Objective:To investigate the efficacy of using a single Kocher-Langenbeck approach to improve anterior column screw fixation for the treatment of transverse + posterior wall acetabular fractures.Method:A retrospective analysis was conducted of the data of 21 patients who had been treated with a single Kocher-Langenbeck approach to improve anterior column screw fixation for transverse + posterior wall acetabular fractures at Department of Orthopaedics, Weifang People's Hospital from May 2021 to May 2023. There were 11 males and 10 females with an age of (51.3±15.5) years. The time from injury to surgery was (10.4±3.6) days. The anterior column screw fixation was improved as follows: screws were implanted 1 to 2 cm in front of the apex of the great notch of the external iliac plate of the pelvis to penetrate out at the upper branch root of the pubic ramus, with the whole screw fully located within the bony channel. Such indexes were recorded as surgical time, intraoperative blood loss, intraoperative fluoroscopy frequency for improved placement of anterior column screws, fracture healing time, incidence of complications, and fracture reduction and hip joint function at the last follow-up.Results:For this cohort, surgical time was (120.9±40.7) minutes, intraoperative blood loss (330.2±65.9) mL, and intraoperative fluoroscopy frequency for improved placement of anterior column screws (6.2±2.3) times. The 21 patients were followed up for (21.5±5.9) months. All fractures achieved bony union after (3.2±1.1) months. Incision fat liquefaction occurred in 1 patient after surgery and symptoms of sciatic nerve injury were observed in 2 patients. Follow-ups observed no such complications as loosening or breakage of internal fixators. According to the Matta scoring criteria, the quality of fracture reduction at the last follow-up was evaluated as anatomical reduction in 15 cases, as satisfactory reduction in 4 cases, as acceptable reduction in 2 cases, giving a satisfaction rate of 90.5% (19/21). According to the improved Merle d'Aubigné & Poster scoring criteria, hip function was evaluated as excellent in 16 cases, as good in 2 cases, and as fair in 3 cases, giving an excellent and good rate of 85.7% (18/21).Conclusion:It is effective to use a single Kocher-Langenbeck approach to improve anterior column screw fixation for the treatment of transverse + posterior wall acetabular fractures, showing advantages of reduced surgical time and intraoperative bleeding.

Objective:To investigate the efficacy of using a single Kocher-Langenbeck approach to improve anterior column screw fixation for the treatment of transverse + posterior wall acetabular fractures.Method:A retrospective analysis was conducted of the data of 21 patients who had been treated with a single Kocher-Langenbeck approach to improve anterior column screw fixation for transverse + posterior wall acetabular fractures at Department of Orthopaedics, Weifang People's Hospital from May 2021 to May 2023. There were 11 males and 10 females with an age of (51.3±15.5) years. The time from injury to surgery was (10.4±3.6) days. The anterior column screw fixation was improved as follows: screws were implanted 1 to 2 cm in front of the apex of the great notch of the external iliac plate of the pelvis to penetrate out at the upper branch root of the pubic ramus, with the whole screw fully located within the bony channel. Such indexes were recorded as surgical time, intraoperative blood loss, intraoperative fluoroscopy frequency for improved placement of anterior column screws, fracture healing time, incidence of complications, and fracture reduction and hip joint function at the last follow-up.Results:For this cohort, surgical time was (120.9±40.7) minutes, intraoperative blood loss (330.2±65.9) mL, and intraoperative fluoroscopy frequency for improved placement of anterior column screws (6.2±2.3) times. The 21 patients were followed up for (21.5±5.9) months. All fractures achieved bony union after (3.2±1.1) months. Incision fat liquefaction occurred in 1 patient after surgery and symptoms of sciatic nerve injury were observed in 2 patients. Follow-ups observed no such complications as loosening or breakage of internal fixators. According to the Matta scoring criteria, the quality of fracture reduction at the last follow-up was evaluated as anatomical reduction in 15 cases, as satisfactory reduction in 4 cases, as acceptable reduction in 2 cases, giving a satisfaction rate of 90.5% (19/21). According to the improved Merle d'Aubigné & Poster scoring criteria, hip function was evaluated as excellent in 16 cases, as good in 2 cases, and as fair in 3 cases, giving an excellent and good rate of 85.7% (18/21).Conclusion:It is effective to use a single Kocher-Langenbeck approach to improve anterior column screw fixation for the treatment of transverse + posterior wall acetabular fractures, showing advantages of reduced surgical time and intraoperative bleeding.

