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28 January 2026, Volume 30 Issue 3 Previous Issue    Next Issue

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Finite element analysis for three different types of internal screw fixation in treatment of severe lumbar 1 vertebral body fractures Shang Depeng, Wei Haiyu, Yang Fan 2026, 30 (3):  537-545.  doi: 10.12307/2026.579 Abstract ( 17 )   PDF (2832KB) ( 27 )   Save BACKGROUND: The surgical treatment of severe lumbar fractures is mainly based on posterior short-segment fixation, and different pedicle screw fixation methods have differences in biomechanical properties. OBJECTIVE: To simulate three different screw fixation techniques in the treatment of severe L1 vertebral fractures using three-dimensional finite element technology, and to compare and analyze the biomechanical characteristics of the upper and lower intervertebral discs, fractured vertebrae, and internal fixation devices during the simulated spinal movement. METHODS: A three-dimensional model of the T11-L3 spine was established to simulate severely unstable fracture of the lumbar 1 vertebral body using the designed three pedicle screw fixation methods: Model A with 4 traditional pedicle screws (2 in each T12 and L2), model B with 4 Universal Spine System pedicle screws (2 in each T12 and L2), and Model C were bilateral intermediate fixation with 6 pedicle screws (2 in each of T12, L1, and L2). Restraint and load were applied to simulate the maximum stress and maximum displacement of the internal fixation, the displacement of the L1 vertebral body, and stress on the intervertebral discs superior and inferior to the injured vertebra during the anterior flexion, posterior extension, left-sided bending, right-sided bending and left-right rotation of the lumbar spine.  RESULTS AND CONCLUSION: (1) The maximum displacement and motion range of the lumbar 1 vertebra with Model C in flexion and extension, left bending, right bending, left rotation, and right rotation were lowest in the tested motion states; the maximum stress of the screws and connecting rods was the smallest; and the maximum stress of intervertebral discs superior and inferior to the injured vertebra was the smallest. This was followed by the Model B, while the maximum displacement and motion range of the lumbar 1 vertebra and the stress and displacement of the screw connecting rod in the Model A were highest, but it showed the worst biomechanical stability and was more prone to adjacent segment degeneration. (2) These results show that bilateral intermediate fixation with six pedicle screws during the treatment of severe lumbar fractures is more dispersed in internal fixator stress and exhibits the least displacement and motion range of the vertebral pedicle screws and rods compared with four universal spinal system pedicle screws and four traditional pedicle screws. Thus, it can effectively reduce the occurrence of internal fixation failure and the adjacent segment degeneration. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of internal fixation with new retrograde intramedullary nail on lateral femur condyle for distal type A2 femur fractures Yu Xinlin, Chen Huiyu, Wang Yingying, Guo Weizhong, Feng Bin Lin Chengshou, Lin Wang 2026, 30 (3):  546-552.  doi: 10.12307/2025.864 Abstract ( 16 )   PDF (3221KB) ( 2 )   Save BACKGROUND: Plate fixation is the mainstream method for the surgical treatment of distal femoral fractures. The intramedullary nailing has the advantages of minimally invasive, such as less soft tissue injury and bone blood supply destruction. At the same time, it is a central fixation and has better biomechanical effect. Therefore, retrograde intramedullary nailing has become another option for the internal fixation of distal femoral fractures. OBJECTIVE: The biomechanical characteristics of new retrograde intramedullary nail on lateral femur condyle, common femoral retrograde intramedullary nail, and lateral femur condyle anatomical locking plate for the treatment of A2-type distal femoral fractures were compared using finite element analysis, and the advantages of new retrograde intramedullary nail on lateral femur condyle was studied. METHODS: A new retrograde intramedullary nail on lateral femur condyle was designed, which was inserted into the bone cortex in front of the insertion point of the lateral collateral ligament of the lateral femoral condyle. A CT scan was performed on the lower limb bone of a male volunteer, and a three-dimensional model of the femur was established. The model was then segmented to create a three-dimensional model of a femoral distal A2-type fracture, The three-dimensional models of small (small group), standard type retrograde intramedullary nail on the lateral femoral condyle (standard group), common retrograde intramedullary needle (common group), and lateral femur condyle anatomical locking plate (plate group) were established respectively. The axial stresses of 600, 1 800 N and the torsional load of 4 000, 8 000 N·mm were applied to the models, and the displacement and stress of femur and the displacement, stress and shear force of internal fixators were observed in each group. RESULTS AND CONCLUSION: (1) When subjected to axial load of 600 and 1 800 N, the femoral peak displacement, the femoral peak stress, and the peak stress of interal fixation in the standard group were the lowest among the four groups. (2) When subjected to torsional load of 4 000 and 8 000 N·mm, the femoral peak displacement and peak displacement of the internal fixation in the standard group were the lowest among the four groups. (3) Compared with femoral lateral condylar locking plate and common retrograde intramedullary needle, the new retrograde intramedullary needle on lateral femur condyle has mechanical advantages of reducing stress concentration and decreasing the risk of internal fixation failure. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis comparing lumbar fusion and artificial intervertebral disc replacement Zhao Jingang, Liu Liping, Chen Jianwei, 2026, 30 (3):  553-560.  doi: 10.12307/2025.870 Abstract ( 21 )   PDF (2343KB) ( 9 )   Save BACKGROUND: Lumbar degenerative disease is a disease of the musculoskeletal system that primarily affects the intervertebral structures, and the disease is treated with lumbar fusion and disc replacement. OBJECTIVE: To conduct comparative analysis of the differences between lumbar fusion, mechanical lumbar disc prosthesis replacement, and viscoelastic lumbar disc prosthesis replacement. METHODS: The computerized tomography images of a healthy adult were used to construct a finite element model of the L2-L5 normal lumbar spine with Mimic, Geomagic, and Ansys software. The equipment required for lumbar fusion and lumbar spine replacement was constructed using modeling software, and the L3-L4 segment of the lumbar spine was processed according to the surgical requirements for lumbar fusion and intervertebral disc replacement, creating the corresponding finite element model. Specific boundary conditions were applied to extract the mobility of each lumbar spine segment, the stresses on the neighboring intervertebral discs, and the stresses on the prosthesis lining. RESULTS AND CONCLUSION: (1) Compared with the preoperative period, the maximum stress in the upper neighboring discs increased by 64.09% and 39.79% in the forward flexion and lateral bending states if the original mobility was maintained after lumbar fusion surgery. The maximum stress in the lower neighboring discs increased by 24.39% and 20.98% in forward flexion and lateral bending. This suggested that the upper adjacent discs would suffer greater stress changes than the lower adjacent discs during heavy physical labor. (2) Disc replacement did not show significant changes in adjacent disc stress, with mechanical prosthesis replacement slightly reducing adjacent disc stress, while viscoelastic prosthesis replacement was more in line with the biological properties of the disc, with maximum adjacent disc stress similar to that of the preoperative period. (3) In terms of stability, the mechanical prosthesis replacement segment showed a 51.67% increase in range of motion in the lateral bending state and a 53.27% increase in range of motion in the posterior extension state, whereas the viscoelastic prosthesis was better able to maintain mobility in the replacement segment. (4) In addition, the stresses in the liner of the mechanical prosthesis were mainly concentrated in the edge region, and this stress distribution may lead to edge wear and thus affect the service life of the prosthesis. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of stress distribution of anchors at different implantation depths under different bone density conditions in rotator cuff tears Wang Meng, Lu Tan, Li Minjie, Liu Zhicheng, Guo Xiaoyong 2026, 30 (3):  561-569.  doi: 10.12307/2025.877 Abstract ( 22 )   PDF (2470KB) ( 1 )   Save BACKGROUND: Arthroscopic anchor repair has become the main treatment method for rotator cuff tears at present. Among them, the insertion status of the anchor is a key factor in the success or failure of the operation. However, currently, the impact of the insertion depth of the anchor on the stress of the bone tunnel and the anchor under different bone density conditions remains unclear. OBJECTIVE: To explore the stress distribution of the bone tunnel and the anchor when the insertion depth of the anchor varies under different bone density conditions by using three-dimensional finite element analysis technology. METHODS: The CT image data of the humerus of volunteers were collected, and the models of the humerus and the anchor were constructed by using Mimics, 3-Matic, and Solidworks software. In 3-Matic, holes with distances of 0, 2, 4, 6, and 8 mm from the surface of the humerus were respectively created at the same position of the humerus and assembled with the anchor. In Mimics, values were assigned based on the CT gray value to obtain a model with normal bone mass (T value ≥ -1.0). The parameters were changed to construct models with reduced bone mass (-2.5 < T value < -1.0) and osteoporosis (T value ≤ -2.5). In each model, a 70 N pulling force was applied to the anchor along the direction tangent to the inner edge of the bone tunnel. The stress distribution and magnitude of the bone tunnel and the anchor when inserted at different depths under different bone density conditions were observed. RESULTS AND CONCLUSION: (1) When the insertion depth was the same, as the bone density decreased, the maximum equivalent stress of the anchor increased, while the maximum equivalent stress of the bone tunnel decreased. (2) When the bone density was the same, as the insertion depth of the anchor increased, the maximum equivalent stress of the anchor decreased. When the insertion depth was 4 mm, the stress of the bone tunnel was the smallest and the distribution was relatively uniform. The stress of the anchor was mainly distributed around the lower anchor hole and the proximal thread, and the stress of the bone tunnel was mainly at the part in contact with the proximal thread. The increase in the insertion depth would change the uniformity and pattern of the stress distribution, while the bone density had a relatively small impact on the stress distribution pattern. (3) It is concluded that the bone density of the humerus is crucial for the anchor repair of rotator cuff tears. It is recommended that clinicians measure the bone density of the greater tuberosity of the humerus before the operation. Excessive insertion depth of the anchor does not significantly increase its stability. Clinicians can conduct personalized preoperative assessments by using the finite element analysis method in combination with the actual situation of patients to achieve the best surgical results. Figures and Tables | References | Related Articles | Metrics

