To compare and analyze the effects of arthroscopic rotator cuff repair release and arthroscopic rotator cuff repair manual release in the treatment of rotator cuff tear complicated with adhesive shoulder capsitis.
Methods
A total of 96 patients with rotator cuff tear combined with adhesive shoulder capsitis were selectedin Jianhu County People's Hospital from October 2019 to October 2022. The inclusion criteria were as follows： there was no significant effect after conservative treatment， and the patients were eligible for rotator cuff tear combined with adhesive shoulder capsitis and underwent preoperative MRI examination of shoulder joint. Exclusion criteria： patients with shoulder infection； large rotator cuff tear，irreparable rotator cuff tear； serious shoulder problems and so on. A random number table was used to divide the subjects into two groups： 48 cases in the arthroscopic rotator cuff repair shoulder joint release group（the intraoperative release group） and 48 cases in the arthroscopic rotator cuff repair manual release group（the manual release group）. Visual analogue scale（VAS）， University of California at Los Angeles shoulder score（UCLA ） and shoulder motion were compared before surgery， one， three and sixmonths after surgery in the two groups. Independent sample t test was used for comparison between the two groups， chi square test was used for classification data such as gender composition ratio， and repeated measurement ANOVA was used for changes in VAS， UCLA scores and shoulder joint motion at multiple time points in the two groups.
Results
There was no statistically significant difference in range of motion， UCLA and VAS scores between the two groups before surgery （ all P＞0.05）. At one， three and six months after surgery， the intraoperative release group had better mobility than the manual release group， and the difference was statistically significant（abduction： t=4.660， 11.145， 8.667， all P ＜0.05； forward flexion： t=3.830， 7.574， 6.890， all P＜0.05；lateral external torsion： t=4.068， 2.034， 2.979， all P＜0.05； extension and internal rotation： t=2.254， 5.543，5.433， all P＜0.05）. The UCLA scores of the intraoperative release group were better than those of the manual release group， and the difference was statistically significant （t=3.336， 7.598， 8.777， all P＜0.05）. The VAS scores of the intraoperative release group were better than those of the manual release group， and the difference was statistically significant （t=18.304， 18.480， 23.741， all P＜0.05）.
Conclusions
Arthroscopic rotator cuff repair and shoulder joint release in the treatment of rotator cuff tear complicated with adhesive shoulder capsitis can significantly reduce pain and improve shoulder joint function. Compared with the rotator cuff repair technique under the microscope， the manual release effect is better and the recovery of patients is better， which is worthy of application and promotion.
To analyze the clinical effect of eccentric rotary acetabular osteotomy （ERAO）in the treatment of developmental dysplasia of the hip （DDH）.
Methods
From March 2010 to February 2022， patients with DDH and treated by ERAO in the First Affiliated Hospital of Sun Yat-sen University were collected. The patients who were evaluated as under stage III of Tönnis hip osteoarthritis staging and aged from 15 to 60 years were enrolled， while the patients with hip surgery history or requiring femoral osteotomy were excluded. A total of 78 patients with 92 hip joints were included in this study. There were 28 males and 50 females. According to Tönnis grades of hip osteoarthritis， there were 15 hips in stage zero， 67 hips in stage Ⅰ，and 10 hips in stage Ⅱ. According to the Crowe classification of hip dysplasia， all the patients were type I. The Harris score was used as the standard for clinical evaluation. Imaging evaluation was conducted by photographing the anterior and posterior positions of the pelvis before and after surgery and the anterior and lateral positions of the affected hip to observe the acetabular head index （AHI）， lateral center-edge angle （LCEA） and Sharp angle，as well as to observe whether there were complications such as infection and neurovascular injury .Comparing preoperative and postoperative differences for statistical significance through t test.
