Zhongguo gu shang = China journal of orthopaedics and traumatology最新文献

{"title":"[Imaging study on the safety of freehand lumbar pedicle screw placement based on the cat's eye segmentation of X-ray films].","authors":"Jintao Xi, Rui Peng, Xiaozhen Wang, Xiongwei Wang, Yang Wang, Yiliang Zhu, Qilin Lu","doi":"10.12200/j.issn.1003-0034.20250735","DOIUrl":"https://doi.org/10.12200/j.issn.1003-0034.20250735","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the safety of manual lumbar pedicle screw placement based on the position of the cat's eye (pedicle projection) on X-ray films.</p><p><strong>Methods: </strong>A total of 150 patients with lumbar spine disorders from December 2022 to June 2024 were enrolled and classified into three types according to the cat's eye position on AP X-rays:type A (the lateral edge of the cat's eye extends beyond the lateral edge of the vertebral body); type B (the lateral edge of the cat's eye largely coincides with the lateral edge of the vertebral body);and type C (the lateral shadow of the pedicle is located at the medial edge of the pedicle). Patients were divided into two groups:the imaging-guided simulation group (90 patients, 30 each in types A, B, and C) and the imaging review group (60 patients, 20 each in types A, B, and C). All patients underwent screw insertion at the intersection of the inferior third of the transverse process and the lateral edge of the articular process. In the imaging-guided simulation group, the lumbar spine was divided into three regions from medial to lateral on AP X-rays;the screw direction was adjusted so that the tip of the screw tract corresponded to these three regions on the virtual projection, and CT analysis was performed to evaluate accuracy and determine whether the medial wall of the pedicle or the lateral edge of the vertebral body was penetrated. The imaging review group included 60 patients with lumbar pedicle screw placements;their AP and lateral X-ray images as well as postoperative CT data were analyzed to quantify the number of screws at corresponding positions and assess effectiveness via postoperative CT evaluation.</p><p><strong>Results: </strong>In the imaging-guided simulation study, the rate of successful screw placement in zone 3 for type A patients was 96.67% (29/30), significantly higher than that in zone 1 50%(15/30) and zone 2 86.67%(26/30), with a statistically significant difference(<i>P</i><0.05);In type B cat's eyes, the placement rates of screws in zone 1 and zone 2 were 90.00% (27/30) and 93.33% (28/30), respectively, significantly higher than those in zone 3 70% (21/30), with a statistically significant difference (<i>P</i><0.05);In type C cat's eyes, the placement rate in zone 1 was 90.00% (27/30), superior to that in zone 2 63.33%(19/30) and zone 3 40%(12/30), also showing a statistically significant difference(<i>P</i><0.05). Imaging analysis revealed that among patients with type A cats eyes, screw placements were in zone 1(3 cases), zone 2 (10 cases), and zone 3 (7 cases);the placement rates in zones 2 and 3 were 90% (9/10) and 100% (7/7), respectively, significantly higher than that in zone 1 33.3%(1/3), with a statistically significant difference (<i>P</i><0.05). For patients with type B cat's eyes, the placement rates in zones 1 and 2 were both 100% (5/5) and 100% (12/12), significantly higher than that in zone 3 33.3%(1/3), with a statistica","PeriodicalId":23964,"journal":{"name":"Zhongguo gu shang = China journal of orthopaedics and traumatology","volume":"39 8","pages":"770-7"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Research progress on the role of exosomal miRNA in spinal cord injury and intervention by traditional Chinese medicine].","authors":"Yanjun Zhang, Long Yang, Tiefeng Guo, Yandong Liu, Pingyi Ma, Linzhao Luo, Xinfeng Liu","doi":"10.12200/j.issn.1003-0034.20250308","DOIUrl":"https://doi.org/10.12200/j.issn.1003-0034.20250308","url":null,"abstract":"<p><p>Spinal cord injury (SCI) remains a significant challenge in modern medicine due to its complex pathophysiological mechanisms, the irreversibility of damage, and limited treatment options. Recent studies have shown that microRNAs (miRNAs) transported by exosomes play a crucial role in the occurrence, progression, and outcomes of SCI. This article systematically reviews the functional mechanisms of exosomal miRNAs in SCI, with a particular focus on elucidating the unique advantages and molecular mechanisms by which Traditional Chinese Medicine (TCM) intervenes in SCI through an integrated \"multi-component, multi-target, multi-pathway\" approach that modulates miRNA networks. The content encompasses the biogenesis of exosomal miRNAs and their regulatory roles in various pathological processes post-SCI, including the inflammatory microenvironment, axonal regeneration, cell apoptosis, and vascular injury. It provides a detailed summary of how active TCM components and compound formulas target specific miRNAs to regulate corresponding signaling pathways, thereby exerting synergistic and integrated effects across multiple aspects such as inhibiting inflammatory responses, reducing apoptosis, and promoting axonal regeneration and revascularization. Despite some progress in SCI research, numerous challenges persist, including the complexity of regulatory mechanisms, difficulties in clinical translation, and shortcomings in delivery technologies. Building on this, the article points out future directions for the integrated treatment of SCI combining traditional Chinese and Western medicine, explores the application prospects of nano-drug delivery systems in enhancing the delivery efficiency and therapeutic specificity of TCM, and provides a theoretical basis and conceptual reference for in-depth exploration of miRNA-targeted therapy and the modernization of TCM research. In conclusion, with the continuous advancement of integrated Chinese and Western medicine research, more effective treatment options for SCI patients are anticipated, ultimately improving their quality of life and prognosis.</p>","PeriodicalId":23964,"journal":{"name":"Zhongguo gu shang = China journal of orthopaedics and traumatology","volume":"39 8","pages":"849-56"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comparison of clinical outcomes between robot-assisted and conventional percutaneous pedicle screw fixation for lumbar fractures based on the AO classification].","authors":"Haiping Cai, Wenbin Xu, Chang Ge, Liqun Duan, Xi Chen, Wenzhi Zhang, Xiuwu Guo","doi":"10.12200/j.issn.1003-0034.20251014","DOIUrl":"https://doi.org/10.12200/j.issn.1003-0034.20251014","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the short-term efficacy of robot-assisted percutaneous pedicle screw fixation versus traditional percutaneous pedicle screw fixation in treating lumbar vertebral fractures, and to evaluate the differences in surgical benefits for different types of stable fractures based on AO classification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis was conducted on 47 patients with single-segment lumbar vertebral fractures admitted between January 2023 and December 2024. Patients were classified by AO type as stable fractures (A1/A2:22 cases) or unstable fractures (A3/B1-B2:25 cases);by surgical approach as robot-assisted percutaneous group (robot group) or conventional percutaneous group (traditional group). Among stable fractures, the robot group comprised 10 cases and the conventional group 12 cases;among unstable fractures, the robot group included 11 cases and the conventional group 14 cases. Perioperative parameters (operational time, intraoperative blood loss, postoperative hospitalization duration), visual analogue scale(VAS), Oswestry disability index(ODI), and anterior vertebral height(AVH) were compared between the two groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All patients were followed up for 12 months. In stable fractures, the robot group exhibited significantly lower intraoperative blood loss (23.50±7.47) mL compared to the conventional group (32.50±9.65) mL (&lt;i&gt;P&lt;/i&gt;=0.026), whereas no statistically significant differences were observed in operative time, postoperative hospitalization duration, VAS, ODI, and AVH scores at different time points before and after surgery between the two groups (all &lt;i&gt;P&lt;/i&gt;&gt;0.05). In unstable