BACKGROUND:The most common complication of traumatic femoral neck fractures after internal fixation is femoral head necrosis.Currently,many studies have reported on the risk factors that affect the occurrence and development of postoperative femoral head necrosis,but there is still a lack of tools to predict the risk of femoral head necrosis after internal fixation of femoral neck fractures.OBJECTIVE:To develop a predictive model that estimates the risk of femoral head necrosis shortly after patients with femoral neck fractures receive cannulated screw internal fixation.METHODS:A retrospective analysis reviewed clinical records of 172 patients who underwent cannulated screw internal fixation for femoral neck fractures at Department of Orthopedics of Mianyang Central Hospital from January 2013 to June 2023.Patients were categorized into two groups based on the presence or absence of femoral head necrosis within one year post-operation:the necrosis group and the non-necrosis group.Univariate analysis,Lasso regression,and multivariate Logistic regression techniques were employed to identify the determinants of femoral head necrosis.A nomogram prediction model was constructed using R language's"rms"package,version 4.0.The receiver operating characteristic curve was used to evaluate the discriminatory ability of the model.The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model,and the decision curve analysis was used to determine its clinical application benefits.Internal validation of the study was conducted using the Bootstrap method,involving 1 000 repeated samplings.To delve deeper into the primary factors influencing femoral head necrosis post-internal fixation of the femoral neck,this paper employed the SHAP method for data set analysis.RESULTS AND CONCLUSION:(1)The risk factors leading to femoral head necrosis in the short term after cannulated screw fixation of femoral neck fractures include:smoking,diabetes,Garden classification,fracture line location,reduction quality,age,and operation time.(2)The prediction model demonstrated robust performance,evidenced by an area under the curve of 0.940(95％Confidence Interval:0.903 to 0.977),indicating a high level of prediction accuracy.The model achieved a sensitivity of 90.2％and a specificity of 87.6％,indicating that its diagnostic performance was stable.The Hosmer-Lemeshow goodness-of-fit test yielded a chi-square value of 6.593 with a P-value of 0.581,confirming that the model's predictions closely align with the observed outcomes.(3)The calibration curve of the model also performed well,and its overall trend was very close to the ideal curve,further proving the high accuracy of the model.(4)The internal validation was carried out by the Bootstrap method with 1 000 repeated samplings,and the area under the curve of the model internal validation was still as high as 0.939,proving that the model had good stability.(5)Through the decision curve,it is found that within the probability threshold range of 1％to 92％,the model can obtain the maximum net benefit value.(6)The SHAP analysis results show that among the risk factors analyzed in this study,the location of the fracture line serves as the most significant predictor of femoral head necrosis following internal fixation with cannulated screws in femoral neck fractures,and subcapital fractures are extremely prone to femoral head necrosis after surgery.(7)It is concluded that the validated prediction model demonstrates strong discriminative power and reliability,offering practical clinical utility.It serves as a useful reference tool for short-term risk assessment of femoral head necrosis following internal fixation of femoral neck fractures.

BACKGROUND:The most common complication of traumatic femoral neck fractures after internal fixation is femoral head necrosis.Currently,many studies have reported on the risk factors that affect the occurrence and development of postoperative femoral head necrosis,but there is still a lack of tools to predict the risk of femoral head necrosis after internal fixation of femoral neck fractures.OBJECTIVE:To develop a predictive model that estimates the risk of femoral head necrosis shortly after patients with femoral neck fractures receive cannulated screw internal fixation.METHODS:A retrospective analysis reviewed clinical records of 172 patients who underwent cannulated screw internal fixation for femoral neck fractures at Department of Orthopedics of Mianyang Central Hospital from January 2013 to June 2023.Patients were categorized into two groups based on the presence or absence of femoral head necrosis within one year post-operation:the necrosis group and the non-necrosis group.Univariate analysis,Lasso regression,and multivariate Logistic regression techniques were employed to identify the determinants of femoral head necrosis.A nomogram prediction model was constructed using R language's"rms"package,version 4.0.The receiver operating characteristic curve was used to evaluate the discriminatory ability of the model.The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model,and the decision curve analysis was used to determine its clinical application benefits.Internal validation of the study was conducted using the Bootstrap method,involving 1 000 repeated samplings.To delve deeper into the primary factors influencing femoral head necrosis post-internal fixation of the femoral neck,this paper employed the SHAP method for data set analysis.RESULTS AND CONCLUSION:(1)The risk factors leading to femoral head necrosis in the short term after cannulated screw fixation of femoral neck fractures include:smoking,diabetes,Garden classification,fracture line location,reduction quality,age,and operation time.(2)The prediction model demonstrated robust performance,evidenced by an area under the curve of 0.940(95％Confidence Interval:0.903 to 0.977),indicating a high level of prediction accuracy.The model achieved a sensitivity of 90.2％and a specificity of 87.6％,indicating that its diagnostic performance was stable.The Hosmer-Lemeshow goodness-of-fit test yielded a chi-square value of 6.593 with a P-value of 0.581,confirming that the model's predictions closely align with the observed outcomes.(3)The calibration curve of the model also performed well,and its overall trend was very close to the ideal curve,further proving the high accuracy of the model.(4)The internal validation was carried out by the Bootstrap method with 1 000 repeated samplings,and the area under the curve of the model internal validation was still as high as 0.939,proving that the model had good stability.(5)Through the decision curve,it is found that within the probability threshold range of 1％to 92％,the model can obtain the maximum net benefit value.(6)The SHAP analysis results show that among the risk factors analyzed in this study,the location of the fracture line serves as the most significant predictor of femoral head necrosis following internal fixation with cannulated screws in femoral neck fractures,and subcapital fractures are extremely prone to femoral head necrosis after surgery.(7)It is concluded that the validated prediction model demonstrates strong discriminative power and reliability,offering practical clinical utility.It serves as a useful reference tool for short-term risk assessment of femoral head necrosis following internal fixation of femoral neck fractures.