Results
The patients were（45±16） years old on average， and the follow-up time was 12 to 138 months， （68±32） months on average. In the shortterm and six months follow-up after surgery， except for two cases of wound infection， there was no other complication such as neurovascular injury. During more than five years follow-up， five patients with five hips underwent total hip replacements. Harris score elevated from （73.5±9.4） to （89.8±6.2） after ERAO surgery， and the difference was statistically significant （t=-7.8， P ＜ 0.001）. The sharp angle was （52.2±3.8）° before surgery， and was improved to（42.4±3.2）° after surgery （t=3.1， P ＜ 0.05）. The LCEA increased from （10.7±2.6）° before surgery to （35.8±6.5）°. The AHI increased from preoperative （48.9±6.5） % to postoperative （88.0±10.7） %， The horizontal distance from teardrop decreased from preoperative （41.2±9.4） mm to postoperative （37.3±8.6） mm， and the vertical distance from teardrop decreased from preoperative （20.8±10.5） mm to postoperative （17.2±10.1） mm.
Conclusions
ERAO can obviously correct the deformity of acetabulum in patients with DDH， improve the stress mode of the abnormal hip joint， and delay the progression of secondary lesions such as osteoarthritis of hip. The short mid-term clinical effect is the definite results. ERAO is an effective surgical method for the treatment of DDH， andbeing worthto promote and apply.
To explore the risk factors of delirium and cardiovascular complications in ultra-senile patients after hip and knee arthroplasties， and to build a visual risk prediction model.
Methods
The clinical data of 118 super-elderly patients who underwent hip and knee arthroplasty in the First Affiliated Hospital of Sun Yat-sen University from October 2018 to October 2021 were retrospectively collected.The patients who were age over 80 years and underwent primary hip or knee arthroplasty were included， while the patients with severe hip arthritis， femoral head necrosis or hip fracture， revision surgery， infection in lungs or urinary system， severe hepatic or renal dysfunction， and combining other severe diseases were excluded.The grouping was based on whether postoperative complications occurred， and they were divided into control group and complication group. The clinical data of the two groups were compared， and the risk factors for postoperative delirium and cardiovascular complications were analyzed by univariate and multivariate logistic regression. R language software was used to establish an alignment chart for predicting risk and construct an online dynamic prediction model and deploy it to the Shinyapps.io website. The predictive performance of the model was evaluated using the area under the curve （AUC）， calibration curve， and clinical decision curve analysis（DCA）.
Results
This analysis showed that for postoperative delirium complications， age （t=-2.164， P＜0.05），hypertension （F=4.635， P＜0.05）， chronic obstructive emphysema （F=22.861， P＜0.05）， postoperative blood albumin （Alb） level （t=3.539， P＜0.05）， preoperative hemoglobin level （t=2.366， P＜0.05）， rest pain （t=-3.180，P＜0.05） and activity pain （t=-2.240， P＜0.05）， the differences of these factors were statistically significant（P＜0.05）. As for postoperative cardiovascular complications， there were statistically significant differences in postoperative blood albumin levels （t=2.069， P＜0.05）， diabetes mellitus （F=-5.696， P＜0.05）， rest pain （t=-3.758，P＜0.05） and activity pain （t=-2.406， P＜0.05） between the two groups （P＜0.05）. Multivariate logistic regression analysis showed that postoperative pain at res［todds ratio （OR）=3.140， 95% confidence interval （CI） （0.170，2.118）］， chronic obstructive pulmonary emphysema［ OR=20.673， 95%CI （1.333， 4.724）］， and hypertension［OR =14.101， 95%CI （0.268， 5.023）］were independent risk factors for postoperative delirium complications（all P＜0.05）. Postoperative pain at rest ［OR=5.522， 95%CI （0.557， 2.861）］and diabetes［OR=5.220，95%CI （0.026， 3.280）］were independent risk factors for postoperative cardiovascular complications （both P ＜ 0.05）. The study concurrently established a predictive model ［AUC= 0.903， 95% CI （0.810， 0.995）］.The model's internal validation showed C-index of 0.903， indicating a certain level of predictive capability.