Purpose Explore the predictive value of nomograms based on enhanced CT radiomics for invasiveness of thymic epithelial tumor.Materials and Methods The clinical and imaging data from 155 cases confirmed with thymic epithelial tumors at the First Affiliated Hospital of Wannan Medical College from January 2015 to January 2023 were retrospectively collected.All cases were randomly divided into training(n=108)and validation(n=47)groups in a 7∶3 ratio.The radiomics features from venous phase images were extracted.The least absolute shrinkage and selection operator algorithm for dimensionality reduction were utilized to establish radiomics labels and calculate the Rad-score.Univariate and multivariate regression analyses were conducted to identify independent risk factors.Imaging feature models,Rad-score and imaging omics clinical combined model were constructed to plot the corresponding nomograms.The diagnostic performance and clinical benefits of the models were evaluated via receiver operating characteristic curves and decision curves.The DeLong test was applied to compare area under the curve differences between models and used calibration curves to assess nomograms calibration.Results 16 optimal image omics features were selected by dimensionality reduction.Logistic regression analysis showed that tumor morphology(OR=2.932,P=0.025),peripheral tissue invasion(OR=11.461,P=0.005)and Rad-score(OR=255.27,P=0.002)were independent risk factors.The area under the curve in the training set and the verification set were 0.852 and 0.831,respectively.Compared with the image feature model and Rad-score in the training set,the differences were statistically significant(Z=3.607,2.270,P<0.05).The threshold probability of the column chart model training set was between 0.08 and 0.88 for clinical benefit.Conclusion The combined model nomograms based on enhanced CT radiomics and clinical features can effectively predict thymic epithelial tumor invasiveness and assist clinicians in formulating precise treatment plans before surgery.

Objective:To investigate the application of combined deep learning and radiomic features derived from enhanced arterial phase CT imaging with clinical data to differentiate between T2 and T3 staging in patients with esophageal cancer.Methods:A retrospective study was conducted using clinical and CT data from 388 patients with pathologically confirmed esophageal cancer treated at The First Affiliated Hospital of Wannan Medical College between May 2015 and April 2024.The dataset was randomly divided into a training set(271 cases)and validation set(117 cases)in a 7:3 ratio.Radiomic and deep learning features were extracted from enhanced arterial phase CT images.The least absolute shrinkage and selection operator algorithm was employed for feature reduction and selection,leading to the development of radiomic(Radscore)and deep learning(Deepscore)scores.Univariate and multivariate Logistic regression analyses were conducted to identify independent risk factors,and clinical,radiomic,deep learning,and combined models were constructed.A nomogram was gener-ated for the combined model.The diagnostic performance of the models was evaluated using the area under the receiver operating charac-teristic curve(AUC)and compared using the DeLong test.Clinical net benefit was assessed through decision curve analysis,and model calib-ration was evaluated using calibration curves.Results:Nine radiomicand 12 deep learning features were selected after dimensionality reduc-tion.Multivariate Logistic regression identified tumor length,boundary,Radscore,and Deepscore as independent risk factors for distinguish-ing between T2 and T3 staging.In the training set,the AUC of the combined model was 0.867,which was significantly higher than that of the clinical(0.774,P<0.001),radiomic(0.795,P<0.001),and deep learning(0.821,P=0.001)models.In the validation set,the AUC of the com-bined model was 0.810,which was significantly higher than that of the clinical(0.653,P=0.002),radiomic(0.719,P=0.033),and deep learn-ing(0.750,P=0.009)models.The decision curve analysis indicated that the combined model provided the highest clinical benefit in both datasets.The calibration curves demonstrated a good fit for both datasets(P=0.084,0.053).Conclusion:The integration of deep learning and radiomic features obtained from enhanced arterial phase CT images with clinical data offers a reliable method for accurately distinguishing between preoperative T2 and T3 staging in esophageal cancer,thereby supporting clinical decision-making for treatment planning.