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High tibial osteotomy on a single plane: femorofibular angle as a reference marker for mechanical axis correction Li Xiaomin, Tian Xiangdong, Wang Chaolu 2026, 30 (3):  570-576.  doi: 10.12307/2025.909 Abstract ( 17 )   PDF (1311KB) ( 4 )   Save BACKGROUND: The femorofibular angle is a commonly used reference angle for mechanical axis correction in high tibial osteotomy on a single plane, but there has been no in-depth study on the application of this angle in high tibial osteotomy on a single plane.  OBJECTIVE: To explore the application effect of the femorofibular angle as a reference for mechanical axis correction in high tibial osteotomy on a single plane.  METHODS: A retrospective analysis was conducted on 64 cases of knee osteoarthritis patients who underwent high tibial osteotomy on a single plane at Third Affiliated Hospital of Beijing University of Chinese Medicine from January 2023 to January 2024. The patients were grouped according to the intraoperative mechanical axis correction reference method. The observation group consisted of 32 cases, which used the femorofibular angle as a reference for mechanical axis correction during surgery. The control group consisted of 32 cases, which used electrocautery line measurement as a reference for mechanical axis correction during surgery. Both groups received the same perioperative treatment and management. The lower limb mechanical axis ratio, hip-knee-ankle angle, proximal medial tibial angle, and femorofibular angle were recorded before and after surgery to assess changes in the lower limb mechanical state. The operation time and number of fluoroscopies were recorded. The visual analog scale score and Lysholm score for pain and knee function were recorded before surgery and at 1 and 3 months after surgery to evaluate changes in knee pain and function.  RESULTS AND CONCLUSION: (1) All patients completed the treatment and follow-up, and no serious adverse events occurred. (2) Before surgery, there was no statistically significant difference in the lower limb mechanical axis ratio, proximal medial tibial angle, hip-knee-ankle angle, and femorofibular angle between the two groups (P > 0.05). At 3 months after surgery, the lower limb mechanical axis ratio, proximal medial tibial angle, hip-knee-ankle angle, and femorofibular angle were significantly improved in both groups compared to before surgery, with statistically significant differences (P < 0.05). There was no significant difference between the two groups (P > 0.05). (3) During surgery, the operation time and number of fluoroscopies in the observation group were less than those in the control group, with statistically significant differences (P < 0.05). (4) At each follow-up point before and after surgery, there was no statistically significant difference in the visual analog scale score and Lysholm score between the two groups (P > 0.05). With the passage of time after surgery, the visual analog scale score and Lysholm score in both groups were significantly improved compared to before surgery (P < 0.05). (5) It is suggested that the application of the femorofibular angle as a reference for mechanical axis correction in high tibial osteotomy on a single plane can accurately locate the range of lower limb mechanical axis correction, is simple and reliable, and reduces the number of fluoroscopies and operation time compared to traditional electrocautery line measurement. Figures and Tables | References | Related Articles | Metrics

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Endoscopic lumbar canal decompression for upper lumbar spinal stenosis: a comparison of biomechanical stability of three surgical models Ma Jingbo, Yang Guangnan, Liu Jiang, Jiang Qiang, Zhang Hanshuo, Han Jiaheng, Ding Yu 2026, 30 (3):  577-585.  doi: 10.12307/2026.545 Abstract ( 22 )   PDF (1990KB) ( 6 )   Save BACKGROUND: Upper lumbar spinal stenosis is a multifactorial degenerative disorder of the spine. For narrowing of the spinal canal in the upper lumbar region (L1-L4), surgical decision-making is particularly complex. Existing minimally invasive surgeries each have their own advantages and limitations. Currently, there are few reports on biomechanical comparison and finite element analysis of different surgical methods for the treatment of high lumbar spinal stenosis.  OBJECTIVE: To analyze the biomechanical impact of endoscopic unilateral laminotomy for bilateral decompression, transforaminal endoscopic lumbar decompression, and cross-overtop decompression in the treatment of upper lumbar spinal stenosis using endoscopy, and to verify the reliability and effectiveness of these three surgical techniques in treating upper lumbar spinal stenosis, providing a biomechanical basis for clinical decision-making. METHODS: The CT images of the lumbar spine of a healthy volunteer were selected, and the finite element model M0 of the normal lumbar L1-L5 segments was established using Mimics, Geomagic, Solid works, and Ansys software. The L2-L3 segment, representing upper lumbar characteristics, was chosen. Based on this model, the surgical models for endoscopic unilateral laminotomy for bilateral decompression (M1), transforaminal endoscopic lumbar decompression (M2), and cross-overtop decompression (M3) were established. Using software, the changes in the range of motion of the entire lumbar segment and the maximum Von Mises stress of the intervertebral discs were simulated and evaluated for each group of models under six loading conditions: flexion, extension, left lateral bending, right lateral bending, left rotation, and right rotation. RESULTS AND CONCLUSION: (1) Compared with model M0, the range of motion in M1, M2, and M3 increased under all six conditions, with M1 showing a greater increase. (2) M1 and M2 demonstrated significant increases in range of motion under forward bending, extension, and right rotation, while the increase under other conditions remained below 7%. (3) Compared with model M3, model M1 exhibited slightly increased overall joint range of motion during extension and left bending, while no significant changes were observed in other aspects, and the L1-L5 lumbar segments did not reach an unstable state. (4) In model M1, the maximum Von Mises stress of the intervertebral discs increased most significantly under flexion and extension loading conditions. However, under left lateral bending, right lateral bending, left rotation, and right rotation loading conditions, the increase did not exceed 5%. (5) These findings suggest that due to the sagittal anatomical characteristics of the facet joints, the unilateral laminotomy for bilateral decompression technique, while decompressing, involves resection of more facet joints, which impacts overall segmental stability. The transforaminal endoscopic lumbar decompression technique is suitable for patients with foraminal stenosis but cannot achieve complete decompression for those with severe ventral central stenosis. The Cross-Overtop technique effectively enlarges the volume of the central canal and lateral recess, optimizing decompression, and shows unique advantages in treating upper lumbar spinal stenosis. Figures and Tables | References | Related Articles | Metrics

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Effects of three internal fixation techniques on biomechanics of adjacent segment degeneration in lumbar interbody fusion Abudusalamu·Tuoheti, Xiao Yang, Wang Yixi, Musitapa·Mijiti, Chen Qihao, Maimaitiming·Saiyiti, Guo Hailong, Paerhati·Rexiti 2026, 30 (3):  586-595.  doi: 10.12307/2025.865 Abstract ( 21 )   PDF (1840KB) ( 6 )   Save BACKGROUND: In 2019, the modified cortical bone trajectory technique was proposed by our team, significantly improving traditional methods. Previous studies have highlighted its superior biomechanical properties for segment fixation. However, a comprehensive systematic analysis of its specific biomechanical effects on adjacent segment degeneration is lacking, particularly regarding its influence on range of motion and intervertebral disc stress in posterior lumbar interbody fusion and transforaminal lumbar interbody fusion techniques. OBJECTIVE: To investigate the biomechanical effects of modified cortical bone trajectory screw techniques on adjacent segment degeneration in posterior lumbar interbody fusion and transforaminal lumbar interbody fusion. METHODS: CT scans were performed on three human cadaver specimens to establish and validate three-dimensional intact finite element models of the L1-S1 segment. For each of these, the posterior lumbar interbody fusion or transforaminal lumbar interbody fusion with three different fixation techniques was reconstructed at the L4-L5 segment. The L4-L5 segment was fixed using three different internal fixation techniques (modified cortical bone trajectory, cortical bone trajectory, and traditional pedicle screws). The range of motion and von Mises stress of the intervertebral disc of the L3-L4 and L5-S1 segments were recorded with a 400 N compressive load and 7.5 N moments in flexion, extension, left-right bending, and left-right rotation. The impacts of the three internal fixation techniques on adjacent segment degeneration in the two kinds of fusion were compared and analyzed.  RESULTS AND CONCLUSION: (1) In the posterior lumbar interbody fusion model, the modified cortical bone trajectory screw group showed a reduced range of motion on adjacent segments (L3-L4, L5-S1) under six loading conditions compared to both the cortical bone trajectory screw group and traditional bone trajectory screw group. Specifically, the modified cortical bone trajectory screw group significantly reduced the maximum stress on the intervertebral disc in the superior adjacent segment (L3-L4) during extension compared to the traditional bone trajectory screw group (P=0.005), while the stress on the intervertebral disc in the inferior adjacent segment (L5-S1) exhibited greater dispersion. Similarly, the cortical bone trajectory screw group also significantly reduced the maximum stress on the intervertebral disc in the superior adjacent segment (L3-L4) during extension compared with the traditional bone trajectory screw group (P=0.03). (2) Compared with transforaminal lumbar interbody fusion, the three internal fixation techniques (modified cortical bone trajectory, cortical bone trajectory, and traditional pedicle screws) showed a trend of reduced range of motion in the inferior adjacent segment (L5-S1) under six loading conditions. In contrast, the maximum stress on the intervertebral discs in both the superior and inferior adjacent segments (L3-L4, L5-S1) exhibited an increasing trend in the posterior lumbar interbody fusion model. (3) It is concluded that in the posterior lumbar interbody fusion model, the modified cortical bone trajectory screw exhibited superior biomechanical properties in reducing the range of motion at adjacent segments, which may have a beneficial effect on reducing the risk of adjacent segment degeneration. Figures and Tables | References | Related Articles | Metrics