Conclusions
This study identified risk factors for delirium and cardiovascular complications in patients undergoing hip and knee arthroplasty at an advanced age. Additionally， a predictive model is developed，suggesting that clinical practitioners can enhance perioperative management based on corresponding predictive results to mitigate the risk of postoperative delirium and cardiovascular complications in such patients.
To investigate the efficacy and safety of hemostatic powder used in total knee arthroplasty （TKA）.
Methods
A prospective randomized cohort study was used in this study.A total of 213 patients （213 knees） with knee osteoarthritis who underwent TKA for the first time in the joint surgery Department of Xuzhou Renci Hospital from January 2023 to November 2023 were included. Patients with coagulation dysfunction and anemia ［hemoglobin（Hb）＜90 g/L］were excluded. The enrolled patients were randomly divided into two groups by envelope method： the experimental group （98 patients received hemostatic powder） and the control group （115 patients did not receive hemostatic powder）. Hb was detected before surgery，one day and three days after surgery， and the total blood loss， intraoperative blood loss and hidden blood loss were compared between the two groups. Blood transfusion rate， incidence of DVT， occurrence of superficial skin infection， and gender were compared by chi square test. T test was used to compare operative time，intraoperative blood loss， occult blood loss， total blood loss， Hb， age， and body mass index （BMI）.
Results
The Gross and Nadler equations were used to calculate blood loss in both groups. The total blood loss of the experimental group was （627.0±92.9） ml， which was less than （815.5±142.4） ml of the control group （t=11.224，P＜0.001）. The hidden blood loss of the experimental group was （530.5±78.6） ml， which was less than （693.4±120.8）ml of the control group （t=11.450， P＜0.001）. The hemoglobin in the experimental group was higher than that in the control group at one day and three days after operation （t=4.771，7.070， both P＜0.05）.There was no statistically significant difference in intraoperative blood loss， operation time， blood transfusion rate， postoperative LHS，superficial skin infection rate or incidence of DVT between the two groups （all P＞0.05）.
Conclusion
Hemostatic powder can reduce perioperative blood loss without increasing complications during total knee arthroplasty.
To conduct a preliminary study on the efficacy of knee osteoarthritis after six months practice of Baduanjin by gait analysis.
Methods
Thirty-nine patients with knee osteoarthritis who were admitted to the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from January first，2021 to December 31， 2021 were selected. Inclusion criteria： （1） meeting the American College of Rheumatology diagnostic criteria for knee osteoarthritis； （2） subjects were over 50 years of age and had symptoms of knee osteoarthritis for at least six months prior to study entry； （3） the patients was not involved in other sports.Exclusion criteria： （1） patients with joint pain or deformity in the spine， hip， ankle， foot and other parts of the joints， patients with mobility problems， patients with a history of hip， knee and ankle surgery； （2） patients with injections of corticosteroids or hyaluronic acid into the knee joints one year prior to entry into the study；（3） patients with a combination of knee tumours， tuberculosis， infections， rheumatoid diseases and other diseases；（4） patients with a combination of severe cardio-cerebral and cerebral vascular diseases or organ failure who cannot tolerate the stimulation and psychiatric patients. The patients were divided into three groups according to the order of admission using the random number table method， 13 cases in each group. Control group： conventional treatment； two times group： on the basis of conventional treatment， practice Baduanjin twice a week， 30 min/time；five times group： on the basis of conventional treatment， practice Baduanjin five times a week， 30 min/time.Spatio-temporal parameters measured by the gait analyser were collected pre-practice， eight weeks and six months after the exercises： step speed， step frequency， step length and foot single support phase were used to statistically analyse the data using repeated measures ANOVA and non-parametric tests.