Objective:To investigate the necessity of internal fixation of the fibular fracture in the treatment of degree Ⅱ ankle supination-external rotation injury by the Dias-Tachdjian classification in children.Methods:A retrospective study was conducted to analyze the data of 69 children with ankle fracture (degree Ⅱ ankle supination-external rotation injury by the Dias-Tachdjian classification) who had been treated at Department of Orthopedic Trauma, The People's Hospital of Weifang and Department of Pediatric Orthopedics, Tianjin Hospital from January 2015 to October 2021. There were 41 males and 28 females with an age of (10.1±1.4) years, and 37 left and 32 right sides affected. The patients were divided into 2 groups according to whether internal fixation of the fibular fracture was performed. Group A consisted of 21 cases with fibular internal fixation and group B of 48 cases without fibular internal fixation. The preoperative data, operation time and operation expenses were recorded and compared between the 2 groups. At the last follow-up, the anteroposterior and lateral radiographs of bilateral full length lower limbs and ankle joints were taken; the lateral distal tibial angle (LDTA) and the anterior distal tibial angle (ADTA) on the affected side, and the disparity between bilateral ankle tibiotalar angles were measured; ankle function was assessed according to the ankle-hindfoot score of American Association of Foot and Ankle Surgery (AOFAS); the occurrence of premature physeal closure (PPC) was recorded.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (19.5±4.1) months. At the last follow-up, the LDTA on the affected side was 89.6° (87.9°, 90.5°) in group A and 88.6°±1.9° in group B; the ADTA on the affected side was 80.9° (79.0°, 81.4°) in group A and 80.0° (78.6°, 81.2°) in group B; the disparity between bilateral ankle tibiotalar angles was 1.1°±0.5° in group A and 1.2°±0.5° in group B; the AOFAS ankle-hindfoot score was (89.5±5.2) points in group A and 89.0 (87.0, 92.0) points in group B. There was no statistically significant difference between the 2 groups in the above items ( P>0.05). The incidence of PPC was, respectively, 14.3% (3/21) and 14.6% (7/48) in groups A and B, showing no statistically significant difference ( P>0.05). Conclusions:In the treatment of degree Ⅱ ankle supination-external rotation injury in children, internal fixation of the fibular fracture has no significant effect on the imaging angles or the function of the ankle joint. After anatomic reduction of the distal tibia, the fibular fracture can be treated without internal fixation to reduce operational trauma, shorten operation time and reduce operation expenses.

Objective:To investigate the efficacy of staged treatment of infectious femoral defects of Cierny-Mader type Ⅳ using bone transport combined with locking plating after En-Bloc resection debridement.Methods:A retrospective analysis was conducted of the 10 patients with distal femoral traumatic bone infection who had been treated at Department of Orthopedics, The People's Hospital of Weifang from January 2020 to January 2023. There were 8 males and 2 females with an age of (48.5±11.4) years. All cases were classified as Cierny-Mader type Ⅳ. At the first stage, En-Bloc resection debridement was performed in all cases to remove previous internal fixation devices and fill the defects with antibiotic bone cement. After infection control, the second stage involved removal of bone cement, re-fixation with internal devices, and external fixation support for bone transport. After the bone segments met, freshening of the bone ends, minor bone grafting, and screw locking of the transported bone segments were performed. Outcomes observed included bone defect length, frame carrying time and index, bone healing time, limb function, and complications.Results:After the first stage of debridement, a bone defect of (9.1±2.1) cm was created in 10 patients. All patients were followed up for (19.8±6.6) months. The duration for carrying external fixation frame was (107.2±25.1) days, and the frame index (11.8±0.5) d/cm. No recurrence was observed postoperatively. Bone union was achieved in 9 patients within 8 months, but in 1 patient only after secondary bone grafting due to poor healing at the meeting ends. All patients returned to their previous life or physical labor with no complications like pain or re-fracture. Three patients experienced varying degrees of knee joint stiffness, but were able to meet needs of daily life; one requested joint release surgery which resulted in satisfactory therapeutic efficacy.Conclusion:Staged treatment of infectious femoral defects of Cierny-Mader type Ⅳ using bone transport combined with locking plating after En-Bloc resection debridement is simple and effective.

