Objective To evaluate the value of ultrasonography in the diagnosis of pediatric ovarian torsion (OT).Methods Ultrasonography was performed in 38 OT,and 52 non-OT children.Bilateral ovarian area was measured.The larger area was defined as S1,whereas,the smaller area was defined as S2.S1/S2 ratio was calculated.Follicles around ovaries,ovarian blood flow,and pelvic effusion were also observed during the ultrasonographic scanning.ROC curve was employed to evaluate the clinical value of ultrasonography in pediatric OT diagnosis.Results ①S1/S2 ratio,incidence of follicles around ovaries and of no ovarian blood flow were all higher in OT compared to non-OT children (P =0.000).While pelvic effusion showed no significant difference between the two groups (P =0.004).②Using S1/S2 ratio to diagnose OT,the area under the ROC curve was 0.925 (0.865-0.986),the best cutoff point was 1.6,sensitivity was 97％ and specificity was 88％.Patients were divided into two groups based on the cutoff point of 1.6,the area under the ROC curve of S1/S2 was 0.924(0.847-0.969),of follicles around ovarian was 0.896(0.781-0.931),and of no ovarian blood flow was 0.911 (0.831-0.961),indicating S1/S2 held the highest diagnostic value.Conclusions Ultrasonography is an accurate method in the early diagnosis of pediatric ovarian torsion,with S1/S2 ratio holding the highest diagnostic value in this application.

BACKGROUND:Lateral retinacular release is effective to treat anterior knee pain, but it has not been confirmed through the parameters of the knee joint. OBJECTIVE: To analyze the relevant parameters on the axial X-ray films of the patela before and after lateral retinacular release and then to find out the efficient parameters for patelofemoral joint disorders on the axial X-ray film of the patela, which are of most clinical significance. METHODS: Fifty patients with anterior knee pain were included randomly who admitted at the Department of Joint Surgery, Affiliated Hospital of Jining Medical University from February 2009 to December 2013, including 45 cases of Outerbridge I-III undergoing arthroscopic lateral retinacular release+articular cartilage repair and 5 cases of Outerbridge IV undergoing lateral retinacular release+knee joint surface replacement. RESULTS AND CONCLUSION:After lateral retinacular release, the congruence angle, patelofemoral index and tilt angle were al reduced significantly (P < 0.05 orP < 0.01), but there was no change in the lateral patelofemoral angle (P > 0.05). The patelar trajectory restored to the corresponding central position of the femoral condyle, and meanwhile, no joint hematoma, deep vein thrombosis and patelar subluxation occurred. These findings indicate that the lateral retinacular release is of great significance for treatment of anterior knee pain induced by lateral patelofemoral compression.

Objective:To investigate the effects of patelloplasty combined with cartilage surface resection on early function and anterior knee pain during total knee arthroplasty(TKA).Methods:This is a prospective controlled study, 100 patients with knee osteoarthritis(KOA) who received TKA treatment in Zoucheng People′s Hospital of Shandong Province from February 2021 to April 2022 were selected and divided into the combined group and the control group using the random number table method, 50 cases in each group. The combined group received patelloplasty combined with cartilage surface resection during TKA, while the control group only received patelloplasty. Preoperative osteoarthritis Kellgren-Lawrance (K-L) grade, joint motion (ROM), the operation time and the decrease of hemoglobin in two groups were recorded.Knee function was evaluated by Hospital for Special Surgery(HSS) knee score at 1, 3, 6, and 12 months after surgery. Anterior knee pain during stair climbing was evaluated by visual analogue scale(VAS), and recovery of patellofemoral joint was evaluated by Feller score system. The measurement data were represented as mean±standard deviation( ± s), and the comparison between groups was conducted using the t-test; the comparison of count data between groups was conducted by Chi-square test. Results:There was no significant difference in preoperative K-L grading and ROM between the two groups ( P> 0.05). The operation time of the combined group was longer than that of the control group[(71.49±9.34) min vs (66.27±8.22) min], the difference was statistically significant ( P <0.05), and there was no statistical significance in the decrease of hemoglobin between the two groups ( P>0.05). At 3, 6 and 12 months after treatment, the HSS scores of the combined group were higher than those of the control group [3 months: (76.93±8.26) vs (71.74±7.84), 6 months: (85.72±6.27) vs (81.47±6.19), 12 months: (88.64±5.27) vs (85.72±4.85)], the difference were statistically significant ( P <0.05). At 1, 3, 6 and 12 months after treatment, the VAS scores of anterior knee pain in combined group were lower than those in control group [1 months: (2.54±0.48) vs (2.77±0.63), 3 months: (2.02±0.53) vs (2.58±0.45), 6 months: (1.32±0.35) vs (1.97±0.38), 12 months: (1.14±0.33) vs (1.75±0.35)], the difference were statistically significant ( P <0.05). The incidence of anterior knee pain at 3, 6 and 12 months after operation in combined group was lower than that in control group [3 months: 20.0% vs 38.0%, 6 months: 14.0% vs 32.0%, 12 months: 10.0% vs 28.0%], the difference were statistically significant ( P <0.05). At 3, 6 and 12 months after treatment, the patellar Feller score in the combined group was higher than that in the control group[3 months: (18.63±3.52) vs (15.36±3.28), 6 months: (22.27±3.18) vs (19.63±3.48), 12 months: (25.82±3.27) vs (22.47±3.47)], the difference were statistically significant ( P <0.05). Conclusion:Patelloplasty combined with cartilage surface resection during TKA can effectively prevent the occurrence of postoperative anterior knee pain and improve the therapeutic effect.

