Objective To evaluate the medial longitudinal arch of the foot with and without hallux valgus in order to establish the relationship between hallux valgus and the arch. Methods 34 feet of 24 cases with hallux valgus and 34 normal feet of 18 cases were investigated by roentgenography. On the dorsal plantar view while weight-bearing standing, the hallux valgus angle (HVA), the first intermetatarsal angle, and the position of the tibial sesamoid relative to the first metatarsus were measured respectively. On the lateral view while weight-bearing standing, the top angle of the medial longitudinal arch, the anterior angle of the medial longitudinal arch (also named as the first metatarsal inclination angle) and the relative height of the talus, which are similar to measurement of the height of the medial longitudinal arch, were measured respectively. The characteristics of the medial longitudinal arch of the feet with and without hallux valgus were compared, and the correlation between the height of the medial longitudinal arch and the severity of the hallux valgus, which were manifested by the hallux valgus angle, first intermatatarsal angle, the relative position of the tibial sesamoid, was analyzed. Results The top angle of medial longitudinal arch was 136.9??7.6? in hallux valgus feet and 126.7??2.1? in normal feet; the anterior angle of medial longitudinal arch was 10.8??2.6? in hullux valgus feet and 16.6??1.6? in normal feet; the relative ratio of height of talus was 0.159?0.03 in hallux valgus feet and 0.199?0.01 in normal feet , there was significant difference between two groups. While with the increase of the lateral displacement of tibial sesamoid, the angle of hullxus valgus and the first intermetatarsal angle, the top angle of medial longitudinal arch became larger, the anterior angle of arch became smaller, and the relative height of talus became lower. The medial longitudinal arch of the foot with hallux valgus was collapsed, and there was moderate to high relationship between the height of the medial longitudinal arch and the severity of the hallux valgus. Conclusion Hallux valgus is a three dimensional deformity, which will disturb the normal biomechanics of the foot.

BACKGROUND:With more and more elderly patients suffering lumbar degenerative disease undergoing internal fixation, infection after spinal internal fixation is a common complication in orthopedic surgeries, but its treatment strategy remains controversial.OBJECTIVE: To explore the curative efficacy of incision infection after internal fixation in the elderly with lumbar degenerative disease.METHODS: 197 patients with lumbar degenerative disease undergoing internal fixation and followed up for more than 2 years admitted in Department of Orthopedics, Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2012 to January 2015, were analyzed retrospectively. The follow-up time was 2-4.9 years. There were 97 cases of lumbar stenosis, 29 cases of lumbar disc herniation, 33 cases of lumbar spondylolisthesis, 17 cases of degenerative scoliosis and 21 cases of lumbar compression fractures.RESULTS AND CONCLUSION: (1) Eleven patients experienced incision infection, including ten acute, and one delayed infection. (2) Among acute infected cases, three were superficial infection in three cases and seven had deep infection,who characterized as exudation (10/10), local pain (8/10) and fever (9/10). Acute infected cases received bacterial culture, drug sensitive test, antibiotic therapy, and debridement of the infected wound, and leaving all internal fixators in situ in all but one case. (3) For delayed infection, one patient had local pain, incision exudation, and intermittent fever,and then the internal fixators were removed. (4) Pseudarthrosis was not founded during 2-year follow-up in all patients.(5) These results suggest that for the elderly patients suffering lumbar degenerative disease with infection after internal fixation, intravenous antibiotics, debridement plus drainage are recommended, but without internal fixator removal, and repetitive debridement and drainage is a rational choice if necessary.

Objective To evaluate factors which maintain the stability of the ankle, and discuss indications for trans-syndesmotic fixation. Methods 12 freshly-frozen cadaver legs amputated below the knee were collected and divided into 2 groups. An ankle fracture model of unconstrained pronation-external rotation was then designed. Group A simulated the injury combined with medial malleolus fracture, and Group B the injury combined with deltoid tear. Ligaments were cut off sequentially to simulate the increasing severity of the injury. Fuji super low-pressure sensitive films and displacement transducers were used to measure the contact area of the tibiotalar articular surface and the width of the syndesmosis. The data were analyzed with SPSS to analyze the relationship of ligament injury and ankle stability. Results In Group A, the articular contact area and the syndesmotic width after section of the deltoid were significantly different from those before the section (P

