Abstract:Snake bite is one of the often overlooked public health issues in tropical and subtropical regions worldwide.Anti-snake venom(ASV)is currently the most effective treatment for snakebite envenomation.However,the application of ASV has the challenges of high cost,high risk of allergy,strong cold-chain dependence,and insuf-ficient supply globally.This paper reviews the production and limitations of traditional ASV and the current optimiza-tion strategies,in order to enhance clinicians'understanding and emphasis of ASV,standardize its usage,and provide new ideas for improving ASV production capacity.

Abstract:Atlas fracture is a diagnostic and therapeutic challenge in spinal surgery.This paper elaborates on four hot issues related to it:how to assess the injury of the transverse atlantal ligament,how to select the fixation method,how to manage the combined injuries,and how is the application of new surgical techniques.Through the a-nalysis of the above issues,it is hoped to provide a reference for the diagnosis and treatment of atlas fractures.

Abstract:Objective To compare the early prevertebral soft tissue high-signal width on T2-weighted MRI between healthy controls and patients with cervical hyperextension injuries,and to evaluate its diagnostic value.Methods A retrospective analysis was performed on 198 individuals who underwent cervical MRI at the Second Af-filiated Hospital of Wenzhou Medical University between Sep.2020 and Sep.2024 due to cervical hyperextension injury or routine health examination.The control group consisted of 116 healthy volunteers with no remarkable ab-normalities on cervical MRI,while the patient group included 82 patients with a definite history of cervical hyperex-tension injury whose MRI findings were consistent with hyperextension-related imaging features.The prevertebral high-signal width at the C1-C7 levels on mid-sagittal T2-weighted images was measured and compared between the two groups.Receiver operating characteristic(ROC)curve analysis was used to assess the diagnostic performance of each cervical level and the maximum width,and optimal cutoff values were determined.Correlations between the prevertebral high-signal width and the level of spinal cord and intervertebral disc injuries were also analyzed.Results The median(P25,P75)prevertebral high-signal width was 1.28(1.01-1.60)mm in the control group and 2.23(1.53-4.47)mm in the patient group.The prevertebral high-signal width at the C1-C5 levels was significantly grea-ter in the patient group than in the control group(all P＜0.05).The area under the ROC curve(AUC)for each level from C1-C5 exceeded 0.9,with the highest value observed at the C3 level(AUC=0.988;cutoff value:2.155 mm;sensitivity:96.3%;specificity:94.0%).The AUC for the"maximum width"across the C1-C5 levels was 0.991,with an optimal cutoff value of 2.91 mm(sensitivity:95.1%;specificity:96.6%).No significant cor-relations were identified between the prevertebral high-signal width and the level of spinal cord injuries(r=-0.049,P=0.521)or intervertebral disc injury(r=-0.075,P=0.408).Conclusion Prevertebral soft tissue high-signal width on T2-weighted MRI demonstrates high diagnostic performance for cervical hyperextension injuries at the C1-C5 levels,with the optimal performance at the C3 level.Among these parameters,the"maximum width"across C1-C5 shows the greatest stability and may serve as a valuable quantitative indicator for early MRI identification of cervical hyperextension injuries.

