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28 September 2026, Volume 30 Issue 27 Previous Issue    Next Issue

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Finite element analysis of effects of opening wedge high tibial osteotomy on knee joint and internal fixation stress Chen Ping, Lu Hongxu, Xilinbaoleri 2026, 30 (27):  6969-6977.  doi: 10.12307/2026.446 Abstract ( 107 )   PDF (35606KB) ( 37 )   Save BACKGROUND: Opening wedge high tibial osteotomy is a well-established method for treating medial compartment knee osteoarthritis with varus deformity. There is still controversy over where the lower limb force correction should be placed after opening wedge high tibial osteotomy. OBJECTIVE: To investigate the mechanical characteristics of the knee joint and the internal fixation device after opening wedge high tibial osteotomy for knee osteoarthritis with varus deformity by finite element analysis of the mechanical loading of different force line patterns on the structures of the knee joint. METHODS: A 57-year-old female volunteer weighing 60 kg, diagnosed with left knee osteoarthritis, was selected. Multislice spiral CT scanning was performed on the left knee joint to obtain imaging data. Finite element analysis software was used for mechanical loading to obtain analysis results. The hinge point of the opening wedge high tibial osteotomy was set approximately 15 mm above the tibial plateau at the fibular head, with a 5 mm lateral tibial cortex preserved at the hinge. The medial cortex osteotomy was positioned 30 mm from the medial tibial plateau and expanded by 5 mm, 10 mm, and 15 mm, respectively. Load lines were set vertically at 25%, 50%, 62.5%, and 75% of the tibial plateau. An 8-hole Tomofix plate with a thickness of 2 mm and eight screws (diameter 4 mm; lengths: 60 mm/60 mm/55 mm/50 mm/38 mm/34 mm/32 mm/20 mm) was placed. The osteotomy gap was filled with cancellous bone. Stress and displacement diagrams for various parts of the knee joint three-dimensional model were obtained.  RESULTS AND CONCLUSION: (1) Before opening wedge high tibial osteotomy, knee joint stress was primarily concentrated on the lateral femoral condyle and medial tibial plateau, areas prone to cartilage wear. Meniscal stress was concentrated on the medial meniscus body and the anterior horn of the lateral meniscus. As the load-bearing region shifted outward, stress on the lateral cartilage and meniscus increased, while medial stress decreased. (2) In the 5 mm osteotomy model post-opening wedge high tibial osteotomy, as the stress loading position moved laterally, stress on the lateral cartilage and meniscus of the femur and tibia gradually increased. Stress on the graft bone was minimal at the 50% load position, and stress on the titanium plate and screws decreased with lateral movement of the load line. (3) Analysis of different expansion heights showed that with increased expansion, stress on the lateral cartilage and meniscus increased, and stress concentration on the titanium plate intensified, while screw stress changes were insignificant. (4) Fatigue fracture of the Tomofix titanium plate and screw breakage at the screw head were prone to occur at the posterior-medial aspect of the plate and at the D and 1 holes. (5) It is concluded that opening wedge high tibial osteotomy can effectively transfer the pressure in the medial compartment of the knee joint, but attention should be paid to the risk of increased stress in the lateral cartilage and meniscus. The posterior medial side of the Tomofix titanium plate and the screws at holes D and 1 are weak areas of stress concentration. During the operation, excessive correction should be avoided and the internal fixation design should be optimized to reduce the risk of complications. Figures and Tables | References | Related Articles | Metrics

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Force analysis of three-dimensional finite element models for single radius and multi radius prostheses during flexion and extension in total knee arthroplasty Chen Dongxu, Huang Dachao, Hu Yang, Li Zhaoxu 2026, 30 (27):  6978-6984.  doi: 10.12307/2026.836 Abstract ( 103 )   PDF (2015KB) ( 42 )   Save BACKGROUND: For patients with end-stage knee osteoarthritis, total knee arthroplasty is often necessary in clinical practice to address issues such as pain and limited mobility. Although knee replacement surgery has achieved good clinical results in treating severe osteoarthritis, there is still controversy over the clinical efficacy of single radius and multi radius prostheses. OBJECTIVE: To compare the stress characteristics of single radius and multi radius prostheses at different flexion angles in total knee arthroplasty using finite element analysis, and provide a basis for clinical selection.  METHODS: Based on normal adult CT data, a three-dimensional skeletal model was established and optimized using Mimics, Geomagic, and SolidWorks. Single radius and multi radius prostheses were assembled, and the 0°-120° flexion state was simulated in Ansys. The peak von Mises stress was used as the observation index to observe the Mises stress distribution and contact area on the tibial prosthesis pad, and to explore the biomechanical behavior changes of the knee joint after total knee arthroplasty.   RESULTS AND CONCLUSION: (1) With the increase of knee flexion angle from 0° to 90°, the contact stress of the tibial pad of both SR and MR prostheses increased with the increase of knee flexion angle. At high flexion angles of 90°to 120°, the stress of the multi radius prosthesis gradually decreased, while the stress of the single radius prosthesis slightly increased. (2) At 0° flexion, the joint capsule stress after single radius prosthesis was lower than that of multi radius prosthesis. (3) The contact area at low and medium flexion angles between 0° and 90° gradually decreased with increasing flexion angle, and the contact area on a single radius polyethylene pad was always greater than that on a multi radius polyethylene pad. (4) These findings indicate that both single radius and multi radius knee joint prostheses can meet clinical needs well. In clinical practice, the appropriate prosthesis should be selected according to the patient's age, activity level, and functional requirements.  Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of biomechanical performance of a novel double-screw technique in lumbar revision of the original fixed segment Zhang Le, Julaiti·Maitirouzi, Xie Xuechen, Li Chunchao, Wang Yixi, Parhat·Rexiti 2026, 30 (27):  6985-6994.  doi: 10.12307/2026.862 Abstract ( 87 )   PDF (8358KB) ( 31 )   Save BACKGROUND: Currently, in clinical practice, the original internal fixation devices are often removed to perform revision surgery for failed vertebral fixation, which poses certain drawbacks and risks. The pedicle double-screw technique can preserve the original internal fixation devices, while the modified cortical bone trajectory technique offers excellent mechanical performance. Combining these two techniques for revision surgery can mitigate the conventional risks, although the mechanical performance of this new modified cortical bone trajectory technique in revision surgery is not yet well understood.  OBJECTIVE: To evaluate the mechanical performance of the cortical bone trajectory and modified cortical bone trajectory techniques in combined fixation during lumbar revision surgery using finite element analysis, and to explore the advantages of modified cortical bone trajectory over cortical bone trajectory in revision surgery.   METHODS: A three-dimensional model of the L1 to L5 vertebrae and intervertebral discs was created based on computed tomography scan data. In this model, screws were placed using the traditional trajectory pedicle screw technique. The traditional trajectory initial group and loosening group were distinguished based on the contact form of the screw-bone surface. Modified cortical bone trajectory and cortical bone trajectory screws were used to perform revision screw placement on the loosening group of the traditional trajectory, re-fixing the lumbar spine. Finite element analysis was employed to assess the mechanical performance of modified cortical bone trajectory and cortical bone trajectory in revision surgery.   RESULTS AND CONCLUSION: (1) Under flexion, extension, lateral bending, and axial rotation conditions, the range of motion of the cortical bone trajectory revision group decreased by 31.97%, 29.15%, 15.12%, and 29.63% compared with the control group, respectively. The stress on the fixed segment intervertebral discs decreased by 15.44%, 78.67%, 54.36%, and 40.55%. (2) The modified cortical bone trajectory revision group showed a decrease in range of motion by 32.16%, 29.33%, 15.47%, and 31.42%, and the stress on the fixed segment intervertebral discs decreased by 16.25%, 83.00%, 64.82%, and 45.83%. (3) Compared with cortical bone trajectory, the modified cortical bone trajectory revision group showed a decrease in range of motion by 0.28%, 0.25%, 0.40%, and 2.54%, and the stress on the fixed segment intervertebral discs decreased by 0.96%, 20.25%, 22.91%, and 8.88%. Additionally, the stress on the fixed segment vertebral bodies decreased by 15.78%, 4.75%, 11.22%, and 7.42%, and the stress on the internal fixation system decreased by 0.15%, 9.80%, 1.04%, and 0.84%. (4) Both cortical bone trajectory and modified cortical bone trajectory techniques effectively enhance the mechanical stability of the fixed segment in lumbar revision surgery, with modified cortical bone trajectory offering superior overall performance, providing a new technical option for clinical revision.  Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of four Kirschner wire fixation methods for treating patellar transverse fractures Li Yongwei, Ye Hong 2026, 30 (27):  6995-7001.  doi: 10.12307/2026.368 Abstract ( 75 )   PDF (3242KB) ( 23 )   Save BACKGROUND: Kirschner wire and tension band internal fixation is the preferred surgical procedure for treating transverse patellar fractures, but it is often associated with postoperative instability, nonunion, and internal fixation failure. Therefore, optimizing the internal fixation method is of great clinical significance. OBJECTIVE: To investigate the effect of crossed Kirschner wire placement on the fixation of transverse patellar fractures.  METHODS: A patellar model was constructed using normal lower limb CT scan data. A transverse patellar fracture and Kirschner wire model was further constructed. Parallel, 30°, 45°, and 60° crossed Kirschner wire placement models were designed. Finite element analysis was performed to analyze the fracture surface stress, fracture surface displacement, Kirschner wire stress, and wire stress under five different working conditions (neutral knee position, 5° flexion, 15° flexion, 45° flexion, and 60° flexion). RESULTS AND CONCLUSION: The fracture surface stresses in the four internal fixation models ranged from 2.06 to 40.00 MPa. The parallel Kirschner wire fixation group had the highest fracture surface stress among all five conditions. The crossed 30° Kirschner wire fixation group had lower fracture surface stress at 15° of knee flexion than the crossed 45° and crossed 60° Kirschner wire fixation groups. The fracture surface displacements in the four internal fixation models ranged from 0.03 to 0.61 mm. The crossed 60° Kirschner wire fixation group had the highest fracture surface displacement at 5° and 15° of knee flexion, the parallel Kirschner wire fixation group had the lowest fracture surface displacement at 5° of knee flexion, and the crossed 30° Kirschner wire fixation group had the lowest fracture surface displacement at 15° of knee flexion. The wire stresses in the four internal fixation models ranged from 56.80 to 2 511.00 MPa. The parallel K-wire fixation group had the highest wire stress at 5° and 15° of knee flexion, and the crossed 30° Kirschner wire fixation group had the lowest wire stress at 5° and 15° of knee flexion. The Kirschner wire stresses in the four internal fixation models ranged from 65.67 to 1 018.00 MPa. The Kirschner wire stress in the 60° crossed Kirschner wire fixation group was highest at 5° of knee flexion, the parallel Kirschner wire fixation group at 15° of knee flexion, and the 30° crossed Kirschner wire fixation group at both 5° and 15° of knee flexion. The results showed that the 30° crossed Kirschner wire placement performed best in terms of fracture stability and stress distribution within the internal fixation system, demonstrating excellent biomechanical advantages.  Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of five internal fixation strategies for Schatzker IV tibial plateau fractures Liu Mingxiang, Zhou Zulong, Fang Run, Kong Lingchao, Wu Chaofan, Wu Chaoqun, Zhang Chengnan, Ning Rende 2026, 30 (27):  7002-7008.  doi: 10.12307/2026.799 Abstract ( 81 )   PDF (2638KB) ( 24 )   Save BACKGROUND: Schatzker IV tibial plateau fractures are highly challenging due to their involvement of the primary weight-bearing area and high rate of soft tissue complications. Although traditional double plating provides mechanical stability, it violates the minimally invasive principle and is associated with more postoperative complications, especially in elderly patients or those with high-energy trauma. Currently, there is a lack of an internal fixation strategy that can meet both mechanical stability and minimally invasive requirements. OBJECTIVE: To establish a three-dimensional model of Schatzker IV tibial plateau fractures using the finite element method and compare the biomechanical stability of five fixation methods to provide an optimal surgical option for the treatment of Schatzker IV tibial plateau fractures. METHODS: A healthy male volunteer underwent knee CT scanning, and a Schatzker IV tibial plateau fracture model was constructed using finite-element software. Five internal-fixation configurations were defined as Groups A, B, C, D, and E. Group A: isolated medial plate; Group B: medial plate plus two posteromedial tension screws; Group C: medial plate plus two lateral tension screws; Group D: posteromedial double plating; Group E: medial-lateral double plating. Under identical boundary and constraint conditions, finite-element analysis software was employed to evaluate the biomechanical performance of five internal fixation models. RESULTS AND CONCLUSION: (1) The finite element analysis results showed that the minimally invasive combinations (Groups B and C) had comparable overall biomechanical performance to traditional double plating. (2) Group B is an ideal choice for elderly patients because it has the lowest fracture fragment stress (9.039 2 MPa), which can effectively prevent osteoporosis-related collapse, and the percutaneous screw technique reduces the risk of soft tissue complications. (3) Group C has potential for application in young patients, thanks to its minimal implant displacement (4.388 mm), providing excellent stability, and the lateral tension screws avoid vascular and nerve injuries associated with the posteromedial approach. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of two fixation methods for Salter-Harris type II distal radius epiphyseal fracture in children Zhou Yunfan, Meng Xiangqi, Shen Chenxiao 2026, 30 (27):  7009-7014.  doi: 10.12307/2026.222 Abstract ( 93 )   PDF (42421KB) ( 18 )   Save BACKGROUND: There is controversy over the selection of treatment options for pediatric distal radius epiphyseal fractures, and there is a lack of theory in biomechanical performance between Kirschner wire internal fixation and splint external fixation in terms of stability. OBJECTIVE: To explore the biomechanical characteristics of external fixation with splints and internal fixation with Kirschner wires in the treatment of Salter-Harris type II distal radial epiphyseal fractures in children through finite element experiments. METHODS: Based on CT data of children's wrist joint, Salter-Harris type II distal radius epiphyseal fracture was simulated, and model A was established. On this basis, two different fixation methods were established: model B, Kirschner wire cross internal fixation (2 Kirschner wires); Model C, externally fixed with 4 clamps. Loads were applied to the model to simulate the displacement and stress distribution of the distal fracture end and the distal radioulnar joint of the wrist joint under axial pressure combined with pronation and supination conditions. RESULTS AND CONCLUSION: (1) Model A has the highest displacement peak area and stress peak displacement degree in the vertical pressure combined pre rotation and post rotation motion states. The maximum stress and relative displacement values between the distal radius fracture end and the distal radioulnar joint are the highest. (2) Compared with Model C, Model B has a smaller maximum stress and displacement value, and the peak area of the displacement cloud map has also decreased. The peak area of the stress cloud map has shifted back towards the center. There is no significant difference in the percentage difference in the maximum stress and displacement values between Models B and C and Model A, indicating that the two fixing methods have similar effects on alleviating relative displacement and structural stress. (3) The results showed that Kirschner wire internal fixation and splint external fixation can effectively maintain the stability of the distal fracture end and the distal radioulnar joint. The splint, as an external fixation device and Kirschner wire internal fixation, showed similar fixation effects on Salter-Harris type II distal radial epiphyseal fractures. Figures and Tables | References | Related Articles | Metrics