fractures, the robot group demonstrated superior surgical duration (64.09±11.36) min, intraoperative blood loss (27.73±12.92) mL, and postoperative hospitalization time (5.91±1.45) days compared to the conventional group (77.86±18.78) min, (46.79±20.34) mL, and (7.64±2.02) days, respectively, with all differences being statistically significant (&lt;i&gt;P&lt;/i&gt;&lt;0.05). On day 1 postoperatively, the VAS in the robotic group was (2.27±0.79) scores, significantly lower than that of the conventional group (3.43±0.94) scores (&lt;i&gt;P&lt;/i&gt;=0.003), although no statistically significant difference was observed between the two groups at the 12 month after surgery (&lt;i&gt;P&lt;/i&gt;=0.159). The ODI at day 1 and 12 months postoperatively were (26.55±6.56) and (8.27±2.10) respectively in the robot group, both significantly better than those of the conventional group (41.64±12.11) and (13.57±4.03), respectively (&lt;i&gt;P&lt;/i&gt;&lt;0.05). The AVH measurements at day 1 and 12 months postoperatively were (2.41±0.56) cm and (2.22±0.55) cm in the robot group, significantly higher than those of the conventional group (2.02±0.31) cm and (1.87±0.30) cm, respectively(&lt;i&gt;P&lt;/i&gt;&lt;0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;For unstable lumbar fractures(A3/B1-B2), robot-assisted percutaneous pedicle screw fixation provides superior ","PeriodicalId":23964,"journal":{"name":"Zhongguo gu shang = China journal of orthopaedics and traumatology","volume":"39 8","pages":"762-9"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Current clinical application status and decision making of internal fixation for lumbar spine].","authors":"Liang Yu, Liujun Zhao","doi":"10.12200/j.issn.1003-0034.20260714","DOIUrl":"https://doi.org/10.12200/j.issn.1003-0034.20260714","url":null,"abstract":"","PeriodicalId":23964,"journal":{"name":"Zhongguo gu shang = China journal of orthopaedics and traumatology","volume":"39 8","pages":"757-61"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical and radiological evaluation of sliding positioning and slotting with bone rongeur in posterior cervical laminoplasty].","authors":"Zhenxing Zhu, Bo Yang, Piyaо Ji, Yonggang Ma, Jianghua Ming, Yan Zhou","doi":"10.12200/j.issn.1003-0034.20250991","DOIUrl":"https://doi.org/10.12200/j.issn.1003-0034.20250991","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the clinical value and imaging evaluation of bone rongeur sliding positioning technique in precise laminotomy during posterior cervical spinal canal expansion and reconstruction surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis was conducted on the clinical data of 60 patients with cervical spondylotic myelopathy who underwent cervical posterior single-door laminoplasty with spinal canal expansion surgery for cervical spine treatment from October 2020 to December 2023, including 40 males and 20 females;age ranged from 39 to 78 years with a mean of (60.3±9.1)years;disease duration ranged from 1 to 120 months with a mean of (19.6±32.1) months. Among the 30 cases with concurrent ossification of the posterior longitudinal ligament of the cervical spine, 18 were focal-type, 7 were segmental-type, 2 were continuous-type, and 3 were mixed-type. The preoperative Modified Japanese Orthopaedic Association (mJOA) scores ranged from 7 to 14 wit a mean of (11.0±1.8) scores. MRI T2-weighted imaging revealed high signal intensity changes in the spinal cord in 31 cases; hypertension was present in 20 cases, and diabetes in 6 cases. The surgical decompression segments were as follows:C&lt;sub&gt;3&lt;/sub&gt;-C&lt;sub&gt;7&lt;/sub&gt; in 31 cases, C&lt;sub&gt;3&lt;/sub&gt;-C&lt;sub&gt;6&lt;/sub&gt; in 11 cases, C&lt;sub&gt;4&lt;/sub&gt;-C&lt;sub&gt;7&lt;/sub&gt; in 14 cases, C&lt;sub&gt;4&lt;/sub&gt;-C&lt;sub&gt;6&lt;/sub&gt; in 2 cases, C&lt;sub&gt;3&lt;/sub&gt;-C&lt;sub&gt;5&lt;/sub&gt; in 1 case, and C&lt;sub&gt;5&lt;/sub&gt;-C&lt;sub&gt;7&lt;/sub&gt; in 1 case. During the procedure, the bone rongeur sliding positioning technique was consistently employed for laminotomy. Based on CT data, the distance between the apexes of both pedicles, the width of the bilateral slits at the decompression