Abstract:Objective To explore the treatment strategies and long-term follow-up effects of combined at-las-axis fractures.Methods A retrospective analysis was conducted on 76 patients admitted to the 909th Hospital with combined atlas-axis fractures from May 2014 to Dec.2020,including 46 males and 30 females.The average age was 48.7 years(range 38-75 years).According to Dickman's classification,there were 30 C1-type Ⅱ odontoid fractures,20 C1-miscellaneous C2 body fractures,15 C1-type Ⅲ odontoid fractures,and 11 C1-Hangman fractures.Based on the C2 fracture types,the stability between C1-C2 and C2-C3 was determined by atlantodens interval(ADI),lateral mass offset(LMO),and C2-C3 angle and displacement:ADI≥5 mm or LMO≥7 mm was considered as instability between C1-C2;C2-C3 angulation≥11° or C2-C3 displacement≥3.5 mm was considered as instability between C2-C3.The unstable segments were fixed with posterior pedicle screws.VAS score,neck disability index(NDI),Frankel grading,and incidence of complications were used to evaluate the long-termefficacy.Radiological imaging was used to assess the bone fusion,angle of local curvature of the cervical spine,and cervical stability.Re-sults Among the 76 patients,29 had stable C1-C2 and C2-C3 and thus received non-operative treatment;the other 47 patients had unstable atlantoaxial fractures and received surgical treatment.All patients were followed up for 67-116 months,with an average of 78.5 months.The VAS score and NDI score at 12 months after surgery and last fol-low-up showed significant improvement compared to the preoperative levels(all P＜0.05).At last follow-up,the Frankel grade was improved by 0 to 2 grades.The local curvature angles of the cervical spine before and 3 d after treatment,and at last follow-up were 27.5°±2.1°,24.4°±1.7°,and 23.8°±1.2°,respectively,showing significantly reduced angles with time(all P＜0.05).The average bone healing time was(5.2±0.5)months,and the incidence of complications was 10.5%(8/76).No severe complications such as deterioration of nerve function,cerebral em-bolism,internal fixation failure,instability of the cervical spine,or cerebrospinal leakage occurred among this case series.Conclusion Based on the C2 fracture type,the stability of combined atlas-axis fractures can be judged by ADI,LMO,and C2-C3 angulation and displacement.The unstable segments should be fixed with posterior pedicle screws,which alleviate neck pain,improve neurological symptoms,and restore cervical physiological curvature,pres-enting with good clinical and radiological long-term results.

Abstract:Objective To evaluate the effects of atorvastatin(ATV)on implant-associated infection in a rat fracture model based on radiographic assessment.Methods Forty male SD rats weighing 200-220 g were randomly divided into 4 groups using a random number table:Model group,low-dose group(ATV-L),medium-dose group(ATV-M),and high-dose group(ATV-H),with 10 rats in each group.An open fracture with inplant infection mod-el by staphylococcus aureus was established in the right femur of rats.Oral administration commenced 3 d post-sur-gery.The ATV-L,ATV-M,and ATV-H groups received concentrations of 10.5,21.0,and 42.0 mg/kg,respective-ly,while the Model group received an equal volume of saline.Weighing was performed weekly,with radiographic ex-ams conducted biweekly to assess callus formation.Rats were euthanized at 8 weeks for tissue collection,general con-dition evaluation,and safety assessment.Micro-CT scans were conducted to analyze the fracture sites with 3D recon-struction.Femur sections were embedded,stained with hematoxy lin-eosin(HE)and safranin O-fast green,to exam-ine inflammatory changes and fracture healing.Results No statistically significant differences were observed in body weight or organ coefficients among groups(P＞0.05).Individual rat deaths occurred due to infection or anes-thesia,with the survival rates of 70%in the Model group,100%in the ATV-L group,90%in the ATV-M group,and 80%in the ATV-H group.Compared with the Model group,the ATV-L group revealed significantly higher callus scores at 4,6,and 8 weeks(all P＜0.05),while the ATV-M and ATV-H groups showed much higher callus scores at 6 and 8 weeks(all P＜0.05).The bone callus of the ATV-L group was 1.43±0.25,1.97±0.27,and 2.15±0.30 at 4,6 and 8 weeks,respectively,which were much higher than those of the ATV-M group(1.18±0.33,1.64±0.20,and 1.74±0.19)and ATV-H group(1.08±0.21,1.24±0.09,and 1.51±0.05)at corresponding time points(all P＜0.05);moreover,comparison between the ATV-H and ATV-M groups revealed much lower values of the former at 6 and 8 weeks(both P＜0.05).Micro-CT results indicated that the ATV-L group exhibited faster fracture healing compared to both the ATV-M and ATV-H groups.HE and safranin O-fast green staining of the femurs also demon-strated superior fracture healing in the ATV-L group compared to the other three groups.Conclusion Low dose of ATV(10.5 mg/kg)treatment significantly inhibits postoperative implant-associated infection and accelerates heal-ing of infected fractures.