Results
There was no statistically significant difference between groups in each gait temporal parameter in the control group，twice group and five times groupbefore practice （all P＞0.05）. After six months of practice of Baduanjin， the left step length of the two times group was better than the control group （P＜0.05）. After eight weeks of practice of Baduanjin， the right step length of the five times group was better than that of the control group （P＜0.05）， and after six months of practice of Baduanjin， step frequency， left step length， and left foot single support phase of the five times group were better than the control group （all P＜0.05）. There was no statistically significant difference in gait parameters among the control group at each examination time point（all P＞0.05）. The differences in the left step length eight weeks and six months after practice compared with the data before practice in the two times group was statistically significant （F=5.83， P＜0.05）. The difference in right step length at six months after practice compared to that before practice was statistically significant （F=5.73， P＜0.05）.The differences in step frequency（F=12.28）， left foot single support phase（H=7.54）and right foot single support phase（H=8.51）at six months after practice in the five times group was statistically significant when compared to the data before practice （all P＜0.05）.
Conclusions
The practice of Baduanjin can improve the subjects' knee movement function. Practising Baduanjin two times or five times a week can improve the gait， and it is more advocated that patients with knee osteoarthritis should practice it five times a week.
To explore the risk factors of osteoporosis in patients with rheumatoid arthritis（RA） and build a prediction model.
Methods
A total of 520 RA patients admitted to the Second People's Hospital of Jiangyou City from January 2021 to June 2022 were selected as the study objects. All the patients underwent bone mineral density examination and volunteered to participate in the study. Exclusion criteria：renal or thyroid dysfunction， malignant tumors， endocrine diseases， osteoarthritis， pregnancy. The patients were randomly divided into modeling group （n=364） and verification group （n=156） according to the ratio of 7∶3. According to the occurrence of osteoporosis， the patients were divided into developing group and nondeveloping group. Clinical data such as age， gender， medical history， smoking， drinking， course of disease and laboratory indicators were collected. Univariate and multivariate logistic regression were used to analyze the risk factors affecting the occurrence of osteoporosis in RA patients. The calibration curve and Hosmer-Lemeshow（H-L） test were used to evaluate the calibration degree of the calibration model， and the receiver operating characteristic （ROC） curve was drawn to verify the differentiation of the model.
Results
The incidence of osteoporosis in 520 patients was 44.8% （233/520）. The incidence of osteoporosis in the modeling group was 45.1% （164/364）. The incidence of osteoporosis in the verification group was 44.2% （69/156）. The results of multivariate logistic regression analysis showed that calcium intake［odds ratio （OR）=2.439］， history of glucocorticoid use （OR=2.552）， age （OR=1.151）， body mass index （BMI） （OR=0.882）， duration of disease（OR=1.071）， erythrocyte sedimentation rate （ESR） level （OR=1.057）， disease activity in 28 joints DAS28 score（OR=2.386） was an independent factor for the occurrence of osteoporosis （P＜0.05）. Based on the above risk factors， a nomogram model was established to predict the risk of osteoporosis in RA patients， and internal and external verification was carried out. The results showed that the calibration curve and ideal curve fit well in both the modeling group and the verification group， indicating that the risk of osteoporosis predicted by the model was basically consistent with the actual risk. The areas under ROC curve were 0.907［ 95% confidence interval （CI）（0.876， 0.939）］and 0.899［ 95%CI （0.8850， 0.948）］respectively， indicating that the prediction model had good prediction ability.
Conclusions
The factors influencing the development of osteoporosis in patients with RA include age， BMI， course of disease， history of glucocorticoid use， calcium intake level， ESR level， and DAS28 score. The prediction model based on the above risk factors can effectively predict the risk of osteoporosis in RA patients， which is helpful for clinicians to identify RA patients with early osteoporosis.
To establish a New Zealand rabbit distraction osteogenesis model， and to investigate the effect of total flavonoids of drynaria rhizome on spinal bone volume of distraction osteogenesis model by Micro-CT bone microstructure indices.
