To investigate the correlation between the three-dimensional morphological parameters of cervical paraspinal muscles and the prognosis of posterior cervical decompression and lateral mass screw fixation (PCL+LSF) for patients with multilevel cervical spondylotic myelopathy.

The clinical data of 162 patients with multilevel cervical spondylotic myelopathy who had undergone PCL+LSF from June 2019 to June 2021 was retrospectively analyzed. They were divided into two groups based on the Neck Disability Index at (24±6) months follow-up after surgery. The general and imaging data of the two groups of patients were compared and analyzed, Three dimensional reconstruction of the cervical paraspinal muscles was performed to evaluate the relative volume and fatty infiltration rate of the cervical paraspinal muscles.

No statistically significant differences between the two groups were noted in terms of gender, age, BMI, surgical time, JOA score and intraoperative bleeding. The relative volume of the levator scapulae muscle in the residual neck and shoulder pain group is smaller [(9.90±3.15) vs (8.36±2.35), t=3.510, P=0.001], and the fat infiltration rate is higher [(31.31±8.45) vs (40.55±11.52), t=5.819, P<0.001]; The relative volume of the sternocleidomastoid muscle in the residual neck and shoulder pain group is smaller [(6.57±1.73) vs (5.89±2.14), t=2.233, P=0.027], and the fat infiltration rate is higher [(11.86±5.63) vs (13.74±5.53), t=1.084, P=0.028]; The relative volume of the splenius capitis muscle in the residual neck and shoulder pain group is smaller [(26.33±7.39) vs (23.76±6.03), t=2.424, P=0.017], and the fat infiltration rate is higher [(13.05±4.09) vs (14.82±4.95), t=2.490, P=0.014]; The relative volume of the trapezius muscle in the residual neck and shoulder pain group is smaller [(25.66±7.38) vs (23.19±5.95), t=2.351, P=0.020], and the fat infiltration rate is higher [(6.09±1.91) vs (7.28±4.01), t=2.406, P=0.018]. The differences are statistically significant.

Reduced relative volume and increased fatty infiltration of the cervical multifidus, semispinalis cervicis, semispinalis capitis and splenius capitis are associated with poor relief of neck and shoulder pain after PCL combined with LSF for multilevel cervical myelopathy.

Based on the AMPK/PGC-1α/SIRT3 signaling pathway, the effect and mechanism of remimazolam in improving neurocognitive impairment after tibial fracture in elderly mice was investigated.

The elderly mice were randomly divided into control group, model group, remimazolam group, remimazolam + AMPK inhibitor Compound C group, with 8 mice in each group. The Morris water maze was used to detect the learning and memory ability of mice in each group. HE staining was used to detect pathological damage in hippocampal tissue. The expression of PINK1, Parkin, p62, Beclin-1, LC3Ⅱ/Ⅰ, p-AMPK/AMPK, PGC-1α, SIRT3 proteins in hippocampal tissue were detected by Western blot. The levels of malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in hippocampal tissues were detected by kits.

For the escape latency period, the analysis of variance of the control group, model group, remimazolam group, and remimazolam + AMPK inhibitor Compound C group on the 1st-5th day of the last dose showed that the differences between the groups were statistically significant, and there was an interaction between groups and time points, and except for the first time point, there were statistically significant differences between the two groups, and there were significant differences between the control group, the model group, the remimazolam group, and the remimazolam + AMPK inhibitor Compound C group at all time points. Compared with the control group, the traversed original platform numbers and dwell time in the target quadrant shortened (P<0.05), and hippocampal tissue presented significant pathological damage, and the PINK1, Parkin, Beclin-1, LC3Ⅱ/Ⅰ, p-AMPK/AMPK, PGC-1α, SIRT3, SOD, GSH-Px in hippocampal tissue decreased whereas p62, MDA increased (P<0.05). Compared with the model group, the traversed original platform numbers and dwell time in the target quadrant prolonged (P<0.05), and pathological damage in hippocampal tissue alleviated, and the PINK1, Parkin, Beclin-1, LC3Ⅱ/Ⅰ, p-AMPK/AMPK, PGC-1α, SIRT3, SOD, GSH-Px in hippocampal tissue increased whereas p62, MDA decreased (P<0.05). Compound C partly reversed the effect of remimazolam (P<0.05).

Remimazolam alleviates the pathological damage of hippocampal tissue by promoting mitophagy and inhibiting oxidative stress, thereby improving the cognitive impairment of mice after fracture surgery, and its mechanism may be related to the activation of AMPK/PGC-1α/SIRT3 signaling pathway.

To explore the application effect of X-ray based on convolutional neural network in the rehabilitation of vertebral compression fractures.

