Objective To explore the effectiveness，safety，and intraoperative precautions of 3D printed cortical bone trajectory(CBT) guiding template in lumbar CBT fixation surgery.Methods The clinical data of 74 patients with osteoporotic lumbar degenerative diseases treated in Hangzhou Hospital of Traditional Chinese Medicine from January 2019 to December 2020 were collected.There were 43 males and 31 females.The age ranged from 68 to 74 years，with an average age of (69.82±5.73)years.There were 39 patients in the guided template CBT group，including 17 males and 22 females.The average age was (70.24±3.83)years (range 68 to 73 years).There were 35 patients in the manual CBT group，including 14 males and 21 females，aged 68 to 74 years，with an average age of (69.51±3.52)years.Gender，age，disease diagnosis，operation duration，blood loss (intraoperative and postoperative blood loss)，intraoperative fluoroscopy times and screw location imaging evaluation were collected.The Oswestry disability index (ODI) and visual analogue scale (VAS) were used to evaluate the functional recovery of the patients preoperative，postoperative，and at followup at the end of one year.Postoperative complications such as wound infection，fusion device displacement，screw extraction and fixation rupture were compared between guided template CBT implantation and manual screw implantation.Results All patients were followed up for 12 to 30 months，with a mean of (20.92±8.57)months.There was a statistically significant difference in operation time between the guided template group and the freehand screw group (t＝－23.20，P＝0.03).The blood loss in guided template CBT group (80.00±12.65)mL was significantly lower than that (230.00±38.70)mL in manual CBT group (t＝－36.62，P＝0.03).The number of radiation-oriented CBT sessions during surgery was significantly lower than that in the hands-free group (3 VS 12 sessions，t＝－5.65，P＜0.01).There were no significant differences in the incidence of wound infection and internal fixation failure between the guided template group and the free hand group (t＝0.94，P＝1.00).At the last followup，there was no significant difference in VAS score and ODI score between the two groups (t＝－1.05，－0.79，P＝0.28，P＝0.36).Conclusion Guided template CBT implantation technique can shorten the operation time，reduce blood loss，and reduce radiation damage to patients and medical staff，so it is a more economical，efficient and effective CBT implantation technique.

Objective To investigate the clinical effect of 3D printing assisted pedicle screw placement combined with improved posterior lumbar interbody fusion(PLIF)in the treatment of degenerative scoliosis.Methods From March 2020 to March 2022，47 patients with degenerative scoliosis admitted to the Spinal Surgery Department of Chengyang District People’s Hospital in Qingdao were randomLy divided into an observation group and a control group.The control group consisted of 23 patients，including 11 males and 12 females with an age range of 54~76 years and an average age of (63.09±6.22)years.The patients of control group underwent conventional posterior pedicle screw fixation and PLIF surgery.The observation group consisted of 24 patients，including 11 males and 13 females with an age range of 51~72 years and an average age of (60.64±5.65)years.The patients underwent posterior pedicle screw fixation and modified PLIF surgery with the preoperative use of 3D printing technology to develop a surgical plan while preserving the posterior longitudinal ligament complex.The surgical time，fluoroscopy times，screw placement time，intraoperative blood loss，postoperative drainage volume，Japanese orthopaedic association(JOA) spinal cord function score，visual analogue scale(VAS) pain score，Oswestry disability index(ODI)score changes at preoperative，1 month，6 months，and 12 months，Cobb angle changes at preoperative and final followup，screw placement status，and occurrence of complications were compared between the two groups.Results The measurements of the actual diameter and length of the pedicle screws，the distance from the entry point to the posterior midline，and the pedicle screw angulation in the observation group were similar to the preoperative measurements of the pedicle screws，with no statistically significant differences (P＞0.05).The observation group had significantly higher acceptable and accurate screw placement rates during surgery compared to the control group (P＜0.05).The observation group had significantly shorter surgical time，fewer fluoroscopy times，shorter screw placement time，less intraoperative blood loss，and lower postoperative drainage volume compared to the control group (P＜0.05).All patients underwent follow-up for an average of (13.20±2.51)months，with a follow-up period of 12~18 months.The observation group had significantly better VAS scores，JOA scores，and ODI scores at 1 month，6 months，and 12 months postoperatively compared to the control group (P＜0.05).In terms of complications，the observation group had significantly better outcomes than the control group (P＜0.05).Conclusion The application of 3D printing assisted screw placement combined with improved PLIF in the treatment of degenerative scoliosis can significantly reduce surgical time，fluoroscopy frequency，screw placement time，intraoperative bleeding，and postoperative drainage volume，improve surgical efficiency and safety，effectively reduce secondary trauma and fluoroscopy radiation damage caused by surgery，protect the physical health of surgical staff and patients，and effectively alleviate postoperative pain of patients.It also has a significant promoting effect on the recovery of postoperative spinal function in patients，and can to some extent reduce the occurrence of postoperative complications.