Objective To investigate the result of arthroscopic surgery in the treatment of sinus tarsi syndrome. Methods The study involved 15 patients (6 males and 9 females) with sinus tarsi syndrome admitted to First Hospital of Nanjing from July 2006 to May 2008. The age of the patients ranged from 23 to 63 years ( average 46.3 years). All the patients had one side involvement, including 10 patients with left side involvement and five with right side involvement. All the operations were performed under the tourniquet control and the patients were placed at the lateral decubitus position. The lateral, anterolateral and posterolateral portals were applied intraoperatively and the medial portal was applied when necessary. Visual analogue scale (VAS) and American orthopedic foot and ankle scale (AOFAS) ankle-hindfoot scale were used for follow-up evaluation. Results More than two lesions were found under arthroscope in all patients. The lesions included scar tissue hypertrophy and inflammation in the sinus tarsal canal, soft tissue impingement in the subtalar joint, synovitis, partial tears of subtalar capsule, interosseous talocalcaneal ligament or cervical ligament, cartilage injury and subtalar degeneration. All patients were followed up for 19-35 months (mean 26. 1 months). At the final follow-up, the VAS score was improved from preoperative 7.6 points ( range 6-9 points) to postoperative 2.5 points (range 1-4 points) (P＜0.01 ), and the AOFAS score improved from preoperative 41. 9 points (range 20-67 points) to postoperative 83. 1 points ( range 70-100 points) ( P ＜ 0. 01 ). The excellence rate of the AOFAS score reached 73% at the final follow-up. Conclusion For patients with sinus tarsi syndrome after a failed conservative treatment, arthroscopic surgery should be performed as soon as possible and the clinical result is satisfactory.

Objective: To explore the relationship between left coronary plaque character with the bifurcation angle and diameter by 256-slice CT angiography (CTA). Methods: A total of 387 consecutive patients who received CTA in our hospital were retrospectively studied. There were 102 patients with normal image including 60 male and 42 female at the mean age of (52.10 ± 9.65) years and 285 patients with left coronary plaque including 166 male and 119 female at the mean age of (55.65 ± 10.40) years. All patients were divided into 4 groups according to the plaque condition, Normal group,n=102 patients without plaque, Non-calciifcation group,n=137, Calciifcation group,n=79 and Mixed group,n=69. The patients with non-calciifcation plaque included 73 of mild stenosis and 57 of moderate to severe stenosis in proximal LDA. Left coronary bifurcation angle, proximal diameter and area were measured by multi-planar reconstruction (MPR) and the maximum density projection (MIP) techniques to analyze the relationship between the above indexes and plaque position, character, degree of local stenosis. Results: Left coronary bifurcation angle, the proximal diameter, area in LDA and LCX in 3 plaque groups were all larger than those in Normal group,P<0.05. In Non-calciifcation group, the above indexes were similar between the patients with mild stenosis and moderate to severe stenosis,P>0.05, while in patients with moderate to severe stenosis, the bifurcation angle and diameter were larger in male than those in female patients,P<0.05. Conclusion: 256-slice CTA could objectively evaluate left coronary bifurcation angle, stenosis degree and plaque character, which are valuable for coronary artery disease prevention, diagnosis and treatment in clinical practice.

Objective　: To verify the feasibility of using a homemade lung phantom for quality control of Cyberknife by comparing the measurement results of the homemade lung phantom and CIRS dynamic phantom in E2E testing of Cyberknife lung tracking.  Methods　 : The patient treatment process was simulated, including CT positioning, plan design, irra- diation implementation, film scanning, and analysis using the homemade phantom and CIRS phantom. The two phantoms were measured five times using MLC under the S7 generation Cyberknife and five times using Iris under the M6 generation Cyberknife. The differences in measurement results between the two phantoms were analyzed using independent sample t-test. Results　: For the S7 generation Cyberknife, the statistical analysis of differences between the two phantoms in the detection values on the X-axis, Y-axis, Z-axis, and total deviation showed P values of 0.236, 0.175, 0.289, and 0.668, respect- ively. For the M6 generation Cyberknife, the statistical analysis showed P values of 0.880, 0.891, 0.573, and 0.433, respect- ively. The P values were all > 0.05. Therefore, there were no statistically significant differences in the detection results between the homemade lung phantom and the CIRS phantom under the S7 and M6 generation Cyberknife. The total deviation values were <1.5 mm. Conclusion　 The homemade lung phantom and CIRS phantom have consistent measurement results in the E2E testing of Cyberknife lung tracking and meet the requirements of Report of AAPM TG-135 and WS 667- 2019 standard. Therefore, the homemade lung phantom is feasible for clinical quality control of Cyberknife.