level postoperatively, the distances from the slitting points to the medial wall of the spinal canal, as well as the transverse diameter of the spinal cord and the interlaminar space at the decompression level were measured. Functional assessment was performed using the mJOA classification system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;CT measurements showed that the distance between bilateral pedicle peaks progressively increased from C&lt;sub&gt;3&lt;/sub&gt; to C&lt;sub&gt;7&lt;/sub&gt;. In the postoperative decompression segments of C&lt;sub&gt;3&lt;/sub&gt;-C&lt;sub&gt;5&lt;/sub&gt;, the width of bilateral slots was greater than the distance between bilateral pedicle peaks(&lt;i&gt;P&lt;/i&gt;&lt;0.001), whereas in the postoperative decompression segments of C&lt;sub&gt;6&lt;/sub&gt;-C&lt;sub&gt;7&lt;/sub&gt;, the width of bilateral slots was smaller than the distance between bilateral pedicle peaks(&lt;i&gt;P&lt;/i&gt;&lt;0.05). The distance from the slotted points on both sides to the medial wall of the spinal canal remains relatively constant, ranging from 4.13 to 5.53 mm. MRI measurements indicate that the transverse diameter of the spinal cord was fairly consistent at the C&lt;sub&gt;3&lt;/sub&gt;-C&lt;sub&gt;5&lt;/sub&gt; segments, whereas it showed a gradual decrease in the C&lt;sub&gt;6&lt;/sub&gt;-C&lt;sub&gt;7&lt;/sub&gt; segments. In all MRI measurements, the interlaminal distance at the deco","PeriodicalId":23964,"journal":{"name":"Zhongguo gu shang = China journal of orthopaedics and traumatology","volume":"39 8","pages":"793-801"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Unilateral superior transverse process-extrapedicular approach vertebroplasty for osteoporotic lumbar fractures with small pedicles:a preliminary observation].","authors":"Bangguo Li, Shaochun Huang, Wei Ma, Ziyang Ding","doi":"10.12200/j.issn.1003-0034.20250798","DOIUrl":"https://doi.org/10.12200/j.issn.1003-0034.20250798","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of unilateral transtransverse process superior border pedicle external approach vertebral body reconstruction for lumbar fractures associated with osteoporosis in small pedicles.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 13 patients with vertebral fractures accompanied by osteoporotic microarches who underwent unilateral transluminal pedicle approach vertebral body reconstruction between October 2021 and March 2024, including 5 males and 8 females, with an average age of (72.92±5.95) ranging from 65 to 85 years old. The cases included 9 L₁ fractures and 4 L₂ fractures, all with a history of low-energy trauma characterized by lower back pain exacerbated upon sitting up and radiating to both costal regions in 4 cases. The disease duration ranged from 1 to 5 days with a mean of (2.92±1.19) days. Preoperative visual analogue scale (VAS) ranged from 5 to 7 with a mean of (6.31±0.75). MRI findings indicated fresh fractures with bone mineral density T-values <-2.5;axial CT measurements revealed pedicle diameters at their narrowest point ranging from 4.2 to 4.7 mm with a mean of (4.42±0.17) mm, all <5 mm. Individualized puncture planning was performed preoperatively, including measurement of skin-puncture distance on CT cross-sections and head-side deviation distance on lateral X-rays for precise intraoperative positioning. Surgical parameters including operative time, number of fluoroscopic procedures, bone cement volume injected, cement dispersion, and complications were recorded. Efficacy was assessed using VAS and the Oswestry disability index (ODI) at preoperative, postoperative day 1, and postoperative 3-month follow-up.</p><p><strong>Results: </strong>All patients underwent the surgery successfully and received follow-up examinations ranging from 3 months to 1 year. The operative duration ranged from 35 to 46 with a mean of (40.15±3.34) minutes. The number of fluoroscopic procedures was 11 to 17 with a mean of (13.77±2.05). The bone cement volume injected ranged from 4 to 6 with a mean of (4.73±0.70) mL, achieving uniform bilateral distribution throughout the bone cement. One case exhibited asymptomatic intervertebral space cement leakage, with no complications such as nerve injury or hematoma observed. Both VAS and ODI at 1 day and 3 months postoperatively were significantly lower than preoperative levels (<i>P</i><0.05), with better outcomes at 3 months compared to 1 day (<i>P</i><0.05).