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Biomechanical finite element analysis of different ulnar shortening osteotomy techniques in treatment of ulnar impaction syndrome Zhang Shuai, Han Shichong, Zeng Wenchao 2026, 30 (27):  7015-7022.  doi: 10.12307/2026.860 Abstract ( 90 )   PDF (3339KB) ( 11 )   Save BACKGROUND: Ulnar impaction syndrome is a common wrist disorder, and ulnar shortening osteotomy is one of the definitive surgical interventions for its treatment. Although various ulnar shortening osteotomy techniques exist, numerous clinical comparative studies have focused on pairwise comparisons, while biomechanical simulations comparing the efficacy of different osteotomy methods via finite element analysis remain unreported.  OBJECTIVE: To simulate and compare the biomechanical characteristics of ulnar impaction syndrome under different osteotomy treatment modalities employing finite element method so as to provide references and evidence for clinical decision-making. METHODS: CT data of the intact ulna and radius from a healthy adult male volunteer were utilized. Modeling and finite element software platforms — Mimics 19.0, Geomagic Studio 2013, SolidWorks 2019, and Ansys 17.0 — were sequentially applied to construct five ulnar osteotomy models: (1) distal ulnar V-shaped osteotomy; (2) distal ulnar transverse osteotomy; (3) ulnar metaphysis transverse osteotomy; (4) distal ulnar trapezoidal osteotomy; (5) distal ulnar oblique osteotomy. Following experimental design and internal fixation principles, plates and screws were assembled. Three simulated wrist motion states (axial compression, pronation, and supination) were applied to each model with corresponding constraints and loads. Stress and displacement nephograms, along with quantitative data at the osteotomy sites and fixation devices, were analyzed and compared against experimental benchmarks to draw relevant conclusions. RESULTS AND CONCLUSION: (1) Under three different motion patterns (different loads), all five ulnar shortening osteotomy models demonstrated comparable stability at the osteotomy sites, with no significant relative differences. (2) Variations in stress deformation of internal fixation devices among the five different ulnar shortening osteotomy methods were observed across three simulated motions: Transverse metaphyseal osteotomy fixation plates exhibited fracture risks during pronation and deformation risks during supination. (3) The V-shaped distal ulnar osteotomy fixation demonstrated superior stability in stress distribution and displacement across all three simulated conditions. Figures and Tables | References | Related Articles | Metrics

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Correlation between lower limb biomechanics during single-leg landing and hip joint muscle strength in patients with anterior cruciate ligament reconstruction Yang Zimeng, Zheng Hongrong, Yu Hao, Gao Peng, Sun Lezhong, Sheng Xiangmei 2026, 30 (27):  7023-7029.  doi: 10.12307/2026.839 Abstract ( 84 )   PDF (1861KB) ( 27 )   Save BACKGROUND: Recovery of knee joint function and muscle strength is a key focus of rehabilitation after anterior cruciate ligament reconstruction. However, abnormal inter-joint mechanical patterns of the lower limbs may alter lower limb biomechanics during movement and increase the risk of anterior cruciate ligament injury.  OBJECTIVE: To explore the lower limb biomechanical characteristics of anterior cruciate ligament reconstruction patients during single-leg landing 2 years after surgery, and their correlation with hip joint muscle strength.  METHODS: Totally 23 subjects who underwent anterior cruciate ligament reconstruction were randomly recruited. The Qualisys three-dimensional motion capture system and AMTI three-dimensional force platforms were used to capture kinematic and kinetic data of both lower limbs during single-leg landing. The Biodex isokinetic muscle testing system was used to measure muscle strength of both hip and knee joints at an angular velocity of 60°/s. Paired sample t-tests were used to compare the biomechanical characteristics of bilateral lower limb joints and the isokinetic muscle strength of the hip and knee joints at 60°/s. Pearson correlation analysis was employed to examine the correlation between kinetic data from the single-leg landing test and the isokinetic muscle strength of the hip and knee.  RESULTS AND CONCLUSION: (1) At the moment of single-leg landing, patients who had undergone anterior cruciate ligament reconstruction on the affected side showed smaller knee extension angles, smaller ranges of knee flexion/extension motion, smaller vertical ground reaction forces, smaller peak moments of hip extension, hip abduction, and knee extension, and larger hip extension angles and larger ranges of hip flexion/extension motion at the time of contact. (2) During angular movement at 60°/s, the muscle strength of the operated side for hip abduction, hip extension, knee flexion, and knee extension was significantly lower. (3) During single-leg landing, the peak vertical ground reaction force on the operated side was significantly related to the peak hip extension torque and hip abduction strength, while the peak knee extension torque on the operated side was significantly related to the strength of hip abduction, flexion, and extension. (4) The results showed that two years post-anterior cruciate ligament reconstruction, patients fail to regain equal strength on the operated side, possibly due to neural inhibition induced by surgery. To reduce vertical ground reaction force during single-leg landing, they use a hip-muscle-powered buffering strategy. Yet, the operated side's lower hip abduction torque peak also compromises coronal-plane knee stability. Therefore, it is recommended that after anterior cruciate ligament reconstruction, patients continue to do hip and knee strengthening exercises for 2 years, focusing on hip abduction, extension, and knee flexion and extension while specifically including neuromuscular training and sport-specific technique guidance. This will enhance neuromuscular control during movement and prevent negative impacts from faulty movement patterns. Figures and Tables | References | Related Articles | Metrics

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Correlation between sacro-femoro-pubic angle and spine-pelvic parameters in patients with Lenke types 1, 5, and 6 adolescent idiopathic scoliosis He Zhuoqun, Wang Haiyan, Li Xiaohe, Zhang Ruofan, Shi Guopeng, Bai Lili, Wang Xiaolu 2026, 30 (27):  7030-7036.  doi: 10.12307/2026.462 Abstract ( 59 )   PDF (2374KB) ( 22 )   Save BACKGROUND: The sacro-femoro-pubic angle, as a coronal plane alternative to the pelvic tilt angle, has an unclear association in different Lenke classifications of adolescent idiopathic scoliosis, limiting clinical application of the sacro-femoro-pubic angle in classification-specific assessment. OBJECTIVE: To explore the correlation between the sacro-femoro-pubic angle and spine-pelvic parameters (pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, and main Cobb angle) in patients with Lenke types 1, 5, and 6 adolescent idiopathic scoliosis, and to establish classification-specific regression models.  METHODS: Clinical and imaging data of 191 adolescent idiopathic scoliosis patients were retrospectively analyzed, including 60 with Lenke type 1, 65 with Lenke type 5, and 66 with Lenke type 6. Pearson or Spearman correlation analysis was used to examine the correlations between left/right sacro-femoro-pubic angle and pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, main Cobb angle, and sagittal vertical axis in each type. Parameters with statistical significance underwent univariate linear regression analysis to construct linear regression models. RESULTS AND CONCLUSION: (1) In Lenke type 1 adolescent idiopathic scoliosis patients, right sacro-femoro-pubic angle showed a significant negative correlation with pelvic tilt (r=-0.366, P=0.028) and a significant positive correlation with lumbar lordosis (r=0.429, P=0.007; r=0.460, P=0.007). In Lenke type 5 adolescent idiopathic scoliosis patients, left/right sacro-femoro-pubic angle showed a significant positive correlation with lumbar lordosis (r=0.415, P=0.007; r=0.400, P=0.007). In Lenke type 6 adolescent idiopathic scoliosis patients, while left/right sacro-femoro-pubic angle showed a significant negative correlation with pelvic tilt (r=-0.385, P=0.007; r=-0.376, P=0.014). Univariate regression models quantified these associations (R²=0.13-0.21). Among them, the regression slope between sacro-femoro-pubic angle and lumbar lordosis was largest (0.85-0.89) in Lenke type 5 adolescent idiopathic scoliosis patients, while the regression slope between sacro-femoro-pubic angle and pelvic tilt ranged from -0.52 to -0.54 in Lenke type 6 adolescent idiopathic scoliosis patients. (2) The results indicate that the association between sacro-femoro-pubic angle and spine-pelvic parameters in Lenke types 1, 5, and 6 adolescent idiopathic scoliosis patients exhibits clear classification-specificity. Lenke types 1 and 5 are primarily characterized by a positive association between sacro-femoro-pubic angle and lumbar lordosis, while Lenke type 6 is characterized by a bilateral negative association between sacro-femoro-pubic angle and pelvic tilt. Figures and Tables | References | Related Articles | Metrics

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Spinal-pelvic sagittal parameters and plantar pressure characteristics in elderly patients with degenerative lumbar spondylolisthesis Han Zijia, He Xiaochen, Wang Jiarong, Tian Yichao, Wang Lixin, Gong Shuhui 2026, 30 (27):  7037-7043.  doi: 10.12307/2026.866 Abstract ( 86 )   PDF (1933KB) ( 268 )   Save BACKGROUND: Degenerative lumbar spondylolisthesis is a common spinal degenerative disorder among older adults, often accompanied by spinopelvic sagittal imbalance. The characteristics of plantar pressure and balance function in these patients have not been fully elucidated. OBJECTIVE: To investigate the spinopelvic sagittal parameters and plantar pressure characteristics in older adults with degenerative lumbar spondylolisthesis, to provide a reference for early diagnosis and the development of rehabilitation plans in older adults with degenerative lumbar spondylolisthesis. METHODS: A total of 33 patients with degenerative lumbar spondylolisthesis (degenerative lumbar spondylolisthesis group) and 35 healthy older adults (control group) were enrolled. Lateral radiographs of the whole spine were obtained to measure spinopelvic sagittal parameters. Plantar pressure distribution, including the pressure ratio, peak pressure in eight regions of interest, and center of pressure trajectory parameters, was collected using a plantar pressure analysis system. The differences in spinal-pelvic sagittal parameters, center of pressure trajectory, and plantar pressure parameters between the two groups were compared and analyzed. RESULTS AND CONCLUSION: (1) Compared with the control group, the degenerative lumbar spondylolisthesis group showed significant increases in pelvic incidence, pelvic tilt, sacral slope, and lumbar lordosis (P < 0.05). (2) Compared with the control group, the degenerative lumbar spondylolisthesis group exhibited a significant increase in the pressure percentage under the left forefoot and the forefoot overall (P < 0.05), while the pressure percentage under the left hindfoot and the hindfoot overall decreased significantly (P < 0.05). (3) Compared with the control group, peak pressure under the left first metatarsal bone was significantly higher in the degenerative lumbar spondylolisthesis group (P < 0.05), whereas peak pressure under the right fifth metatarsal and the left medial arch was significantly lower (P < 0.05). (4) Compared with the control group, under eyes-open and eyes-closed conditions, the degenerative lumbar spondylolisthesis group demonstrated a significant increase in center of pressure trajectory length, 95% confidence ellipse area, and the average center of pressure displacement in the anteroposterior (X) and mediolateral (Y) directions (P < 0.05). (5) It is indicated that older adults with degenerative lumbar spondylolisthesis exhibit characteristic changes in spinopelvic sagittal alignment, notably increased pelvic incidence, pelvic tilt, sacral slope, and lumbar lordosis. Their plantar pressure distribution shifts anteriorly, with increased forefoot pressure and decreased hindfoot pressure, indicating an imbalance in foot mechanical symmetry and disruption of the normal tripod support structure. These alterations are accompanied by reduced center of pressure stability, reflecting impaired balance function in degenerative lumbar spondylolisthesis patients. Figures and Tables | References | Related Articles | Metrics