Objective To evaluate early and mid term effectiveness of periacetabular osteotomy(PAO)through modified Smith Peterson for development dysplasia of the hip (DDH)in adults.Methods 21 adults with DDH underwent PAO through modified SmithPeterson at Quanzhou Orthopaedics Hospital between April 2018 and January 2021.There were 1 male (1 hip) and 20 females (20 hips) containing 12 left hips and 9 right hips.The ages ranged from 18 to 44 years with a mean of (32.15±10.81)years.Among them，5 cases (5 hips) were categorized as modified T-nnis stage 0，14 cases (14 hips) as stage I，and 2 cases (2 hips) as stage Ⅱ.Intraoperative blood loss，surgical duration，hospitalization duration，occurrence of complications and preand post-operative Harris hip scores were recorded.Imaging assessments included lateral center edge(LCE) angle，acetabular inclination angle (T-nnis angle)，extrusion index (EI)，and anterior center edge (ACE) measured via X-rays.Results Bleeding volume was (779.52±29.60)mL，operation time was (115.95±4.44)min，the length of hospital stay was (7.29±0.35)days.Follow-up of all patients was (33.73±9.12)months (range 24~48 months).There were no complications such as vascular injury，fracture of posterior column of acetabulum，poor wound healing，infection，deep venous thrombosis of lower extremity.Postoperative numbness of the lateral femoral cutaneous nerve occurred in 2 adults(2 hips) and disappeard postoperatively 3 months without special treatment.At last follow up，Harris hip score was (89.67±3.44)，significantly better than preoperative ones (72.67±4.32)(P＜0.05).At 1 year after operation，X-ray films showed that the all osteotomies healed and there was no osteotomy block osteonecrosis.Postoperative LCE angle was (31.67±3.86)°，significantly better than preoperative ones (9.86±3.25)°(P＜0.05).Postoperative T-nnis angle was (6.57±2.44)°，significantly better than preoperative ones(15.05±2.48)°(P＜0.05).Postoperative EI was (11.33±2.96)%，which was significantly better than preoperative ones (29.19±2.89)% (P＜0.05).Postoperative ACE angle was (30.67±3.71)°，which was significantly better than preoperative ones (8.62±3.31)°(P＜0.05).Conclusion If the indications for surgery are strictly controlled and prevention and treatment of common surgical complications are payed attention to，PAO through modified Smith Peterson for DDH in adults can effectively improve the osseous covering of hip joint and significantly improve hip joint function，providing satisfactory early and mid-term clinical outcome.