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Correlation between spinal sagittal imbalance and knee joint parameters detected by whole-body EOS imaging Zhou Feng, Fu Pengfei, Qian Yufan, Xu Pingcheng, Guo Jiongjiong, Zhang Lei 2026, 30 (3):  596-603.  doi: 10.12307/2025.983 Abstract ( 19 )   PDF (1303KB) ( 0 )   Save BACKGROUND: With changing lifestyles and aging, sagittal spinal imbalance has become a common orthopedic issue significantly affecting knee and pelvic function. Understanding the impact of sagittal spinal imbalance and its compensatory mechanisms is crucial for improving the clinical management of chronic pain. OBJECTIVE: To evaluate the alignment of the spine-pelvis-lower extremities using whole-body EOS imaging, analyze the correlation between spinal sagittal imbalance and knee joint parameters, and explore their compensatory mechanisms. METHODS: A total of 71 patients with chronic low back pain or patellofemoral pain who visited Department of Orthopedics, First Affiliated Hospital of Soochow University between January 1, 2021 and December 31, 2023 were included. Radiographic measurements were performed using whole-body EOS to determine pelvic tilt, pelvic incidence, lumbar lordosis, sagittal vertical axis, global tilt, hip-knee-angle, knee flexion angle, lateral distal femoral angle, and medial proximal tibial angle. Patients were classified into normal group (pelvic incidence − lumbar lordosis < 10°), compensated group (10° ≤ pelvic incidence − lumbar lordosis ≤ 20°), and decompensated group (pelvic incidence − lumbar lordosis > 20°) based on the SRS-Schwab spinal deformity classification according to pelvic incidence − lumbar lordosis difference. The differences in radiographic parameters among the groups were analyzed. The differences in American Knee Society Knee Score and Oswestry Disability Index scores were compared among each group. Patients were divided into chronic low back pain group and non-chronic low back pain group, patellofemoral pain group and non-patellofemoral pain group based on clinical symptoms, and the relationship between radiographic parameter differences and clinical symptoms was analyzed. RESULTS AND CONCLUSION: (1) When pelvic incidence − lumbar lordosis was less than 20°, lateral distal femoral angle and medial proximal tibial angle tended to stabilize. When pelvic incidence − lumbar lordosis was greater than 20°, it showed a linear correlation with lateral distal femoral angle and medial proximal tibial angle, with lateral distal femoral angle increasing and medial proximal tibial angle decreasing with increasing pelvic incidence − lumbar lordosis values. (2) Compared with the normal group, the compensated group had significantly increased pelvic tilt (P < 0.01), while knee joint parameters hip-knee-angle and knee flexion angle showed no significant differences; the decompensated group showed significant increases in pelvic tilt (P < 0.01), and decreases in hip-knee-angle, and knee flexion angle (P < 0.01). Compared with the compensated group, the decompensated group showed a significant decrease in hip-knee-angle (P < 0.05), but had no significant differences in pelvic tilt and knee flexion angle. (3) Compared with the non-patellofemoral pain group, patients with patellofemoral pain had significant decreases in spinal lumbar lordosis, lateral distal femoral angle, and medial proximal tibial angle (P < 0.05) and a significant increase in pelvic incidence − lumbar lordosis (P < 0.05). (4) Patients with low back pain had significant differences in radiographic parameters compared with the non-chronic low back pain group (P < 0.05). (5) Compared with the normal group, both the compensated and decompensated groups showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores (P < 0.05). Compared with the compensated group, the decompensated group showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores (P < 0.05). (6) Pelvic incidence − lumbar lordosis values increased with age and were higher in females compared with males. (7) This study systematically reveals the spine and lower limbs play an important role in disease progression and clinical symptoms. Associated symptoms low back pain and patellofemoral pain are related to the stability of the spine-pelvis-lower extremity alignment. Furthermore, spinal sagittal imbalance is more severe in elderly and female patients. Figures and Tables | References | Related Articles | Metrics

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Application of 3D printed titanium cage cutting model in anterior cervical vertebrae subtotal decompression and bone graft fusion Jia Yingao, Gao Shitao, Wang Fei 2026, 30 (3):  604-611.  doi: 10.12307/2025.985 Abstract ( 15 )   PDF (1313KB) ( 3 )   Save BACKGROUND: As a mainstream surgical technique for the treatment of cervical spondylotic myelopathy through the anterior cervical subtotal decompression and bone graft fusion, it has many advantages. However, due to the high risk of this surgery and the particularity of the cervical anatomy, it is also a challenge for the surgeon. The gradual maturity of 3D printing technology and the continuous development of applications in the medical field are now able to provide more perfect personalized treatment. OBJECTIVE: To investigate the efficacy of 3D printed titanium cage cutting model in anterior cervical vertebrae subtotal decompression and bone graft fusion.  METHODS: Medical records of 57 patients undergoing anterior cervical corpectomy decompression and fusion surgery admitted to the Department of Spine Surgery of Affiliated Hospital of Yan’an University from April 2021 to April 2023 were retrospectively analyzed. According to whether the 3D printed titanium cage cutting model was used in the operation, the patients were divided into the traditional titanium cage bone grafting group (control group, n=30) and the 3D printed titanium cage model group (observation group, n=27). The general data, amount of blood loss during operation, number of C-arm X-ray machine fluoroscopy during operation, operation time, as well as anterior intervertebral edge height (H1), posterior intervertebral edge height (H2) and C2-C7 Cobb angle of the two groups measured on the cervical lateral X-ray films before, 3 days and 6 months after operation were recorded and analyzed. The settling degree of the titanium cage was assessed with the distance of the height of the anterior and posterior edges of the vertebral body at 3 days and 6 months after surgery. Visual analog scale was used to evaluate neck pain and Japanese Orthopaedic Association was used to evaluate nerve function.  RESULTS AND CONCLUSION: (1) Follow-up was conducted for at least 6 months. (2) The amount of intraoperative blood loss and fluoroscopy times in the observation group were less than those in the control group (P < 0.05). The operative time of the observation group was significantly shorter than that of the control group (P < 0.05). (3) There were no significant differences in C2-C7 Cobb angle, visual analog scale score, Japanese Orthopaedic Association score, anterior vertebral border height (H1) and posterior vertebral border height (H2) before surgery, 3 days and 6 months after surgery between the two groups  (P > 0.05). (4) There were five patients in the observation group (with severe subsidence rate of 19%) with severe subsidence at the anterior and posterior edges of the surgical segment, and seven patients in the control group (with severe subsidence rate of 23%) with severe subsidence (H1 or H2 subsidence ≥3 mm) at the surgical segment 6 months after surgery. There was no significant difference in the rate of severe subsidence of titanium cage between the two groups (P > 0.05). (5) At the last follow-up, bone fusion was achieved at the operative level in both groups, and there was no statistical significance in bone graft fusion rate between the two groups (P > 0.05). (6) The results showed that the application of 3D printed titanium cage cutting model in anterior cervical corpectomy decompression and fusion surgery had the same clinical effect as that of traditional surgery, but the former could effectively reduce the fluoroscopy times of C-arm X-ray machine, the amount of blood loss and the operation time, and had unique advantages in the pruning and implantation of titanium cage during surgery.  Figures and Tables | References | Related Articles | Metrics

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Safety of 3D printed titanium alloy bone trabecular cup prosthesis combined with modified Kidney Tonifying and Blood Activating Decoction for elderly hip arthroplasty Wang Jiangjing, Zhao Na, Hu Xiaona, Zhao Na 2026, 30 (3):  612-619.  doi: 10.12307/2025.872 Abstract ( 20 )   PDF (1165KB) ( 5 )   Save BACKGROUND: The titanium alloy bone trabecular bone socket cup prosthesis printed by 3D technology has superior biological characteristics, which helps to promote osteogenic differentiation of stem cells. The Kidney Tonifying and Blood Activating Decoction has the functions of tonifying the kidneys, strengthening tendons, promoting blood circulation, and relieving pain. However, the application of the combination of the two in elderly hip arthroplasty is rarely reported. OBJECTIVE: To evaluate the application value and safety of 3D printed titanium alloy bone trabecular cup prosthesis combined with modified Kidney Tonifying and Blood Activating Decoction in elderly hip arthroplasty.   METHODS: A total of 200 elderly patients who received hip arthroplasty in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2022 to January 2024 were selected and randomly divided into control group (n=100) and trial group (n=100). The control group underwent Pinnaele cup prosthesis hip arthroplasty combined with modified Kidney Tonifying and Blood Activating Decoction, while the trial group underwent 3D printed titanium alloy bone trabecular cup prosthesis hip arthroplasty combined with modified Kidney Tonifying and Blood Activating Decoction. The medication was taken continuously for 1 week before hip arthroplasty and for 4 weeks after arthroplasty. The differences in pain, swelling, hemorheology, inflammatory factors, bone metabolism, intra-articular stress, and hip abduction muscle strength were compared between the two groups to evaluate the clinical efficacy and safety of the two treatment options.  RESULTS AND CONCLUSION: (1) Four weeks after surgery, the pain visual analog scale score, limb swelling, whole blood viscosity, and plasma viscosity of the trial group were lower than those of the control group (P < 0.05). The interleukin-6 level of the trial group was lower than that of the control group, and the interleukin-10 level was higher than that of the control group (P < 0.05). The levels of type I collagen carboxyl terminal peptide β specific sequence and tartrate-resistant acid phosphatase 5b in the trial group were lower than those in the control group, while the levels of osteocalcin, bone-specific phosphatase and type I procollagen amino-terminal propeptide were higher than those in the control group (P < 0.05). The intra-articular stress and hip abduction muscle strength in the trial group were higher than that of the control group (P < 0.05). (2) Three months after surgery, the excellent and good treatment rate in the trial group was higher than that in the control group, and the incidence of safety evaluation events such as postoperative incision hematoma and infection was lower than that in the control group (P < 0.05). (3) It suggests that 3D printed titanium alloy trabecular acetabular cup prosthesis combined with modified Kidney Tonifying and Blood Activating Decoction can improve the blood rheology of elderly patients with hip arthroplasty, inhibit inflammatory response, reduce postoperative pain and swelling, and enhance bone metabolism, thereby promoting postoperative hip joint function recovery, and reducing the incidence of adverse events, with high safety.    Figures and Tables | References | Related Articles | Metrics

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Univariate and multivariate regression analysis of femoral neck shortening after cannulated screw fixation in femoral neck fractures Xu Xinbao, Chen Feiyang, Chen Yinbing, Zhang Feixiang, Lyu Shujun, Cui Haidong, Chen Zhigang 2026, 30 (3):  620-625.  doi: 10.12307/2025.931 Abstract ( 21 )   PDF (832KB) ( 3 )   Save BACKGROUND: With the development of the aging trend of society, the incidence of femoral neck fractures is increasing. Currently, the preferred surgical treatment is cannulated screw internal fixation. However, post-surgical femoral neck shortening occurs in some cases, resulting in impaired hip functionality. OBJECTIVE: To investigate the incidence of femoral neck shortening following the use of half-threaded cannulated screws for internal fixation in patients with femoral neck fractures, to analyze the effect on hip function, and to identify factors contributing to neck shortening.   METHODS: A retrospective analysis was conducted on the medical records of 102 patients treated with half-threaded cannulated screws in an inverted triangle setup for femoral neck fractures at Affiliated Hai’an Hospital of Nantong University from January 2016 to January 2021. This group included 36 males and 66 females at the mean age of (57.2±7.7) years, with 34 cases of Garden type I and II fractures and 68 of Garden type III and IV fractures. The mean bone mineral density value T was -2.8 SD. The Harris score was used to evaluate the hip function. During the follow-up period, the occurrence of femoral neck shortening was determined using X-ray imagery, and the factors influencing this shortening were examined using both univariate and multivariate regression analyses. RESULTS AND CONCLUSION: (1) Among the 102 patients with femoral neck fractures, 30 patients developed femoral neck shortening, accounting for 29.4%. 72 patients had no femoral neck shortening (70.6%). (2) The Harris score for patients experiencing neck shortening was significantly lower than that for patients without shortening (P < 0.05). (3) The study identified several factors associated with femoral neck shortening following the internal fixation of femoral neck fractures included age, gender, bone mineral density value T, preoperative Garden classification, and quality of reduction. These factors not only affect the shortening of the femoral neck after surgery, but are also directly related to the functional performance of the patient’s hip joint. (4) Femoral neck shortening after surgery for femoral neck fracture is associated with various clinical parameters, especially the patient’s age, gender, bone mineral density, preoperative classification, and accuracy of reduction during surgery. Figures and Tables | References | Related Articles | Metrics

