Objective To evaluate the accuracy of dose-length product (DLP) values in CT dose reports by comparing them with the DLP values measured using a pencil-type ionization chamber. Methods Experiments were conducted using four CT scanners with different detector row numbers from two manufacturers (A and B), along with a head phantom and a pencil-type ionization chamber. Other scanning parameters were fixed, while pairwise combinations of kV and mAs were tested. The DLP values were measured under various scanning conditions using the pencil-type ionization chamber (DLP_measured) and the corresponding DLP values in CT dose reports were recorded (DLP_reported). All data were subjected to statistical analysis. Results Differences were observed between DLP_reported and DLP_measured values. The smallest mean absolute value of ΔDLP was approximately 2.526 mGy·cm observed on the 40-row CT scanner of manufacturer A. There was a difference between the ΔDLPs of the four CT scanners. Both DLP_reported and DLP_measured exhibited a linear relationship with mAs. Conclusion The percentage errors between DLP_reported and DLP_measured values for all four CT scanners were within the national standard tolerance of 15%. DLP values in CT dose reports can serve as a reference for assessing patient radiation dose during scanning. However, for radiation dose-related research, data measured using dosimetric instruments such as pencil-type ionization chamber are recommended.

Threatened abortion is a common disease of obstetrics and gynecology and one of the diseases responding specifically to traditional Chinese medicine （TCM）. The China Association of Chinese Medicine organized experts in TCM obstetrics and gynecology， Western medicine obstetrics and gynecology， and pharmacology to deeply discuss the advantages of TCM and integrated Chinese and Western medicine treatment as well as the medication plans for threatened abortion. After discussion， the experts concluded that chromosome， endocrine， and immune abnormalities were the key factors for the occurrence of threatened abortion， and the Qi and blood disorders in thoroughfare and conception vessels were the core pathogenesis. In the treatment of threatened abortion， TCM has advantages in preventing miscarriages， alleviating clinical symptoms and TCM syndromes， relieving anxiety， regulating reproductive endocrine and immune abnormalities， personalized and diversified treatment， enhancing efficiency and reducing toxicity， and preventing the disease before occurrence. The difficulty in diagnosis and treatment of threatened abortion with traditional Chinese and Western medicine lies in identifying the predictors of abortion caused by maternal factors and the treatment of thrombophilia. Recurrent abortion is the breakthrough point of treatment with integrated traditional Chinese and Western medicine. It is urgent to carry out high-quality evidence-based medicine research in the future to improve the modern diagnosis and treatment of threatened abortion with TCM.

Objective To analyze the blindness and visual impairment attributed to myopic maculopathy in highly myopic patients based on the ATN classification system,as well as associated risk factors.Methods In this retrospective case-control study,clinical data of 642 adult patients(642 eyes)with high myopia admitted to the Department of Fundus Disease,Chengdu Bright Eye Hospital from January 2022 to September 2023 were collected and analyzed.Comprehensive ophthalmic examinations were conducted for all patients.Myopic maculopathy in patients with high myopia was diagnosed and graded according to the ATN classification system.The patients were divided into the blindness or visual impairment group and the non or mild visual impairment group based on the WHO diagnostic criteria for blindness and visual impair-ment.Multivariate Logistic regression was utilized to analyze the risk factors for blindness or visual impairment in patients with high myopia.Results Among the 642 eyes,myopic maculopathy was identified in 355 eyes(55.30％).Of these,there were 330 eyes(51.40％)with myopic atrophy maculopathy(A2 and above),137 eyes(21.34％)with myopic trac-tion maculopathy,and 82 eyes(12.77％)with myopic neovascular maculopathy.The percentages of blindness and visual impairment were 2.02％(95％CI:0.93％-3.11％)and 8.41％(95％CI:6.26％-10.56％),respectively.Multivariate Lo-gistic regression analysis showed that older age,longer axial length and higher grade of myopic atrophy maculopathy were independent risk factors for blindness or visual impairment in patients with high myopia(all P＜0.05).Conclusion The ATN classification system can comprehensively reflect the disease severity and visual impairment of patients with myopic maculopathy.Older age,longer axial length and higher grade of myopic atrophy maculopathy are independent risk factors for blindness or visual impairment in patients with high myopia.