From January 2022 to June 2023, 130 patients with vertebral compression fracture were selected from our hospital and randomly divided into routine X-ray-assisted PVP treatment (A) group and convolutional neural network X-ray-assisted PVP treatment (B) group, with 65 cases in each group, to observe the rehabilitation effects of the two groups.

All 130 patients were followed up completely, with a follow-up rate of 100.00%. The follow-up period ranged from 1 to 12 months, with an average of (7.33±1.95) months. Among them, the follow-up time of group A ranged from 1 to 12 months, with an average of (7.48±1.58) months. The follow-up period of Group B ranged from 1 to 12 months, with an average of (7.35±1.68) months. Compared with group A, the number of X-ray exposure, bone cement injection amount, intraoperative blood loss, operative time and hospitalization days in group B were significantly decreased (P<0.05). Compared with group A before treatment, there were no significant differences in anterior vertebra height and kyphotic Cobb angle between group A and group B (P>0.05). After treatment, the anterior vertebra height and kyphotic Cobb Angle of the two groups were significantly increased, and the Cobb Angle of the injured vertebra was significantly decreased, but there was no significant difference between group B and group A (P>0.05). Before surgery, there was no significant difference in the VAS score of group B compared with group A (P>0.05); 24 h after surgery, the VAS score of the two groups was significantly increased (P<0.05), and the VAS score of group A was significantly increased (P<0.05); 12 months after surgery, the VAS score of the two groups was significantly decreased (P<0.05), and the VAS score of group B was significantly lower than that of group A (P<0.05); Before surgery, there was no significant difference in ODI score between group B and group A (P>0.05). 24 h and 12 months after surgery, ODI score of both groups was significantly decreased (P<0.05), and that of group B was significantly decreased compared with group A (P<0.05). Compared with group A, the number of complications such as bone cement leakage, refracture of injured vertebra and fracture of adjacent vertebra in group B was significantly reduced, and the total adverse reaction rate in group B (6.15%) was significantly lower than that in group A (20.00%), with significant differences among groups (P<0.05).

X-ray based on convolutional neural network has a significant effect on vertebral compression fractures, and can significantly improve the rehabilitation effect of patients after vertebraplasty, which is worthy of clinical application.

To analyze the effect of resistance abdominal breathing training combined with pelvic floor muscle function training on the rehabilitation effect of patients with lumbar postoperative syndrome (FBSS).

According to the 2016 Sepsis 3.0 standard, the sample size was calculated using the PASS 15.0 software. A prospective study was conducted to collect 78 patients with FBSS who were hospitalized at Xiangya Baolai Rehabilitation Hospital from January 2023 to June 2024 (7 cases were lost to follow-up). The patients were divided into 4 groups according to the parallel control, random single-blind method: Group A (n=19) received conventional core muscle strength training, Group B (n=18) received combined resistance abdominal breathing training in addition to Group A, Group C (n=17) received combined pelvic floor muscle function training in addition to Group A, and Group D (n=17) received combined resistance abdominal breathing training and pelvic floor muscle function training in addition to Group A. The clinical efficacy, pain visual analogue scale (VAS) score, Oswestry Disability Index (ODI) score, pelvic floor muscle electromyography value, abdominal cross-muscle thickness, and diaphragm thickness fraction of the four groups were compared.

Among the 78 patients with FBSS, 7 were lost to follow-up. The follow-up rate was 91.03%.The total effective rate of group D (94.12%) was higher than that of group A (52.63%), Group B (66.67%), and group C (64.71%) (P<0.05); There was no statistically significant difference in the total effective rate among group A, Group B and group C (P>0.05). After 1 month, 3 months and 6 months of treatment, the VAS scores and ODI scores of the four groups were all lower than those before treatment (P<0.05). Moreover, the VAS score and ODI score of group D after 1 month, 3 months and 6 months of treatment were all lower than those of group A, group B and group C (P<0.05). After 1 month, 3 months and 6 months of treatment, the electromyography values of the pelvic floor muscles in the rapid contraction stage, the continuous contraction stage and the durable contraction stage in the four groups were all increased compared with those before treatment (P<0.05). Moreover, after 1 month, 3 months and 6 months of treatment, the electromyography values of the pelvic floor muscles in the rapid contraction stage, the continuous contraction stage and the durable contraction stage in group D were all higher than those in group A, group B and group C (P<0.05). After 1 month, 3 months and 6 months of treatment, the fractions of transversus abdominis thickness and diaphragm thickness in the four groups were all increased compared with those before treatment (P<0.05). Moreover, after 1 month, 3 months and 6 months of treatment, the thickness fractions of the transabdominis and diaphragm in group D were higher than those in group A, Group B and group C (P<0.05).