Objective:To investigate and compare the value of cross-sectional area measurement and width measurement by high frequency ultrasound in the diagnosis of congenital adrenal hyperplasia (CAH) in infants.Methods:The abdominal ultrasound images of 20 infants who were diagnosed as CAH in Tianjin Children′s Hospital and clinical diagnosised from November 2013 to August 2018 were analyzed retrospectively. The maximum cross-sectional area of adrenal gland and the maximum width of single limb were measured respectively to assess the size of adrenal gland. Fifty normal full-term infants were selected as control group at the same period. The differences of maximum cross-sectional area of adrenal gland, the maximum width of single limb between CAH group and control group were compared. ROC curve was plotted to compare the diagnostic values of cross-sectional area measurement and width measurement.Results:①There was significant difference in maximum cross-sectional area of adrenal gland between infants with CAH and normal infants[(129.47±37.39)mm 2 vs (54.42±20.85)mm 2; t=10.004, P<0.001]. There was significant difference in maximum width of adrenal gland between infants with CAH and normal infants [(4.56±1.20)mm vs (3.25±0.66)mm; t=5.445, P<0.001]. ②The area under ROC curve(AUC) of cross-sectional area measurement was 0.966, the best cutoff value was 87.5 mm 2, the sensitivity was 95.0%, and the specificity was 92.5%. AUC of width measurement was 0.817, the best cutoff value was 5.25 mm, the sensitivity was 90.0%, and the specificity was 62.5%. The difference of AUC between cross-sectional area measurement and width measurement was 0.149, which was statistically significant ( Z=2.309, P=0.021). Conclusions:Both cross-sectional area measurement and width measurement by high frequency ultrasound have diagnostic values for CAH in infants, with the former more valuable than the latter.

To disscuss the role of cross‐sectional area measurement under high frequency ultrasound in the diagnosis of congenital adrenal hyperplasia ( CA H ) in infants . Methods T he abdominal ultrasound images of 20 infants with CA H w hich were admitted to our hospital and clinical diagnosised from November 2013 to August 2018 were analyzed retrospectively . T he size of adrenal glands were evaluated by measuring the maximum cross‐sectional area .Fifty normal full‐term infants were selected as control group synchronism . T he size of adrenal glands between infants with CA H and normal infants were compared . T he area under the curve ( AUC ) and best cutoff value were obtained by drawing ROC curve .Sensitivity and specificity were also obtained . Results T here was significant difference in maximum cross‐sectional area of adrenal gland between CA H group and control group[ ( 129 .70 ± 37 .34) mm2 vs ( 54 .41 ± 20 .84) mm2 , t ＝10 .004 , P ＝0 .001] . T he AUC of cross‐sectional area measurement was 0 .966 ,and best cutoff value was 87 .5 mm2 . T he sensitivity and specificity were 95 .0% and 92 .5% . Conclusions High‐frequency ultrasound is convenient and accurate in measuring the maximum cross‐sectional area of adrenal gland in infants . Cross‐sectional area measurement has high sensitivity and specificity to the diagnosis of CA H . T he presence of CA H is highly suspected w hen the area of adrenal gland reached 87 .5 mm2 .