Abstract:Objective To explore and compare the accuracy of different warning assessment tools for early death prediction among trauma patients.Methods The databases of China Biology Medicine disc,CNKI,Wanfang data,VIP,Cochrane Library,PubMed,Web of Science,and Embase were searched for published Chinese or English diagnostic studies on the effectiveness of in-hospital mortality assessment tools for trauma patients,in May 2024.Two evaluators independently screened the literature,extracted information and evaluated the reference quality using the diagnostic research quality assessment tool(QUADAS-2).Meta-analysis was performed using the RevMan 5.3 soft-ware,and network meta-analysis was performed using the Stata 26.0 software.Results A total of 38 references in-volving 36 assessment tools were included.For further analysis,the assessment tools studied by＜2 references were excluded,and finally a total of 18 assessment tools were analyzed in the study.QUADAS-2 determined a low overall risk of bias.The surface under the cumulative ranking curve results showed that the top three tools for sensitivity were:TRISS(trauma and injury severity score,89.2%)＞RSI(reverse shock index,85.0%)＞CRAMS scale(cir-culation,respiration,abdomen/thorax,motor,and speech,68.4%).The top three tools for specificity were:A-PACHE Ⅱ(81.8%)＞SI(shock index,77.0%)＞RAPS(rapid acute physiology score,68.1%).Conclusion A phased strategy is recommended for trauma assessment.At the emergency scene and during initial hospital arrival,RSI and SI can be used for rapid triage.During the subsequent in-hospital monitoring phase,TRISS or APACHE Ⅱ can be employed for precise prognosis prediction,depending on the available medical resources.

Abstract:Objective To evaluate the efficacy of 3D printing-assisted Joy Stick technique in managing type C3 distal humerus fractures.Methods A retrospective analysis was conducted on 36 patients with type C3 dis-tal humerus fractures,who were admitted to the Department of Traumatic Orthopaedics or Orthopaedics of the two hospitals of the authors from Apr.2022 to Mar.2024.This cohort included 19 male and 17 female patients,with a mean age of 56.8(range 18-74)years.Injury mechanisms were as follows:5 cases of ground-level falls,17 road traffic accidents,and 14 falls from height.Preoperatively,3D printed models were manufactured based on the CT da-ta to assist in surgical planning.A posterior midline approach was employed to access the fracture site through both sides of the triceps muscle.The Joy Stick technique was used to reduce the medial and lateral condyles,followed by bilateral plate fixation.The union time,range of motion of the affected elbows and Mayo elbow performance score(MEPS)at the final follow-up were recorded and analyzed.Results The 36 patients were followed up for 14.2(range 12-16)months.The time to union ranged from 10 to 16 weeks,mean 12.6 weeks.The average elbow range of motion of the affected limb was 116.3°±9.4°,and the MEPS ranged from 66 to 98(mean 84.7).Based on MEPS,functional outcomes were rated as excellent in 18 cases,good in 13,moderate in 4,and poor in 1,showing a good to excellent rate of 86.1%.Conclusion 3D printing-assisted Joy Stick technique is a safe and effective meth-od for treating type C3 distal humerus fractures.

Abstract:Objective To investigate the feasibility and clinical efficacy of the reverse repair of the donor site of the great toe fibular flap with the plantar perforator flap based on the tibial digital artery of the second toe.Methods From Apr.2021 to Dec.2023,clinical data of 18 patients whose donor site wound of the great toe fibular flapwere reversely repaired with the plantar perforator flap based on the tibial digital artery of the second toe in our department were retrospectively analyzed.Among them,there were 14 males and 4 females;the mean age was 40.8(range,27-56)years.The operation time was 157-236 min,mean 175 min.There were 4 thumb,6 index,5 middle and 3 ring finger injuries.After reconstruction of the fingers with fibular flaps of the great toe,the soft tissue defects at the donor sites measured 1.6 cm×2.8 cm to 2.4 cm×3.2 cm.Plantar perforator flaps based on the tibial digital artery of the second toe were used to repair the donor site wound of the great toe,harvested at a size of 1.8 cm×2.9 cm to 2.5 cm×3.4 cm.All the donor sites of the second toe were closed directly.Results All the plantar perfora-tor flaps of the second toes survived successfully.The mean follow-up time was 19.7(range,13-28)months.The texture and color of the flaps were close to the surrounding skins.The walking and activity functions of the first and second toe joints were not obviously affected.The reconstructed finger pulp was full,with good appearance and an average Vancouver scar scale score of 0.3.The plantar perforator flaps based on the tibial artery of the second toe showed soft texture,without ulceration or bloated appearance.Wearing shoes or walking function was not affected.Patients were satisfied with the appearance and function of their hands and feet.Conclusion Reverse repair of the fibular flap of the great toe with plantar perforator flaps based on the tibial digital artery of the second toe showed small donor site damage,good texture matching and wear resistance,reliable blood supply,direct suture of the donor site,and postoperative aesthetics,being a good choice to repair the donor site of the fibular flap of the great toe.