Objective To analyze the diagnosis and treatment of intestinal obstruction patients caused by intra-abdominal hernia with no abdominal surgery history ,in order to raise awareness .Methods Clinical data of 23 intestinal obstruction patients caused by intra-abdominal hernia with no abdominal surgery history were retrospectively analyzed.The clinical manifestations ,type,and risk factors were analyzed .And its diagnosis and prevention was dis-cussed.Results 23 patients were caused by intestinal blood circulation disorders ,in which there were 11 cases small intestine mesentery hernia ,2 cases duodenal hernia ,2 cases pericecal hernia ,3 cases omentum hernia ,1 case obturator hernia,2 cases congenital dysplasia and intestinal mesenteric torsion induced small hernia ,2 cases formation of intra-abdominal pressure alone belted intestine ,8 cases of intestinal necrosis .22 patients were cured after surgery ,1 case died,12 cases had postoperative complications .The incidence rate of postoperative complications of patients with in-testinal necrosis was 59.3%( wound infection 37.1%, pneumonia 22.2%), which was significantly higher than 11.8%of patients without intestinal necrosis (wound infection 5.9%,pneumonia 5.9%)(χ2 =3.861,3.861,all P<0.05).Conclusion The intestinal obstruction caused by intra-abdominal hernia with no abdominal surgery history is closed loop obstruction , preoperative diagnosis is difficult , with the rapid progression of the disease , and intestinal strangulation ,intestinal necrosis can occur in the short term whithout timely surgical treatment .Therefore ,early diagno-sis and prompt surgical treatment is the key to the diagnosis and treatment of intestinal obstruction caused by intra -ab-dominal hernia with no abdominal surgery history .

Objective To evaluate of three-dimensional spiral CT cholangiography to bile duct configuration before laparoscopic cholecystectomy.Methods A retrospective analysis was performed for 60 patients with cholelithiasts concurrent with choledocholithiasis from May 2009 to April 2012,which were treated with endoscopic retrograde cholangiopancreatography (ERCP),endoscopic sphincterotomy (EST),and endoscopic nasobiliary drainage (ENBD),then three-dimensional spiral CT cholangiography(SCTC) was performed through endoscopic nasobiliary drainage (ENBD) tube,and the bile duct tree image of SCTC was evaluated,then laparoscopic cholecystectomy (LC) was carried out.Results Sixty cases were performed three-dimensional SCTC.The left and right hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100％ patients,and cholecyst bile duct was visible in 75％patients,and three-dimensional SCTC can tell the position of cholecyst duct and the place where the cholecyst bile duct enteres into the common bile duct.Conclusion Three-dimensional SCTC can show the shape of bile duct tree,especially the cholecyst duct,and has some guidance values to judge the structure of the bile duct tree and the configuration of cholecyst bile duct during operation,which can decrease the possibility of bile duct injure.