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Establishment and validation of a model for femoral head necrosis after internal fixation of femoral neck fracture using logistic regression and SHAP analysis Liao Long, Zhao Zepeng, Li Zongyuan, Yu Qinglong, Zhang Tao, Tang Jinyuan, Ye Nan, Xu Han, Shi Bo 2026, 30 (3):  626-633.  doi: 10.12307/2025.866 Abstract ( 18 )   PDF (1379KB) ( 2 )   Save BACKGROUND: The most common complication of traumatic femoral neck fractures after internal fixation is femoral head necrosis. Currently, many studies have reported on the risk factors that affect the occurrence and development of postoperative femoral head necrosis, but there is still a lack of tools to predict the risk of femoral head necrosis after internal fixation of femoral neck fractures. OBJECTIVE: To develop a predictive model that estimates the risk of femoral head necrosis shortly after patients with femoral neck fractures receive cannulated screw internal fixation. METHODS: A retrospective analysis reviewed clinical records of 172 patients who underwent cannulated screw internal fixation for femoral neck fractures at Department of Orthopedics of Mianyang Central Hospital from January 2013 to June 2023. Patients were categorized into two groups based on the presence or absence of femoral head necrosis within one year post-operation: the necrosis group and the non-necrosis group. Univariate analysis, Lasso regression, and multivariate Logistic regression techniques were employed to identify the determinants of femoral head necrosis. A nomogram prediction model was constructed using R language's "rms" package, version 4.0. The receiver operating characteristic curve was used to evaluate the discriminatory ability of the model. The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model, and the decision curve analysis was used to determine its clinical application benefits. Internal validation of the study was conducted using the Bootstrap method, involving 1 000 repeated samplings. To delve deeper into the primary factors influencing femoral head necrosis post-internal fixation of the femoral neck, this paper employed the SHAP method for data set analysis.  RESULTS AND CONCLUSION: (1) The risk factors leading to femoral head necrosis in the short term after cannulated screw fixation of femoral neck fractures include: smoking, diabetes, Garden classification, fracture line location, reduction quality, age, and operation time. (2) The prediction model demonstrated robust performance, evidenced by an area under the curve of 0.940 (95% Confidence Interval: 0.903 to 0.977), indicating a high level of prediction accuracy. The model achieved a sensitivity of 90.2% and a specificity of 87.6%, indicating that its diagnostic performance was stable. The Hosmer-Lemeshow goodness-of-fit test yielded a chi-square value of 6.593 with a P-value of 0.581, confirming that the model’s predictions closely align with the observed outcomes. (3) The calibration curve of the model also performed well, and its overall trend was very close to the ideal curve, further proving the high accuracy of the model. (4) The internal validation was carried out by the Bootstrap method with 1 000 repeated samplings, and the area under the curve of the model internal validation was still as high as 0.939, proving that the model had good stability. (5) Through the decision curve, it is found that within the probability threshold range of 1% to 92%, the model can obtain the maximum net benefit value. (6) The SHAP analysis results show that among the risk factors analyzed in this study, the location of the fracture line serves as the most significant predictor of femoral head necrosis following internal fixation with cannulated screws in femoral neck fractures, and subcapital fractures are extremely prone to femoral head necrosis after surgery. (7) It is concluded that the validated prediction model demonstrates strong discriminative power and reliability, offering practical clinical utility. It serves as a useful reference tool for short-term risk assessment of femoral head necrosis following internal fixation of femoral neck fractures. Figures and Tables | References | Related Articles | Metrics

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Effect of sacroiliac joint ankylosis on outcomes of L5/S1 transforminal lumbar interbody fusion and lumbar sagittal parameters Wang Yalei, Wang Xuezhi, Zhou Tao, Shen Xinxin, Fang Ding, Chen Hongliang 2026, 30 (3):  634-641.  doi: 10.12307/2025.863 Abstract ( 18 )   PDF (1357KB) ( 8 )   Save BACKGROUND: The correlation between sacroiliac joint degeneration and lumbar degenerative disease has been analyzed in the literature in the past, but the clinical efficacy and imaging changes after interbody fusion with sacroiliac joint ankylosis in patients with lumbar degenerative disease have not been reported in the literature.  OBJECTIVE: To investigate the effect of sacroiliac joint ankylosis on the clinical efficacy and lumbar sagittal regression after L5/S1 single-segment transforminal lumbar interbody fusion in patients with lumbar degenerative disease. METHODS: Thirty-seven patients who underwent L5/S1 segmental transforminal lumbar interbody fusion for lumbar degenerative disease with sacroiliac joint ankylosis between June 2020 and September 2023 in Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed as group A. Thirty-seven patients with lumbar degenerative disease without sacroiliac joint ankylosis who were matched for general information during the same period were selected as controls in group B. Clinical efficacy was assessed using the Oswestry disability index and visual analog scale for lumbar and lower limb pain. The lumbar sagittal parameters included lumbar anterior convexity angle, lumbar partial anterior convexity angle, and lower lumbar anterior convexity angle. Pfirrmann grading was used to assess the degree of preoperative disc degeneration, postoperative endplate damage and screw loosening, and to record the fusion of the operated segments at the final postoperative follow-up visit. RESULTS AND CONCLUSION: (1) There was no statistically significant difference in age, body mass index, bone mineral density, operation time, intraoperative bleeding, preoperative primary diagnosis and postoperative follow-up time between the two groups (P > 0.05). (2) The preoperative Pfirrmann grading of lumbar disc degeneration in group A patients (3.4±0.9) was significantly higher than that of group B (3.1±0.6), and the difference was statistically significant (t=2.059, P=0.044). (3) All patients showed significant improvement in postoperative lumbar sagittal parameters compared with preoperative ones (all P < 0.05). During the follow-up period, there was a loss of correction in patients in group A. There was no statistical difference in the lumbar anterior convexity angle, lower lumbar anterior convexity angle, and local anterior convexity angle at the last follow-up compared with the preoperative period (P > 0.05). The lumbar anterior convexity angle, lower lumbar anterior convexity angle, and local anterior convexity angle in group A were significantly lower than those of group B patients at both preoperative and final follow-up, and the differences were statistically significant (all P < 0.05). (4) There was no statistically significant difference in postoperative endplate injury between the two groups (χ²=0.181, P=0.670), and screw loosening was significantly higher in group A than in group B, with a statistically significant difference (χ²=4.163, P=0.041). (5) At the last follow-up, the incidence of grade 3 fusion and grade 4 fusion was significantly higher in group A than in group B. The difference in the distribution of fusion grades between the two groups was statistically significant (χ²=7.848, P=0.031). (6) The Oswestry disability index and lower limb visual analog scale scores at the last follow-up of both groups were significantly improved compared with the preoperative period (P < 0.05).The visual analog scale scores for low back pain at 3 months after surgery and at the last follow-up of group A were significantly higher than those of group B (t=2.010, P=0.048; t=2.133, P=0.036). (7) It is concluded that regardless of whether it is accompanied by sacroiliac joint ankylosis or not, lumbar degenerative disease patients who undergo interbody fusion with foramen magnum can achieve good therapeutic effects, but lumbar degenerative disease patients with sacroiliac joint ankylosis who undergo interbody fusion with foramen magnum at the L5/S1 segments have a poorer improvement of low back pain than patients without sacroiliac joint ankylosis after the operation. Furthermore, patients with preoperative sacroiliac ankylosis who underwent L5/S1 segmental transforminal lumbar interbody fusion had a low fusion rate and were prone to loss of correction of the lumbar sagittal position. Figures and Tables | References | Related Articles | Metrics

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Analysis of factors for recurrent fractures of vertebral and adjacent vertebrae after osteoporotic compression fracture in the elderly patients with underlying diseases Abuduwupuer·Haibier, Shang Qisong Song Xinghua 2026, 30 (3):  642-651.  doi: 10.12307/2026.052 Abstract ( 15 )   PDF (1596KB) ( 1 )   Save BACKGROUND: Distinct risk factors for new adjacent vertebral fractures following percutaneous vertebroplasty in the elderly patients with osteoporotic vertebral compression fractures and underlying diseases may be different, yet there is a scarcity of pertinent research on this topic. OBJECTIVE: To investigate the high-risk factors for refracture in patients with osteoporotic vertebral compression fractures following percutaneous vertebroplasty and to delve deeper into the correlation between these risk factors and the recurrence of fractures in the operated vertebra as well as its adjacent vertebrae post-percutaneous vertebroplasty. METHODS: According to the inclusion criteria, 412 patients with osteoporotic vertebral compression fractures who underwent percutaneous vertebroplasty at the Sixth Affiliated Hospital of Xinjiang Medical University between January 2018 and December 2023 were retrospectively screened. According to whether re-fracture occurred during the follow-up period, the patients were divided into a re-fracture group (n=75) and a non-re-fracture group (n=337). The following variables of the two groups of patients were reviewed: age, gender, body mass index, cement leakage, bone density T value, cement dosage, occupation, smoking, drinking, adverse reactions, medical insurance, hypertension, type 2 diabetes, chronic obstructive pulmonary disease, cerebral hemorrhage, coronary heart disease, psychological trauma, psychiatric treatment, osteoarthritis, gout, scoliosis, spinal surgery, chronic kidney, anti-osteoporosis treatment, previous fracture history (fracture caused by osteoporosis) and fracture injury plane. The above factors were analyzed using univariate analysis. The factors with P < 0.05 were subjected to binary logistic analysis to explore the related factors of postoperative vertebral recompression fracture. RESULTS AND CONCLUSION: (1) Univariate analysis showed that after percutaneous vertebroplasty, vertebral refracture was associated with age, smoking history of > 10 years, cement leakage, hypertension, type 2 diabetes, scoliosis, spinal surgery, and chronic kidney disease, with statistically significant differences (P < 0.05). (2) By binary Logistic regression, bone cement leakage condition (OR=2.547, 95%CI:1.283-5.048, P < 0.05), smoking history > 10 years (OR=2.336, 95%CI:1.157-4.701, P < 0.05), a history of hypertension (OR=4.657, 95%CI:2.137-10.242, P < 0.05), a history of type 2 diabetes mellitus (OR=8.956, 95%CI:3.941-21.301, P < 0.05), and a medical history of scoliosis (OR=3.754, 95%CI:1.755-8.619, P < 0.05), medical history of spinal surgery (OR=2.700, 95%CI:1.058-6.725, P < 0.05), and a history of chronic kidney disease (OR=2.812, 95%CI:1.078-7.739, P < 0.05) were risk factors for refracture of the operated vertebral body and adjacent vertebrae. (3) The results showed that cement leakage, smoking for > 10 years, hypertension, type 2 diabetes mellitus, scoliosis, spinal surgery, and chronic kidney were risk factors for recurrent fractures of the operated vertebrae and adjacent vertebrae in patients with osteoporotic vertebral compression fractures. Surgeons should conduct a comprehensive assessment of patients before percutaneous vertebroplasty in order to more accurately predict the possibility of re-fracture and provide a basis for the formulation of personalized treatment plans to reduce the risk of future recurrent fractures.  Figures and Tables | References | Related Articles | Metrics