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Efficacy and biomechanical analysis of L-shaped plate treatment for osteoporotic Schatzker type II tibial plateau fractures Shi Gaolong, Hu Zhenghui, Ling Zhuoyan, Xie Zonggang 2026, 30 (27):  7044-7052.  doi: 10.12307/2026.299 Abstract ( 68 )   PDF (2422KB) ( 40 )   Save BACKGROUND: Schatzke type II fractures often involve the posterolateral plateau, resulting in weakened bone strength, increased fixation challenges, and increased risk of postoperative collapse. Optimizing treatment strategies to balance stability and minimize trauma is urgently needed. OBJECTIVE: To evaluate the clinical efficacy of simple lateral L-shaped plate fixation for osteoporotic Schatzker type II tibial plateau fractures involving the posterolateral aspect, and to compare its biomechanical properties with those of lateral L-shaped plate combined with posterior T-shaped plate fixation using finite element analysis. METHODS: A retrospective analysis was conducted on 39 patients with osteoporotic Schatzker type II tibial plateau fractures involving the posterolateral aspect treated between January 2018 and December 2023. Patients were divided into L-shaped plate group (simple lateral L-shaped plate fixation, n=24) and combined group (lateral L-shaped plate combined with posterior T-shaped plate fixation, n=15). Key indicators were compared, including operative time, intraoperative blood loss, bone mineral density, preoperative tibial plateau collapse, time from injury to surgery, postoperative radiographic parameters (tibial plateau varus angle and posterior tilt angle), knee range of motion, and Hospital for Special Surgery and Lysholm scores. Simultaneously, finite element models of Schatzker type II tibial plateau fracture were established based on CT data from a healthy adult male. Four groups were constructed: non-osteoporotic bone (Group A: simple L-shaped plate; Group B: L-shaped + T-shaped plate) and osteoporotic bone (Group C: simple L-shaped plate; Group D: L-shaped + T-shaped plate). Under axial loads of 250, 500, and 750 N, the overall displacement, tibial stress, and internal fixation stress of the models were analyzed in each group. RESULTS AND CONCLUSION: (1) Clinical trial results: The results showed no significant differences between the two groups in age, gender, body mass index, bone mineral density, preoperative tibial plateau collapse, or time from injury to surgery (P > 0.05). Operative time and intraoperative blood loss in L-shaped plate group were significantly lower than those in combined group (P < 0.000 1). Immediate postoperative tibial plateau varus angle and posterior tilt angle showed no significant differences between groups (P > 0.05). At the final follow-up, the varus angle in L-shaped plate group was smaller than in combined group (P=0.04), while the posterior tilt angle showed no significant difference (P > 0.05). At the final follow-up, no statistical differences were observed in knee range of motion, Hospital for Special Surgery scores, or Lysholm scores between groups (P > 0.05). (2) Finite element analysis results: Under the same loads, both non-osteoporotic and osteoporotic bone models with T-shaped plate-assisted fixation (Groups B/D) exhibited superior performance in terms of overall displacement and lower tibial stress compared with simple L-shaped plate fixation (Groups A/C). (3) These findings suggest that for osteoporotic Schatzker type II tibial plateau fractures involving the posterolateral aspect, simple lateral L-shaped plate fixation can achieve satisfactory reduction stability and functional recovery, with clinical outcomes comparable to dual-plate fixation. Finite element analysis indicates superior biomechanical performance with dual-plate fixation; however, considering the significantly reduced surgical trauma and favorable clinical outcomes with simple lateral L-shaped plate fixation, routine addition of a posterior T-shaped plate is not necessary. Figures and Tables | References | Related Articles | Metrics

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Interactive biomechanical effects between medial meniscus anterior horn transverse tears and osteoarthritic degeneration: a finite element simulation analysis Chen Jiahao, Zhang Jiahao, Tian Jiaqing, Xiang Ruian, Wang Shuai, Xu Xuemeng 2026, 30 (27):  7053-7060.  doi: 10.12307/2026.425 Abstract ( 65 )   PDF (2152KB) ( 21 )   Save BACKGROUND: Meniscus injury, as a significant contributing factor to knee joint degeneration, can accelerate the progression of osteoarthritis through anterior horn tears that alter joint stress distribution. Existing studies primarily focus on biomechanical changes in normal bone conditions, while the regulatory role of different bone conditions on the injury mechanism remains unclear. OBJECTIVE: To investigate the effect of medial meniscus anterior horn transverse tears on the biomechanical differences of knee joints with varying bone conditions. METHODS: Imaging data of the lower limb from a healthy adult were used to construct a normal knee joint model in Mimics 2017. The model was further optimized and assembled using Geomagic Studio 2017 and SolidWorks 2017, and a medial meniscus anterior horn transverse tear model was established. Material properties were defined in Ansys Workbench 2017, and bone mass reduction and osteoporosis states were simulated to generate three finite element models for biomechanical analysis. Model validation was performed through anterior drawer and axial loading tests. Subsequently, the femur was constrained, the distal tibia was fixed, and a 1 000 N axial compressive load was applied. Peak stress and strain distribution were calculated across different bone quality models. RESULTS AND CONCLUSION: (1) Under static standing conditions, both intact and injured medial meniscus models exhibited significantly higher joint stress loading in the bone mass reduction and osteoporosis groups compared with the normal bone group. (2) In the medial meniscus anterior horn transverse tear model, stress loading on femoral cartilage and medial and lateral menisci showed a progressive increase compared with the intact model, whereas the stress on medial and lateral tibial cartilage decreased with reduced bone quality. In the injury model, stress was concentrated at the tear margins. (3) The subchondral bone region demonstrated elevated stress levels under reduced bone mass conditions, particularly after medial meniscus injury, where both strain distribution and peak equivalent stress were significantly increased, with statistically significant differences (P < 0.05). (4) This study demonstrates that medial meniscus anterior horn transverse tears, under conditions of reduced bone mineral density, exacerbate the reduction of joint contact area and local stress concentration, which may lead to increased tibia subchondral bone strain. These findings indicate an interactive biomechanical effect between bone degeneration and meniscal injury and provide a reference for selecting meniscal repair strategies according to different bone quality levels. Figures and Tables | References | Related Articles | Metrics

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Biomechanical characteristics of cervical spine movement in cervical spondylotic myelopathy analyzed based on motion capture and Opensim simulation technology Zuo Kuangshi, Wei Haokai, Liu Qiuli, Li Zhifei, Han Bin, Liu Jun, Zhang Zhanming, Zhou Jinyan 2026, 30 (27):  7061-7072.  doi: 10.12307/2026.451 Abstract ( 83 )   PDF (2786KB) ( 22 )   Save BACKGROUND: Previous studies have confirmed that neck muscle strength and intervertebral stress can influence the progression of cervical spine degeneration. However, no quantitative analysis has been conducted to examine the interaction between the biomechanical changes in cervical spondylotic myelopathy and cervical vertebral stress and paravertebral muscles. OBJECTIVE: To explore the cervical spine movement patterns of patients with cervical spondylotic myelopathy based on biomechanical principles, quantify the synergistic imbalance effects between paraspinal muscle strength and intervertebral stress in these patients, and discuss and reveal the dialectical relationship between the traditional Chinese medicine theory of “musculoskeletal imbalance” and the modern biomechanical concept of “dynamic and static imbalance” in cervical spondylotic myelopathy. METHODS: Twenty cervical spondylotic myelopathy patients who visited the orthopedic outpatient and inpatient departments of the First Affiliated Hospital of Guangxi University of Chinese Medicine were analyzed as the cervical spondylotic myelopathy group. Ten healthy individuals from health check-up centers and "prevention of disease" centers were included as the healthy group. The age and gender of all subjects were recorded. The six-degree-of-freedom motion data of the neck were collected through motion capture and Opensim virtual simulation models, with repeated measurements taken three times. After optimizing and sorting out the data, the range of motion, peak changes in motion angle, distribution of the center of pressure on the vertebral body, average muscle strength of each muscle, average maximum joint pressure, and average maximum joint shear force of the two groups were quantified using the Forward Dynamics tool algorithm. RESULTS AND CONCLUSION: (1) There were no significant differences in gender and age between the two groups from a statistical perspective. (2) In the left rotation, right rotation, and extension directions, the peak changes in movement angles were significantly smaller in the cervical spondylotic myelopathy group compared with the healthy group. In the lateral flexion, rotation, and extension directions, the range of motion was significantly greater in the cervical spondylotic myelopathy group compared with the healthy group. (3) Comparisons of pressure centers at C4 and C5 vertebrae indicated that the joint pressure centers in cervical spondylotic myelopathy patients were more dispersed. (4) The average muscle strength of cervical spondylotic myelopathy patients was significantly lower than that of the healthy population. (5) The maximum joint pressure on the C4 to C6 vertebrae during extension movements in cervical spondylotic myelopathy patients was significantly greater than that in the healthy population, while the maximum joint pressure on the C3 to C7 vertebrae during flexion, lateral flexion, and rotation movements was lower than that in the healthy group; the average maximum joint shear force on the C4 to C7 vertebrae during extension, lateral flexion, and rotation movements in the healthy population was greater than that in the cervical spondylotic myelopathy group. (6) It is indicated that during cervical movements, cervical spondylotic myelopathy patients exhibit reduced cervical muscle strength, baseline vertebral stress imbalance, altered stress distribution and pressure center distribution in the vertebral facet joints, accelerated degenerative changes in cervical vertebral bone structure and muscle, and impaired cervical stability. The biomechanical alteration mechanisms of “musculoskeletal imbalance” and “dynamic-static imbalance” in cervical spondylotic myelopathy are correlated. Figures and Tables | References | Related Articles | Metrics

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Digital measurement and correlation analysis of anatomical CT for clinical application in the hip joint Wu Chao, Su Ning, Chen Guoqiang, Li Xiaohe, Ou Wenjing 2026, 30 (27):  7073-7081.  doi: 10.12307/2026.239 Abstract ( 57 )   PDF (3057KB) ( 13 )   Save BACKGROUND: The complexity of hip joint anatomy makes it difficult to quantitatively assess by parameter indexes, and real-image rendering technology is important for the accurate display of hip joint microstructure and detection of diseases. OBJECTIVE: To evaluate the anatomical and morphological parameters of the hip joint through three-dimensional digital measurement by CT multi-planar reconstruction and cinematic rendering, compare the differences and analyze the correlation, so as to provide a precise anatomical parameter basis for the diagnosis and evaluation of hip-related diseases and hip arthroplasty. METHODS: Spiral CT images of the hip joints of 156 subjects (312 sides) aged 18 years or older without hip trauma or disease were collected and divided into six groups, each 10 years old. The CT images were processed with cinematic rendering and multi-planar reconstruction. Sharp angle, femoral head distance, acetabular coverage, acetabular depth, Cape verde, femoral offset, center edge angle, acetabular anterior section angle, posterior acetabular section angle, and acetabular anteversion were measured bilaterally. SPSS statistical software was used to compare the differences in anatomical parameters of bilateral hip joints in different age groups, and to analyze the correlation between different anatomical indexes and clinical baseline data.  RESULTS AND CONCLUSION: (1) Comparison of the anatomical parameters of the hip joint by left and right sides exhibited that the difference between Cape verde and femoral offset was statistically significant (P < 0.05). (2) Compared by gender, the sharp angle, femoral offset, femoral head distance and anterior acetabular tilt were greater in women than in men (P < 0.05). (3) Compared by different age groups, the values of the young group in the indexes of acetabular depth, acetabular coverage, acetabular anterior section angle, posterior acetabular section angle, anterior acetabular tilt, and center edge angle were smaller than those of the old group (P < 0.05). (4) When acetabular coverage-traditional method was compared with acetabular coverage-innovative method and acetabular depth-coronal with acetabular depth-axial position, the differences were not statistically significant, but there was a significant correlation (r=0.76, 0.95, P < 0.01). Sharp angle was negatively correlated with body mass index, acetabular coverage, acetabular depth, center edge angle, acetabular anterior section angle, and posterior acetabular section angle (P < 0.05), and acetabular coverage, acetabular depth, center edge angle, acetabular anterior section angle, and posterior acetabular section angle were positively correlated with each other (P < 0.01). (5) It is indicated that cinematic rendering and multi-planar reconstruction technology facilitates accurate measurement and assessment of hip joint anatomical parameter indexes, and there are obvious differences in parameter indexes between different genders and age groups, with certain characteristic trends, and there are significant correlations between different anatomical parameter indexes. Figures and Tables | References | Related Articles | Metrics