Methods
Twelve New Zealand male rabbits， weighing 1.8 to 2.2 kg， were randomly divided into three groups according to the random number table method： the blank group， the control group and the experimental group， with four animals in each group. The control and experimental groups were subjected to distraction osteogenesis modelling， and the blank group were subjected to sham operation. After the operation， the experimental group were given total flavonoids of drynaria rhizome（0.03g·kg-1·d-1 ） ， and the other two groups were given equal amounts of saline lavage for 60 d. After the animal was sacrificed， the same spinal bones were removed and scanned by micro-CT. Bone mineral density （BMD），bone volume fraction （BV/TV）， trabecular separation （Tb.Sp）， trabecular thickness （Tb.Th）， trabecular gap （Tb.N） and bone surface area to bone volume ratio （BS/BV） were measured. One-way ANOVA was used to analyse the data of the three groups， and LSD test was used for multiple comparisons.
Results
All the rabbits were observed and showed normal activities after operation. The rabbits in the control and experimental groups showed a decrease in running and jumping. Quantitative analysis of micro-CT showed statistically significant differences in BMD， BS/BV， Tb.Th， Tb.N， BV/TV， and Tb.Sp among the three groups （F=3.751， 3.141， 8.590， 4.037， 4.133，5.110， all P＜0.05）. BMD， Tb.Th， Tb.N， BV/TV decreased， and BS/BV and Tb.Sp increased in the control group compared with the blank group （all P＜0.05）. Compared with the experimental group， BMD， Tb.Th， Tb.N， BV/TV decreased and Tb.Sp increased in the control group （all P＜0.05）； the difference was not statistically significant in the blank group compared with the experimental group （all P ＞0.05）.
Conclusions
Bone mass may decrease after distraction osteogenesis， this may lead to a risk of osteoporosis. The total flavones of drynaria rhizome can maintain the spine bone mass of distraction osteogenesis model and prevent the occurrence of osteoporosis.
To explore the influence of systemic immune inflammation index （SII） on bone mass density （BMD） and osteoporosis （OP）， and provide a basis for early screening and diagnosis of osteoporosis.
Methods
According to the PRISMA standard， six databases including PubMed， Web of Science， Excerpta Medica Database （Embase）， China National Knowledge Infrastructure （CNKI）， China Science and Technology Journal Database （VIP）， and Wanfang were searched for observational studies from database establishment to December 28， 2023. Related data were extracted from included literatures and quality of each articles was evaluated. For different outcomes， the calculation of pooled effect values， meta regression， subgroup analysis，sensitivity analysis， and publication bias test （Egger method and funnel plot） were performed. STATA 15.0 was used to analysis， with a testing level of α=0.05.
Results
A total of eight observational studies were included，including 11453 subjects. Compared with the low-level SII group， the high-level SII group has lower BMD levels in the femoral neck， and the difference is statistically significan［trandom effects mode： β=-0.023， 95%confidence interval （CI） （-0.039， -0.006）， I2=78.3%， P=0.001l］. Through subgroup analysis， high levels of SII were associated with a decrease in femoral neck BMD in the elderly population and postmenopausal female［age ≥60 years old： β=-0.016， 95%CI（-0.031， -0.002）； postmenopausal women： β=-0.029， 95%CI （-0.048，-0.010）］. Compared with the low-level SII group， the high-level SII group has a higher risk of OP［ random effects model： odds ratio （OR）=1.990； 95% CI （1.280， 3.090）， I2=72.5%， P=0.012］. The results of subgroup analysis showed that high levels of SII were associated with the risk of OP in postmenopausal women［OR=2.250，95%CI （1.270， 4.000）］. Continuous SII was not related to the risk of OP［ random effects model： OR=1.010，95%CI （0.910， 1.310）， I2=100%］. The meta regression analyses indicated that no factor affecting heterogeneity among studies was identified. Sensitivity analyses suggested that the results of this study were robust， and no publication bias was found.