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Differences in scapular kinematics between healthy individuals and rotator cuff tear patients based on biplane X-ray Guo Zicheng, Meng Jingyuan, Zhang Jiechao, Ding Li, Tang Xiaoye, Tian Lichao, Wang Yilin, He Yong 2026, 30 (3):  652-660.  doi: 10.12307/2025.874 Abstract ( 23 )   PDF (1440KB) ( 1 )   Save BACKGROUND: Due to the complex movement of the scapula, which is a six-degree-of-freedom activity in three-dimensional space, it is difficult to measure it accurately using traditional methods. The image and model matching technology based on dual-plane X-ray is a three-dimensional measurement method that has gradually developed and matured in recent years. Two high-speed cameras are used to project and shoot from orthogonal directions. Compared with a single perspective, this method has advantages in observation range and reduction of out-of-plane errors, and is suitable for the study of scapula kinematics. OBJECTIVE: X-ray biplane and image-model registration technology were used to explore the differences in scapular kinematics between normal individuals and patients with rotator cuff tears, providing a basis for the treatment and rehabilitation of rotator cuff tear patients.  METHODS: From April 2023 to January 2024, 10 patients with normal shoulders and 10 patients with rotator cuff tears who met the inclusion criteria were enrolled from Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. The subjects underwent a shoulder CT scan to create a 3D model and a local scapular coordinate system. X-ray biplane images were taken during shoulder abduction with two C-arm machines. The 2D and 3D images were registered to compare scapular kinematic differences between the two groups at 0°, 15°, 30°, 45°, 60°, 75°, and 90° of abduction, including scapular rotation angle and displacement distance.  RESULTS AND CONCLUSION: (1) During shoulder abduction, the scapula of both groups showed upward rotation, but the upward rotation of the rotator cuff tear group was greater than that of the control group, and the difference was significant when the abduction was 30°-90° (P < 0.01). At the same time, the scapula internal rotation of both groups gradually increased, but the rotator cuff tear group was significantly greater than the control group when the abduction was 45°-90° (P < 0.01). In addition, the anteroposterior tilt of the scapula of the two groups was significantly different when the abduction was 15°-90° (P < 0.01). The scapula posterior tilt of the control group gradually increased during abduction, while the scapula of the rotator cuff tear group tilted forward except for a slight posterior tilt at 15°-30° abduction. (2) In terms of displacement, the upward displacement of the rotator cuff tear group was less than that of the control group during abduction, and the difference was significant at 15°-90° (P < 0.05), but there was no significant difference in lateral and anterior-posterior displacement between the two groups (P > 0.05). (3) Rotator cuff tear can cause scapular dyskinesis, characterized by increased upward rotation, internal rotation, and abnormal forward tilt during shoulder abduction. Identifying and addressing scapular dyskinesis is crucial for treating rotator cuff tear. Figures and Tables | References | Related Articles | Metrics

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Subtalar arthroereisis for treatment of pediatric flexible flatfoot: relationship between radiographic indicators and clinical efficacy Liao Guangtao, Feng Ziyu, Fu Xiaoyong, Zhao Qinglan, Chen Chao, Hong Jinsong 2026, 30 (3):  661-670.  doi: 10.12307/2026.511 Abstract ( 17 )   PDF (1420KB) ( 2 )   Save BACKGROUND: Pediatric flexible flatfoot is a common foot deformity that often leads to foot pain and reduced quality of life.  OBJECTIVE: To explore the relationship between radiographic parameters and clinical efficacy of subtalar arthroereisis in the treatment of pediatric flexible flatfoot. METHODS: A retrospective study was conducted on 56 pediatric patients (mean age of 11.8 years) who underwent subtalar arthroereisis at Guangzhou Orthopedic Hospital between January 2022 and May 2023. All patients underwent detailed radiographic examinations and clinical evaluations before and after surgery, including the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot score and Visual Analog Scale score. Paired t-tests and independent t-tests were used to compare changes in radiographic parameters and clinical scores before and after surgery. Correlation analyses were conducted to evaluate the relationship between radiographic parameters and clinical outcomes.  RESULTS AND CONCLUSION: (1) All radiographic parameters significantly improved during the 8 to 12-month follow-up after surgery (P < 0.001). (2) Clinical evaluation results indicated that the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot score significantly improved from 66.2±6.0 preoperatively to 91.3±5.8 postoperatively, and the Visual Analog Scale score significantly decreased from 3.1±0.8 preoperatively to 1.3±0.8 postoperatively (P < 0.001). (3) Independent t-tests showed a significant difference in postoperative the first metatarsal angle and Visual Analog Scale score grades (P=0.043), with a smaller the first metatarsal angle associated with less postoperative pain; preoperative lateral arch angle showed a significant difference between the “excellent” and “good” groups in postoperative American Orthopaedic Foot & Ankle Society Ankle-Hindfoot scores (P=0.033), suggesting that a smaller preoperative posterior arch angle might predict better postoperative foot function recovery. (4) Correlation analysis showed that preoperative posterior arch angle (r=-0.486, P < 0.01) and heel pitch angle (r=-0.344, P < 0.01) were significantly negatively correlated with postoperative American Orthopaedic Foot & Ankle Society Ankle-Hindfoot, while preoperative medial longitudinal arch angle (r=0.293, P < 0.05) was significantly positively correlated with postoperative American Orthopaedic Foot & Ankle Society Ankle-Hindfoot. Postoperative medial longitudinal arch angle (r=0.331, P < 0.05) and lateral arch angle (r=0.387,  P < 0.01) were significantly positively correlated with postoperative American Orthopaedic Foot & Ankle Society Ankle-Hindfoot, whereas postoperative Bohler's angle (r=-0.272, P < 0.05), posterior arch angle (r=-0.461, P < 0.01), and heel pitch angle (r=-0.318, P < 0.01) were significantly negatively correlated with postoperative American Orthopaedic Foot & Ankle Society Ankle-Hindfoot. (5) It is concluded that subtalar arthroereisis is significantly effective in correcting pediatric flexible flatfoot, and improvements in radiographic parameters are closely related to clinical efficacy. Preoperative and postoperative radiographic evaluations can serve as important reference indicators for predicting postoperative clinical outcomes, guiding clinicians to optimize treatment plans and rehabilitation programs.  Figures and Tables | References | Related Articles | Metrics

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Mechanism by which vascular endothelial growth factor A targets regulation of angiogenesis in the treatment of steroid-induced osteonecrosis of the femoral head Wang Zhengye, Liu Wanlin, Zhao Zhenqun 2026, 30 (3):  671-679.  doi: 10.12307/2026.012 Abstract ( 28 )   PDF (948KB) ( 5 )   Save BACKGROUND: Steroid-induced osteonecrosis of the femoral head (SANFH) is a severe orthopedic disease characterized by interruption of the blood supply to the femoral head and necrosis of subchondral bone, leading to joint dysfunction. Long-term use of glucocorticoids is the main cause of SANFH, and its pathogenesis involves multiple factors, including intravascular coagulation and osteocyte apoptosis. Vascular endothelial growth factor A (VEGF-A), as a key angiogenic factor, has potential value in the treatment of SANFH. OBJECTIVE: To summarize the mechanisms of action of VEGF-A in SANFH, including its progress in promoting angiogenesis, anti-apoptosis, and lipid metabolism regulation, and to discuss the prospects for clinical application of VEGF-A targeted therapy. METHODS: Literature related to VEGF-A targeted regulation of angiogenesis in the treatment of SANFH was identified through searches of PubMed, Web of Science, CNKI, and WanFang databases from database inception to November 2024. After quality assessment, 71 articles were selected, data were extracted by independent researchers, and disagreements were resolved through group discussions. RESULTS AND CONCLUSION: (1) VEGF-A binds to its receptors VEGFR-1 and VEGFR-2, activating downstream signaling pathways that promote the proliferation, migration, and angiogenesis of endothelial cells. Therefore, it can promote the formation of collateral circulation and improve blood supply to the area of bone necrosis. (2) Reduced expression of VEGF-A may lead to a decrease in the number of blood vessels within bone tissue, exacerbating the ischemic state of the femoral head. Furthermore, VEGF-A has anti-apoptotic effects and reduce apoptosis in osteocytes and bone marrow cells, thus protecting bone tissue. (3) The role of VEGF-A in regulating lipid metabolism and inflammatory responses, as well as promoting the osteogenic differentiation of bone marrow mesenchymal stem cells, provides a new perspective for the treatment of SANFH. (4) The development of VEGF-A protein delivery systems, such as lipid nanoparticles and exosome-based delivery systems, offers new possibilities for the clinical application of VEGF-A. (5) The research progress of VEGF-A in SANFH treatment has laid a solid foundation for the development of new treatment strategies and has opened up new avenues for future research directions and clinical applications. (6) With further clarification of the mechanisms of action of VEGF-A and continuous advancements in delivery technologies, more effective treatments will be provided for SANFH patients, improving their prognosis. Figures and Tables | References | Related Articles | Metrics