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Digital six-axis external frame assisted unilateral external fixator for treatment of tibial shaft fractures: achieving anatomical reduction and stabilization Zhang Ji, Qiao Feng, Lu Yufeng 2026, 30 (27):  7082-7087.  doi: 10.12307/2026.424 Abstract ( 69 )   PDF (1587KB) ( 10 )   Save BACKGROUND: The trend in external fixator development is towards intelligence and miniaturization. Professor Qiao Feng of Xi'an Honghui Hospital designed a digital six-axis external fixator technology, based on CT data, which can accurately reduce fractures and is applied to lower limb fracture and orthopedic treatment, known as the Qiao’s spatial frame technology. Considering the large size of the digital six-axis external fixator, Professor Qiao Feng further developed a digital six-axis external fixator-assisted reduction and unilateral external fixator technology for the treatment of tibial shaft fractures. The developed unilateral external fixator is small in size, can be coupled with the six-axis external fixator, and is relatively less expensive than similar external fixators such as the Taylor spatial frame. OBJECTIVE: To explore the effectiveness and reliability of digital six-axis external frame (Qiao’s spatial frame) assisted reduction and unilateral external fixator fixation for the treatment of tibial shaft fractures. METHODS: A retrospective analysis was conducted on 103 patients with tibial shaft fractures treated with digital external fixators in the Department of Integrated Traditional Chinese and Western Medicine Orthopedics of Xi'an Honghui Hospital from January 2018 to December 2022. The cases were divided into a Qiao’s spatial frame group (n=51) and a Qiao’s spatial frame assisted reduction and unilateral external fixator fixation group (n=52). The displacement distance and angle of the fracture were measured on X-rays 4 weeks after reduction. Independent sample t test and chi-square test were used to compare fracture displacement, fracture healing time, lower extremity functional score and the incidence of pin tract complications. RESULTS AND CONCLUSION: (1) There was no significant statistical difference in the displacement of the fracture 4 weeks after reduction between the Qiao’s spatial frame group and the Qiao’s spatial frame assisted reduction and unilateral external fixator fixation group (P > 0.05). (2) There was no significant statistical difference in the fracture healing time, lower extremity functional score and pin tract infection rate between the two groups (P > 0.05). (3) The pin tract traction pain in the Qiao’s spatial frame assisted reduction and unilateral external fixator fixation group was significantly reduced compared with the Qiao’s spatial frame group, with significant differences (15 cases versus 2 cases, P < 0.05). (4) It is indicated that Qiao’s spatial frame assisted reduction and unilateral external fixator fixation technology achieves anatomical reduction and stable fixation by coupling a Qiao’s spatial frame with a unilateral external fixator structure, significantly reducing the volume of traditional circular external fixators and reducing the incidence of needle tract complications, providing a minimally invasive and effective treatment option for closed and open tibial shaft fractures. Figures and Tables | References | Related Articles | Metrics

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Application of anatomical biomimetic reconstruction of the external rotators combined with repair of the zona orbicularis in unilateral artificial femoral head replacement Ma Zaichao, Maimaitiyibubaji·Abudukadier Lyu Qing, Yang Zengqiang, Li Biao, Cui Yong 2026, 30 (27):  7088-7094.  doi: 10.12307/2026.863 Abstract ( 58 )   PDF (2349KB) ( 27 )   Save BACKGROUND: The current focus of related research on surgical techniques for elderly hip fractures has shifted from mechanical structural repair to biomechanically precise reconstruction based on the principles of bionic medicine. Although the theory of anatomical reduction and repair is widely accepted, how to achieve an optimal balance between repair stability and joint range of motion through personalized treatment plans still requires further investigation. OBJECTIVE: To investigate the application effect of anatomical bionic reconstruction of the external rotator muscles combined with repair of the zona orbicularis in unilateral artificial femoral head replacement. METHODS: A retrospective cohort study was conducted, including 124 elderly patients with unilateral femoral neck fractures admitted to the Fifth Affiliated Hospital of Xinjiang Medical University from June 2021 to March 2023. All patients underwent  artificial femoral head replacement via a posterolateral approach. Based on comprehensive analysis of clinical data and preoperative doctor-patient communication, the patients were divided into two group: 65 patients underwent anatomical bionic reconstruction of the external rotator muscles combined with repair of the zona orbicularis (trial group), while 59 patients received conventional suture (fixing the joint capsule combined with the external rotator tendon to the greater trochanter, control group). Operative time, intraoperative blood loss, incision length, wound healing, hospital stay, complication rates, and readmission rates were recorded in the two groups. Postoperative visual analog scale scores, Harris scores, hip flexion-extension range of motion, and internal-external rotation range of motion were compared between the two groups to evaluate the clinical application value of the anatomical bionic reconstruction technique in unilateral artificial femoral head replacement. RESULTS AND CONCLUSION: (1) No significant differences were found in the general data between the two groups (P > 0.05). (2) Perioperative indicators: one case in the trial group and two cases in the control group had grade B healing wounds, which healed well after active anti-infection treatment and regular dressing changes. The trial group showed significantly better intraoperative blood loss and incision length than the control group (P < 0.05). Operative time was longer in the trial group compared with the control group, but the difference was not statistically significant (P > 0.05). No significant differences were observed in wound healing or hospital stay between the two groups (P > 0.05). (3) There was no significant difference in the time to full weight-bearing activity between the two groups (P > 0.05). Compared with the control group, the trial group showed significantly better postoperative visual analog scale scores (except at 1 month postoperatively), Harris scores, hip flexion-extension range of motion, and internal-external rotation range of motion, indicating that superior long-term prognosis in the trial group was significantly better than that of the control group. (4) No significant difference was found in postoperative acetabular abduction angle between the two groups (P > 0.05). However, the trial group had a significantly higher postoperative anteversion angle than the control group (P < 0.05). (5) During regular follow-up, no prosthetic loosening, periprosthetic infection, or fractures were observed in either group. No dislocations occurred during hospitalization in either group. After discharge, one case in the trial group and three cases in the control group experienced dislocation, all of which were successfully reduced by manipulation under anesthesia. The difference was not statistically significant. (6) The results indicate that anatomical bionic reconstruction not only ensures joint stability but also achieves better functional outcomes, providing a new reference dimension for clinical surgical selection. Figures and Tables | References | Related Articles | Metrics

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Supercapsular percutaneously assisted total hip approach combined with local and intravenous tranexamic acid reduces perioperative hidden blood loss in hemiarthroplasty Wang Yijun, Zhang Weicheng, Wu Xiaoyang, Ju Zhengye, Zhu Feng, Zhou Jun, Li Rongqun, Xu Yaozeng, Zhang Lianfang 2026, 30 (27):  7095-7100.  doi: 10.12307/2026.864 Abstract ( 65 )   PDF (1245KB) ( 18 )   Save BACKGROUND: Intraoperative blood loss in hip hemiarthroplasty is reduced with the supercapsular percutaneously assisted total hip approach compared with the posterolateral approach, but the difference in hidden blood loss between the two approaches and the effect of tranexamic acid on it has not been fully investigated. OBJECTIVE: To investigate whether the supercapsular percutaneously assisted total hip approach reduces perioperative hidden blood loss in hip hemiarthroplasty for unstable femoral neck fractures in advanced age compared with the posterolateral approach and to analyze the effect of combined local and intravenous tranexamic acid on it.  METHODS: This study retrospectively analyzed a total of 200 elderly unstable femoral neck fracture patients who underwent hip hemiarthroplasty in the Department of Orthopedics, First Affiliated Hospital, Soochow University from January 1, 2020 to December 31, 2024. They were divided them into four groups (n=50 per group) according to the surgical approach and whether tranexamic acid was used in the perioperative period: (1) posterolateral approach group; (2) posterolateral approach + tranexamic acid group (combined local and intravenous administration of tranexamic acid); (3) supercapsular percutaneously assisted total hip approach group; and (4) supercapsular percutaneously assisted total hip approach + tranexamic acid group (combined local and intravenous administration of tranexamic acid). General data such as age, gender, height, weight, operation side, and basic preoperative data such as preoperative hemoglobin, hematocrit, prothrombin time, activated partial thromboplastin time and fibrinogen were collected from the patients. The hemoglobin and hematocrit were tested on the third postoperative day, and the total blood loss and hidden blood loss were calculated in each group. RESULTS AND CONCLUSION: (1) There was no statistically significant difference between the preoperative general data of the four groups. (2) Total blood loss and hidden blood loss on postoperative day 3 were reduced in the supercapsular percutaneously assisted total hip group compared with the posterolateral approach group, with significant differences (P < 0.05). (3) The posterolateral approach combined with tranexamic acid group had significantly less total blood loss and hidden blood loss than the posterolateral approach group without tranexamic acid, with significant differences (P < 0.05). (4) The supercapsular percutaneously assisted total hip approach combined with tranexamic acid group had significantly less total blood loss and hidden blood loss than the supercapsular percutaneously assisted total hip group without tranexamic acid, with significant differences (P < 0.05). (5) The incidence of lower extremity venous thrombosis was low in all study patients and there was no statistical difference among the groups. (6) It is concluded that hip hemiarthroplasty using supercapsular percutaneously assisted total hip approach in elderly patients with unstable femoral neck fractures reduces perioperative total and hidden blood loss compared with the posterolateral approach. The combination of local and intravenous tranexamic acid reduced perioperative blood loss in both the conventional and supercapsular percutaneously assisted total hip approaches to hip hemiarthroplasty without increasing the risk of thrombosis.  Figures and Tables | References | Related Articles | Metrics

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Impact of HoloLens 2–assisted navigation for precision acetabular cup placement on the learning curve of surgeons with different levels of experience Xia Qingquan, Wu Xuhua, Yin Yelin, Xu Qing, Meng Xiangchao, Rong Ke 2026, 30 (27):  7101-7107.  doi: 10.12307/2026.856 Abstract ( 54 )   PDF (1921KB) ( 24 )   Save BACKGROUND: There is a long surgical learning curve for safe and accurate placement of the acetabular prosthesis in hip replacement surgery. Mixed reality technology can fuse virtual image data models with real patient entities, which can help operations such as virtual surgery and intraoperative navigation, potentially improving the accuracy of acetabular prosthesis placement and shortening the surgical learning curve for less experienced surgeons. OBJECTIVE: To develop positional data for the accurate placement of acetabular components via HoloLens 2, and conduct surgical operations in combination with an in-vitro 3D-printed pelvic acetabular model, so as to clarify the efficacy of mixed reality technology in both training and intraoperative guidance for hip replacement surgery.   METHODS: Orthopedic surgeons with extensive experience in joint replacement surgery and those with limited experience in acetabular cup placement were recruited to perform in vitro surgical operations for joint replacement using an in vitro 3D printed pelvic acetabular model under conventional surgical operation and/or guided by HoloLens 2 head-mounted device, respectively. The abduction angle, the anteversion angle, the offset degree of the acetabular prosthesis were measured and recorded to compare the differences in the accuracy of acetabular component placement angles.  RESULTS AND CONCLUSION: (1) Under manual operation conditions, the experienced surgeon group had an acetabular cup abduction angle of (41.52±3.76)° and an anteversion angle of (21.35±3.63)°; the inexperienced surgeon group had an abduction angle of (44.29±7.62)° and an anteversion angle of (21.55±7.82)°. The differences in placement angles between the two groups were statistically significant (P < 0.05). (2) After using the HoloLens device for assistance, the inexperienced surgeon group had abduction and anteversion angles of (41.10±1.28)° and (20.09±0.53)°, respectively, while the experienced surgeon group had abduction and anteversion angles of (41.08±1.09)° and (20.28±0.65)°, respectively. There was no significant difference between the two groups. (3) This suggests that for total hip replacement, the use of mixed reality technology significantly improves the accuracy of acetabular cup placement compared with manual operation. The application of mixed reality technology provides significant clinical assistance for surgeons in precisely reaming the acetabulum and placing the acetabular cup, and can shorten the learning curve for orthopedic surgeons.  Figures and Tables | References | Related Articles | Metrics