Conclusions
High level of SII associates with lower BMD levels and higher OP risk， especially in postmenopausal women and the elderly population. SII can comprehensively reflect the immune and inflammatory status of the body， and it is calculated from blood routine examination results， which is easy to obtain. Therefore， this study may provide new ideas for early screening and diagnosis of osteoporosis.
Artificial joint replacement is one of the effective treatments for osteoarthropathy. Although the postoperative effect of this treatment is satisfactory， periprosthesis osteolysis is still an important factor leading to the failure of joint replacement. Among them， macrophage polarization is the most important factor to induce osteolysis around the prosthesis. Therefore， it is a better choice to regulate the polarization of macrophages by non-surgical treatment， thus preventing osteolysis and treating bone lesions. The main metabolic patterns of macrophage polarization， the relationship between inflammation and osteoclast/osteoblast，and the potential signaling pathways are described for the first time. The relationship between the mechanism of macrophage polarization and periprosthesis osteolysis as well as the therapeutic measures were described. The effect of macrophage polarization in the periprosthesis micro-environment affects the long-term applicability of the prosthesis. Therefore， immunomodulation can be used as an intervention to prolong the use of prostheses，and metabolic reprogramming can be regarded as an emerging potential target.
The calcar femorale is a dense bone plate located inside and behind the femoral neck and body junction deep in the lesser trochanter. The calcar femorale forms a complete internal weight bearing system with the stress-resistant trabecula and the stress-resistant trabecula， which is a part of the overall weight bearing system and a supplement and reinforcement of the external weight bearing system. Osteopaedics are familiar with the definition of the calcar femorale， but the calcar femorale is sometimes misunderstood when actually working as a bony plate within cancellous bone on X-ray. The structure of the calcar femorale is often mistaken for primary medial compression battress of the femoral neck. Therefore， through literature review， this article redefined the definition of calcar femorale， further summarized the site and structural characteristics of calcar femorale ， and systematically described its role in the lower neck of femur and lesser trochanter area as well as its position in the weight-bearing system.
Total knee arthroplasty （TKA） is widely carried out in clinical practice and can significantly improve the quality of life of patients with end-stage knee joint diseases. With the continuous improvement of the design of artificial knee joint prosthesis and the increase of the elderly population， the number of patients receiving total knee arthroplasty has increased year by year. As one of the postoperative complications of TKA， the incidence of periprosthetic distal femoral fracture （PDFF） has also gradually increased. Most of the PDFF patients are elderly， often accompanied by osteoporosis and various underlying diseases. Compared with conventional fractures， the patient's condition is more complex and difficult to manage. Orthopedic doctors are required to not only develop treatment plans based on the type of fracture， but also comprehensively evaluate the overall condition and consider the reconstruction of joint function. This article reviewed the research status of incidence rate， fracture classification and treatment of PDFF after TKA in recent years.
Knee osteoarthritis （KOA） has become an important factor affecting the quality of life of the elderly. Studies have shown that early KOA is mainly confined to the single compartment. For unicompartmental KOA， unicompartmental knee arthroplasty （UKA） has become an important treatment. Compared with total knee arthroplasty （TKA）， UKA has significant advantages， but the long-term survival of the prosthesis is lower. Among the factors affecting the survival rate of UKA prosthesis， the position of the prosthesis is one of the important factors， so it is crucial to choose the appropriate position of the prosthesis during the surgical procedure. In this study， by searching the keywords "unicompartmental knee arthroplasty"， "fixedbearing"， "prosthesis"， "appropriate position" in Pubmed， Medline， Clinical Key， China National Knowledge Infrastructure（CNKI）， Wanfang， and China Science and Technology Journal Databases（VIP）. Relevant literature in recent years was collected and organized. In summary， the femoral prosthesis should be placed in the coronal plane at the center of the femoral condyle， in the sagittal plane between flexion of five degrees and extension of 10°， and in the transverse plane between internal and external rotations of three degrees. The tibial prosthesis can be placed in the coronal plane in a neutral position or in a mildly inverted position， and in the sagittal plane between zero and eight degrees， but the anatomical posterior slope angle of the patient has to be taken into account. In the transverse plane， internal and external rotations of three degrees should be chosen. The difference in height between the preoperative and postoperative joint lines should be limited to less than two minimeters.The above summarization is expected to provide clinicians with a reference to improve the accuracy of prosthesis placement in unicompartmental knee arthroplasty and to improve the long-term survival of the prosthesis.