A total of 44 patients with diabetic foot ulcers were treated in the Traumatic Orthopedics Department of Weifang People′s Hospital from January 2019 to December 2022. After debridement of foot ulcers the wounds were soaked in alkaline water of pH 7.5-8.0 (study group, n=22) or covered with vaseline gauze following iodophor disinfection (control group, n=22). The therapeutic effects of the two methods were compared. Four weeks after debridement, the wound area of study group was smaller than that of control group (3.15 (0, 7.60) vs. 6.75 (3.50, 9.32)cm 2, P<0.05), and the proportion of positive wound bacterial culture was lower than that of control group (40.9% (9/22) vs. 72.7% (16/22), P<0.05). At 12 weeks after surgery, there was no statistically significant difference in the wound healing rate between the two groups (72.7% (16/22) vs. 63.6% (14/22)), but the healing time of the study group was significantly shorter than that of the control group ((6.56±2.68) vs. (9.50±3.87) weeks, P<0.05). It is suggested that immersion of weak alkaline solution is helpful to promote wound healing for patients with diabetic foot ulcers after debridement surgery.

Objective:To explore the clinical effect on reconstruction of the soft tissue defects after resection of mucous cysts of distal interphalangeal joint (DIP) with transfer of the flap of dorsal branch of proper palmar digital artery.Methods:From September 2021 to September 2023, 8 patients (8 digits) with mucous cysts on DIP were treated in the Department of Hand and Microsurgery, the Affiliated Hospital of Binzhou Medical University. All 8 cases were females, aged 55-65 years old, with an average age of 60 years old. The cyst was located in the thumb in 1 case, in the index finger in 3 cases, in the middle finger in 3 cases, and in the ring finger in 1 case. After extensive resection of the mucous cysts, the size of soft tissue defects was at 0.8 cm×0.6 cm-1.7 cm×0.9 cm. Pedicled with the dorsal branch of proper palmar digital artery, the flaps adjacent to the defects were designed to cover the wounds. The size of the flaps was 1.2 cm×1.0 cm-2.0 cm×1.2 cm. Donor sites of the flap were covered by the full thickness skin grafts of medial upper arm. The postoperative follow-up was conducted by the combination of outpatient revisits and telephone reviews to observe the survival of the flap, and the functional recovery was evaluated according to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Results:All flaps survived well after surgery. Postoperative follow-up ranged from 4 to 12 months, with a mean of 10 months. At the final follow-up, there was no recurrence of mucous cyst and all symptoms disappeared. All flaps healed well, with good appearance, soft texture and without obvious difference in colour from the surrounding skin. All skin grafts healed in one stage. The range of motion of the affected DIP was 0°-70°, and the TPD was at 7-8 mm, both caused no impact on daily life. The outcomes were excellent according to the evaluation criteria set by the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Conclusion:The flap pedicled with dorsal branch of proper palmar digital artery has obvious advantages with less damage and simple operation in the treatment of a mucous cyst of DIP. It is an ideal surgical procedure.

Objective To explore the feasibility and accuracy of neutrophil-to-lymphocyte ratio(NLR)in the prediction of testicular torsion(TT)in children with acute scrotal pain.Methods A retrospective case-control study was performed on 158 pediatric patients with ultrasound suspicion of TT who underwent surgical testicular examination during Jan.2017 and Jan.2024.The patients were divided into TT group and non-TT group.Clinical data and laboratory data at admission were analyzed.Sensitivity and specificity of NLR to TT were determined with the area under the curve(AUC)represented on the receiver operating characteristic(ROC)curves.Results There were with no statistically significant differences in clinical data between the two groups(P＞0.05).The NLR was significantly higher in the TT group than in the non-TT group[(4.82±2.37)vs.(2.85±0.75),P＜0.05].The optimal cut-off value of TT predicted by NLR was 2.07,the AUC was 0.809(95％CI:0.709-0.909),and the sensitivity and specificity were 97.9％and 93.3％,respectively,which were significantly higher than other factors.Conclusion For suspicious ultrasound diagnosis of pediatric acute scrotal pain cases,NLR can be used to predict the possibility of TT and may help to evaluate the urgent surgical treatment in these patients.