Accurate classification of the acetabular injuries and appropriate treatment plan are great challenges for orthopedic surgeons because of the irregular anatomical structure of the acetabulum and aggregation of important vessels and nerves around it. Letournel-Judet classification system has been widely applied to classify acetabular fractures. However, there are several limitations, including incomplete inclusion of fracture types, difficulty in understanding and insufficient guidance for surgical treatment, etc. Serious complications such as traumatic arthritis are common due to wrong classification and diagnosis and improper selection of surgical strategy, which brings a heavy burden to the society and families. Three-column classification, based on anatomic characteristics, has advantages of containing more fracture types and being easy to understand, etc. To solve the problems existing in the diagnosis and treatment process based on Letournel-Judet classification, achieve accurate diagnosis and treatment of patients with acetabular fractures, and obtain satisfactory prognosis, the Orthopedic Trauma Emergency Center of Third Hospital of Hebei Medical University and the Trauma Orthopedic Branch of the Chinese Orthopedic Association organized experts from relevant fields to formulate the Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification ( version 2023) in terms of principles of evidence-based medicine. Based on the three-column classification, 15 recommendations were proposed, covering the diagnosis, treatment, complication prevention and management, etc, so as to provide reference for accurate diagnosis and treatment of acetabular fractures.

Objective:To evaluate the anterior expansion of sacral foramen and decompression of sacral plexus via the lateral-rectus approach (LRA) in the surgical treatment of sacral fractures complicated with sacral plexus injury.Methods:From January 2013 to June 2018, 11 patients were treated at Department of Orthopaedics, The Third Hospital Affiliated to Southern Medical University for obsolete sacral fractures complicated with sacral plexus injury. They were 8 males and 3 females, aged from 17 to 54 years (average, 38 years). According to the Denis classification, all the sacral fractures belonged to Denis Zone Ⅱ. According to British Medical Research Council (BMRC) grading system, the nerve injury was complete damage in 2 cases and partial damage in 9. The mean time from injury to surgery was 6 months (range, from 0.7 to 12.0 months). After the sacroiliac joint was exposed via the LRA, the lumbosacral trunk was exposed and released between iliac vessels and the iliopsoas. Next, the S1 foramen was expanded and the S1 nerve root was released after separation of the median sacral artery and the internal iliac artery. Reduction and fixation of the sacroiliac joint was carried out for patients with unstable sacral fracture. X-ray and CT examinations of the pelvis were performed to evaluate fracture healing and neurological function recovery postoperatively.Results:Of this cohort of 11 cases, operation succeeded in 10 but failed in one whose sacral fracture was found to have completely healed with the S1 foramina totally occluded. The surgical time averaged 110 min (range, from 70 to 220 min) and the blood loss 1, 100 mL (range, from 450 to 2, 800 mL). Postoperative X-ray and CT examinations showed that the sacral foramens were expanded significantly without any complications. The follow-up time averaged 18 months (range, from 12 months to 4 years). By the BMRC grading system at the last follow-up, the neural function was completely recovered in 5 cases, partially recovered in 4 cases and not recovered in one.Conclusion:Significant anterior expansion of sacral foramen and decompression of sacral plexus via the LRA is a viable and effective alternative for treatment of sacral fractures complicated with sacral plexus injury.

Objective:To explore the efficacyof direct anterior approach (DAA) combined with direct posterior approach (DPA) for the treatment of Pipkin IV fracture.Methods:Data of 18 patients with Pipkin IV fracture treated through DAA combined with DPA from January 2016 to April 2019 was retrospectively analyzed. There were 13 males and 5 females, with an average age of 43.2 years (range,19-56 years). Fractures were caused by traffic accident in 15 and by falling in 3. The fracture lines of 13 cases were located below the fovea of the femoral head and 5 cases were located above the fovea. According to Letournel-Judet classification for acetabular fractures, there were 14 cases of posterior acetabular wall fractures, 2 cases of posterior wall fractures involving posterior column, and 2 transverse plus posterior wall fractures. The operation was performed through DAA approach to treat the femoral head fractures, and DPA approach was used to treat acetabular fractures. Radiographs and CT scans of the pelvis were reexamined after surgery, and fracture reduction, healing, and complications such as femoral head necrosis, sciatic nerve injury, superior gluteal neurovascular injury and heterotopic ossification were evaluated. Quality of acetabular reduction was evaluated according to the criteria proposed by Matta. Thompson-Epstein scoring system was used to evaluate hip function.Results:The average operation time was 133 min (range, 75-205 min). And the average blood loss was 371 ml (range, 240-600 ml). All 18 patients were followed up for 6 to 36 months, with an average period of 15.7 months. All fractures healed 10 to14 weeks after surgery. Three patients had symptoms of sciatic nerve injury after the injury, who recovered 6 to 12 weeks after the operation. All femoral head fractures were reduced. According to Matta criteria of reduction quality, anatomic reduction was gained in 13 cases, and satisfactory reduction was obtained in 3 cases, while unsatisfactory reduction was found in 2 cases, and the overall satisfactory rate was 88.9%(16/18). Two patients had Brooker I level heterotopic ossification. There was no iatrogenic vascular injury, avascular necrosis of femoral head, infection, internal fixation failure or other complications. According to the Thompson-Epstein scoring system at the latest follow-up, the functional results of the affected hip were excellent in 7 cases, good in 8, fair in 2 and poor in 1.Conclusion:Treatment of Pipkin IV fractures through DAA combined with DPA approach reduces surgical invasion. And it can directly reduce and fix the femoral head and posterior acetabular fracture, and protect the important structures such as the arteriae circumflexa femoris medialis, sciatic nerve and lateral femoral cutaneous nerve, and reduce the occurrence of complications such as femoral head necrosis and heterotopic ossification. Therefore, DAA combined with DPA is aneffective method for the treatment of Pipkin IV fractures.