Knee osteoarthritis （KOA） has a high incidence in middle-aged and elderly people，which seriously affects the quality of life of middle-aged and elderly people. It has become one of the main diseases leading to joint deformities in middle-aged and elderly people. Due to the serious consequences of KOA， it is currently advocated to intervene in the early and middle stages of KOA. Arthroscopic surgery is one of the options for the treatment of KOA in the early and middle stages due to its unique advantages. When arthroscopic surgery is applied to KOA in the early and middle stage， its main functions are to repair damaged cartilage， remove hyperplastic osteophytes， and clean up diseased synovial tissue， which can greatly relieve the symptoms of patients， delay the progression of KOA， and delay the time of joint replacement. By screening the relevant literature from July 2013 to April 2024， this article reviewed the related research on arthroscopic surgery in the treatment of early and mid-stage KOA from the aspects of arthroscopic surgery to repair articular cartilage defects， arthroscopic surgery combined with other methods to treat KOA， and the long-term efficacy of arthroscopic surgery， in order to provide a theoretical basis for the application of arthroscopic surgery in the early and middle stage of KOA.
Medial compartment knee osteoarthritis is the main type of knee osteoarthritis. Some existing studies have found a close relationship between coronaltibiofemoral subluxation and knee osteoarthritis，but the impact of the coronal tibial-femoral subluxation （CTFS） is rarely considered in the X-ray evaluation of knee osteoarthritis （OA）. Open wedge high tibial osteotomy （OWHTO） is a commonly used knee-preserving treatment method that can correct knee joint deformities， adjust lower limb alignment， change joint load distribution， and improve symptoms of knee osteoarthritis. Studies have shown that performing OWHTO on patients with medial compartment knee osteoarthritis can improve the biomechanical status of the knee joint and promote the recovery of knee joint function. This article summarized the relationship between medial compartment knee osteoarthritis and CTFS， the measurement of CTFS， and the correction of CTFS by OWHTO in recent years， providing better reference for clinical work.
While the long-term survival and outcomes of total knee arthroplasty are remarkable，revisions due to a variety of reasons cannot be ignored. At the same time， as the population is aging and the average life expectancy of a human being far exceeds the life expectancy of a prosthesis， the challenge of rising demand for revisions needs to be addressed. The incidence of instability after total knee arthroplasty has been growing significantly， and dislocation events continue to be observed in the clinic. Based on all these， this article systematically reviewed the current literature with regard to dislocations of the tibiofemoral joints following total knee arthroplasty， and provided an overview of the diagnostic， etiologic， and therapeutic research， with the aim of improving the ability to face this rare but catastrophic clinical episode， as well as to be able to maximize the therapeutic outcome， improve the clinical prognosis， and help to reduce the risk of possible revisions.
To investigate the clinical effect of free anteriolateral thigh perforator flap with fascia lata to repair the complex soft tissue defect of foot and ankle.
Methods
From January 2017 to January 2022，the anterolateral femoral perforator flap wih fascia lata was used to repair the sof tissue defect in 15 cases of foot and ankle injury in Foshan Gaoming District People's Hospital . The soft tissue defect area was （5.0×7.0） cm2 to （9.5×15.0） cm2. After discharge，the patients were followed up in outpatient clinic or wechat， including the appearance color， sensation of the flap， functional recovery of the foot and ankle and the donor site.