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Effect of proximal femoral morphology on coronal varus positioning of cementless femoral stems Song Yang, Yuan Liufeng, Guo Zheng, Shen Dahui, Sun Shoukang, Xu Xiangjun, Guo Dongsheng, Dong Yuefu 2026, 30 (27):  7108-7114.  doi: 10.12307/2026.447 Abstract ( 53 )   PDF (2470KB) ( 9 )   Save BACKGROUND: Coronal prosthetic alignment of femoral stems significantly influences the prognosis of total hip arthroplasty. Currently, systematic analysis of the relationship between proximal femoral anatomical parameters and femoral stem prosthetic alignment remains insufficiently explored, and the quantitative impact of critical anatomical parameter thresholds on coronal varus implantation remains unelucidated. OBJECTIVE: To explore the effects of proximal femoral morphology and angular parameters on coronal varus alignment of uncemented femoral stems in total hip arthroplasty, determine predictive thresholds for key parameters, and construct a risk assessment model to provide clinical decision-making support for preoperative planning and surgical strategies of total hip arthroplasty. METHODS: Medical records of 276 cases undergoing primary total hip arthroplasty between January 2022 and December 2024 were retrospectively enrolled. Uncemented femoral stems were implanted via an anterolateral approach. Preoperative anatomical parameters of the affected proximal femur were measured: neck-shaft angle, femoral cortical index, canal flare index, and greater trochanter base to lateral cortical perpendicular intersection ratio. At 1 month postoperatively, cases were divided into a varus group (<−3°) and a non-varus group (≥−3°) based on the angle between the femoral stem axis and femoral medullary canal axis. Univariate analysis, receiver operating characteristic curve analysis, and multivariate logistic regression were employed to evaluate correlations between anatomical parameters and varus alignment. RESULTS AND CONCLUSION: (1) A total of 139 patients were included (varus group: 32 cases; non-varus group: 107 cases). (2) Univariate analysis demonstrated that the varus group had a smaller neck-shaft angle (P < 0.001) and higher greater trochanter base to lateral cortical perpendicular intersection ratio (P < 0.001) than the non-varus group. (3) Receiver operating characteristic curve analysis identified thresholds for varus prediction: neck-shaft angle ≤ 127.6° (area under the curve = 0.713) and greater trochanter base to lateral cortical perpendicular intersection ratio > 0.52 (area under the curve = 0.724). The area under the curve of combined prediction for neck-shaft angle and greater trochanter base to lateral cortical perpendicular intersection ratio was 0.772, demonstrating higher predictive efficacy than individual parameters. (4) Multivariate logistic regression confirmed that neck-shaft angle ≤ 127.6°and greater trochanter base to lateral cortical perpendicular intersection ratio > 0.52 were independent risk factors. (5) In summary, neck-shaft angle and greater trochanter base to lateral cortical perpendicular intersection ratio are independent risk factors for coronal varus alignment of uncemented femoral stems in total hip arthroplasty. The combined predictive model outperformed single parameters. Preoperative precise measurement of neck-shaft angle and greater trochanter base to lateral cortical perpendicular intersection ratio can guide prosthesis selection, optimize femoral prosthesis alignment strategies during total hip arthroplasty, and decrease the risk of varus implantation. Figures and Tables | References | Related Articles | Metrics

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Effect of CYP3A4*1G gene polymorphism on pharmacokinetics and pain threshold of sufentanil after joint replacement in elderly patients Peng Changsheng, Zhou Jianjun, Hu Xuhua, Jin Ming, Xie Wenlong 2026, 30 (27):  7115-7122.  doi: 10.12307/2026.241 Abstract ( 55 )   PDF (1906KB) ( 6 )   Save BACKGROUND: Pain management after joint replacement in elderly patients is the focus of clinical attention. Sufentanil is often used for postoperative analgesia due to its strong analgesic effect. There are individual differences in pain threshold among patients, which may be related to drug metabolism. CYP3A4 is a key enzyme in the metabolism of sufentanil, and its genetic polymorphism can affect enzyme activity.  OBJECTIVE: To explore the effect of CYP3A4*1G polymorphism on the pharmacokinetics and pain threshold of sufentanil in elderly patients undergoing joint replacement to provide a basis for the formulation of individualized analgesic regimens. METHODS: A total of 150 elderly patients who underwent joint replacement in Xiantao First People's Hospital from January 2020 to January 2025 were selected as the study objects. The clinical data, pharmacokinetic parameters and post-administration pain threshold of patients with different genotypes were compared. Multiple linear regression was used to analyze the association between CYP3A4*1G and pain threshold under different genotypes. The effects of different genotypes and pharmacokinetic parameters on pain threshold were observed by two-factor analysis of variance. Pearson correlation was used to analyze the correlation between the blood concentration of sufentanil and the pain threshold under different genotypes.  RESULTS AND CONCLUSION: (1) Of the 150 patients enrolled, 88 were in the wild homozygote group, 54 were in the mutant heterozygote group, and 8 were in the mutant homozygote group. (2) CYP3A4*1G allele mutation rate was 23.33%. The distribution of CYP3A4*1G alleles was consistent with Hardy-Weinberg genetic balance test (χ2=0.102, P=0.950). (3) Compared with wild homozygote group, terminal elimination half-life, area under the curve, and pain threshold at each time point in mutant heterozygote group and mutant homozygote group were significantly increased (P < 0.05), and clearance rate was significantly decreased (P < 0.05). Compared with mutant heterozygote group, terminal elimination half-life, area under the curve, and pain threshold at each time point in mutant homozygote group were significantly increased (P < 0.05), and clearance rate was significantly decreased (P < 0.05). (4) Multiple linear regression analysis showed that CYP3A4*1G gene polymorphism was significantly associated with pain threshold in mutant homozygotes and mutant heterozygotes (P < 0.05). (5) The results of two-factor analysis of variance showed that regardless of pharmacokinetic parameters, the difference of pain threshold among different genotypes was statistically significant (P < 0.001), the pain threshold of mutant homozygote > mutant heterozygote > wild homozygote. (6) The pain threshold of electrical stimulation in patients with different genotypes increased after injection of sufentanil compared with before administration, and decreased with the decrease of blood concentration of sufentanil, showing a good correlation (r=0.81, 0.89, 0.86, all P < 0.05). (7) It is indicated that in elderly patients undergoing joint replacement, the pain threshold increased after sufentanil injection, while CYP3A4*1G allele mutation would slow down sufentanil metabolism, and the pain threshold was significantly positively correlated with sufentanil blood concentration. Figures and Tables | References | Related Articles | Metrics

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TiRobot navigation versus conventional minimally invasive percutaneous pedicle screw fixation for treating thoracolumbar spine fractures Xue Ningning, Zhao Yibo, Zhao Xiaofeng, Qi Detai, Wang Haomin, Zhao Bin 2026, 30 (27):  7123-7129.  doi: 10.12307/2026.801 Abstract ( 100 )   PDF (1560KB) ( 21 )   Save BACKGROUND: The precision of pedicle screw placement directly impacts the prognosis of minimally invasive surgery for thoracolumbar fractures. Given the technological disparity between TiRobot assisted intelligent navigation and conventional C-arm 2D fluoroscopy, this study focuses on neurologically intact cases to demonstrate the former’s advantages through multidimensional evaluation of screw placement accuracy, surgical efficiency, and perioperative clinical metrics.  OBJECTIVE: To compare the clinical efficacy of percutaneous pedicle screw fixation under the guidance of the TiRobot system with traditional percutaneous pedicle screw fixation using "C" arm X-ray fluoroscopy for the treatment of thoracolumbar spine fractures without associated nerve injury.  METHODS: Retrospective analysis was conducted on 37 patients with single-segment thoracolumbar fractures treated surgically at the Second Hospital of Shanxi Medical University from November 2022 to March 2024. The trial group (the TiRobot-assisted group) included 18 cases, with 10 males and 8 females, and a total of 108 pedicle screws were implanted. The control group (the traditional "C" arm X-ray fluoroscopy group) included 19 cases, with 12 males and 7 females, and a total of 114 pedicle screws were implanted. The study compared general information, surgical time, intraoperative blood loss, intraoperative fluoroscopy duration, postoperative hospital stay, preoperative, 1-week postoperative, 6-month postoperative, and 12-month postoperative visual analog scale scores for lower back pain, lower back Oswestry disability index, percentage of anterior height of the injured vertebra, Cobb angle of sagittal plane kyphosis of the injured vertebra, screw placement accuracy, and facet joint involvement rate. RESULTS AND CONCLUSION: (1) The general information of the two groups of patients, surgical time, intraoperative blood loss, postoperative hospital stay days, visual analog scale scores, Oswestry disability index, percentage of the anterior edge height of the injured vertebra, and Cobb angle difference in the sagittal plane of the injured vertebra were all statistically insignificant (all P > 0.05). (2) The fluoroscopy time during surgery was significantly shorter in the trial group than that in the control group, with a statistically significant difference (P < 0.05). (3) The accuracy rate of screw placement in the trial group was 95.4%, and the rate of facet joint invasion was 2.8%. In the control group, the accuracy rate of screw placement was 86.0%, and the rate of facet joint invasion was 10.5%. The accuracy rate of screw placement in the trial group was higher than that in the control group, and the rate of facet joint invasion was lower than that in the control group, with both data differences being statistically significant (P < 0.05). (4) It is indicated that the percutaneous pedicle screw internal fixation under the guidance of TiRobot-assisted has higher accuracy than the traditional group of screws, which can effectively protect the facet joints and other spinal structures behind the spine, facilitate the reconstruction of spinal stability, and can effectively reduce the radiation exposure time of patients and medical staff during the operation. Figures and Tables | References | Related Articles | Metrics

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Correlation between preoperative anemia and lower extremity deep vein thrombosis in patients after elective lumbar fusion Zhang Haoliang, Wang Zhibing, Shan Tao, Han Guosong, Li Chun 2026, 30 (27):  7130-7134.  doi: 10.12307/2026.840 Abstract ( 63 )   PDF (1270KB) ( 10 )   Save BACKGROUND: Lower extremity deep vein thrombosis is a catastrophic complication after lumbar spine fusion, and previous studies have shown that some patients, such as those with prosthetic arthroplasty and abdominal surgeries, suffer from a combination of preoperative anemia, which predisposes them to postoperative deep vein thrombosis of the lower extremities. However, whether preoperative anemia increases the risk of lower extremity deep vein thrombosis after lumbar spine fusion is unclear. OBJECTIVE: To investigate the correlation between preoperative anemia and deep vein thrombosis of the lower extremities in patients after lumbar fusion. METHODS: The clinical data of 1 178 patients who underwent lumbar spinal fusion treatment admitted to Third Affiliated Hospital of Anhui Medical University from January 2020 to December 2023 were retrospectively analyzed. According to whether or not the patients developed lower extremity deep vein thrombosis after the operation, and the patients were divided into the deep vein thrombosis group (ultrasound report suggestive of lower extremity deep vein thrombosis) and the non-deep vein thrombosis group (ultrasound report suggestive of no lower extremity deep vein thrombosis manifestation). The incidence of anemia was compared between the two groups. The risk factors for lower extremity deep vein thrombosis in patients undergoing lumbar spinal fusion were determined by univariate analysis and multifactorial logistic regression analysis. RESULTS AND CONCLUSION: (1) Of the 1 178 patients, 43 (3.7%) were in the deep vein thrombosis group and 1 135 (96.4%) in the non-deep vein thrombosis group. (2) The prevalence of preoperative anemia in the deep vein thrombosis group was 32.6%, which was significantly higher than that in the non-deep vein thrombosis group, which was 10.9% (P < 0.05). (3) The results of univariate analysis showed significant differences in preoperative hemoglobin (P < 0.001), preoperative erythrocytes (P=0.028), D-dimer positivity (P=0.029), hypertension (P=0.019), the number of fused segments (P=0.023), anemia (P < 0.001), and transfusion (P=0.006) (P < 0.05). (4) Multifactorial analysis showed that preoperative anemia (OR=4.221, 95%CI:1.198-14.802, P=0.025) and D-dimer positivity (OR=2.023, 95%CI:1.065-3.844, P=0.031) were independent risk factors for the development of deep vein thrombosis after lumbar fusion. (5) It is indicated that patients undergoing elective lumbar fusion have a high incidence of preoperative anemia, and preoperative anemia is an independent risk factor for deep vein thrombosis after lumbar fusion. It is recommended that preoperative anemia should be actively managed and corrected before performing elective lumbar fusion to reduce the risk of deep vein thrombosis. Figures and Tables | References | Related Articles | Metrics