Abstract:Objective To explore the clinical application of a self-designed internal anchor positioning de-vice in arthroscopic repair of rotator cuff tear.Methods A retrospective analysis was conducted on 50 patients with rotator cuff tears who were admitted to the Department of Orthopedics,Wulong District People's Hospital from Jan.2022 to Jun.2023.There were 23 males and 27 females aged 52 to 67 years,with an average age of 55.3 years.There were 17 cases of traumatic tear(6 falls and 11 stretch injuries)and 33 cases of degenerative tear.According to the placement methods of internal rowanchors,patients were divided into a manual placement group(n=26)or a self-designed locator group(n=24).Both groups received arthroscopic rotator cuff repair surgery.The Constant score and American Shoulder and Elbow Surgeons(ASES)score before,and 6 and 12 months after surgery were re-corded to evaluate the pain relief and functional improvement for the shoulder joint.At the same time,the intraoper-ative placement number,frequency,and time of the internal anchors were recorded for all patients,as well as the oc-currence of adverse events of anchor loosening,extraction,breakage,entering the joint cavity,etc.Results All pa-tients were followed up for 12-16 months,with(14.5±1.6)months for the manual placement group and(14.1±1.5)months for the self-designed locator group,without any statistically significant difference(P=0.645).The postoperative Constant scores and ASES scores of each group were significantly improved with time(all P＜0.05),but comparison at each time point between the two groups showed no statistically significant differences(all P＞0.05).For the manual placement group,a total of 36 anchors were placed in 42 times,with an average placement time of(2.78±1.24)min per session;for the self-designed locator group,a total of 40 anchors were placed in 41 times,with an average placement time of(1.56±0.82)min per session,revealing statistically significant difference(P＜0.05).Moreover,the former revealed 16.7%incidence of adverse events:2 loosening,1 extraction,2 breakage and 1 entering the joint cavity,which was much higher than the 2.5%adverse events(only 1 extraction)for the lat-ter(P＜0.05).Conclusion The use of the self-designed anchor positioning device in arthroscopic repair of rotator cuff tear can improve the accuracy of anchor placement and shorten the placement time.Moreover,it is expected to reduce the incidence of anchor failure events.

Abstract:Open abdomen(OA)therapy exerts a remarkable effect in the treatment of severe abdominal diseases,yet it may induce enteroatmospheric fistula(EAF),which is associated with high morbidity and mortality rates.Enteral nutrition(EN),an important nutritional therapeutic modality,supplies nutrients via the physiological gastrointestinal tract.It can maintain the integrity of intestinal barrier function and improve the immune status of pa-tients.A growing number of studies have demonstrated that EN exerts long-term positive effects in patients with EAF.This paper reviews the pathogenesis of EAF secondary to OA and points out the relevant risks associated with long-term parenteral nutrition.It further explores the clinical application of EN in patients with EAF.Finally,the strategies for EN therapy in these patients are summarized,and the importance of nutritional support for such patients is emphasized,aiming to provide a reference for clinical nutritional treatment.

