Xiangyao Sun

This prospective multicenter controlled cohort study evaluated whether structured supervised early operative exposure improves educational and clinical outcomes among junior Orthopedic residents. The goal of this protocol is to describe a structured, competency-based approach for implementing supervised early operative exposure in orthopedic residency training and evaluating its educational and clinical impact. Ninety-six first and second-year residents across three tertiary teaching hospitals were allocated to early exposure or traditional training and followed for 12 months. Residents receiving early supervised exposure demonstratedprocedures andincrease in surgical confidence (mean change 2.4 points; 95% CI 1.9-2.9; p < 0.001), reduced operative duration by approximately 20% in common procedures, and maintained low complication rates within accepted clinical benchmarks. Patient satisfaction and functional recovery outcomes remained high and improved in parallel with resident development. Surgical confidence showed a strong positive correlation with supervisor-rated technical skill (r = 0.81). These findings indicate that competency-based supervised early operative participation enhances resident performance and patient outcomes without compromising safety, supporting its integration into Orthopedic residency training.

Clinical decision-making is central to orthopedic residency training but is challenging to teach using traditional didactic lectures, which emphasize information transmission over active reasoning. Structured case-based learning (CBL) has been proposed as a learner-centered alternative that targets diagnostic reasoning, management planning, and decision-making under uncertainty. To compare the educational effectiveness of structured case-based learning versus traditional didactic lectures (TDL) in enhancing clinical decision-making among orthopedic surgery residents. A retrospective, multicenter cohort study was conducted across four postgraduate medical education programs in China. A total of 120 orthopedic residents were included (CBL and TDL, n = 60). Both groups completed an 8-week curriculum covering eight high-risk orthopedic topics with equivalent instructional time and objectives. The CBL intervention incorporated flipped pre-work, progressive case disclosure, forced decision nodes, and structured debriefing, while the TDL arm used slide-based lectures with question-and-answer periods. The primary outcome was a prespecified composite clinical decision-making score derived from standardized objective structured clinical examination (OSCE) decision stations, a Script Concordance Test, and time-to-correct-decision metrics. Secondary outcomes included knowledge performance, appropriateness of management, communication scores, retention at 8 weeks, learner satisfaction, engagement, and cognitive load. Assessors were blinded to the instructional group. Baseline characteristics and performance were comparable between groups. The CBL group achieved significantly higher composite decision-making scores than the TDL group at post-intervention and at 8-week retention, with moderate effect sizes. Secondary outcomes, including OSCE performance, reasoning under uncertainty, decision speed, knowledge scores, appropriateness of management, and communication ratings, consistently favored CBL. Learner satisfaction was higher in the CBL group, while cognitive load and attendance were similar between groups. Structured case-based learning was associated with superior educational performance compared with traditional lectures among orthopedic residents, with durable gains in decision-making. These findings support the integration of structured, decision-focused case discussions into residency didactic curricula.

Clinical decision-making is central to orthopedic residency training but is challenging to teach using traditional didactic lectures, which emphasize information transmission over active reasoning. Structured case-based learning (CBL) has been proposed as a learner-centered alternative that targets diagnostic reasoning, management planning, and decision-making under uncertainty. To compare the educational effectiveness of structured case-based learning versus traditional didactic lectures (TDL) in enhancing clinical decision-making among orthopedic surgery residents. A retrospective, multicenter cohort study was conducted across four postgraduate medical education programs in China. A total of 120 orthopedic residents were included (CBL and TDL, n = 60). Both groups completed an 8-week curriculum covering eight high-risk orthopedic topics with equivalent instructional time and objectives. The CBL intervention incorporated flipped pre-work, progressive case disclosure, forced decision nodes, and structured debriefing, while the TDL arm used slide-based lectures with question-and-answer periods. The primary outcome was a prespecified composite clinical decision-making score derived from standardized objective structured clinical examination (OSCE) decision stations, a Script Concordance Test, and time-to-correct-decision metrics. Secondary outcomes included knowledge performance, appropriateness of management, communication scores, retention at 8 weeks, learner satisfaction, engagement, and cognitive load. Assessors were blinded to the instructional group. Baseline characteristics and performance were comparable between groups. The CBL group achieved significantly higher composite decision-making scores than the TDL group at post-intervention and at 8-week retention, with moderate effect sizes. Secondary outcomes, including OSCE performance, reasoning under uncertainty, decision speed, knowledge scores, appropriateness of management, and communication ratings, consistently favored CBL. Learner satisfaction was higher in the CBL group, while cognitive load and attendance were similar between groups. Structured case-based learning was associated with superior educational performance compared with traditional lectures among orthopedic residents, with durable gains in decision-making. These findings support the integration of structured, decision-focused case discussions into residency didactic curricula.