Objective To investigate the prevalence of Enterobius vermicularis infections among children in China from 2016 to 2021, so as to provide insights into enterobiasis control and formulation of the enterobiasis control strategy among children. Methods Publications pertaining to the prevalence of E. vermicularis infections among children were retrieved from Wanfang Data, CNKI, VIP and PubMed databases published from January 2016 to June 2023. Eligible publications were screened according to inclusion and exclusion criteria, and the publication bias was evaluated using the assessment tool for prevalence studies proposed by the Joanna Briggs Institute Evidence-Based Practice Resources in Australia. The study period, study areas, study subjects, sample size and number of infections were extracted from publications, and a pooled analysis was performed using a meta-analysis. A meta-regression analysis was performed with the prevalence of E. vermicularis infections as an independent variable, and sample size, source of samples, study area, study method, geographical area and province as dependent variables to identify the source of the study heterogeneity. Results A total of 66 studies were included, covering 23 provinces (municipalities, autonomous regions) in China, and with the investigations conducted between 2016 and 2021. Meta-analysis showed that the pooled prevalence of E. vermicularis infections was 4.5% [95% confidence interval (CI): (3.1%, 6.0%)] among children in China from 2016 to 2021, and the annual prevalence was 4.1% [95% CI: (2.2%, 6.5%)], 4.2% [95% CI: (2.4%, 6.6%)], 4.2% [95% CI: (2.2%, 6.8%)], 3.2% [95% CI: (1.5%, 5.4%)], 2.3% [95% CI: (0.9%, 4.3%)] and 1.1% [95% CI: (0.4%, 2.1%)] from 2016 to 2021. The pooled prevalence of E. vermicularis infections was 4.9% [95% CI: (3.4%, 6.8%)] in studies with a sample size of < 5 000 cases, which was higher than that in studies with a sample size of 5 000 cases and higher [2.1%, 95% CI: (0.2%, 3.6%)], and the pooled prevalence of E. vermicularis infections was 5.2% [95% CI: (2.9%, 8.2%)] among subjects from schools, which was higher than that among subjects from communities [4.2%, 95% CI: (2.7%, 6.0%)]. The pooled prevalence of E. vermicularis infections was 4.4% [95% CI: (2.8%, 6.2%)] among children included in comprehensive surveillance, which was higher than that among children included in specific surveillance [4.8%, 95% CI: (2.6%, 7.7%)], and the pooled prevalence of E. vermicularis infections was 5.7% [95% CI: (3.8%, 7.8%)] among children included in county-level surveys, which was higher than that among children included in city-[4.8%, 95% CI: (2.3%, 8.0%)] and province-level surveys [1.8%, 95% CI: (0.3%, 4.7%)]. In addition, the pooled prevalence of E. vermicularis infections was higher among children in southern China [11.3%, 95% CI: (7.5%, 15.7%)] than that in central China [5.2%, 95% CI: (2.8%, 8.2%)], eastern China [5.2%, 95% CI: (2.8%, 8.2%)] and southwestern China [2.6%, 95% CI: (1.4%, 4.1%)]. Meta-regression analysis identified geographical area and survey province as factors affecting the study heterogeneity. Conclusions Currently, the overall prevalence of E. vermicularis infections is moderate among children in China, and the prevalence varies greatly in regions, with a high prevalence rate in southern China and presence of small-scale clusters. Enterobiasis surveillance and health education pertaining to enterobiasis control are required with adaptations to local circumstance to reduce the prevalence of E. vermicularis infections among children.