Results
All 15 cases of free anteriolateral thigh perforator flaps survived， two cases of flaps were found vascular crisis 48 h after operation， the flaps suvived after emergency investigation. All the cases were followed up for 10 to 18 months， with an average follow-up time of （12.0±0.6） months. 10 cases were followed up in outpatient department and five cases were followed up on Wechat. The 15 cases had good appearance， no obvious pigmentation soft texture of the flap， nor influence on ankle joint movement .The two-point resolution of the flap was nine to 12 mm， with an average of （9.00±0.20） mm. According to the AOFAS ankle-hind foot score， 10 cases were excellent and five cases were good. The donor site of the skin flap healed well， 13 cases of the donor area were sutured linearly， two cases of the donor area could not be sutured directly， and the donor site healed after free skin graft ，there was no obvious muscle loss in the thigh of the donorsite.
Conclusion
Free anteriolateral thigh perforator flap with fascia lata can be transplanted to repair the complex tissue defect of foot and ankle， the flap can be cut with large area， flexible texture， early functional exercise good ankle function recovery， little damage in the donor site， and suitable for clinical.
To evaluate the implementation effect of "internet + home nursing service"after total hip arthroplasty （THA） in the elderly.
Methods
A convenience sampling method was employed to include 60 elderly patients who underwent THA at the First People's Hospital of Guangzhou.Using the random number table method， thepatients were randomly divided into an intervention group and a control group， with 30 patients in each group. The intervention group received "internet + home nursing service"， while the control group received routine nursing care. Hip function， self-care ability， ability to daily living， quality of life， and the incidence of complications were evaluated atone， three， and sixmonths after discharge.The data analysis was compared using repeated measures analysis of variance and chi square tests.
Results
The interaction effects between the two groups about hip function， self-care ability， daily living ability， and quality of life scores before and after the intervention were statistically significant （F=23.401， 11.675， 9.863， 2.967， all P＜0.05）； the intervention group performed significantly better in these indicators compared to the control group. The incidence of complications was lower than that in the control group （χ2=5.880， P＜0.05）.
Conclusion
"Internet +home nursing service" can effectively improve the self-care and daily living ability of elderly patients after THA， effectively promote the recovery of hip function， reduce the incidence of complications， and improve the quality of life.
To evaluate the application and effectiveness of a combined hierarchical teaching and virtual simulation teaching （HT-ST） method in the standardized training of orthopedic residents.
Methods
Forty orthopedic residents who received specialized training from September 2021 to September 2022 were selected as the experimental group， and applied a combined hierarchical and virtual simulation teaching approach. Eligible students were stratified based on elements such as years of study and academic performance， and teaching content was restructured according to the stratification of students. Orthopedic theory and clinical skills were implemented through stratified teaching， combined with virtual arthroscope and virtual operating room. The control group consisted of 41 residents trained from September 2020 to September 2021，who received hierarchical teaching only. Both groups were assessed on professional knowledge， clinical thinking ability， clinical work capability， and clinical skill proficiency， and all participants completed a satisfaction survey. T test was used for the measurement data， and Mann-Whitney U test was used for the counting data.
Results
The experimental group demonstrated significantly better performance in professional knowledge acquisition （t=5.851， P＜0.001） and clinical thinking （t=7.942， P＜0.001）. The work capability including disease inquiry and physical examination （t=5.369）， disease diagnosis （t=6.178）， disease treatment （t=6.197），communication with patients （t=6.597）， and case writing （t=6.955） were all better in the experimental group than the control group （all P＜0.001）. The clinical skills including basic first aid skills （t=6.553），physical examination （t=7.176）， orthopedic basic skills （t=7.321） 3， imaging judgment （t=7.387）， operation disinfection and draping （t=8.744） were also better in the experimental group than the control group （all P＜0.001）. The members in the experimental group showed a higher level of satisfaction with the HT-ST method.
Conclusion
The integration of hierarchical teaching with virtual simulation teaching significantly enhanced the training outcomes for orthopedic residents and is considered an effective instructional method. However， the results require further validation with a broader sample.