Acetabular fracture is an intra-articular fracture, and its treatment principle is also equivalent to that of intra-articular fracture, namely anatomical reduction of articular surface and firm fixation. Therefore, the choice of surgical approach is of great importance to the surgical exposure, reduction quality and fixation effect of acetabular fracture, which directly affects the surgical curative effect. Proper surgical approach is not only good for clear surgical exposure, easy operation, and ideal reduction quality and fixation effect, but also has great advantages in shortening the operation time, reducing intraoperative bleeding, reducing surgical trauma and avoiding surgical complications. The selection of surgical approach for acetabular fractures is closely related to the fracture injury mechanism, fracture classification, and clinical manifestations, etc.. The surgical efficacy depends on the fracture reduction quality, fixation effect, and surgical trauma degree, etc., which are closely related to the selection of surgical approach. At present, the alternative surgical approaches are generally divided into anterior approach and posterior approach. However, due to the complexity of acetabular fractures, no single surgical approach can fit all acetabular fractures, and each approach has its own indications, advantages and disadvantages.

Objective:To explore the surgical indications, techniques and methods of closed reduction and minimally invasive fixation for the treatment of pelvic fractures of Tile C2 and C3, and evaluate the clinical efficacy.Methods:A retrospective analysis of the data of 20 cases with Tile C2 and C3 pelvic fractures treated with closed reduction and minimally invasive fixation from January 2016 to July 2019. There were 7 males and 13 female, with an average age of 35.6±14.6 years (range 12-60 years). The time from injury to operation was 5-30 d, with an average of 19.3±7.1 d. Tile classification of pelvic fracture: 13 cases of C2 type and 7 cases of C3 Type. 2 cases were complicated with ipsilateral or bilateral lumbosacral nerve injury. Classification of nerve injury: 2 cases were partial injury, British Medical Research Council (BMRC) Grade M3. The operation is treated with closed reduction and minimally invasive fixation. First, the side with obvious displacement is fixed on the operating table with a pelvic reduction frame, and the side with less displacement is traction. After reduction, insert S 1 and S 2 sacroiliac screw guide-pin on this side to the contralateral sacral fracture. And then change the traction, fix the reset side on the operating table, change the side with obvious traction displacement, after the reset is ideal, pass the inserted guide-pin through the contralateral sacroiliac joint to the outer iliactable. Then insert the sacroiliac screw. The patients complicated with acetabular fracture were reduced and fixed by the corresponding approach, and the anterior ring was fixed by INFIX. The operation time, intraoperative bleeding volume and postoperative complications were recorded. The quality of fracture reduction was evaluated by Matta's criteria, and the clinical effect was evaluated by Majeed score. Results:All the 20 patients successfully completed the operation. The operation time was 105-210 min, with an average of 167.00±31.21 min. The intraoperative bleeding volume was 30-100 ml, with an average of 82.00±5.36 ml. Postoperative X-ray and CT showed that the fracture was reduced and fixed. According to the Matta's criteria, the reduction quality was rated as excellent in 14 cases, good in 4 case, fair in 2 case, with an excellent and good rate of 90%. Two patients showed symptoms of lateral femoral cutaneous nerve injury without other complications related to surgery. Follow-up for 1 to 4 years, the fractures healed, and the healing time was 6 to 12 weeks. According to the Majeed score, the result was rated as excellent in 18 cases, good in 2 case, with an excellent and good rate of 100%.Conclusion:Closed reduction and minimally invasive fixation for the treatment of pelvic fractures of type C2 and C3, with the characteristics of less damage and good results, will become a trend in the treatment of pelvic fractures.