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Research progress in the relationship between nontraumatic necrosis of the femoral head and lipid metabolism and its treatment Zhou Zixiang, Zhao Baoxiang 2026, 30 (3):  680-690.  doi: 10.12307/2026.004 Abstract ( 25 )   PDF (1403KB) ( 3 )   Save BACKGROUND: The pathogenesis of nontraumatic necrosis of the femoral head is still unclear. Among them, the lipid metabolism disorder is an important hypothesis of the cause of nontraumatic necrosis of the femoral head. Regulating blood lipid metabolism to inhibit the progression of femoral head necrosis has become an important method for the treatment of nontraumatic femoral head necrosis. OBJECTIVE: To review the research progress in the relationship between nontraumatic necrosis of the femoral head and lipid metabolism disorder and the treatment of nontraumatic necrosis of the femoral head. METHODS: Using “osteonecrosis of femoral head, nontraumatic osteonecrosis of femoral head, femoral head necrosis, osteonecrosis and lipid, lipid metabolism osteonecrosis, polymorphisms osteonecrosis of femoral head, pathway osteonecrosis of femoral head, steroid-induced osteonecrosis of the femoral head, alcohol-induced osteonecrosis of femoral head” as Chinese and English search terms, relevant articles were searched on CNKI, WanFang databases, Yiigle, and PubMed databases. Finally, 104 articles were included for summarization. RESULTS AND CONCLUSION: (1) Patients with femoral head necrosis are often accompanied by dyslipidemia. It was found that high total cholesterol, high triglyceride, high low-density lipoprotein cholesterol, high apolipoprotein B, low low-density lipoprotein cholesterol and low apolipoprotein were the risk factors causing necrosis of the femoral head. In patients with different triggers of femoral head necrosis, blood lipid levels are usually different. (2) Hormone and alcohol, as the two major causes of nontraumatic necrosis of the femoral head, can induce adipogenic differentiation of bone marrow mesenchymal stem cells, increase the number of fat cells in the bone marrow cavity, and accumulate fat droplets, ultimately leading to necrosis of the femoral head. (3) Many adipokines and molecules related to lipid metabolism, such as adiponectin, leptin, lipid carrier protein 2, etc. have been confirmed to be related to femoral head necrosis. (4) Some signaling pathways, such as peroxisome proliferator-activated receptor γ, wnt/β-catenin and adenosine activated protein kinase, can change the osteogenic and adipogenic differentiation potential of bone marrow mesenchymal stem cells, and thus participate in the occurrence and development of necrosis of the femoral head. Lipid metabolism signaling pathways, such as phosphatidylinositol 3 kinase/protein kinase B and bone morphogenetic protein 2, are also related to necrosis of the femoral head, which may affect the progression of femoral head necrosis through the regulation of lipid metabolism. (5) Studies have found that cordycepin, Panax notoginseng saponins, gushiling capsule and other Chinese medicines, as well as statins can achieve the therapeutic effect on nontraumatic necrosis of the femoral head by improving lipid metabolism disorder. Figures and Tables | References | Related Articles | Metrics

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Role and pathogenesis of pyroptosis and inflammatory factors in osteoporosis Xu Jiamu, Yang Cheng, Li Weimin, Wang Chunqing 2026, 30 (3):  691-700.  doi: 10.12307/2026.010 Abstract ( 25 )   PDF (2057KB) ( 7 )   Save BACKGROUND: Studies have shown that there is a close relationship between pyroptosis, inflammatory factors and osteoporosis. OBJECTIVE: To review the effects of pyroptosis and inflammatory factors on the pathogenesis of osteoporosis from the perspectives of osteogenic differentiation and osteoclastic differentiation, based on an overview of pyroptosis in relation to the interaction of relevant inflammatory factors. METHODS: The first author used the computer to search the literature published by each database until 2024, and searched CNKI, WanFang, VIP and PubMed databases with the search terms of “pyroptosis, inflammatory factors, osteoporosis, osteoblast, osteoclast, bone metabolism, signaling pathway, review” in Chinese and English. A total of 79 papers were finally included according to the inclusion criteria. RESULTS AND CONCLUSION: The progression of osteoporosis is closely related to inflammation, in which pyroptosis plays a key role. Immune cells induce pyroptosis through apoptosis pathway, promote the secretion of inflammatory factors such as interleukin-18, interleukin-1β and NLRP3, build an inflammatory immune microenvironment, and regulate bone metabolism through complex signaling pathways, resulting in enhanced bone absorption and reduced bone formation, thereby leading to osteoporosis. Previous studies have shown that inhibiting pyroptosis is anti-inflammatory and slows the progression of osteoporosis, and it has been shown to improve inflammatory bone loss in vitro and in animal models. At present, research on pyroptosis and osteoporosis is limited. On the one hand, the exact mechanism of osteoporosis and the pathogenesis of pyroptosis are unknown, and the specific pathways and regulatory mechanisms remain to be understood. On the other hand, therapeutic strategies targeting pyroptosis are still theoretical, not clinically proven, and drug side effects are unknown. In the future, the research focus is to further explore the pathogenesis, especially the mechanism of pyroptosis, identify potential therapeutic targets, further study the pyroptosis signaling pathway and Gasdermin protein, and develop new drugs to improve the therapeutic effect in patients with osteoporosis. Figures and Tables | References | Related Articles | Metrics

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Immune microenvironment regulates bone regeneration Yang Hu, Zheng Yu, Jia Chengming, Wang Tong, Zhang Guangfei, Ji Yaoyao 2026, 30 (3):  701-710.  doi: 10.12307/2026.013 Abstract ( 21 )   PDF (1292KB) ( 0 )   Save BACKGROUND:  The local immune microenvironment plays an important regulatory role in the process of bone formation, and the immune system is intricately linked to the skeletal system. OBJECTIVE: To systematically review the promotion of bone regeneration from three aspects: immune cell regulation of microenvironment, regulation of immune response by small extracellular vesicles, and induction of immune response by bone biomaterials, and to elucidate the immune regulatory mechanisms involved in bone regeneration. METHODS: Relevant literature was retrieved from PubMed, CNKI, WanFang Database, and VIP Database, using the search terms of “osteoimmunology, immune microenvironment, small extracellular vesicles, bone regeneration, bone tissue repair, biomaterials, and tissue engineering” in English and Chinese. Repeat and irrelevant literature was screened and removed, and 92 articles that met the criteria were selected for intensive reading and review. RESULTS AND CONCLUSION: Multiple immune cells and bone cells are in the same microenvironment, and immune cells can regulate the differentiation and activity of bone cells, collectively forming an immune microenvironment that affects bone regeneration. Neutrophils can significantly reduce local inflammatory responses in the early stages of bone injury, creating a favorable microenvironment for bone regeneration. M1 macrophages can clear foreign bodies and reduce early inflammatory responses, while M2 macrophages can promote the expression of osteogenic markers and factors, playing an important role in the repair process of bone injury. B cells and T cells can directly or indirectly affect the generation and activity of osteoblasts and osteoclasts, regulate bone metabolism, and promote bone regeneration. Extracellular vesicles of small cells regulate the local immune microenvironment through paracrine secretion, promoting bone formation and angiogenesis at the site of bone injury. The metal ions, surface hydrophilicity, porosity, pore size, surface morphology, and surface roughness on the surface of biomaterials can directly regulate local immune responses, and have anti-inflammatory, angiogenic, and osteogenic effects, thereby accelerating bone regeneration. Figures and Tables | References | Related Articles | Metrics

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Intervertebral disc rehydration after posterior lumbar dynamic internal fixation Wang Peng, Li Zhijun, Zhang Shaojie, Wu Yimin 2026, 30 (3):  711-720.  doi: 10.12307/2025.879 Abstract ( 20 )   PDF (931KB) ( 2 )   Save BACKGROUND: With the development of the concept of minimally invasive surgery, lumbar posterior dynamic internal fixation has become the mainstream operation for the treatment of diseases caused by intervertebral disc degeneration OBJECTIVE: To review the latest progress of lumbar posterior dynamic internal fixation in the treatment of lumbar degenerative diseases and postoperative intervertebral disc rehydration. METHODS: The relevant literature published in CNKI, WanFang, and PubMed databases from 2010 to 2025 was searched with the Chinese and English search terms “lumbar spine, dynamic internal fixation, intervertebral disc degeneration, Coflex system, Dynesys system, In-space system, PercuDyn system, intervertebral disc rehydration, crushing stress.” By reading the articles, we eliminated the literature with little relevance to the article topic, poor quality and outdated content, and finally 65 articles were included for summary. RESULTS AND CONCLUSION: (1) Although the main surgical method for the treatment of disc degeneration is still the traditional open surgical method of implantation, posterior lumbar dynamic internal fixation has made great progress. (2) Posterior lumbar dynamic fixation can be divided into open dynamic fixation system and percutaneous dynamic fixation system. Each system can be divided into interspinous dynamic internal fixation system and pedicle dynamic internal fixation system according to the different fixation positions. According to the design of specific instruments and the differences of operation methods in the surgery, different operation methods have been derived. At present, the focus of research at home and abroad is on open dynamic internal fixation system. (3) Under the premise that the clinical effect of posterior lumbar dynamic internal fixation is better than that of traditional interbody fusion surgery, it can cause the rehydration phenomenon of postoperative lumbar intervertebral disc, and further improve the long-term postoperative efficacy of patients. Figures and Tables | References | Related Articles | Metrics

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Application and prospect of artificial intelligence in screening and diagnosis of scoliosis Guan Yujie, Zhao Bin 2026, 30 (3):  721-730.  doi: 10.12307/2026.528 Abstract ( 24 )   PDF (1148KB) ( 1 )   Save BACKGROUND: Scoliosis is a three-dimensional deformity characterized by lateral bending and rotation of the spine. Its onset age covers the entire life cycle, becoming an important health issue that threatens people’s health. Artificial intelligence continues to advance with the development of computer science. At present, artificial intelligence has great potential for application in medical diagnosis and treatment, and is gradually being applied in screening and diagnosis of scoliosis.                                                     OBJECTIVE: To comprehensively review the application of artificial intelligence in screening and diagnosis of scoliosis, elaborate on the progress of its application in recent years from multiple aspects, and look forward to its innovative points, providing reference for the future trend of intelligence. METHODS: Search covered databases such as PubMed, IEEE Xplore, CNKI, and WanFang, using Chinese and English search terms such as “scoliosis, artificial intelligence, machine learning, screen, diagnosis.” Boolean logic was used to optimize the search strategy. Articles directly related to the application of artificial intelligence in screening and diagnosis of scoliosis were included, and articles with weak correlation, outdated experimental design, or poor credibility were excluded. Finally, 83 articles were included for analysis.                                                        RESULTS AND CONCLUSION: (1) Artificial intelligence has shown unique application value and development prospects in multiple fields such as early screening of scoliosis, chest X-ray screening, smartphone screening, X-ray diagnosis, CT and MRI diagnosis, and reconstruction of three-dimensional spinal images. (2) The application of artificial intelligence in the screening and diagnosis of scoliosis has improved efficiency, reduced misdiagnosis rates, and alleviated the burden on medical staff, facilitating early detection and diagnosis of scoliosis and safeguarding spinal health.  Figures and Tables | References | Related Articles | Metrics