This study aims to explore the connections between risk factors and clinical outcomes in octogenarian patients diagnosed with adult degenerative scoliosis (ADS). A total of 394 patients participated in this study, with 206 individuals in the younger group and 188 in the octogenarian group. We meticulously gathered patient demographics, including basic information, comorbidities, radiographic data, clinical scoring systems, and details on medical and surgical complications as well as revision surgeries. Univariable linear regression analysis revealed positive correlations between age and several postoperative outcomes: Sagittal vertical axis (SVA) (B = -0.572, P = 0.001), Oswestry Disability Index (ODI) (B = 0.145, P < 0.001), and Japanese Orthopaedic Association (JOA) score (B = 0.035, P < 0.001). Additionally, a positive relationship was observed between age and both proximal junctional kyphosis (PJK) (B = 0.055, P = 0.039) and internal fixation loosening (B = 0.253, P < 0.001). Receiver operator characteristic (ROC) curve analysis indicated that the age threshold values for predicting PJK and internal fixation loosening were 71.5 and 79.5, respectively. In octogenarian patients with ADS, the cost associated with spinal deformity surgery is accompanied by a greater incidence of surgical complications. Compared to younger patients, surgical intervention tends to be more effective at enhancing objective motor functions while having a lesser impact on the subjective experiences of octogenarian patients.

Background: This study aims to analyze the diagnosis and treatment conditions of polytrauma patients with spinal injuries, to clarify the site of the first surgical intervention, the timing of the surgery, and factors influencing prognosis. Methods: This study collected and analyzed data on polytrauma patients with spinal injuries who were treated from January 2017 to January 2023. Data collected primarily included basic patient information, treatment strategy-related information, clinical scoring systems, imaging parameters, and prognosis. The impacts of relevant variables on postoperative survival outcomes were analyzed. Results: This study included 60 patients. There was no significant change in the number of patients rated ASIA grade E after 90 days of admission, while there was a significant increase in those rated grade D ( P P =0.003). The survival rate of patients who underwent their first spinal surgery between 12 and 48 h was significantly better than those operated earlier than 12 h or later than 48 h ( P =0.047). Patients who experienced hemorrhagic shock postsurgery had the lowest survival rate ( P P =0.004) and the number of surgeries outside the spine ( P =0.033), as covariates, were significantly correlated with patient mortality (R ² =0.519). Conclusions: Performing spinal surgery too early or too late can adversely affect patient outcomes; the appropriate timing of surgery should be chosen based on the specific characteristics of the patient. In polytrauma patients under emergency conditions, the use of combined surgical treatments should be minimized to prevent the occurrence of a ‘second hit’. Patients who experience hemorrhagic shock have the worst postsurgical survival; targeted treatment should be administered upon hospital admission.

Introduction: The treatment of skip-level cervical degenerative disease (CDD) with no degenerative changes observed in the intervening segment (IS) is complicated. This research aims to provide a reference basis for selecting treatment approaches for noncontiguous CDD.Methods: To establish accurate finite element models (FEMs), this study included computed tomography (CT) data from 21 patients with CDD (10 males and 11 females) for modeling. The study primarily discusses four cross-segment surgical approaches: upper (C3/4) anterior cervical discectomy and fusion (ACDF) and lower (C5/6) cervical disc arthroplasty (CDA), FA model; upper CDA (C3/4) and lower ACDF (C5/6), AF model; upper ACDF (C3/4) and lower ACDF (C5/6), FF model; upper CDA (C3/4) and lower CDA (C5/6), AA model. An initial axial load of 73.6 N was applied at the motion center using the follower load technique. A moment of 1.0 Nm was applied at the center of the C2 vertebra to simulate the overall motion of the model. The statistical analysis was conducted using STATA version 14.0. Statistical significance was defined as a p value less than 0.05.Results: The AA group had significantly greater ROM in flexion and axial rotation in other segments compared to the FA group (p < 0.05). The FA group consistently exhibited higher average intervertebral disc pressure in C2/3 during all motions compared to the AF group (p < 0.001); however, the FA group displayed lower average intervertebral disc pressure in C6/7 during all motions (p < 0.05). The AA group had lower facet joint contact stresses during extension in all segments compared to the AF group (p < 0.05). The FA group exhibited significantly higher facet joint contact stresses during extension in C2/3 (p < 0.001) and C6/7 (p < 0.001) compared to the AF group.Discussion: The use of skip-level CDA is recommended for the treatment of non-contiguous CDD. The FA construct shows superior biomechanical performance compared to the AF construct.