</p><p><strong>Conclusion: </strong>For osteoporotic lumbar fractures with narrow pedicles, unilateral percutaneous vertebral body formation via an extra-pedicular approach via the superior border of the transverse process is a technically feasible and highly effective treatment modality, offering advantages including shorter operative time, enhanced safety, reduced fluoroscopic requirements, and minimal invasiveness.</p>","PeriodicalId":23964,"journal":{"name":"Zhongguo gu shang = China journal of orthopaedics and traumatology","volume":"39 8","pages":"786-92"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Multilevel interpretable modeling and analysis of changes in dual pain dimensions in knee osteoarthritis].","authors":"Jiaxu Han, Yehui Peng, Wei Yang, Mengjie Wu, Xinghua Xiang, Yaxin Tian, Dezhi Tang","doi":"10.12200/j.issn.1003-0034.20260298","DOIUrl":"https://doi.org/10.12200/j.issn.1003-0034.20260298","url":null,"abstract":"<p><strong>Objective: </strong>Based on real-world clinical data, aimed to systematically characterize the key factors, decision-making pathways, and structural relationships influencing pain, and to investigate the differences and associated structural effects of changes across two pain dimensions in patients with knee osteoarthritis(KOA).</p><p><strong>Methods: </strong>Using the visual analog scale (VAS) and Traditional Chinese Medicine(TCM) pain symptom score as bimodal pain dimensions, XGBoost models were constructed under a unified feature system. Multi-layer interpretability analysis was conducted through SHAP, rule extraction, and Bayesian networks to examine the observational data from 187 cases of KOA.</p><p><strong>Results: </strong>The model identified age, disease duration, body mass index (BMI), administration time and local joint symptoms as key factors influencing changes in the TCM pain symptom score, while baseline VAS and medication use were key factors for changes in the VAS. Decision path analysis revealed that the primary pathway for changes in TCM pain symptoms was \"age<69 years, BMI≥23.94 kg·m^-2, and joint swelling score<4, \" while the main pathway for VAS changes was \"baseline VAS≥6 and concurrent use of analgesics.\" Furthermore, the structural relationships between variables and the two pain dimensions were revealed. For example, under the condition of \"age <69 years, BMI≥23.94 kg·m^-2, and joint swelling score<4\", the conditional probability of a \"significant change\" in the TCM pain symptom score was higher than that in the VAS.</p><p><strong>Conclusion: </strong>Under a unified model framework, an analytical approach for examining differential changes in related indicators was explored. Through multi-layered interpretability analysis encompassing \"feature importance assessment-decision rule extraction-Bayesian network inference, \" it was found that the dual pain dimensions share common influencing factors in reflecting pain changes in knee osteoarthritis, yet also exhibit structural association differences. These findings provide a reference basis for identifying pain change characteristics and selecting pain assessment tools in KOA patients, and offer a replicable methodological paradigm for similar analyses.</p>","PeriodicalId":23964,"journal":{"name":"Zhongguo gu shang = China journal of orthopaedics and traumatology","volume":"39 8","pages":"825-32"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Preliminary study on the learning curve of ultrasonic measurement of lumbar spinous process distance change rate].","authors":"Yantao Song, Xu Wei, Xu Wang, Chen Zhang, Guanghui Liu, Na An, Xiaoqi Zhao","doi":"10.12200/j.issn.1003-0034.20250956","DOIUrl":"https://doi.org/10.12200/j.issn.1003-0034.20250956","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the learning curve associated with ultrasound measurement of the change rate of lumbar spinous process distance in patients with lumbar disc herniation.