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A meta-analysis of risk factors for residual back pain after vertebral augmentation for osteoporotic vertebral compression fractures Yang Peng, Xu Chenghan, Zhou Yingjie, Chai Xubin, Zhuo Hanjie, Li Lin, Shi Jinyu 2026, 30 (3):  731-739.  doi: 10.12307/2025.869 Abstract ( 21 )   PDF (2331KB) ( 10 )   Save OBJECTIVE: Patients with osteoporotic vertebral compression fractures still have residual back pain after vertebral augmentation. The current research is characterized by limited sample size, complex confounding factors, and inconsistent research results. To gain a deeper understanding of this phenomenon, the aim of this study was to identify and evaluate the risk factors for residual back pain after surgery through a systematic review and meta-analysis. METHODS: A comprehensive search was conducted in CNKI, VIP, WanFang, CBMdisc, PubMed, The Cochrane Library, Embase, and Web of Science for case-control studies on residual back pain after vertebral body augmentation for osteoporotic vertebral compression fractures from database inception to July 2024. The search terms were a combination of subject terms and free terms. The basic information, patient characteristics, surgical-related indicators, and risk factors for surgical back pain of the included studies were extracted. After evaluating the bias risk of all included studies, a meta-analysis was conducted using Stata 14.0 software on the relevant indicators. RESULTS: (1) 21 case-control studies with a total of 8 043 patients were included. Among them, 965 patients developed back pain. The quality score of all 21 studies was ≥7. (2) The meta-analysis results showed that age (WMD=0.98, 95%CI: 0.40-1.56, P=0.010), bone mineral density (WMD=-0.28, 95%CI:-0.34 to -0.21, P=0.000), the number of vertebral fractures (OR=3.50, 95%CI:2.65-4.62, P=0.000), thoracolumbar fracture index (OR=3.65, 95%CI:2.61-5.11, P=0.000), cement volume (OR=6.89, 95%CI:2.62-18.17, P=0.000), and cement distribution (OR=2.38, 95%CI:1.93-2.93, P=0.000) were risk factors for the development of back pain after vertebral body augmentation in patients with osteoporotic vertebral compression fractures. CONCLUSION: Current evidence indicates that age, bone mineral density, the number of vertebral fractures, thoracolumbar fracture index, bone cement injection volume, and the distribution of bone cement are risk factors for low back pain. Specifically, bone mineral density, the number of vertebral fractures, thoracolumbar fracture index, and non-uniform distribution of bone cement are identified as independent risk factors for low back pain. Patients exhibiting these high-risk factors require vigilant monitoring and prompt intervention to mitigate the occurrence of clinical low back pain, thereby enhancing patient outcomes and quality of life.  Figures and Tables | References | Related Articles | Metrics

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A systematic review of application value of machine learning to prognostic prediction models for patients with lumbar disc herniation Wang Zhipeng, Zhang Xiaogang, Zhang Hongwei, Zhao Xiyun, Li Yuanzhen, Guo Chenglong, Qin Daping, Ren Zhen 2026, 30 (3):  740-748.  doi: 10.12307/2026.875 Abstract ( 25 )   PDF (1010KB) ( 2 )   Save OBJECTIVE: Based on different algorithms of machine learning, the prediction model of lumbar disc herniation has become a trend and hot spot in the development of precision medicine. However, there is limited evidence on the reporting quality and methodological quality of prediction models of lumbar disc herniation outcomes using machine learning. This article is aimed to explore the performance of machine learning algorithms in predicting the prognosis of lumbar disc herniation by comprehensively analyzing the report quality and risk of bias of previous studies that developed and validated prognosis prediction models based on machine learning through a comprehensive literature search, in order to explore the performance of machine learning algorithms in predicting the prognosis of lumbar disc herniation. METHODS: The databases of CNKI, WanFang, VIP, SinOMED, PubMed, Web of Science, Embase, and The Cochrane Library were searched by computer. Studies on the use of machine learning to develop (and/or validate) prognostic prediction models for lumbar disc herniation were collected from the inception of the database to December 31, 2023. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. The reporting quality and risk of bias of the included studies were assessed by the Multivariable Transparent Reporting of Predictive Models (TRIPOD) statement and the Predictive Model Risk of Bias Assessment Tool (PROBAST). The results of the evaluation were analyzed using descriptive statistics and visual charts.  RESULTS: (1) A total of 23 articles were included, and the TRIPOD compliance of each study ranged from 11% to 87%, with a median compliance of 54%. The quality of reporting of titles, detailed descriptions of treatment measures, blinding of predictors, handling of missing data, details of risk stratification, specific procedures for enrollment, model interpretation, and model performance was mostly poor, with TRIPOD adherence rates ranging from 4% to 35%. (2) Of all included studies, 61% had a high risk of bias and 39% had an unclear overall risk of bias. The area under the curve, accuracy, sensitivity and specificity were used to evaluate the performance of the model. The areas under the curve of 20 models were reported, ranging from 0.561 to 0.999. Three models reported the accuracy of the model, ranging from 82.07% to 89.65%. (3) Among all included studies, the statistical analysis domain was most often assessed as having a high risk of bias, mainly due to the small number of valid samples, the selection of predictors based on univariate analysis and the lack of calibration and discrimination assessment of the model in the study.  CONCLUSION: These results indicate that machine learning can achieve good predictive ability in the development and validation of prognostic models for lumbar disc herniation. The commonly used algorithms include regression algorithm, support vector machine, decision tree, random forest, artificial neural network, naive Bayes and other algorithms. Reasonable algorithms combined with clinical practice can improve the accuracy of prognosis prediction of lumbar disc herniation. However, the reporting and methodological quality of prognosis prediction models based on machine learning are poor, the prediction performance of different models varies greatly, and the generalization and extrapolation of research models are unclear. There is an urgent need to improve the design, implementation and reporting of such studies. To promote the application of machine learning in the clinical practice of lumbar disc herniation prediction models, it is necessary to comprehensively consider various predictors related to the prognosis of the disease before modeling, and strictly follow the relevant standards of PROBAST tool during modeling. Figures and Tables | References | Related Articles | Metrics

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Risk prediction models of recurrence after percutaneous endoscopic lumbar discectomy: a systematic review and meta-analysis Yu Weijie, Cao Dongdong, Guo Tianci, Niu Puyu, Yang Jialin, Wang Simin, Liu Aifeng 2026, 30 (3):  749-759.  doi: 10.12307/2025.867 Abstract ( 21 )   PDF (2581KB) ( 5 )   Save OBJECTIVE: Postoperative recurrence is a common complication of percutaneous endoscopic lumbar discectomy for lumbar disc herniation, which can significantly increase the risk of reoperation. A well-performing risk prediction model can help identify high-risk groups early and prevent postoperative recurrence. This study systematically evaluated the risk prediction model for postoperative recurrence after percutaneous endoscopic lumbar discectomy to provide a reference for surgical decision-making.  METHODS: The PubMed, Embase, Web of Science, CNKI, WanFang Data, VIP, and CBM were electronically searched to collect studies on the recurrence risk prediction models after percutaneous endoscopic lumbar discectomy from inception to July 1, 2024. Two reviewers independently screened the literature and extracted data. The models’ risk of bias, applicability, and report quality were assessed using prediction model risk of bias assessment tool (PROBAST) and Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) tools, respectively. Meta-analysis of postoperative recurrence rate of percutaneous endoscopic lumbar discectomy and related predictors was performed using Revman 5.4 software.  RESULTS: (1) A total of 15 studies were included, all of which were retrospective studies, including 24 models for predicting the risk of recurrence after percutaneous endoscopic lumbar discectomy. (2) The PROBAST evaluation results indicated that all 15 studies exhibited a high risk of bias. Regarding applicability, two studies demonstrated a low risk, while 13 presented a high risk. (3) Regarding the TRIPOD reporting quality, the overall quality across the 15 studies was low. The primary reasons for this low compliance included the failure to report blinding, a lack of explanation for the sample size calculation method, lack of detailed description of missing data processing methods, and lack of information such as introduction to the model used. (4) Furthermore, the area under the receiver operating characteristic curve for the model ranged from 0.684 to 0.972, with the number of potential predictor variables varying from 15 to 28. (5) The results of meta-analysis showed that the postoperative recurrence rate of lumbar disc herniation patients treated with percutaneous endoscopic lumbar discectomy was 12% (95%CI=9.0%-15.0%), Modic changes (OR=6.72, 95%CI=3.90-11.59), body mass index (OR=1.28, 95%CI=1.10-1.49), work intensity (OR=3.22, 95%CI=1.85-5.59), age (OR=2.28, 95%CI=1.50-3.48), and smoking history (OR=2.65, 95%CI=1.75-4.00) were independent influencing factors for postoperative recurrence of percutaneous endoscopic lumbar discectomy (all P < 0.05).   CONCLUSION: The overall predictive performance of the recurrence risk prediction models after percutaneous endoscopic lumbar discectomy is satisfactory; however, the model exhibits a high overall risk of bias and applicability, coupled with low reporting quality. Additionally, there is a lack of prospective research and external validation. Future, risk prediction models should consider factors such as Modic changes, body mass index, work intensity, age, and smoking history as potential predictors.  Figures and Tables | References | Related Articles | Metrics