ObjectiveTo study the preoperative evaluation of three-dimensional spiral CTcholangiography(SCTC) in patients with bile duct obstruction.MethodsA retrospective analysis was performed for 60patients with bile duct obstruction from May 2008 to April 2011,who were treated with endoscopic retrograde cholangiopancreatography( ERCP),then SCTC was performed through endoscopic nasobiliary drainage( EN-BD) tube,and the bile duct tree image of SCTC of bile duct obstruction was evaluated.ResultsIn 60 cases of bile duct obstruction who performed three-dimensional SCTC,the left and right hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100％ patients,cholecyst bile duct was visible in 80％ patients,and three-dimensional SCTC can tell the position of cholecyst duct and the place where the cholecyst bile duct enters into the common bile duct.ConclusionThree-dimensional SCTC can show the shape of bile duct tree,especially the cholecyst duct,and has some guidance values in judging the structure of the bile duct tree and the shape of cholecyst bile duct during operation.

Objective To summarize the curative effect of three-dimensional spiral CT cholangiography combined with endoscopic retrograde cholangiopancreatography(ERCP),endoscopic sphincterotomy(EST)and laparoscopic cholecystectomy(LC)for treatment of patients with cholelithiasts concurrent with choledocholithiasis.Methods A retrospective analysis was carried out for 30 cases of cholelithiasts concurrent with choledocholithiasis which were treated with ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy from July 2007 to June 2009.And the post operation parameters were compared with those of 36 patients who received traditional operation from July 2005 to June 2007.Results All the procedures were successfully accomplished.Complication occurred in 2 cases.both with mild acute pancreatitis.With the three-dimensional spiral CT cholangiography,the intra-hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100 percent patients,and choleeyst bile duct was visible in 73%patients,and three-dimensional spiral CT cholangiography can tell the position of cholecyst duct,then can decrease the possibility of damage of bile duct.The gastrointestinal function recovery time and feeding time after operation,the in hospital time after operation in the ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy group were superior to those of the traditional operation patients(P＜0.05).Conclusion ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy for treatment of patients with cholelithiasts concurrent with choledocholithiasis is safe,with less trauma and fast recover after operation and Can decrease the possibility of damaging bile duct,which can be used widely.

Objective To study the preventive effect of biliary duct injury(BDI)of three-dimensional spiral CT cholangiography(SCTC)before laparoscopic cholecystectomy(LC).Methods A retrospective analysis was carried out for 30 patients suffering from cholelithiasts concurrent with choledocholithiasis from July 2007 to June 2009.EAndoscopic sphincterotomy(EST),then three-dimensional SCTC was carried out through endoscop-ic nasobiliary drainage(ENBD)before IX,and the preventive effect of BDI was evaluated.Results The visibility of intra-hepatic bile duct,the hepatic bile duct and the common bile duct were 100% the visibility of chol-ecyst bile duct was 73% ,and three-dimensional SCTC can tell the position of cholecyst duct,BDI was not happened in all these patients.Conclusion Three-dimensional SCTC before LC can decrease the possibility of BDI.

OBJECTIVE To investigate hand hygiene of healthcare workers in burn ward in our hospital and provide scientific basis for the effective prevention and control of hospital infection in burn ward.METHODS Selected randomly 30 healthcare workers in burn ward and sampled from hands for bacterial culture.RESULTS The average colony of hand pathogens of the 30 healthcare workers was 105.42 CFU/cm2,the maximam was 1093 CFU/cm2.Among the hand pathogens,40.91% were Bacillus subtilis,36.36% were micrococcus and 13.64% were Staphylococcus aureus.CONCLUSIONS Hand hygiene of healthcare workers are not optimistic in burn ward.Strengthening the education of hand hygiene and raising the executable rate of hand hygiene are important measures to prevent and control the hospital infection in burn ward.

Objective To explore the clinical effect of treatment for cholecystolithiasis and calculus of com-mon bile with duodenoscope and laparoscope. Methods 48 cases of patients with cholecystolithiasis and calculus of common bile duct were analysed, of whom 30 cases were treated by traditional operation, and 18 cases were treated by duodenoscope and laparoscope. The operation time, stay-in-hospital time after operation, the gastrointestinal function recovery time after operation, the degree of pain were compared. Results The cost of duodenoscope and laparoscope was higher than that of traditional operation group, but the other parameters were better ( P < 0.05 ). Conclusion Treating cholecystolithiasis and calculus of common bile duct with duodenoscope and laparoscope is safe, less traumatic and the patients may recover faster than routine treatment.

Objective To explore how to prevent biliary duct injury during laparoscopic cholecystectomy.Methods The clinical data of 484 cases of laparoscopic cholecystectomy from December 2002 to December 2007 were retrospectively analyzed,and the experiences of preventing biliary duct injury were summarized.Results No biliary duct injury case was found but 26 cases were converted to laparotomy during operation and 20 cases were placed drainage tube.Conclusion Familiar with the anatomy of bile duct,careful handling of the Calot's triangle are the keys to prevent biliary duct injury in LC.