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 90 patients with lumbar disc herniation who underwent ultrasound measurement of the change rate of lumbar spinous process distance from October 2018 to October 2020. Patients were sequentially numbered from 1 to 90 according to their visit order. All ultrasound measurements were performed by the same physician. Examination time was recorded for each patient. The cumulative sum analysis (CUSUM) method was used to plot the learning curve scatter diagram, which was then fitted with a polynomial function to calculate the inflection point (turning point) of the curve. Based on this turning point, patients were divided into a learning exploration group and a learning stability group. Intergroup comparisons of various indicators were performed to verify the existence of the learning curve.</p><p><strong>Results: </strong>(1)The best-fit simulation function for the learning curve was Y=8.75+1.86X-0.05X²+0.000 3X³(<i>R</i>²=0.951, <i>P</i><0.05), with the turning point identified at the 27th case. (2)There were no statistically significant differences between the learning exploration group and the learning stability group regarding age, sex, body mass index (BMI), disease duration, Oswestry disability index(ODI) scores, or the change rate of lumbar spinous process distance(<i>P</i>>0.05). However, the mean examination time was significantly longer in the learning exploration group(3.88±1.30) min compared to the learning stability group(2.21±0.32) min(<i>P</i><0.05).</p><p><strong>Conclusion: </strong>Ultrasound measurement of the change rate of lumbar spinous process distance exhibits a distinct learning curve. The turning point occurs at the 27th case. Once the stable phase is reached, the average examination time stabilizes at approximately (2.21±0.32) min.</p>","PeriodicalId":23964,"journal":{"name":"Zhongguo gu shang = China journal of orthopaedics and traumatology","volume":"39 8","pages":"801-5"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Evolution and prospect of treatment decision-making systems for spinal metastases:from traditional frameworks to the era of precision medicine].","authors":"Xuyong Cao, Yaosheng Liu","doi":"10.12200/j.issn.1003-0034.20250293","DOIUrl":"https://doi.org/10.12200/j.issn.1003-0034.20250293","url":null,"abstract":"<p><p>The treatment of spinal metastases is highly dependent on multidisciplinary collaboration. This study systematically reviews the evolution of clinical decision-making systems for spinal metastases, from traditional frameworks to the era of precision medicine. The neurologic, oncologic, mechanical, systemic(NOMS) framework, introduced in 2006, focused on surgical and radiotherapeutic interventions;however, it had notable deficiencies in its neurologic assessment grading and, in terms of oncologic management, largely overlooked the role of systemic therapy in achieving local control of bony metastatic lesions. The LMNOP (location, mechanical, neurologic, oncologic, patient) framework, proposed in 2011, attempted to explore individualized surgical approaches, but its accuracy in determining optimal strategies remained suboptimal, and it still fell short in adequately incorporating systemic therapeutic factors. In 2017, the International Spinal Oncology Consortium introduced the MNOP(mechanical, neurologic, oncologic, patient) system, which placed greater emphasis on patient survival assessment. In 2018, the Dutch guidelines standardized surgical timing and radiotherapy strategies, and in the same year, the MOSS (medical/mental, oncological, stenosis, stability) framework achieved innovations in systematic evaluation, non-surgical interventions, and the integration of psychological status. In 2021, the Department of Orthopedics at the Chinese PLA General Hospital proposed the SENO framework for spinal metastases, which encompasses four major elements:systemic conditions, effectiveness of systemic treatment of tumors, neurology, and oncology. Built upon the foundation of the ESCC Twelve-Point Grading System developed by the Chinese PLA General Hospital, the SENO framework has successfully established a novel precision