Hybrid construction (HC) may be an ideal surgical strategy than noncontinuous total disc replacement (TDR) and noncontinuous anterior cervical discectomy and fusion (ACDF) in the treatment of noncontinuous cervical spondylopathy. However, there is still no consensus on the segmental selection for ACDF or TDR in HC. The study aims to analyse the effects of different segment selection of TDR and ACDF on cervical biomechanical characteristics after HC surgery. Twelve FEMs of C2–C7 were constructed based on CT images of 12 mild cervical spondylopathy volunteers. Two kinds of HC were introduced in our study: Fusion-arthroplasty group (Group 1), upper-level (C3/4) ACDF, and lower-level TDR (C5/6); Arthroplasty-fusion group (Group 2), upper-level (C3/4) TDR and lower-level ACDF (C5/6). The follow-load technique was simulated by applying an axial initial load of 73.6 N through the motion centre of FEM. A bending moment of 1.0 Nm was applied to the centre of C2 in all FEMs. Statistical analysis was carried out by SPSS 26.0. The significance threshold was 5% (P < 0.05). In the comparison of ROMs between Group 1 and Group 2, the ROM in extension (P = 0.016), and lateral bending (P = 0.038) of C4/5 were significantly higher in Group 1 group. The average intervertebral disc pressures at C2/3 in all directions were significantly higher in Group 1 than those in Group 2 (P < 0.005). The average contact forces in facet joints of C2/3 (P = 0.007) were significantly more than that in Group 2; however, the average contact forces in facet joints of C6/7 (P < 0.001) in Group 1 group were significantly less than that in Group 2. Arthroplasty-fusion is preferred for intervertebral disc degeneration in adjacent upper segments. Fusion-arthroplasty is preferred for patients with lower intervertebral disc degeneration or lower posterior column degeneration. Trial registration: This research was registered in Chinese Clinical Trial Registry (ChiCTR1900020513).

Development and validation of a risk prediction score for the severity of acute hypertriglyceridemic pancreatitis in Chinese patients

Study design: A retrospective study. Objective: To evaluate the different degeneration patterns of paraspinal muscles in degenerative lumbar diseases and their correlation with lumbar spine degeneration severity. Summary of background data: The degeneration characteristics of different paraspinal muscles in degenerative lumbar diseases remain unclear. Methods: 78 patients diagnosed with single-level degenerative lumbar spondylolisthesis (DLS) and 76 patients with degenerative lumbar kyphosis (DLK) were included as DLS and DLK groups. Paraspinal muscle parameters of psoas major (PS), erector spinae (ES) and multifidus muscle (MF) were measured, including fatty infiltration (FI) and relative cross-sectional area (rCSA), namely the ratio of the paraspinal muscle CSA to the CSA of the vertebrae of the same segment. Sagittal parameters including lumbar lordosis (LL) and sagittal vertical axis (SVA) were measured. The paraspinal muscle parameters and ES/MF rCSA ratio were compared between the two groups. Paraspinal muscles parameters including rCSA and FI were also compared between each segments from L1 to L5 in both DLS and DLK groups. In order to determine the influence of sagittal spinal alignment on paraspinal muscle parameters, correlation analysis was conducted between the MF, ES, PS rCSA and FI and the LL in DLS and DLK group. Result: MF atrophy is more significant in DLS patients compared with DLK. Also, MF fatty infiltration in the lower lumbar spine of DLS patients was greater compared to DLK patients. DLK patients showed more significant atrophy of ES and heavier ES fatty infiltration. MF FI was significantly different between all adjacent segments in both DLS and DLK groups. In DLS group, ES FI was significantly different between L2/L3 to L3/L4 and L4/L5 to L5/S1, while in DLK group, the difference of ES FI between all adjacent segments was not significant, and ES FI was found negatively correlated with LL. Conclusions: Paraspinal muscles show different degeneration patterns in degenerative lumbar diseases. MF degeneration is segmental in both DLS and DLK patients, while ES degenerated diffusely in DLK patients and correlated with the severity of kyphosis. MF degeneration is more significant in the DLS group, while ES degeneration is more significant in DLK patients. MF is the stabilizer of the lumbar spine segments, while the ES tends to maintain the spinal sagittal balance.