Abstract:Objective To compare the efficacy of unilateral and bilateral approaches in percutaneousky-phoplasty(PKP)in elderly patients with osteoporotic vertebral compression fractures(OVCF).Methods A retro-spective analysis was conducted on 148 patients with OVCF who underwent PKP at our department from Oct.2022 to Sep.2024.There were 56 males and 92 females aged 60-88 years,with an average of 72.1 years.Patients were divided into unilateral(n=74)or bilateralapproach groups(n=74 for each)according to the surgical approaches.The peri-operative indicators,pain degrees,lumbar spine function,and postoperative adverse events like leakage,re-fracture,as well as pre-and post-operative imaging characteristics were analyzed.Results The two groups were comparable in terms of general data,injury course and bone density(all P＞0.05),but the unilateral approach group revealed much less operation time(min,35.2±10.3),intraoperative blood loss(mL,9.6±3.5),volume of bone ce-ment[mL,3(3,4)]and frequency of X-rays(11.6±5.7),than the bilateral approach groups[(56.6±11.3)min,(16.2±6.2)mL,5(4,6)mL,and 20.7±7.3].Repeated measures ANOVA revealed statistically significant time effects on imaging parameters(P＜0.05),but the inter-group and interaction effects showed no significant im-pact(P＞0.05).Generalized equation model analysis revealed a statistically significant effect of time point on pain intensity(P＜0.05),while inter-group and interaction effects showed no significant difference(P＞0.05).The ODI showed a similar trend.Analysis of preoperative and postoperative radiographic features revealed that patients with T12 vertebral compression fractures exhibited localized increased density and markedly reduced height on preopera-tive X-rays,with compression reaching approximately one-third of vertebral height.Postoperative follow-up X-ray demonstrated restoration of vertebral height.Patients with T7 vertebral compression fractures showed typical wedge-shaped deformity on preoperative X-rays,and postoperative follow-up X-ray indicated restoration of physiological ver-tebral curvature and improved wedge-shaped deformity.In the unilateral approach group,10 cases(13.5%)devel-oped adverse events,while the bilateral approach group revealed 14 cases(18.9%)of adverse events,with no statis-tically significant difference(95%CI:-0.174 to 0.066,P＞0.05).Conclusion Both unilateral and bilateral ap-proaches can effectively improve OVCF.The unilateral approach has advantages in improving perioperative relevant indicators.The surgical approach should be reasonably selected based on the individual differences to achieve the best treatment effect.

Abstract:Objective To compare the mid-to long-term outcomes of different fusion strategies in short-segment fixation for patients with thoracolumbar fractures.Methods A retrospective analysis was conducted on 242 patients with single-segment thoracolumbar fractures who underwent short-segment posterior fixation at our depart-ment from Jun.2017 to Aug.2024,with a minimal follow-up period of one year.Among them,147 were male and 95 were female,aged 17-59 years,with a mean age of 45.6 years.The injury causes included falls in 197 cases,road traffic injuries in 32 cases,and others in 13 cases.Based on the intraoperative fusion strategies,patients were divid-ed into non-fusion group(190 cases),partial fusion group(37 cases),or total fusion group(15 cases).Patients in the three groups were comparable in terms of general data and injury severity(P＞0.05).The oswestry disability in-dex(ODI),visual analog scale(VAS)score,the 36-item short form health survey(SF-36)scores,and hospital anxiety and depression scale(HADS-A and HADS-D)scores were recorded preoperatively and at the final follow-up.Surgery-related complications within 90 d after surgery,operative time,intraoperative blood loss,and hospital stay were compared among the three groups.Results The non-fusion,partial,and total fusion groups were followed up for respectively(62.7±25.4),(58.1±23.4),and(60.0±33.1)months,revealing no significant differences(P＞0.05).At the final follow-up,the abovementioned three groups showed the VAS scores of 1.5±0.7,1.7±0.8,and 1.5±0.5;ODI of 8.1%±3.2%,7.3%±2.8%and 7.7%±3.5%,SF-36 scores of 87.9±2.1,78.6±1.6 and 78.9±1.2;HADS-A scores of 1.5±0.6,1.4±0.6 and 1.4±0.5;and HADS-D scores of 0.1±0.3,0.2±0.4,0.1±0.4,significantly improvement compared to the preoperative values(all P＜0.05);however,comparison between the three groups revealed no significant differencs(All P＞0.05).But the non-fusion group reported much less opera-tion time(min,110.1±34.1)and intraoperative blood loss(mL,111.7±72.1)than the partial fusion group[(124.7±41.2)min,(171.6±123.0)mL]and the total fusion group[(128.3±31.2)min,(160.0±66.4)mL](all P＜0.05).Conclusion For single-segment thoracolumbar fractures without significant deformity,severe dis-placement,or neurological injuries,short-segment posterior fixation provides similar mid-to long-term functional and psychological improvement.The non-fusion technique leads to much shorter operation time and less intraoperative blood loss,therefore,being a commendable treatment option for such patients.

