40.74± 3.82), (38.46±3.86), (3.89±0.97), (3.89±0.97), (86.98±8.16)] were significantly higher in the study group (t=4.947, 4.746, 2.910, 2.901, 5.298, P<0.05). There was no statistically significant difference in the occurrence of postoperative complications and total complication rate (4.35% vs 13.04%) between the two groups (χ²=2.190, P>0.05). The SF-36 scale scores of each factor were higher in both groups at 2 years after surgery compared with the preoperative period (t=10.748/8.895, 9.078/6.221, 7.860/4.977, 6.165/4.224, 5.918/4.519, 11.746/10.577, and 5.820/3.773, P<0.05); and the study group had an increase in SF-36 scale scores at 2 years after surgery compared with the preoperative period. 2-year SF-36 scale scores for each factor [(61.09±7.26), (58.24±6.25), (68.06±7.21), (67.24±7.32), (64.17±8.21), (65.22±7.22), (65.13±6.14)] were higher than those of the control group [(55.45±7.12)points,, (65.13±6.14)]) points, (52.45±6.25) points, (61.25±6.21) points, (62.45±6.54) points, (60.12±7.22) points, (60.45±7.25) points, and (61.24±6.12) points] (t=3.762, 4.443, 4.854, 3.307, 2.515, 3.162, 3.043, P<0.05).

For patients with avascular necrosis of the femoral head, superselective vascular intervention combined with core decompression and bone grafting can achieve better results, improve hip function and quality of life.

Traditional bone-repair materials are limited by poor growth-factor stability, imprecise release kinetics, and insufficient adaptation to pathological microenvironments. Functionalized photocrosslinkable hydrogels provide a tunable platform for local delivery and for regulating immune, metabolic, redox, and angiogenic responses. This review summarizes recent advances in these hydrogels for bone regeneration, with emphasis on microenvironment reprogramming, stimulus-responsive release, biomimetic design, and coordinated repair mechanisms. Current studies show that physical, chemical, and multistimulus-responsive systems can improve the spatial and temporal control of bioactive cargo, while material composition, structure, and interfacial properties influence macrophage polarization, stem-cell osteogenesis, and vascular-bone coupling. Most evidence, however, remains preclinical. Reproducible manufacturing, long-term biosafety, regulatory classification, and validation in clinically relevant models remain major barriers to translation. Addressing these issues may support the development of functionalized hydrogels from passive carriers into adaptive platforms for bone-defect repair.

Thoracolumbar fracture-dislocation (AO-type C injury) is usually caused by high-energy trauma resulting in three-column spinal injury, and represents the most severe type of spinal fracture. Characterized by flexion- or distraction-type injury, it is frequently accompanied by multi-directional shear forces, which contribute to great difficulty in surgical reduction and a high risk of dural tear injury. At present, most available literature on the surgical management of AO-type C injuries consists mainly of case reports, and reduction techniques for AO-type C injuries at different spinal levels and with different injury mechanisms are still under continuous exploration. Therefore, this article reviews the latest advances in the surgical treatment of AO-type C injuries, with an emphasis on surgical reduction techniques. Meanwhile, a flow chart for individualized reduction techniques is proposed to provide references for surgeons.