comprehensive treatment model characterized by \"minimally invasive intervention first, followed by systemic therapy\". Clinical practice has demonstrated that the SENO framework offers significant advantages in therapeutic outcomes compared with traditional decision-making approaches. The continuous evolution of clinical decision-making systems for spinal metastases profoundly reflects the broader transformation of oncology from experience-based medicine to evidence-based medicine. Looking ahead, with the deep integration of artificial intelligence and multi-omics technologies, decision-making systems for spinal metastases are poised to advance toward a comprehensive, intelligent \"prevention-intervention-rehabilitation\" continuum, bringing new promise for improving patient prognosis.</p>","PeriodicalId":23964,"journal":{"name":"Zhongguo gu shang = China journal of orthopaedics and traumatology","volume":"39 8","pages":"836-42"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Preliminary construction and validation of an auxiliary diagnosis model for cervical instability based on multimodal deep learning].","authors":"Guangyi Yang, Changxiao Han, Minshan Feng, Haibao Wen, Jing Li, Bochen Peng, Liguo Zhu","doi":"10.12200/j.issn.1003-0034.20251185","DOIUrl":"https://doi.org/10.12200/j.issn.1003-0034.20251185","url":null,"abstract":"<p><strong>Objective: </strong>To preliminarily construct and validate a diagnostic model for Cervical Spine Instability (CSI) based on multimodal deep learning, and to develop an open-access, web-based prototype platform tailored for clinical scenarios.</p><p><strong>Methods: </strong>Clinical data from 122 subjects were included, integrating three-position X-ray images and nine structured clinical variables. The model architecture featured an imaging branch built on ResNeXt50 and a clinical branch based on a Fully Connected Neural Network(FCNN), with cross-modal fusion performed at the feature level(ResNeXt50-FCNN). Modality ablation studies were conducted using two control groups:\"Imaging-only\"(ResNeXt50) and \"Clinical-only\"(FCNN). Evaluation metrics included Area Under the Receiver Operating Characteristic Curve(AUC), Average Precision(AP), Accuracy, Precision, Recall, F1-score, and Specificity. Grad-CAM was employed for attention visualization of the imaging branch, while SHAP(SHapley Additive exPlanations) was used to interpretglobal and individual feature contributions of the clinical branch. Finally, the optimal model was deployed via the Streamlit framework to create an interactive, clinically usable platform.</p><p><strong>Results: </strong>The multimodal model achieved superior comprehensive performance on the validation set compared to the control groups, yielding an AUC of 0.964, AP of 0.973, Accuracy of 0.919, Precision of 0.875, F1-score of 0.933, and Specificity of 0.813. Ablation studies demonstrated that the fusion strategy significantly compensated for the insufficient sensitivity of the \"Imaging-only\" model and the low specificity of the \"Clinical-only\" model. Grad-CAM visualizations revealed that the model consistently focused on suspected abnormal structures across all three positions, effectively suppressing background interference. SHAP analysis identified age, limitation of flexion-extension, tenderness, gender, and headache as the primary contributing variables. The developed AI platform(https://cervical-instability-classifier.streamlit.app/) provides real-time outputs of diagnostic probabilities and visualizations of feature contributions.</p><p><strong>Conclusion: </strong>This study successfully constructed and preliminarily validated a CSI discrimination model based on multimodal deep learning, demonstrating promising diagnostic performance, interpretability, and potential for clinical application. However, given the limited sample size of this study, further external validation is required to confirm the model's generalizability and ultimate clinical utility.</p>","PeriodicalId":23964,"journal":{"name":"Zhongguo gu shang = China journal of orthopaedics and traumatology","volume":"39 8","pages":"806-14"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}