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Relationship between range of motion during distal femoral fracture release surgery and postoperative knee joint function: validation of a multivariate prediction model Dong Ruibo, Tang Dongming, Fei Fenglong, Chen Fengming, Tang Yongnan 2026, 30 (27):  7135-7141.  doi: 10.12307/2026.445 Abstract ( 68 )   PDF (1652KB) ( 6 )   Save BACKGROUND: Postoperative knee joint stiffness after distal femoral fracture is a core problem affecting functional recovery of patients. Its pathological mechanisms involve factors such as extensor mechanism adhesion, joint capsule contracture, and abnormal articular surface morphology.  OBJECTIVE: To explore the efficacy of arthroscopy combined with small incision adhesion release in the treatment of extension stiff knee after distal femoral fracture, and to analyze the risk factors affecting the functional recovery of knee joint.  METHODS: One hundred and fifty-two patients with non-infectious extension stiff knee after distal femoral fracture were selected in Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine from March 2019 to October 2024. Patients were divided into good recovery group (≥70, n=122) and poor recovery group (< 70, n=30) according to Hospital for Special Surgery score 6 months after operation. The clinical data including patient age, reduction quality and continuous passive motion exercise were collected. The risk factors were analyzed by univariate and multivariate Logistic regression. A prediction model was established and the effectiveness of the model was evaluated by receiver operating characteristic curve, calibration curve, and decision curve.  RESULTS AND CONCLUSION: (1) Univariate analysis showed that age ≥60 years old, non-anatomical reduction, no continuous passive motion exercise, postoperative complications, intraoperative flexion and extension range < 120°, increased preoperative changes of medial tibial joint line and decreased preoperative Hospital for Special Surgery score were significantly related to poor postoperative functional recovery (all P < 0.05). (2) Multivariate analysis confirmed that age ≥60 years, no continuous passive motion exercise, postoperative complications, intraoperative range of motion < 120°, low preoperative Hospital for Special Surgery score, and large change of medial tibial joint line were independent risk factors (all P < 0.05). (3) Threshold effect analysis revealed that there was a nonlinear relationship between intraoperative range of motion and recovery risk (P < 0.001), with 120° as the inflection point. When the activity was less than 120°, the recovery risk decreased by 3.3% for each increase (OR= 0.967). When ≥ 120°, the risk was no longer significantly reduced (P=0.073). (4) The discrimination (area under the curve = 0.821, 95% CI: 0.760–0.953), calibration (Brier value =0.097), and clinical net benefit (decision curve threshold 0.1–0.9) of the prediction model were all good. (5) These findings suggest that the functional recovery of stiff knee patients after distal femoral fracture is closely related to the threshold of intraoperative activity (120°), age, rehabilitation management, and preoperative joint state. The prediction model based on six independent risk factors has good efficacy and can provide basis for clinical intervention. Figures and Tables | References | Related Articles | Metrics

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Healing characteristics and influencing factors of large-segment infectious bone defect of tibia repaired by bone transfer Bu Jianwen, Xie Zengru, Ma Chuang 2026, 30 (27):  7142-7150.  doi: 10.12307/2026.758 Abstract ( 65 )   PDF (3701KB) ( 20 )   Save BACKGROUND: Severe segmental infectious bone defects of the tibia pose a significant challenge in orthopedic treatment due to persistent infection, poor local blood supply, and poor soft tissue conditions. Although bone transplantation techniques are the main repair method, the healing process is complex and influenced by multiple factors. The underlying mechanisms are not yet fully understood. Therefore, it is necessary to conduct in-depth research on the healing characteristics and influencing factors to optimize the treatment. OBJECTIVE: To explore the healing characteristics and influencing factors of large-segment infectious bone defect of tibia repaired by bone transfer and analyze the influencing factors.  METHODS: A total of 98 patients with large-segment infectious bone defect of the tibia treated by Ilizarov bone transfer in The First Affiliated Hospital of Xinjiang Medical University from May 2020 to October 2022 were selected as the study subjects. According to the clinical criteria of delayed or nonunion and union of fractures, they were divided into delayed or nonunion group (n=48) and union group (n=50), and the general data of the two groups were compared. A combined model was constructed. Cox regression analysis was used to evaluate the relationship between the fluctuation of bone specific alkaline phosphatase, N-terminal fragment of osteocalcin and amino terminal propeptide of type 1 procollagen and healing. Least Absolute Shrinkage and Selection Operator regression and multiple Logistic regression were used to analyze the risk factors affecting healing. After adjusting for confounding variables in Cox proportional risk model, the association of bone specific alkaline phosphatase, bone specific alkaline phosphatase, and amino terminal propeptide levels with poor healing was analyzed. The prediction model of regression equation y=1-1/(1+e-z) was established and verified.   RESULTS AND CONCLUSION: (1) There were significant differences in long-term smoking history, diabetes mellitus, soft tissue injury, fibula fracture, wound infection, weight bearing started within 6 weeks after surgery, displacement direction, bone displacement distance, bone specific alkaline phosphatase, N-terminal fragment, and amino terminal propeptide levels between delayed union or nonunion group and union group (P < 0.05). (2) The combined model showed that regardless of whether bone specific alkaline phosphatase, N-terminal fragment, and amino terminal propeptide were within the normal range; the risk of poor healing increased by 3%, 2%, and 4%. (3) Least Absolute Shrinkage and Selection Operator regression and multifactor Logistics regression analysis showed that after adjusting for potential confounders, soft tissue injury, weight bearing started within 6 weeks after surgery, wound infection, combined fibula fracture, and decreased levels of bone specific alkaline phosphatase, N-terminal fragment, and amino terminal propeptide were all independent risk factors for healing (P < 0.05). (4) After the adjusted Cox proportional risk model, bone specific alkaline phosphatase (HR=0.67, 95%CI:0.54-0.87, P < 0.001), N-terminal fragment (HR=0.80, 95%CI:0.55-0.99, P < 0.001), amino terminal propeptide (HR=0.85, 95%CI:0.43-0.97, P < 0.001) were important influencing factors for poor healing in patients with large-segment infectious bone defects of the tibia. (5) With the decrease of bone specific alkaline phosphatase, N-terminal fragment, and amino terminal propeptide levels (Q2-Q4), the correlation effect also increased, and the differences in trend test were statistically significant (Pfor trend < 0.05). Through Bootstrap self-sampling, the prediction model had good differentiation and accuracy. (6) It is concluded that the reduction of serum bone transformation markers bone specific alkaline phosphatase, N-terminal fragment, and amino terminal propeptide levels after the repair of large-segment infectious bone defects of the tibia by Ilizarov bone transfer is closely related to poor healing, and soft tissue injury, weight bearing started within 6 weeks after surgery, wound infection, combined fibula fracture and bone specific alkaline phosphatase, N-terminal fragment, and amino terminal propeptide levels are important factors affecting healing of patients.  Figures and Tables | References | Related Articles | Metrics

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Pain, inflammation, and stress response of fascia iliaca compartment block and femoral nerve block in hip fracture surgery Guo Dongdong, Gu Yongfu, Zhang Kairan 2026, 30 (27):  7151-7159.  doi: 10.12307/2026.861 Abstract ( 57 )   PDF (1445KB) ( 10 )   Save BACKGROUND: Hip fracture is a common and serious injury in the elderly population, with postoperative pain management directly impacting rehabilitation quality and functional recovery. While peripheral nerve blocks have become an integral component of multimodal analgesia, systematic comparison of different blocking techniques across various types of hip fractures remains limited. OBJECTIVE: To compare the analgesic effects, safety profiles, and postoperative recovery impacts of fascia iliaca compartment block and femoral nerve block in different types of hip fracture surgeries.  METHODS: A total of 180 patients scheduled for hip fracture surgery between January 2022 and June 2024 were enrolled and divided according to fracture type into femoral neck fracture group (n=60), intertrochanteric fracture group (n=60), and subtrochanteric fracture group (n=60). Patients in each group were randomly assigned to either fascia iliaca compartment block group or femoral nerve block group using a random number table, with 30 patients in each subgroup. Corresponding nerve blocks were performed preoperatively. Numerical Rating Scale scores at immediate postoperative, 6, 12, and 24 hours postoperatively, morphine consumption within 24 hours, time to first ambulation, length of hospital stay, inflammatory markers (interleukin-6, tumor necrosis factor-α) and stress response indicators (cortisol, blood glucose) at 24 hours postoperatively, and incidence of adverse reactions were recorded. Multivariate regression analysis was performed to identify factors influencing analgesic efficacy, and a nomogram prediction model was constructed. RESULTS AND CONCLUSION: (1) In femoral neck fracture and intertrochanteric fracture subgroups, fascia iliaca compartment block group showed significantly lower Numerical Rating Scale scores than femoral nerve block group at immediate postoperative, 6 and 12 hours (P < 0.01). (2) In femoral neck fracture group, the mean differences were 0.86 points (95%CI: 0.47-1.25), 0.90 points (95%CI: 0.45-1.35), and 0.79 points (95%CI: 0.30-1.28), respectively; in intertrochanteric fracture group, the mean differences were 0.83 points (95%CI: 0.43-1.23), 0.87 points (95%CI: 0.44-1.30), and 0.70 points (95%CI: 0.31-1.09), respectively. (3) In femoral neck fracture and intertrochanteric fracture groups, morphine consumption within 24 hours was significantly reduced (all P < 0.001), time to first ambulation was earlier (all P < 0.05), and length of hospital stay was shorter (all P < 0.05) in the fascia iliaca compartment block subgroup compared with the femoral nerve block subgroup. (4) In subtrochanteric fracture group, no significant differences were observed between fascia iliaca compartment block and femoral nerve block subgroups in all observed parameters (P > 0.05). (5) Fascia iliaca compartment block group showed significantly lower levels of inflammatory markers interleukin-6 (P < 0.001), tumor necrosis factor-α (P < 0.001) and stress indicators cortisol (P < 0.001), blood glucose  (P < 0.001) compared with femoral nerve block group. The overall incidence of adverse reactions was comparable between the two blocking techniques (P=0.825), mainly including nausea/vomiting, constipation, and urinary retention. (6) Multivariate regression analysis revealed that block technique (β=-3.76, P < 0.001), fracture type (subtrochanteric fracture β=5.47, P < 0.001), age ≥75 years (β=-1.75, P=0.022), and American Society of Anesthesiologists grade III (β=2.32, P=0.016) were independent predictors of analgesic efficacy. (7) The nomogram prediction model demonstrated good calibration. Interleukin-6 levels were positively correlated with length of hospital stay (r=0.42, P < 0.001) and time to first ambulation (r=0.38, P < 0.001). It is concluded that compared with femoral nerve block, fascia iliaca compartment block provides superior postoperative analgesia for patients with femoral neck fractures and intertrochanteric fractures, significantly reduces inflammatory and stress responses, shortens time to first ambulation and hospital stay, and promotes early recovery. However, in patients with subtrochanteric fractures, the two blocking techniques show comparable efficacy. Block technique, fracture type, age, and American Society of Anesthesiologists grade are independent factors influencing analgesic efficacy. The constructed nomogram prediction model can provide reference for individualized analgesic strategy selection in clinical practice. Figures and Tables | References | Related Articles | Metrics

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Impact of lesser trochanter displacement on hip function following minimally invasive intramedullary nailing for geriatric intertrochanteric fractures Peng Guofei, Zhai Yifa, Lu Shuang, Jiang Kundou, Zhang Bin, Zhang Yi, She Rongfeng 2026, 30 (27):  7160-7166.  doi: 10.12307/2026.408 Abstract ( 63 )   PDF (1589KB) ( 16 )   Save BACKGROUND: Percutaneous minimally invasive intramedullary nailing is a common and effective treatment for intertrochanteric fractures in the elderly, effectively avoiding complications. However, intertrochanteric fractures involving the lesser trochanter remain problematic, particularly with lesser trochanteric separation. Due to the diverse types of lesser trochanteric separation, there are few reports on whether lesser trochanteric separation should be fixed.  OBJECTIVE: To investigate the impact of lesser trochanter displacement distance on postoperative functional outcomes in elderly patients with intertrochanteric fractures treated with minimally invasive intramedullary nailing, providing clinical data to determine whether fixation is necessary.  METHODS: A retrospective analysis was conducted on 46 elderly patients with lesser trochanter displacement following intramedullary nailing for intertrochanteric fractures, treated in the Department of Emergency Surgery, Guizhou Provincial People’s Hospital from August 2020 to December 2023. Patients were divided into two groups based on displacement distance: group A [displacement ≥1 cm, n=23; 11 males and 12 females; mean (77.57±8.97) years] and group B [displacement <1 cm, n=23; 7 males and 16 females; mean (79.04±8.74) years]. Postoperative functional outcomes were compared between the two groups, including time to first straight-leg raise, time to first ambulation, fracture healing time, Harris Hip Scores at 1, 2, 3, 6, 9, and 12 months, and final follow-up excellent rate of Harris Hip Scores.   RESULTS AND CONCLUSION: (1) There were no significant differences in preoperative general data between the two groups (P > 0.05). (2) The time to first straight-leg raising (18.44±3.99) days after surgery in group A was significantly longer than that in group B (15.91±3.64) days (P < 0.05). The time to first ambulation (7.83±1.92) days after surgery in group A was significantly longer than that in group B (6.70±1.80) days (P < 0.05). However, there was no significant difference in fracture healing time between the two groups (P > 0.05). (3) At 1, 2, 3, and 6 months after surgery, Harris Hip Scores in group B were significantly higher than those in group A (P < 0.05). There was no significant difference in Harris Hip Scores between the two groups at 9 and 12 months after surgery (P > 0.05). (4) Hip function at last follow-up: 17 patients in group A achieved a Harris Hip Score of 90 or above, with an excellent rate of 74%; 20 patients in group B achieved a Harris Hip Score of 90 or above, with an excellent rate of 87%. There was no significant difference between the two groups (P > 0.05). (5) This suggests that functional recovery within 6 months after surgery varies among elderly patients with intertrochanteric fractures and differing lesser trochanteric displacement. Beyond 6 months after surgery, a displaced lesser trochanter does not affect hip function. Therefore, routine surgical fixation of displaced lesser trochanters may not be necessary for most elderly patients, though individual assessment remains important for patients with higher functional demands based on the patient's activity needs and physical condition.   Figures and Tables | References | Related Articles | Metrics