Objective To compare the effects of the subvastus approach and the medial parapatellar approach on the early patellofemoral joint function after total knee arthroplasty.Methods In this retrospective randomized controlled study，80 patients who underwent total knee arthroplasty for knee degenerative diseases at Affiliated Hospital of Weifang Medical University from November 2021 to November 2022 were selected.They were divided into two groups based on the surgical approach：the subvastus approach(SVA) and the medial parapatellar approach (MPA)，with 40 cases in each.The SVA group comprised 11 males and 29 females，aged between 55 and 77 years，averaging (66.03±5.01)years.The MPA group comprised 13 males and 27 females，aged between 56 and 75 years，with an average age of (65.78±4.42)years.Axial knee films at 30 ° and 60 ° flexion in Laurin’s position were taken preoperatively and one month postoperatively in both groups to evaluate patellar lateral displacement and tilt angles.Operation time，intraoperative lateral patellar release，postoperative straight leg raising time，range of motion(ROM) at various postoperative stages，visual analogue scale (VAS) for pain，Lonner patellofemoral score，and intraoperative and postoperative complications were compared between groups.Results One month post surgery，the SVA group exhibited a lateral patellar displacement of (－1.91±1.94)mm at 30 ° knee flexion，outperforming the MPA group (－2.92±2.12)mm (P＜0.05).At 60 ° flexion，the difference in lateral patellar displacement between groups was not statistically significant (P＞0.05).The postoperative patellar tilt angles at 30 ° and 60 ° knee flexion were (5.64±2.17)° and (5.81±2.13)° in the SVA group，and (6.63±2.12)° and (6.82±1.77)° in the MPA group，both showing significant reductions from preoperative measurements (P＜0.05)，with the SVA group exhibiting greater postoperative improvement.The operation time for the SVA group (86.13±6.80)min exceeded that of the MPA group (82.83±6.06)min (P＜0.05).However，the SVA group had better outcomes in terms of intraoperative lateral patellar release，postoperative straight leg raising time，and ROM at different time points：65%，(26.25±6.71)hours，(99.75±8.87)°，and (106.53±6.67)°，compared to 92.5%，(34.84±7.56)hours，(89.93±11.30)°，and (102.53±8.90)° in the MPA group.Over time，the postoperative Lonner patellofemoral score tended to increase and the VAS tended to decrease in both groups.The SVA group’s VAS at different time points postoperatively were superior to the MPA group (P＜0.05).The Lonner patellofemoral scores at one and three months postoperatively were superior to the MPA group (P＜0.05)，with no significant difference between the groups at six months postoperatively (P＞0.05).Conclusion Compared with the medial parapatellar approach，the subvastus approach has less impact on patellofemoral function in the early postoperative period after total knee arthroplasty and is more conducive to accelerating postoperative recovery and reducing the occurrence of postoperative patellofemoral joint complications.

Objective To compare the therapeutic effects of intramedullary nail fixation using suprapatellar and infrapatellar approaches in the treatment of tibial shaft fractures and explore the differences in the effectiveness of different approaches in the treatment of tibial fractures，and analyze the causes of postoperative anterior knee pain.Methods A retrospective analysis was conducted on 143 cases of tibial shaft fractures treated with intramedullary nails at Jingmen People’s Hospital from January 2019 to December 2022.74 cases underwent suprapatellar approach were included in Group A.There were 39 males and 35 females in group A.The patients aged 34~55 years，with an average age of (41.56±3.24)years.In group B，69 cases were treated through the infrapatellar approach.There were 35 males and 34 females and the patients aged 30 to 56 years，with an average age of (40.56±5.54)years.After surgery，all patients were followed up for 6 months to compare the surgical time，intraoperative blood loss，occult blood loss at 48 hours after surgery，length of hospital stay，intraoperative X-ray fluoroscopy frequency，visual analog scale(VAS) for pain at different postoperative stages，hospital for special surgery(HSS) knee joint score，Lysholm score，and range of motion(ROM) between the two groups.Results All patients were followed up for 7 to 10 months，with an average of (8.31±1.21)months.All patients successfully completed the surgery without any vascular or nerve damage during the operation.Except for 3 cases of intramuscular venous thrombosis in the calf after surgery，all other patients did not