Resistance abdominal breathing training combined with pelvic floor muscle function training can effectively alleviate the pain symptoms of patients with FBSS, increase the pain threshold, pelvic floor muscle electromyography values, transversus abdominis thickness and diaphragm thickness fraction, with remarkable effects.

To explore the impact of timing selection for total hip arthroplasty (THA) on postoperative outcomes in the elderly with femoral neck fracture (FNF).

A total of 158 elderly patients with FNF admitted from August 2021 to August 2024 were selected as the research subjects. According to the different timing of THA, the patients were divided into the study group (undergoing THA within 48 h after fracture, n=79) and the control group (undergoing THA after 48 h of fracture, n=79). To further balance the potential differences between the two groups, propensity score matching (PSM) was used to match the baseline data at a ratio of 1:1. Perioperative data and hip joint function [Harris hip score (HHS), Functional recovery scale (FRS) for hip fracture, Visual analogue scale (VAS) for pain] of the matched patients were compared and analyzed. Cox proportional hazards model was used to analyze the impact of timing selection on complication events.

After PSM, 59 patients were matched in both the study group and the control group, with comparable baseline data (P>0.05). Compared with the control group, the study group had significantly shorter operation time and post-operative hospital stay (P<0.05), as well as significantly less intra-operative blood loss and a lower incidence of complications (P<0.05). HHS score and FRS score of both groups were significantly higher than those before surgery (P<0.05), while VAS scores were significantly lower than those before surgery (P<0.05), and these changes were more pronounced in the study group (P<0.05). Cox proportional hazards model analysis indicated that after adjusting for covariates, performing THA within 48 hours of admission remained an independent protective factor for reducing the incidence of post-operative complications in patients with FNF (HR=0.217, 95% CI: 0.060, 0.784, P=0.020).

For elderly patients with FNF who meet the surgical indications and have no clear contraindications, undergoing THA within 48 hours of fracture results in more significant improvement in hip function scores and pain relief, and a reduction in postoperative complications. This study recommends prioritizing this treatment regimen.

To investigate the effect of denosumab injection combined with calcium carbonate D3 tablets on the recovery of elderly patients with intertrochanteric fracture of femur (IFF) after intramedullary nail fixation.

A retrospective collection of case data was conducted on 80 elderly IFF patients who underwent proximal femoral anti rotation intramedullary nail fixation surgery in the hospital from February 2022 to February 2025. According to different postoperative treatment plans, the patients were divided into a control group (treated with calcium carbonate D3 tablets, 38 cases) and an observation group (treated with denosumab injection combined with calcium carbonate D3 tablets, 42 cases). Both groups were treated for 12 months. The bone density values, bone formation and resorption markers [osteocalcin (BGP), type I procollagen N-terminal propeptide (PINP), alkaline phosphatase (BALP), and tartrate resistant acid phosphatase (TRACP-5b)], inflammatory markers [C-reactive protein (CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR)], excellent hip joint function rate, and incidence of complications and adverse reactions were compared between two groups.

The bone density values between the femoral neck and trochanter in both groups after 6 and 12 months of treatment gradually increased compared to before treatment, and were higher after 12 months of treatment than after 6 months of treatment (P<0.05). Further inter group comparison showed that the bone density values between the femoral neck and trochanter in the observation group were higher than those in the control group at 6 and 12 months of treatment (P<0.05). After 12 months of treatment, serum BGP, PINP, and BALP levels increased in both groups, while TRACP-5b levels decreased, with the observation group showing more significant changes (P<0.05). After 12 months of treatment, the levels of various inflammatory indicators in both groups decreased, and the observation group had even lower levels (P<0.05). After 12 months of treatment, compared with the control group, the observation group showed a significant increase in the rate of excellent hip joint function and a significant decrease in the rate of recurrent fractures (P<0.05). There was no significant difference in the incidence of nonunion, delayed union, and internal fixation failure between the two groups (P>0.05).

The combination of denosumab injection and calcium carbonate D3 tablets can not only improve bone density and metabolism in elderly patients with IFF, but also alleviate inflammatory reactions, improve hip joint function, and reduce the risk of recurrent fractures.

To investigate the levels of serum CXC chemokine ligand 1 (CXCL1), CC chemokine (CCL) 4 and CCL11 in patients with knee osteoarthritis (KOA) complicated with osteoporosis (OP), and to analyze their relationship with bone density, bone metabolism indexes and inflammatory factors.