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A visual analysis of research hotspots of H-type vessels in various bone diseases Peng Hao, Chen Qigang, Shen Zhen 2026, 30 (3):  760-769.  doi: 10.12307/2025.999 Abstract ( 21 )   PDF (5085KB) ( 11 )   Save BACKGROUND: H-type vessels (CD31hiEmcnhi) possess unique functionalities that offer new perspectives and entry points for comprehensively understanding the mechanisms of vascular-mediated bone metabolism regulation. This has triggered a significant paradigm shift in bone science research from a “bone-centric” approach to an “integrative bone-vascular” framework. OBJECTIVE: To perform a visual analysis based on literature data in the field of H-type vessels, aiming to identify research hotspots and emerging trends. METHODS: A systematic search was conducted in the CNKI and Web of Science databases for English and Chinese publications related to H-type vessels, covering the period from 2014 to 2024. The CiteSpace 6.2.R4 information visualization software was utilized to analyze and visualize data on publication countries, authors, institutions, keywords, and timeline views.  RESULTS AND CONCLUSION: (1) A total of 59 Chinese and 185 English publications were included in the analysis. Since the introduction of the H-type vessel concept in 2014, the number of related research publications has been steadily increasing, accompanied by a significant growth in academic output. China leads the research in this domain, with major institutions including Southern Medical University, Sichuan University, and Shanghai Jiao Tong University. Keyword analysis indicated that current research hotspots primarily focus on the generation and regulatory mechanisms of H-type vessels, their roles in bone formation and remodeling, and their associations with bone metabolic diseases. Additionally, emerging keywords such as “induced membrane,” “cartilage repair,” and “traditional Chinese medicine” suggest that research is progressively moving towards diversification and multidisciplinary integration. (2) H-type vessels play a crucial role in the development and progression of bone diseases, and relevant studies are pivotal for a deeper understanding of the physiological and pathological processes of bone tissue. Future research should further elucidate the specific mechanisms of H-type vessels in various disease contexts and promote the clinical translation of basic research findings. These efforts will provide innovative ideas and strategies for the prevention and treatment of bone-related diseases. Figures and Tables | References | Related Articles | Metrics

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An artificial neural network model of ankylosing spondylitis and psoriasis shared genes and machine learning-based mining and validation Zhao Feifan, Cao Yujing 2026, 30 (3):  770-784.  doi: 10.12307/2026.009 Abstract ( 23 )   PDF (7974KB) ( 9 )   Save BACKGROUND: Ankylosing spondylitis is closely related to the occurrence and development of psoriasis, but the key genes and regulatory mechanisms are still unclear. OBJECTIVE: To establish an artificial neural network model of genes shared by ankylosing spondylitis and psoriasis based on the GEO database and evaluate its effect, and also to determine whether there is a causal relationship between the expression of key genes and the two diseases using Mendelian randomization.  METHODS: Datasets GSE25101 (816 ankylosing spondylitis samples and 816 healthy control samples), GSE30999 (85 psoriasis samples and 85 healthy control samples), GSE73754 (52 ankylosing spondylitis samples and 20 healthy control samples), and GSE14905 (33 psoriasis samples and 49 healthy control samples) were downloaded from the GEO database. GSE25101 and GSE30999 were used as the training datasets of ankylosing spondylitis and psoriasis, respectively, and their respective differentially expressed genes were identified through difference analysis to obtain the common driver genes of the two diseases, and the key core genes were further screened out based on Mendelian randomization. The key core genes were further screened out, and artificial neural network models were constructed based on the key core genes and validated in external datasets GSE73754 and GSE14905, followed by the construction of the corresponding nomogram to predict the incidence rates of the diseases. Also, the results of immune infiltration in ankylosing spondylitis and psoriasis were analyzed. Finally, Mendelian randomization was used to assess causal relationships between key genes and diseases, and drug-gene interactions were analyzed using the Dgidb database to predict drug targets.  RESULTS AND CONCLUSION: (1) A total of 61 differential genes were obtained in ankylosing spondylitis and 4 309 differential genes were obtained in psoriasis. Eight shared differential genes were obtained after intersection, and five key genes (DNMT1, GNG11, CDC25B, S100A8, and S100A12) were further screened by machine learning. The key genes were utilized to build artificial neural network models of ankylosing spondylitis and psoriasis, with the area under curve values of 0.979 and 0.989 in the training sets GSE25101 and GSE30999, respectively, and 0.818 and 0.874 in the external validation datasets GSE73754 and GSE14905, respectively. (2) Nomogram was constructed based on the five core genes, and the calibration curves showed that the predicted probabilities of the nomogram models were almost the same as that of the ideal model. Immune cell infiltration showed that the key genes were associated with activated B cells, natural killer cells, γδ T cells, follicular helper T cells, monocytes, plasma cell-like dendritic cells, and neutrophils. Mendelian randomization showed that S100A8 was a risk factor for the occurrence of ankylosing spondylitis and psoriasis. Finally, DGIdb screening was utilized to obtain 81 targeted drugs, only 16 of which, including methotrexate, atogepant, ubrogepant, rimegepant, eptinezumab, azacitidine, selenium, hydroxyurea, ifosfamide, floxuridine, curcumin, mitoxantrone, cisplatin, arsenic trioxide, diethylstilbestrol, and decitabine, were approved by the U.S. Food and Drug Administration. (3) A large number of successful cases have been accumulated in international databases, research results and data analysis of European groups, especially in genomics and disease phenotyping studies. These experiences provide valuable references for the epidemiological characterization of diseases in China, genetic diversity and their response to the environment and lifestyle. (4) An artificial neural network model of the common driver genes of ankylosing spondylitis and psoriasis was constructed and validated, the causal relationship between the key genes and the pathogenesis of the two diseases was discovered, and the targeted drugs for potential treatments were predicted, which hopefully provides a new perspective for exploring their pathogenesis and therapeutic directions. Figures and Tables | References | Related Articles | Metrics

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A genetic perspective reveals the relationship between blood metabolites and osteonecrosis: an analysis of information from the FinnGen database in Finland Liu Chu, Qiu Boyuan, Tong Siwen, He Linyuwei, Chen Haobo, Ou Zhixue 2026, 30 (3):  785-794.  doi: 10.12307/2026.007 Abstract ( 20 )   PDF (3307KB) ( 8 )   Save BACKGROUND: In China, the patient population with osteonecrosis is large, and there is an urgent need to find new preventive targets to develop more effective treatment strategies. Metabolomics studies have shown that there is an association between human metabolites and osteonecrosis, but the causal relationship between blood metabolites and osteonecrosis has not yet been clarified. OBJECTIVE: To investigate the causal relationship between blood metabolites and osteonecrosis through two-sample Mendelian randomization analysis. METHODS: The public data of 486 blood metabolites (exposure factors) and osteonecrosis (outcome factors) were collected. Data of 486 blood metabolites were derived from a genome-wide association estimate for blood metabolites published in Nature Genetics in 2014, which covered 7 824 European adults. The single nucleotide polymorphism data for osteonecrosis were obtained from the FinnGen public database R11 dataset, containing information on a total of 431 614 samples and 21 306 430 single nucleotide polymorphism loci, with 1 788 cases of osteonecrosis and 429 826 controls, with all participants being of European descent. Mendelian randomization analysis (inverse variance weighting method, MR-Egger method, and weighted median method) was performed by Rstudio software, and then the heterogeneity test, horizontal pleiotropy test and Steiger directionality test were performed to ensure the robustness and reliability of the results. RESULTS AND CONCLUSION: (1) Sixteen blood metabolites were identified as having a significant causal relationship with osteonecrosis (Pinverse variance weighting <  Pfalse discovery rate < 0.05). (2) Eight blood metabolites increased the risk of osteonecrosis (including four known metabolites and four unknown metabolites), specifically pantothenate, beta-hydroxyisovalerate, hippurate, salicyluric glucuronide, X-08766, X-11452, X-12776 and X-14662. (3) Eight blood metabolites could reduce the risk of osteonecrosis (six known metabolites and two unknown metabolites), including cortisol, 1-palmitoylglycerol (1-monopalmitin), pyroglutamyl glycine, 2-stearoylglycerophosphocholine, p-cresol sulfate, ergothioneine, X-06307, X-12092. (4) The above results suggest that there is a causal relationship between 16 blood metabolites and osteonecrosis, which is expected to be a potential target for intervention in the occurrence and treatment of osteonecrosis in the future. (5) Despite the lack of relevant data from large-scale Asian populations at present, this study provides important reference value for the field of osteonecrosis in China based on European population data. In the future, domestic medical workers may be able to achieve precise intervention for osteonecrosis by regulating metabolite levels. In addition, based on the results of this study, relevant researchers can further explore the mechanism of action of metabolites in the treatment of osteonecrosis with traditional Chinese medicine, which not only helps to deepen the understanding of traditional Chinese medical therapies but also promotes the progress of integrated traditional Chinese and Western medicine research, driving the development of personalized treatment plans that are more suitable for the characteristics of the Chinese population. Figures and Tables | References | Related Articles | Metrics

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Pain after total knee arthroplasty: current status and trend analysis Zhang Anqi, Hua Haotian, Cai Tianyuan, Wang Zicheng, Meng Zhuo, Zhan Xiaoqian, Chen Guoqian 2026, 30 (3):  795-804.  doi: 10.12307/2025.928 Abstract ( 23 )   PDF (3424KB) ( 14 )   Save BACKGROUND: The number of patients receiving total knee arthroplasty has been increasing globally each year. Pain management is a crucial aspect following total knee arthroplasty, as effective pain control can facilitate early mobilization, reduce complications, enhance patient satisfaction, and accelerate the rehabilitation process.  OBJECTIVE: To construct a visual map of post-total knee arthroplasty pain, understand the international research status and trends in this field, and provide a reference for future studies. METHODS: Relevant research articles on post-total knee arthroplasty pain were retrieved from the CNKI, WanFang Data, and Web of Science core databases, covering the period from January 2000 to December 2023. The CiteSpace software (version 6.2.3) was used to analyze the annual publication output, authors, institutions, countries, keywords, and references. Utilizing R programming language (version 4.4.1), a database was established to create line charts and bar graphs.  RESULTS AND CONCLUSION: (1) Our analysis included 3 796 publications, predominantly in Chinese (3 509 articles) with the remainder in English (287 articles). (2) The United States was the most productive country in English literature, with Harvard University leading institutional output. Guangzhou University of Chinese Medicine was the top publishing institution in Chinese literature. (3) Keyword clustering identified “quality of life,” “phobia,” and “acupuncture” as emerging focal points in Chinese literature, while “satisfaction” and “psychological factors” were prominent in English literature over the past five years. Co-occurrence and clustering analysis revealed dense internal connections among institutions, authors, and publications, but sparse external collaborations. (4) The study’s bias on visualization analysis may have introduced bias by excluding less influential papers. (5) Regarding research hotspots, domestic research emphasized the efficacy and exploration of analgesic methods, in contrast to international research that focused on pain mechanism subtyping and analgesic drug innovation. Future research is expected to trend towards traditional Chinese medicine for postoperative pain, multimodal analgesia, and the investigation and prevention of pain typing mechanisms. Figures and Tables | References | Related Articles | Metrics