Objective:To investigate the surgical methods of sacroiliac joint dislocation with ipsilateral sacrosacral wing fracture through the lateral-rectus approach (LRA) for exposure, fracture reduction and fixation, and nerve exploration and decompression, and to evaluate its clinical efficacy.Methods:Data of 12 patients with sacroiliac joint dislocation and ipsilateral sacral wing fracture treated with LRA for exposure, reduction and fixation of sacroiliac wing fracture and sacroiliac joint dislocation, lumbosacral trunk nerve exploration and decompression (combined with lumbosacral trunk nerve injury) were retrospectively analyzed from January 2016 to July 2019. They were 3 males and 9 females, aged 34.35±16.32 years (13-58 years). The time from injury to operation was 29.25±25.49 d (7-96 d). By the Tile classification, there were 7 cases of type C1.3, 1 case of type C2, 4 cases of type C3. Among them, 8 cases were combined with ipsilateral or bilateral lumbosacral nerve injury. The grade of nerve injury: 6 cases of complete injury and 2 cases of partial injury. Interval time from injury to surgery: less than 1 week: 1 case, 1-2 weeks: 2 cases, 2-3 weeks: 4 cases, >3 weeks: 5 cases. Surgery was performed through LRA, the sacroiliac joint was exposed outside the peritoneum, and the sacral fracture and sacroiliac joint dislocation were reduced. At the same time, the lumbosacral nerve was decompressed and loosened for patients with lumbosacral nerve injury. Then the posterior ring was fixed with a sacroiliac screw or a transsacroiliac joint plate attached to the bony surface.Results:All the 12 cases underwent the operation successfully. The average surgical time was 172.08±36.8 min (range, 105-230 min) and the mean blood loss was 981.67±369.44 ml (range, 400-1 700 ml). Postoperative X-ray and CT indicated an excellent reduction of fracture. One patient with bladder dysplasia had wound fat liquefaction after operation, and no other surgery-related complications. During the follow-up period of 12-72 months, all sacral fractures healed, and the healing time was 7.7±3.38 weeks (6-12 weeks) without complications such as loss of fracture reduction and internal fixation failure. At the 1-year follow-up, 6 of the 8 patients with lumbosacral nerve injury recovered completely, one recovered partially, and the other one had no recovery without nerve exploration.Conclusion:LRA is an ideal surgical approach for treatment of sacroiliac joint dislocation complicated with ipsilateral sacral wing fracture and lumbosacral nerve injury, because it can well expose the medial pelvic joint from the sacroiliac joint to the symphysis pubis, allow direct release of the lumbosacral plexus nerve compressed and stretched, and together with traction of the lower limbs, lead to satisfactory fracture reduction.

Objective:To investigate the clinical efficacy of lateral-rectus approach(LRA) for vertical shear fracture of pelvis combined with lumbosacral plexus nerve injury.Methods:A retrospective study was conducted of the 37 patients who had been treated at Department of Orthopaedics, The Third Affiliated Hospital to Southern Medical University for vertical shear pelvic fracture combined with lumbosacral plexus nerve injury from August 2010 to August 2018. They were 25 males and 12 females, aged from 18 to 61 years (mean, 36.2 years). By the Tile classification, there were 31 cases of type C1.3, 5 cases of type C2 and one of type C3. LRA was used in all the patients to explore and release the lumbosacral plexus nerve and to reduce the sacral fracture. The posterior ring was fixated with an anterior iliac plate or sacral screws before fixation of the anterior ring and treatment of the acetabular fracture. The operation time, intraoperative bleeding volume, quality of fracture reduction, fracture union time and recovery of nerve and muscle strength were recorded.Results:For this cohort, the operation time ranged from 105 to 228 minutes (mean, 155.0 minutes) and the intraoperative bleeding volume from 680 to 2, 440 mL (mean, 1, 070 mL). Thefollow-up time ranged from 1 to 8 years (average, 2 years). According to the Matta criteria, the quality of fracture reduction was evaluated as excellent in 21 cases, as good in 12 cases and as fair in 4 cases, giving an excellent and good rate of 89.2%. Follow-ups revealed reduction loss in 4 patients, nonunion and reduction loss in one patient and bony union in the other 32 patients after 8 to 12 weeks (mean, 10.1 weeks). According to the criteria by the Nerve Injuries Committee of the British Medical Research Council (BMRC), the recovery of nerve and muscle strength achieved M5 (full recovery of neurological symptoms) in 22 cases, M4 (fine recovery of neurological symptoms) in 7 cases, M1, M2 and M3 (partial recovery of neurological symptoms) in 5 cases, and M0 (no recovery of neurological symptoms) in 3 cases.Conclusion:LRA is an ideal surgical approach for treatment of pelvic vertical shear fractures complicated with lumbosacral plexus nerve injury, because it can well expose the medial pelvic joint from the sacroiliac joint to the symphysis pubis, allow direct release of the lumbosacral plexus nerve compressed and stretched, and, together with traction of the lower limbs, lead to satisfactory fracture reduction.