A prospective collection of 181 KOA patients admitted to our hospital from September 2021 to August 2023 were selected as research objects, patients were divided into combined OP group (n=108) and non-combined OP group (n=73) according to whether they were combined with OP. The general data of two groups were collected, and the levels of serum CXCL1, CCL4 and CCL11 were detected. The bone mineral density (BMD) of total hip, femoral neck and lumbar L1-L4, serum bone metabolism indexes and inflammatory factors were detected. The correlation between serum CXCL1, CCL4 and CCL11 levels and bone mineral density, serum bone metabolism indexes and inflammatory factors were analyzed by Pearson correlation analysis. Multivariable binary Logistic regression analysis was used to analyze the independent influencing factors of KOA combined with OP, and the diagnostic value of serum CXCL1, CCL4 and CCL11 in KOA combined with OP were analyzed by receiver operating characteristic (ROC) curve.

The levels of serum CXCL1, CCL4, CCL11, bone metabolism indexs type I collagen carboxy terminal cross-linked peptide (s-CTX), type I collagen amino terminal propeptide (PINP), osteocalcin (BGP), bone alkaline phosphatase (BAP), interleukin-1β (IL-1β), IL-6 and tumor necrosis factor-α (TNF-α) in OP group were higher than those in non-combined OP group (P<0.05), and the BMD of total hip, femoral neck and lumbar L1-L4 were lower than those in non-combined OP group (P<0.05). Pearson Correlation Analysis showed that, the levels of CXCL1, CCL4 and CCL11 in serum of KOA patients with OP were positively correlated with bone metabolism indexes s-CTX, PINP, BGP, BAP and inflammatory factors IL-1β, IL-6 and TNF-α, and negatively correlated with total hip, femoral neck and lumbar L1-L4 BMD (P<0.05). ROC curve analysis showed that: the area under the ROC curve (AUC) of the combined diagnosis of KOA combined with OP was 0.853, which was better than the single diagnostic efficacy of serum CXCL1, CCL4 and CCL11 levels (0.789, 0.693, 0.741).

The levels of CXCL1, CCL4 and CCL11 are abnormally elevated in the serum of patients with KOA combined with OP, multivariate analysis confirms that the three are independent influencing factors of KOA combined with OP, and they have certain diagnostic efficacy for KOA combined with OP, and the levels of CXCL1, CCL4 and CCL11 are negatively correlated with bone mineral density, and positively correlated with bone metabolism indexes and inflammatory factors.

Osteoporosis (OP) is a common disease in the elderly, which is characterized by decreased bone strength, decreased bone mineral density and increased risk of fracture. It is mainly caused by the imbalance of bone remodeling, that is, bone resorption caused by osteoclasts exceeds bone synthesis. Ferroptosis is an iron-dependent regulatory cell death mode caused by lipid peroxidation. Intracellular divalent iron ions (Fe²⁺) produce a large number of iron-dependent reactive oxygen species through REDOX reactions, which promote lipid peroxidation and lead to cell death. At present, the role and detailed mechanism of ferroptosis in the development of OP have not been fully elucidated. Ferroptosis may be mediated by glutathione peroxidase 4(GPX4), iron overload and lipid peroxidation affect osteoblasts and osteoclasts to accelerate the progression of OP. Based on the theory of ferroptosis, this review further discusses the role of ferroptosis in the development of OP and potential therapeutic targets, in order to provide new strategies and directions for the diagnosis and treatment of OP and drug research and development.

Knee diseases, especially osteoarthritis of the knee, have led to family and social involvement due to their high prevalence and severe impact on independent living. Total knee arthroplasty (TKA) is the main treatment modality for patients with end-stage knee disease, and postoperative swelling after TKA has become an important factor that reduces the efficacy of the surgery and hinders the patient's recovery due to a combination of mechanisms. Although with the advancement of perioperative management and technology, there is still a lack of systematic compilation and discussion on the Chinese and Western medicine treatment of postoperative swelling after TKA. The purpose of this article is to discuss the pathogenesis of postoperative swelling (systemic and local inflammatory reactions, occult blood loss and tourniquet reaction, etc.),list the Chinese and Western medical treatments, and conduct an in-depth research and discussion by collecting relevant literature in recent years. In view of the complex pathogenesis, single treatment method and lack of attention to the existing problems of postoperative swelling, an overview of the recent studies on the treatment of postoperative swelling after TKA by Chinese and Western medicine is given, with a view to providing more personalised and diversified treatments for this type of patients, and efficient and safe therapeutic solutions for the clinic. It was found that the combination of Chinese and Western medicines in the treatment of postoperative swelling had better clinical effects in the vast majority of cases, especially the internal and external treatments of Chinese medicine, which are often neglected by the clinic, showed greater potential. The combination of Chinese and Western medicine provides more diversified and multimodal options for clinical practice, which is not only conducive to patients' postoperative recovery, but also effective in alleviating the burden on hospitals and society.