Abstract:Objective To investigate the application and effect of radial collateral artery perforator flap with preservation of the posterior antebrachial cutaneous nerve in the repair of hand soft tissue defects.Methods Eight-een patients with hand soft tissue defects who were admitted to the two hospitals of authors between Aug.2022 to Aug.2024 were included.There were 10 males and 8 females.The average age was 38 years(range,18-60 years).The causes of hand soft tissue defects included machine crush(n=6),road traffic accident(n=4),skin soft tissue avulsion(n=3),scar resection at late-stage post-injury(n=2),and others(n=3).Defects were loca-ted on the dorsal side of the hand in 8 patients,palmar side of the hand in 6 patients,and fingers in 4 patients.De-fect size ranged from 6.5 cm×12.0 cm to 4.5 cm×6.5 cm.To repair the defects,radial collateral artery perforator flaps with preservation of the posterior antebrachial cutaneous nerve were designed and harvested according to the size and shape of the defects.The donor site was directly closed using subcutaneous tension-reducing suture.Results After surgery,all flaps survived and the wounds healed in stage I.All patients were followed up for an average of 8.8(range 6-14)months.The flaps did not appear swollen,exhibiting soft texture and good elasticity,without pig-mentation,ulceration or frostbite.The junction between the peripheral edge of the flap and the native tissues of the hand healed well,with no flap contracture or scar hyperplasia.Only linear scars remained at the donor site,where the skin sensation on the posterior forearm was consistent with that on the healthy side,without the occurrence of numbness,pain,or hypoesthesia.Conclusion Radial collateral artery perforator flap with preservation of the poste-rior antebrachial cutaneous nerve can prevent postoperative adverse events such as numbness,pain,and hypoesthesia in the posterior forearm region,which represents an excellent option for the repair and reconstruction of soft tissue defects of the hand.

Abstract:The harsh environmental conditions in plateau regions,including high altitude,low oxygen levels,and intense ultraviolet radiation,coupled with the unique demands of military missions,make ocular trauma one of the most common injuries among plateau-based troops.This poses a serious threat to the health of personnel and the combat effectiveness of the force.Based on practical experience in managing ocular trauma within plateau-based mil-itary units,this paper reviews existing literature and analyzes current conditions.It summarizes the primary types of ocular trauma encountered,progress in establishing treatment systems,and existing shortcomings.Targeted develop-ment recommendations are proposed,including improving prevention systems,optimizing tiered diagnosis and treat-ment,strengthening grassroots training,and advancing scientific research and innovation.The aim is to provide theo-retical reference for enhancing ocular trauma treatment capabilities and establishing an integrated medical support model for plateau-based military units.

Abstract:Objective To investigate the association between different military operational task attributes and the spectrum of musculoskeletal diseases.Methods A retrospective analysis was conducted on medical patrol data from our hospital between Nov.2023 and Mar.2025,involving 951 individuals with 1008 documented cases.Based on core task attributes,cases were categorized into a duty group(n=604,primarily static tasks such as sentry duty)or a training group(n=404,primarily dynamic training such as tactical exercises).Diseases were classified according to standard criteria.Chi-square test was used to analyze differences in the disease spectrum,injury mecha-nisms,and affected anatomical sites between the two groups.Results Lumbar muscle strain was the most common injury in both groups,with a significantly higher incidence in the duty group(19.04%vs.12.87%,P=0.010).The proportion of acute injuries was much higher in the training group compared to the duty group(P=0.036).Analysis of lower limb injuries revealed significant differences between the groups:knee injuries were more common in the training group(37.83%vs.29.13%,P<0.05),while foot injuries were more common in the duty group(20.47%vs.10.87%,P<0.05).Conclusion Military task attributes are a critical factor influencing the differentiation of the musculoskeletal disease spectrum.Long-term static duties predispose personnel to chronic lower back and foot inju-ries,whereas high-intensity dynamic training increases the risk of lower limb injuries,particularly to the knees.