experience serious complications such as deep tissue infection，internal fixation failure，skin necrosis，and osteomyelitis.There was no statistically significant difference in intraoperative bleeding，hospital stay，and bone healing time between the two groups of patients (P＞0.05).There was no statistically significant difference (P＞0.05) in HSS scores between postoperative follow-up at 1 and 3 months.After 6 months of follow-up，the HSS score of Group A was better than that of Group B，and the difference was statistically significant (P＜0.05).The surgical time and intraoperative Xray fluoroscopy frequency in Group A were significantly less than those in Group B，and the difference was statistically significant (P＜0.05).There was no statistically significant difference in ROM between the two groups at 1，3，and 6 months after surgery (P＞0.05).The Lysholm score of Group A was better than that of Group B at 3 and 6 months after surgery，and the difference was statistically significant (P＜0.05).There was no statistically significant difference (P＞0.05)in the VAS scores of preoperative and postoperative 1 and 3 months.On the 6th month after surgery，the VAS score of Group A was lower than that of Group B，and the difference was statistically significant (P＜0.05).Conclusion Both approaches for intramedullary nail treatment of tibial fractures are safe and reliable，and can achieve good surgical results.But the suprapatellar approach has more advantages.Reducing iatrogenic injuries during surgery，moderate tailcap protrusion，and continuous postoperative functional exercise can reduce the incidence of knee joint pain.

Objective To summarize the operation points and short-term curative effect of minimally invasive incision combined with open reduction and internal fixation in the treatment of tibial plateau fracture combined with anterior cruciate ligament intercondylar ridge fracture.Methods 25 patients ［17 males，8 females，38 to 55 years old，mean age (45.74±5.63)years］with tibial plateau fracture complicated with avulsion fracture of anterior cruciate ligament insertion point treated in the Department of Orthopaedics of Shanghai Jiaotong University School of Medicine Affiliated Xinhua Hospital from January 2019 to January 2021 were selected as the research objects.The classification of tibial plateau fracture was Schatzker Ⅱ~Ⅴ，and the surgical classification of anterior cruciate ligament intercondylar ridge insertion fracture was Meyers McKeever Ⅱ~Ⅳ.Open reduction and internal fixation of tibial plateau with steel plate combined with medial longitudinal incision of patellar ligament were implemented in all operations.The anterior cruciate ligament and the fracture block at the insertion point of intercondylar crest were firmly fixed by suture technique combined with tunnel fixation technique.The incidence of postoperative adverse reactions was counted，and Lysholm score，International knee documentation committee，international knee documentation committee(IKDC) score，Tegner score and the hospital special surgery(HSS) score were used to comprehensively evaluate the knee function at the last follow-up.Results All patients underwent successful operation.After follow-up for 12 to 18 months，with an average of (14.5±2.1)months.The fractures were clinically healed.One patient had postoperative incision fat liquefaction，which was cured after debridement，dressing change and drainage，followed by second stage suture，and the wounds of other patients were healed in phase Ⅰ.One patient developed knee stiffness 2 months after operation，which was released manually under intravenous anesthesia，and the range of motion gradually returned to normal.Two patients developed traumatic arthritis of knee joint，and their symptoms improved after oral nonsteroidal antiinflammatory drugs.At the last followup，all patients had knee straightening of 0 °，knee flexion of 100 ° to 135 °，with an average of (118.45±15.36)°. Lysholm score was (82.35±5.63).IKDC score was (85.67±6.44).Tegner score was (5.75±0.54).HSS score was(83.43±8.87)，and it was excellent in 15 cases，dood in 7 cases，medium in 3 cases and poor in 0 case.The excellent and good rate was 88%.Conclusion For patients with tibial plateau fracture combined with anterior cruciate ligament intercondylar ridge fracture，open reduction and internal fixation combined with anterior patellar minimally invasive incision and nonmicroscopic line crossing tunnel technology can realize onestage fixation of anterior cruciate ligament stop fracture block，which is conducive to early knee function rehabilitation exercise，early recovery of affected limb function and reduction of complications.