Objective To explore the outcomes of computer-assisted design of therapeutic personalized footwear for diabetic foot.Methods Fifty-eight cases of diabetic foot were included in the study.Ten items of data from theses patients were measured with methods provided by Salford University.All characteristics of the footwear were calculated with computer.Shoes were specially designed with the formula and computational method provided by Safford university.All patients had worn the shoes for 13 months.Special questionnaires were used to measure the outcomes.Results Thirty-two cases had been followed up for one month,25 cases for 2 months,25 cases for 3 months and 42 cases for 13 months.The score had improved from 67.94±15.14 before wearing the shoes to 78.13±1.44 thirteen months after wearing.The health score of the foot had improved.There was significant difference between before and after wearing the footwears.Conclusion Special-designed diabetic shoes play an important role in the prevention of ulcer for diabetic foot patients.Computational method and data model obtained from Salford university needs to be modified when applying it for Chinese.

Objective:To evaluate the radiation shielding performance for a novel self-shielded ZAP-X radiotherapy system used for intra-cranial and neck treatments. The present evaluation was performed according to the relevant Chinese national standards and the clinical placement of the radiotherapy system in an unshielded treatment room.Methods:The radiation source of the ZAP-X was a 3 MV linear accelerator. A total of 33 detection sites were selected surrounding the self-shielded system at 1.3, 2.3 and 3.3 m away from the periphery of the equipment. The maximum ambient dose equivalent rate in each irradiation condition was measured accordingly. A commonly used clinical treatment plan was selected to simulate the treatment process. During the delivery of this treatment plan, the cumulative doses of these 33 sites were measured, separately. The applicable current radiation protection standard for radiotherapy in China was chosen to evaluate the radiation shielding performance of the system.Results:According to the measurement result of the ambient dose equivalent rates along the aforementioned perimeter lines, a suggestion was put forward to redefine the existing 1 m controlled area by determining the distance at which the instantaneous dose rate of 10 μSv/h will not be exceeded. This is to meet the requirements of the Chinese standard GBZ 121-2020.Conclusions:According to the existing Chinese national radiation protection standards, the self-shielded radiotherapy system in the unshielded treatment room has the clinical applicability in China. But for such a novel self-shielded system, the corresponding performance testing and radiation protection standards shall be formulated.

Objective: To discuss the feasibility of applying home-made auto quality assurance (AQA) phantom in Cyberknife AQA test. Methods: The same treatment plan for AQA test was designed in the Cyberknife treatment planning system. The AQA tests were performed under the same conditions using the home-made AQA phantom and the AQA phantom in the fourth-generation (G4) Cyberknife mode and the fifth-generation (VSI) Cyberknife mode, respectively, and each measurement was repeated five times to analyze and compare the differences in test results between the two phantoms. Results: The total deviations of the home-made AQA phantom and the AQA phantom in the AQA test under the G4 Cy- berknife mode were (0.28 ± 0.12) mm and (0.28 ± 0.15) mm, respectively (P > 0.05); the test results under the VSI Cy- berknife mode were (0.46 ± 0.19) mm and (0.50 ± 0.07) mm, respectively (P > 0.05); the total deviations of all test results were smaller than 1.0 mm, which met the requirements of WS 667—2019 Specification for Testing of Quality Control in Ro- botic Arm Radiotherapy Device. Conclusion The test results of the home-made AQA phantom and the AQA phantom are consistent in the AQA test, and the home-made AQA phantom can be used for Cyberknife quality control.

Objective To explore the feasibility of quartz glass for radiotherapy dosimetry through the experimental study of the thermoluminescence characteristics of synthetic quartz glass. Methods The thermoluminescence glow curves of quartz glass under different annealing conditions were analyzed, the thermoluminescence characteristics of quartz glass were studied, and the measurement parameters were optimized. Using the Co-60 reference radiation field in the National Secondary Standard Dosimetry Laboratory, the quartz glass samples under different annealing conditions were irradiated following the dose levels of radiotherapy, i.e., 0.5, 1.0, 2.0, 4.0, 6.0, 8.0, and 10.0 Gy, respectively. According to the relationship between the absorbed dose of quartz glass and the relative thermoluminescence signal intensity, the linearity and dispersion of the dose response of quartz glass were obtained, and the feasibility of quartz glass for radiotherapy dosimetry was analyzed. Results The linear correlation coefficient of dose response of quartz glass under annealing condition of 430℃ for 10 min was 0.9984, and the dose response dispersion was 0.97% at the absorbed dose of 2 Gy. The linear correlation coefficient of dose response of quartz glass under annealing condition of 600℃ for 1 h was 0.9911, and the dose response dispersion was 1.4% at the absorbed dose of 2 Gy. Conclusion Preliminary results suggest that quartz glass with annealing condition of 430℃ for 10 min has the potential to be used for radiotherapy dosimetry.