Abstract:Objective To explore the application of K-wire spreader combined with tarsal sinus approach for minimally invasive internal fixation for Sanders typeIⅡ/Ⅲ fractures of the calcaneus.Methods A total of 104 patients with Sanders typeⅡ/Ⅲcalcaneal fractures treated at our hospital from during 2023 were selected.Accord-ing to the random number table method,patients were divided into a study group or a control group,with 52 cases in each group.The age range was 20-60 years,with an average of 50.0 years.There were 91 males and 13 females,with 49 cases of road traffic injuries,31 falls from heights,and 24 heavy object compression.Sanders classification defined 64 cases of type Ⅱ and 40 type Ⅲ,with 49 affecting the left side and 55 the right side.The control group received minimally invasive steel plate fixation through the tarsal sinus approach,while the study group used K-wire spreader to assist in fracture reduction based on the tarsal sinus approach.Surgical parameters,fracture healing time,X-ray results before surgery,3,6 and 12 months after surgery,as well as ankle joint function and complications at 12 months after surgery were compared between the two groups.Results The study group had a shorter surgical time and less frequency of X-ray fluoroscopy compared to the control group(P<0.05),but thefracture healing time-showed no statistically significant difference(P>0.05).Repeated measurement analysis of each group showed an increasing trend in Bohler angle and calcaneal height at 3,6,and 12 months postoperatively,and a decreasing trend of Gissane angle,calcaneal width and length(all P<0.05).At 3,6,and 12 months postoperatively,the Bohler an-gles in the study group were 23.26°±4.42°,31.24°±3.86°,and 31.66°±3.75°,respectively,which were higher than those in the control group(19.53°±3.85°,26.32°±4.17°,and 27.13°±4.16°).The Gissane angles were 131.53°±6.65 °,127.24°±4.54°,and 127.32°±4.62°,respectively,which were lower than those in the control group(137.36°±7.37°,132.42°±7.24°,and 131.84°±6.85°,P<0.05).The excellent rate of ankle joint function recovery in the study group was higher than that in the control group(P<0.05),but the calcaneus height,width,and length showed no statistically significant difference,nor did the incidence of complications(all P>0.05).Conclusion The use of K-wire spreader combined with tarsal sinus approach steel plate internal fixation for Sanders type Ⅱ/Ⅲ calcaneal fractures can shorten the surgical time,reduce X-ray fluoroscopy,promote the re-covery of Bohler angle and calcaneal height,and achieve a better ankle joint functional recovery.

Abstract:Objective To evaluate the anatomical safety and clinical efficacy of arthroscopic management of posterior ankle impingement syndrome via a posterolateral dual-portal approach in the lateral decubitus position.Methods This study employed a three-phase progressive design,i.e.,phase 1:measure the safe operative distance to the sural nerve through the posterolateral dual-portal approach based on 11 specimens;phase 2:measure the dis-tances from the posterior ankle bony landmarks to the posterior tibial artery based on the time-of-flight magnetic reso-nance angiography(TOF-MRA)imaging data of 21 patients treated non-surgically at our center during 2024,to vali-date vascular safety in the operative zone;and phase 3:validate the clinical feasibility,by retrospectively analyzing clinical data of 75 patients with posterior ankle impingement syndrome who underwent arthroscopic treatment via a posterolateral dual-portal approach at our center between Jun.2013 and Dec.2024 after failed non-surgical treat-ment.Among the 75 patients,there were 56 males and 19 females aged 23-41(mean 29.0)years,with 34 cases of chronic overuse,19 biomechanical abnormalities,12 anatomic variations,and 10 trauma.Clinical efficacy was sys-tematically evaluated using the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot scale and vis-ual analog scale(VAS)for pain.Results In the 11 specimens,the distance from the lateral/posterior portals to the sural nerve was(13.87±4.51)mm and(13.56±3.95)mm,respectively,without any statistically significant difference(mean difference=0.31 mm,P=0.879).TOF-MRA imaging data of the21 cases revealed that the dis-tance from the posterior tibial artery to the posterior ankle process,posterolateral talar process,and posterior subtalar joint was(12.52±3.05)mm,(12.88±2.05)mm,and(17.64±3.13)mm,respectively(F=33.412,P<0.001,one-way repeated-measures ANOVA).Patients were followed up for a mean of 43(range 19-47)months,which showed that the AOFAS scores improved from 65.3±6.3 to 91.8±4.6(mean improvement 26.5±6.5,P<0.001),and VAS decreased from 6.1±0.8 to 0.7±0.5(mean reduction 5.4±0.9,P<0.001).No complica-tions of infection,nerve injury,etc.occurred.Conclusion This integrated study(anatomic,imaging,and clinical)systematically demonstrates that the posterolateral dual-portal arthroscopic approach can effectively eliminate im-pingement pathology and improve function.It presents the advantages of optimal visualization,high anatomical safe-ty,low complication rates,and significant clinical efficacy,meriting wider clinical adoption.