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Construction and validation of a temperature prediction model for cortical bone during orthopedic surgery Hu Zanying, Gao Fei 2026, 30 (27):  7167-7175.  doi: 10.12307/2026.275 Abstract ( 46 )   PDF (4253KB) ( 30 )   Save BACKGROUND: Cortical bone drilling, cutting, friction, and heat generation can easily cause local temperature rise. If it exceeds the bone tissue tolerance threshold and continues to act, it can lead to complications such as bone necrosis, delayed healing, or prosthesis loosening. The coupling of commonly used clinical parameters such as rotational speed, feed rate, and irrigation significantly affects the degree of thermal accumulation, and there is an urgent need to establish a quantitative tool that can predict the temperature field and heat affected zone to define the safe operating window. OBJECTIVE: To establish a temperature prediction model for cortical bone in orthopedic surgery by analyzing the temperature distribution of cortical bone at different depths and radial directions.  METHODS: A three-dimensional transient heat transfer control equation was established to describe the cortical bone drilling process. The moving/distributed heat source method was introduced to characterize the interface heat input caused by the shear of the anterior cutting surface and the friction of the posterior cutting surface, and the temperature field evolution at different radial and depth positions was calculated. Using the inverse heat transfer method, the distribution ratio of heat flux and heat between the tool chip bone interface was inverted under the constraint of a finite temperature sequence of measurement points. The model prediction was further validated through experimental comparison. RESULTS AND CONCLUSION: (1) Inverse heat transfer inversion showed that approximately 11.7% of the total heat entered the cortical bone solid under given operating conditions. (2) The established temperature prediction model exhibited good consistency with fresh pig bone drilling experiments in terms of peak temperature, temperature rise starting point, and temperature time curve morphology, confirming the reliability of the model in characterizing spatiotemporal temperature distribution. (3) In terms of spatial distribution, the closer to the pore wall (radius X approaching 2.0 mm), the earlier the temperature rise and the higher the peak value. Along the depth direction (z=0-5 mm), the temperature rise first occurred near the surface and gradually extended to the deeper part. (4) The heat affected zone increased with the increase of rotation speed: Under the conditions of a drill diameter of 4 mm and a feed rate of 60 mm/min, the heat affected zone was about 0.71 mm at 800 r/min and about 0.86 mm at 1 000 r/min. (5) The above results indicate that increasing the rotation speed will increase the bone thermal load and heat affected zone thickness while controlling the drill diameter and feed rate. Therefore, in clinical practice, it is necessary to synergistically optimize the rotational speed and cooling/irrigation strategy to reduce the risk of thermal bone injury. This model can be used for preoperative parameter screening and intraoperative risk assessment, providing quantitative basis for developing a "safety parameter window," improving cutting tools and irrigation plans, and enhancing patient outcome performance. Figures and Tables | References | Related Articles | Metrics

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Low-frequency repetitive transcranial magnetic stimulation improves limb motor function and upper limb muscles in stroke patients: a meta-analysis Ren Pengbo, Li Tingwen, Cai Feng, Zhang Jianhua 2026, 30 (27):  7176-7181.  doi: 10.12307/2026.443 Abstract ( 55 )   PDF (2141KB) ( 14 )   Save OBJECTIVE: Low-frequency repetitive transcranial magnetic stimulation significantly improves upper limb motor function in stroke patients, but its efficacy in reducing upper limb muscle spasticity remains controversial. Therefore, this study systematically evaluated the effects of low-frequency repetitive transcranial magnetic stimulation on limb motor function and upper limb muscle spasticity in stroke patients. METHODS:  Utilizing computer search technology, this study meticulously screened randomized controlled studies targeting stroke patients undergoing low-frequency repetitive transcranial magnetic stimulation treatment from databases such as PubMed, EMBASE, ScienceDirect, Cochrane Library, Web of Science, CNKI, VIP Information, WanFang Data, and China Biology Medicine (CBM). The experimental group received low-frequency repetitive transcranial magnetic stimulation therapy, or low-frequency repetitive transcranial magnetic stimulation combined with physical therapy or conventional rehabilitation therapy. The control group received conventional rehabilitation therapy, sham stimulation, or physical therapy. Subsequently, a meta-analysis was conducted on these studies using the RevMan 5.3 statistical software package. RESULTS: This meta-analysis included a total of 8 high-quality randomized controlled trials, encompassing 502 patients. The meta-analysis results revealed that compared with the control group, patients receiving low-frequency repetitive transcranial magnetic stimulation exhibited significant improvements in Brunnstrom hand function scores [mean difference (MD)=1.51, 95% confidence interval (CI): 1.22 to 1.80, P < 0.000 01], Fugl-Meyer motor function scores (MD=5.69, 95% CI: 3.18 to 8.20, P < 0.000 01), Modified Barthel Index scores (MD=8.55, 95% CI: 3.27 to 13.84, P=0.002), and Berg Balance Scale scores (MD=5.72, 95% CI: 3.13 to 8.32, P < 0.000 1). However, comparisons of Modified Ashworth Scale scores between the two groups after treatment showed no statistically significant difference (MD=-0.11, 95% CI: -0.17 to 0.85, P=0.82). CONCLUSION: Low-frequency repetitive transcranial magnetic stimulation can significantly improve the limb motor function and upper limb muscle condition in stroke patients, particularly enhancing hand motor function, overall motor ability, daily living self-care skills, and balance capacity. However, in terms of alleviating upper limb muscle spasticity, low-frequency repetitive transcranial magnetic stimulation has not demonstrated a clear advantage. Nevertheless, this conclusion still requires further verification through more high-quality studies with longer intervention durations and follow-up data. Figures and Tables | References | Related Articles | Metrics

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Local administration of liposomal bupivacaine reduces postoperative pain and complications in spinal surgery: a meta-analysis Nong Jiahong, Shi Dayang, Jin Jiacheng, Li Zhuhai, Wei Minke, Wei Jianxun 2026, 30 (27):  7182-7188.  doi: 10.12307/2026.321 Abstract ( 73 )   PDF (3270KB) ( 34 )   Save OBJECTIVE: The purpose of this meta-analysis was to assess whether the local application of liposomal bupivacaine in spinal surgery effectively reduces postoperative pain, opioid consumption, and the incidence of related complications. METHODS: The study was conducted strictly in accordance to the methodological guidelines proposed by Cochrane Handbook. The protocol of the present work was registered with PROSPERO. Two researchers independently conducted literature searches in electronic databases including CNKI, WanFang Data, VIP, PubMed, Web of Science, Embase, Cochrane Library, and Google Scholar, collecting eligible trials published between January 2015 and December 2024, followed by systematic data collection and organization. The risk of bias or the quality of each included study was evaluated by two assessors. Data were analyzed using STATA software. RESULTS: (1) 13 studies involving 2 962 patients were included in the present work. The risk of bias of randomized controlled trials were rated as low to moderate, while the quality of the included cohort studies was allocated to high. (2) The results of this study revealed that total opioid consumption in the liposomal bupivacaine group was significantly lower than that in the control group [SMD=-0.36, 95% CI (-0.71, -0.02)]. However, the sensitivity analysis indicated that the robustness of this result was low. (3) Furthermore, the pain scores, opioid consumption and treatment-related complication rates at each follow-up point in the liposomal bupivacaine group were not significantly different from those in the control group (P > 0.05). CONCLUSION: Local administration of liposomal bupivacaine in spinal surgery did not increase the risk of treatment-related complications and effectively reduced total opioid consumption. However, no enough evidence supported that liposomal bupivacaine could significantly improve pain intensity during the spinal surgery.  Figures and Tables | References | Related Articles | Metrics

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Application of finite element analysis in unicompartmental knee arthroplasty for knee osteoarthritis Ma Changcheng, Fan Haiyan, Li Xiang, Liu Zhichao, Shao Jie, Yang Yun 2026, 30 (27):  7189-7195.  doi: 10.12307/2026.390 Abstract ( 46 )   PDF (1313KB) ( 22 )   Save BACKGROUND: Single condylar knee arthroplasty is an effective method to treat unilateral compartment knee osteoarthritis. As an advanced biomechanical research tool, finite element analysis provides important support for the prosthesis design and surgical planning of single condylar knee arthroplasty and the biomechanical characteristics of knee joint after unicompartmental knee arthroplasty. OBJECTIVE: To explore the application progress of finite element analysis in unicompartmental knee arthroplasty, including the optimization of unicompartmental knee arthroplasty prosthesis design, surgical planning and biomechanical characteristics of knee joint after unicompartmental knee arthroplasty.  METHODS: The first author used PubMed, CNKI, and WanFang for articles published from database inception to August 2025. English search terms were “FEA, UKA, knee osteoarthritis, knee joint, femoral component, tibia component, biomechanics, ligament of knee joint.” Chinese search terms were “finite element analysis, unicompartmental knee arthroplasty, knee osteoarthritis, knee joint, femoral component, tibial component, biomechanics, knee ligament.” Finally, 66 articles were included for review, including 57 in English and 9 in Chinese. RESULTS AND CONCLUSION: (1) Optimization of prosthesis design: By constructing unicompartmental knee arthroplasty models of different unicondylar prostheses, the stress distribution under different prosthesis structures was analyzed using finite element analysis, which provided accurate data guidance for the optimization of unicondylar prosthesis design. (2) Accurate surgical planning: Finite element analysis can accurately predict the influence of different osteotomy schemes on the biomechanics of knee joint by quantifying mechanical parameters, including tibial kyphosis, joint line position, and lower limb force line, which provides theoretical guidance for surgeons to choose the best surgical scheme, improve surgical accuracy, reduce the risk of complications, and improve the long-term survival rate of prosthesis. (3) Finite element analysis was used to predict the biomechanical characteristics after operation, which can simulate the mechanical behavior of knee joint after operation, including ligament tension, cartilage contact pressure, and bone strain distribution, and solve the mechanical details that two-dimensional images cannot capture. Figures and Tables | References | Related Articles | Metrics

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3D-printed personalized osteotomy guides affect mid- to long-term efficacy of unicompartmental knee arthroplasty: mechanisms, evidence, and prospects Tan Kunyuan 2026, 30 (27):  7196-7202.  doi: 10.12307/2026.467 Abstract ( 79 )   PDF (1342KB) ( 23 )   Save BACKGROUND: Unicompartmental knee arthroplasty is a commonly used surgical method for treating localized knee osteoarthritis, and its success relies on precise osteotomy and prosthesis positioning. Traditional techniques depend on the surgeon's experience and two-dimensional imaging, which makes it difficult to completely avoid alignment errors; these errors may affect the prosthesis survival rate and long-term efficacy. OBJECTIVE: To systematically summarize the factors determining the mid- and long-term efficacy of unicompartmental knee arthroplasty, analyze the technical principles of personalized osteotomy guides based on 3D printing combined with digital design, artificial intelligence planning, and physical manufacturing, providing evidence to improve surgical accuracy. Furthermore, this article elaborates on enhancing surgical precision by optimizing biomechanics and reducing abnormal prosthesis wear, thereby improving prosthesis survival rate, maintaining joint function, and reducing the risk of adverse reactions. METHODS: Relevant literature published in PubMed and China National Knowledge Infrastructure was searched, using Chinese and English search terms including “3D printing, unicompartmental knee arthroplasty, patient-specific instrumentation, mid-term, long-term, outcome.” After screening, a total of 65 articles were included for analysis. RESULTS AND CONCLUSION: (1) Personalized osteotomy guides based on 3D printing significantly improved the surgical precision of unicompartmental knee arthroplasty through CT scanning, 3D reconstruction, and 3D printing customization. (2) Compared with traditional surgery, personalized osteotomy guides based on 3D printing reduced the error in coronal and sagittal prosthesis placement, improved lower limb alignment, increased prosthesis survival, and reduced mid- to long-term adverse reactions such as aseptic loosening. However, controversies remain regarding poor tibial rotation positioning, increased costs, and no significant advantage in short-term functional scores. (3) Compared with robot-assisted surgery, personalized osteotomy guides based on 3D printing have slightly lower precision, but a shorter learning curve and lower cost. Currently, this field lacks long-term randomized controlled evidence and relies heavily on high-quality imaging data, resulting in a long preoperative preparation period. (4) This article analyzes existing research on personalized osteotomy guides, summarizing the role of this technology in improving surgical precision. It also discusses its current status and limitations in terms of cost-effectiveness, clinical workflow integration, and the insufficient high-quality evidence. (5) To promote the widespread application of personalized guides in the precise treatment of unicompartmental knee arthroplasty, future research should focus on conducting multi-center long-term randomized controlled trials, integrating artificial intelligence and intraoperative dynamic navigation technology, and establishing efficacy prediction models based on real-world data. This will provide a more solid theoretical basis for its clinical application. Figures and Tables | References | Related Articles | Metrics

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Deep learning in bone imaging diagnosis Zhang Xin, Zhang Meishu, Ge Miao, Sun Jianhao, Lyu Longlong, Gao Peng 2026, 30 (27):  7203-7209.  doi: 10.12307/2026.427 Abstract ( 77 )   PDF (1506KB) ( 51 )   Save BACKGROUND: Deep learning methods have made breakthrough progress in the field of bone imaging diagnosis. They have overcome the problems of easy misdiagnosis and low efficiency in traditional bone imaging diagnosis methods, and are conducive to the popularization of intelligent diagnosis methods in orthopedics. OBJECTIVE: To review the application, advantages and disadvantages of deep learning in the diagnosis of common bone diseases.  METHODS: Literature published from January 2021 to June 2025 on deep learning-assisted skeletal image diagnosis was retrieved from CNKI, WanFang, PubMed, and Web of Science databases. Chinese and English search terms included “artificial intelligence, deep learning, machine learning, computer-aided diagnosis, skeletal imaging, fracture, bone tumor, osteoporosis, osteoarthritis, synovitis, spinal, cartilage, classification, detection, segmentation.” According to the inclusion criteria, 76 articles were finally included in this review. RESULTS AND CONCLUSION: Deep learning models have become powerful tools for bone imaging diagnosis and are gradually gaining recognition from clinicians, improving the efficiency of bone imaging diagnosis. Deep learning technology uses its image feature capture ability to help improve the clinical diagnosis of fractures, bone tumors, osteoporosis, osteoarthritis, synovitis, spinal lesions and other diseases, providing reference for clinicians to make decisions. Although deep learning diagnostic applications have great potential, they are prone to the problem of insufficient generalization ability of the model, relying heavily on a large amount of labeled data, which leads to a lack of credibility of the model and thus hinders its clinical promotion and application. Future research should focus on enhancing the robustness of models and improving their generalization ability. In conclusion, deep learning has certain reference value in clinical skeletal imaging diagnosis. Figures and Tables | References | Related Articles | Metrics

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Integration of CD4+ T cell dynamic expression of quantitative trait loci reveals immunotherapeutic targets for sarcopenia Jin Zicheng, Cui Kai, Li Yuzhou 2026, 30 (27):  7210-7218.  doi: 10.12307/2026.798 Abstract ( 76 )   PDF (7520KB) ( 9 )   Save BACKGROUND: Sarcopenia is a degenerative illness in the elderly, and there is currently a dearth of particular therapeutic medications. Abnormalities in immune cells are risk factors for sarcopenia. CD4+ T lymphocytes play a vital role in skeletal muscle repair and regeneration. Previous research generally used expression quantitative trait loci data from whole tissues or blood to identify pharmacological targets, making it difficult to uncover the regulatory effects of gene expression on distinct cell subpopulations and their dynamic activation states. This study integrates dynamic expression quantitative trait locus data of CD4+ T cells to evaluate the immune cell specificity and activation time-dependent impacts of gene expression on sarcopenia, providing a platform for the development of precise immune intervention techniques. OBJECTIVE: To reveal the specific causal relationship between gene expression of different activation phases of CD4+ T cell subsets and sarcopenia. METHODS: Based on the study by Soskic et al. (CD4+ T cell dynamic expression quantitative trait loci data, covering 46 “cell-activation state” expression profiles in European populations), the Database of Immune Cell Expression, eQTLs and Epigenomics platform (led by the National Institutes of Health, providing immune cell expression quantitative trait loci data), the eQTLGen platform (jointly constructed by 37 institutions, providing a resource library of blood-specific expression quantitative trait loci in European populations), the Genotype-Tissue Expression platform (led by the National Institutes of Health, integrating data from 49 human tissues in European populations, providing skeletal muscle expression quantitative trait loci data), and the GWAS Catalog platform (developed by the European Bioinformatics Institute, providing genome-wide association study data globally), a two-sample Mendelian randomization analysis was systematically conducted. First, Mendelian randomization analysis will be undertaken utilizing dynamic expression quantitative trait loci of CD4+ T cells as exposure and sarcopenia phenotype as outcome to screen for candidate genes. Subsequently, Mendelian randomization analysis was undertaken using expression quantitative trait loci data from immune cells, whole blood, and skeletal muscle tissue to validate gene specificity. Simultaneously, the reproducibility of the results was tested by combining Mendelian randomization analysis based on summary data, heterogeneity testing, colocalization analysis, and differential gene expression analysis (using the dataset # GSE111016 from the Gene Expression Omnibus database). All data are publicly aggregated statistics data and conform to ethical norms. All analyses properly screened instrumental variables and followed the STROBE standards for observational research. RESULTS AND CONCLUSION: (1) After Mendelian randomization analysis and heterogeneity tests based on summary data, the results showed that RAB29, member RAS oncogene family (RAB29), NADH:ubiquinone oxidoreductase core subunit S3 (NDUFS3), and matrix metallopeptidase 24 antisense RNA (MMP24OS) had specific causal associations with sarcopenia. The expression level of RAB29 at 5 days post-activation of CD4+ naive T cells and the expression level of MMP24OS at 5 days post-activation of CD4+ memory T cells were positively causally associated with the risk of sarcopenia; the expression levels of NDUFS3 at 16 and 40 hours post-activation of naive T cells were negatively causally associated with the risk of sarcopenia. (2) Colocalization analysis further indicated that the expression quantitative trait loci of RAB29, NDUFS3, and MMP24OS had possible causative variations with the genome-wide association study signals for sarcopenia. (3) The results of differential gene expression analysis demonstrated that compared with the healthy control group, the expression level of NDUFS3 in the sarcopenia group was dramatically downregulated, but there was no significant change in the expression levels of RAB29 and MMP24OS between the two groups. It is confirmed that NDUFS3 is a possible gene therapy target for sarcopenia with temporal regulatory properties in CD4+ T cells. This analysis is based on data from the European population. In the future, a Mendelian randomization analysis framework for dynamic expression quantitative trait loci can be introduced to create and formulate precise intervention methods for the temporal control of T cell activity based on the Chinese population. Figures and Tables | References | Related Articles | Metrics

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Total knee arthroplasty alignment technology: visual analysis of the latest research hotspots Lin Haishan, Wang Wei, Ding Xuming, Wang Jindong, Wang Yaohua 2026, 30 (27):  7219-7228.  doi: 10.12307/2026.145 Abstract ( 65 )   PDF (4003KB) ( 12 )   Save BACKGROUND: Some patients report dissatisfaction after total knee arthroplasty due to persistent issues like limited mobility, joint instability, and residual pain. To address these challenges, various osteotomy methods and alignment strategies have been proposed and clinically implemented. However, the optimal approach remains debated, with no clear consensus.   OBJECTIVE: To comprehensively analyze global trends in alignment techniques for total knee arthroplasty and identify research hotspots through bibliometric and visual analysis, offering evidence-based insights to guide clinical decision-making.   METHODS: We retrieved publications (articles and reviews) on total knee arthroplasty alignment techniques published between January 1, 2015 and December 31, 2024, from the Web of Science database (https://www.webofscience.com, developed by the Institute for Scientific Information, USA). Data on countries, institutions, publication years, authors, journals, mean citation rates, H-index, titles, keywords, and the top 25 most-cited articles were extracted and analyzed. Keyword co-occurrence was assessed using VOSviewer and CiteSpace to predict research trends of alignment technology in total knee arthroplasty.   RESULTS AND CONCLUSION: (1) Totally 866 retrieved articles (792 research articles, 74 reviews) were found. (2) United States accounted for the highest number of publications. The University of California was the most prolific institution, and Stephen M. Howell was the most published author. Knee Surgery Sports Traumatology Arthroscopy had the highest publication and citation counts. (3) Frequent keywords included: total knee arthroplasty, alignment techniques, arthroplasty, clinical outcomes, and survival rate. Keyword and reference analysis highlighted kinematic alignment and robotic navigation as emerging research priorities. (4) It is concluded that publications on total knee arthroplasty alignment techniques continue to grow annually. The United States dominates research output and is now the country with the most articles published on total knee arthroplasty alignment technology and the largest contributor in this field, followed by the United Kingdom in overall contributions. Advanced tools like computer-assisted navigation and patient-specific osteotomy instruments are increasingly used to achieve alignment goals, though no universally optimal solution has been established to date. In the future, "robot-assisted navigation," "patient satisfaction," "long-term survival rate," "scope of indications," and "personalized osteotomy alignment" may be hot topics in the research of total knee arthroplasty alignment technology. Figures and Tables | References | Related Articles | Metrics

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Bibliometric analysis of development of precision, minimally invasive and intelligent robot-assisted spinal surgery Wan Ronghao, Shi Zhan, Jiang Jile, Han Xiao, He Da, Wu Jingye 2026, 30 (27):  7229-7236.  doi: 10.12307/2026.406 Abstract ( 54 )   PDF (14030KB) ( 8 )   Save BACKGROUND: In recent years, the application of robot-assisted surgery technology in the field of spinal surgery has become increasingly widespread, significantly enhancing the precision and minimally invasive level of surgeries and promoting the rapid development of this field. However, with the explosive growth of related literature, researchers urgently need to conduct systematic bibliometric analysis to sort out the research hotspots, cooperation networks and development trends in this field, so as to grasp the future research directions and promote academic exchanges and cooperation.  OBJECTIVE: To analyze the research hotspots, development trends, and domestic and international cooperation characteristics of robot-assisted surgical techniques in the field of spinal surgeries and explore their promoting effects on the precision and minimally invasive nature of spinal surgeries using bibliometric methods.  METHODS: Original research papers on robot-assisted spinal surgery published in the Science Citation Index Expanded (SCI-E) database of the Web of Science (WOS) core collection were searched from January 1, 2005 to March 31, 2025. Bibliometric analysis was conducted using the Web of Science online analysis platform, the Bibliometric platform, and the VOSviewer software.  RESULTS AND CONCLUSION: (1) A total of 772 original research articles were included in this study. The research on robot-assisted spinal surgery has been growing rapidly, with an average annual publication volume exceeding 50 since 2019, reaching a historical peak of 136 in 2024. (2) China (279 articles) and the United States (255 articles) are the countries with the highest publication volume, while the United Kingdom has the highest average citation frequency (69.57 times). (3) International Journal of Medical Robotics and Computer Assisted Surgery (84 articles) and Spine (33 articles, with a total citation frequency of 539 times) are the core journals in this research field. The research hotspots focus on the accuracy and safety of robot-assisted spinal pedicle screw placement, with high-frequency keywords including “accuracy,” “navigation,” “pedicle screw,” etc. (4) The international cooperation network shows that China, the United States, and Germany have close cooperation. Beijing Jishuitan Hospital in China is the core research institution, and Professor Da He is the author with the highest publication volume (21 articles). (5) The highly cited literature mainly focuses on the comparative studies of robot-assisted and traditional surgical methods in terms of screw placement accuracy, safety, and radiation dose. (6) Robot-assisted surgical technology is promoting the development of spinal surgery towards precision, minimally invasive, and intelligent directions. In the future, it is necessary to continue to strengthen cross-disciplinary cooperation at home and abroad to promote greater development in this field. Figures and Tables | References | Related Articles | Metrics