Abstract:Traumatic brain injury(TBI)is one of the leading causes of disability and death worldwide,pla-cing a heavy burden on families and society.Exploring the pathophysiological mechanism of secondary brain injury after TBI is very important to improve the treatment and prognosis,and establishing a better animal model of TBI will help researchers further explore the pathophysiology of TBI.Rodents are widely used in TBI models because of their small size and low cost.In this review,we describe the relevant studies on common TBI rodent models of weight drop injury,controlled cortical impact injury,blast-mediated traumatic brain injury,and fluid percussion injury,in order to select relevant animal models more pertinently.

Abstract:Snakebite envenomation(SBE)represents a prevalent and potentially fatal clinical emergency,frequently accompanied by both localized and systemic complications,including coagulopathy,compartment syn-drome,renal failure,and neurological damage.In severe instances,multi-organ failure may ensue,posing a signifi-cant threat to patient survival.Though timely administration of antivenom has proven effective in preventing SBE-re-lated complications,its utilization is constrained by the issues of accessibility,affordability,and species specificity.Furthermore,the inadequate early recognition of complications and insufficient follow-up treatment in clinical settings have contributed to the persistent occurrence of long-term sequelae following SBE incidents.This comprehensive re-view aims to delineate recent progress in the study of SBE-associated complications,including their pathogenesis,clinical manifestations,diagnostic and therapeutic strategies,and rehabilitation approaches,with the ultimate objec-tive of enhancing clinical management,diagnostic and treatment approaches,and rehabilitation strategies for SBE complications.

Abstract:Objective To observe the clinical effect of 3D printing guide plate combined with open reduc-tion and bone graft hollow nail fixation in the treatment of scaphoid fractures of the wrist.Methods A total of 66 patients with scaphoid fractures of the wrist who were admitted to our hospital from Apr.2021 to Jan.2024 were se-lected,with 37 males and 29 females aged 24-68 years,mean 43.5 years.The causes of fractures were 19 falls,32 road traffic accidents and 15 falls from heights.According to the improved Herbert classification,there were 25 cases of type A2,29 type B2 and 12 type B3.The time from injury to surgery was 2-12 d,mean 6.8 d.All the fractures were confirmed by X-ray,CT and MRI.They were divided into either control group(received open reduction and bone graft hollow nail fixation,35 cases)or study group(received an additional 3D printing guide plate besides open reduction and bone graft hollow nail fixation,31 cases)according to their surgical methods.Patients in both groups were followed up after surgery,for perioperative parameters,range of motion(ROM)and functional recovery of the-wrist,pain before and after surgery,complications,etc.Results Patients were followed up for 8-18 months,mean 12.6 months.The study group showed that the intraoperative blood loss was(4.4±1.0)mL,intraoperative fluoros-copy(6.6±1.3)times,operative time(28.1±3.3)min and fracture healing time(2.2±0.2)month,which were all much lower than those of the control group[(8.8±1.6)mL,(9.5±2.3)times,(39.3±4.7)min,(3.0±0.2)month].But the hospitalisation cost was much higher in the study group than in the control group(ten thou-sand CNY,2.9±0.2 vs.2.3±0.3,P<0.05).The wrist function score in the study group was 66.9±3.2 at post-operative 1 month and 82.2±5.1 at postoperative 6 months,much higher than the 58.3±4.2 and 73.9±6.1 in the control group;while the VAS in the study group was2.3±0.1 and1.6±0.1,respectively,much lower than the 3.1±0.1 and 2.4±0.1 in the control group(P<0.05).Moreover,at postoperative6 months,the study group a-chieved a palm-flexion ROM of 36.5°±2.6°,dorsiflexionROM of 13.5°±1.6°,radial flexion ROM of 12.3°±1.3° and ulnar flexion ROM of 23.5°±1.4°,all much higher than the 33.6°±2.9°,11.9°±1.7°,10.4°±1.2°,and19.6°±1.2° in the control group(P<0.05).Incidence of complications showed no significant difference be-tween the two groups(P>0.05).Conclusion 3D printing guide plate combined with open reduction and bone graft hollow nail fixation in the treatment of scaphoid fracture of the wrist can improve perioperative parameters,re-duce postoperative pain and improve wrist joint function.