Objective    To conduct an in-depth anatomic study on the posterior relevant structures of the knee joint, so as to provide more appropriate approach for the surgical treatment of posterolateral tibial plateau fractures.   Methods   A total of 10 knee joints of 5 adult cadaveric specimens that were fixed by formaldehyde were observed to learn its anatomic structure through the hierarchical dissection of the posterior knee. The distribution and morphological characteristics of the posterior knee muscles, as well as the course of the associated vessels and nerves, were observed. The diameters and positional relationships of the popliteal artery, posterior tibial artery, anterior tibial artery, peroneal artery, and tibial nutrient artery were measured. Additionally, relevant data of the popliteus, soleus, and gastrocnemius muscles were recorded.    Results   There were three anatomical structures and features: bare triangle, cushion-like protection, and pouch-like space behind the tibial plateau. The popliteal artery and the posterior tibial artery were located in the lateral one-third of the proximal tibia and along the lateral border of the tibia. These anatomical features determined that medial approach with lateral traction could provide optimal exposure of the posterolateral tibial plateau. The morphological characteristics and related data of the popliteus muscle exhibited discrepancies from the current anatomical literature. The distances from the popliteal artery and posterior tibial artery to the medial and lateral borders of the tibia measured in the coronal plane were (2.98±0.26) cm and (1.73±1.14) cm, respectively, showing significant differences (P<0.05, t=9.547, P=0.000). The heights from the origins of the anterior tibial artery, peroneal artery and tibial nutrient artery to the tibial plateau were (5.33±0.44) cm, (10.40±0.28) cm, and (10.59±0.23) cm, respectively, their outer diameters were (4.91±0.17) mm, (2.28±0.24) mm, and (1.44±0.08) mm, respectively. The angle between the medial vertical border and the superior border of the popliteal muscle was approximately 120°, with the length of the superior border (4.11±0.07) cm and the length of the medial vertical border (8.68±0.13) cm. Additionally, relevant data for the gastrocnemius and soleus muscles was obtained. The area of the bare triangle was (4.36±0.15) cm².    Conclusions    There is a "subtle" pathway from the posteromedial to the posterolateral tibial plateau, through which a muscular cushion-like structure protects the critical neurovascular structures at posterior aspect of the knee joint. This approach allows for full exposure, reduction, and fixation of posterolateral tibial plateau fractures, offering advantages such as safety, simplicity, and minimally invasive technique. 

Objective    To observe the morphological characteristics of posterior talofibular ligament (PTFL) and clarify its anatomical types, so as to provide useful information for the precise anatomy of talofibular joint and the surgical repair of ligament.    Methods    One hundred lower limbs of human cadavers were used to dissect PTFL and intermalleolar ligament (IML), observing their morphological characteristics and variations. The length, origin width, insertion width of PTFL were measured.   Results   Based on the morphological features, PTFL was classified into: Type I: PTFL appeared as a single, continuous band without significant branching, presenting as an independent strip in 72 cases (72%), among which 28 cases showed connection to intermalleolar ligament (IML); Type II: PTFL was divided into two fiber bundles, running parallel or with a small angle to each other in 23 cases (23%), among which 6 cases had connection to IML; Type III: PTFL was divided into three fiber bundles, running parallel or with small angles to each other in 4 cases (4%), and only 1 case connected to IML. PTFL has an average length of (22.51±3.67) mm, an average origin width of (7.26±1.41) mm, and an average insertion width of (5.61±1.43) mm. There were statistically significant differences in the insertion width (P<0.05) and length (P<0.05) among types I～III. There were significant differences in the insertion width (P<0.05) and length (P<0.05) between male and female. Conclusions    The classification of PTFL and its relationship with IML in this study is a supplement to the detailed anatomy of the ankle joint. In clinical diagnosis, attention should be paid to the characteristics and variations of PTFL and IML, as it is helpful for understanding the mechanism of posterior ankle ligament injuries and providing important information for their diagnosis and treatment. 

Objective   To evaluate the feasibility of establishing a safe minimally invasive endoscopic spinal channel via the base of the superior articular processes at the L3-5 vertebral levels, by performing radiographic measurements of the anatomical parameters of these processes in 203 samples.   Methods   CT data of 203 cases of lumbar vertebrae were collected from two tertiary hospitals in Inner Mongolia, with no restriction on gender and age ranging from 20 to 79 years. The participants were divided into three groups based on age: Group A (20-39 years), Group B (40-59 years), and Group C (60-79 years). The radiological data was imported into Mimics 21.0 software in DICOM format. Three parameters were measured, including the left-right diameter, anterior-posterior diameter, and puncture angle of the base of the superior articular process, using a multi-operator repeated measurement approach with the average value. The following parameter differences: (1) between the bilateral bases of the superior articular processes of the same vertebra in subjects of the same age and gender; (2) between genders for the same vertebra within the same age group; (3) between different vertebrae in subjects of the same age and gender; and (4) between different age groups for the same vertebra and gender; were compared.   Results   There were no statistically significant differences in anatomical parameters between the superior articular processes on both sides of the same vertebral body. For the same vertebral body and age group, there were significant differences in the anterior-posterior diameter, with males having larger values than females. There were no significant differences in the left-right diameter between genders in Group A, while in Groups B and C the differences between sexes for the same vertebral body and age group were statistically significant, with males having larger values than females. There was no consistent pattern of differences in the puncture angle between genders for the same vertebral body and age group. There were significant differences in the puncture angle among different vertebra bodies in subjects of the same age and gender, and the puncture angle at the superior articular process of the lower vertebrae was larger than that of the upper vertebrae, the other two anatomical parameters showed varying degrees of differences across different vertebral levels. Comparisons of the anterior-posterior diameter between the same gender and  vertebral bodies among different age showed no significant differences in most cases. Comparisons of the left-right diameter between the same gender and  vertebral bodies among different age showed significant differences in most cases, while differences in the puncture angle were inconsistent among different age groups.   Conclusions   From an anatomical perspective, it is feasible to establish a safe minimally invasive endoscopic spinal channel within the superior articular process at the basal level of the L3-5 vertebral bodies.

Objective    To explore the influencing factors of the anatomical location of inferior vena cava origin and its clinical significance based on CT images.   Methods    CT and clinical data of 132 normal adults were retrospectively analyzed. Parameters including DBIL3V, vertebral body measurements (L3 height, L2 transverse diameter), fat tissue distribution (visceral/subcutaneous fat tissue area and thickness), and psoas major muscle parameters (area and diameter) were measured. The correlation between DBIL3V and these indicators was analyzed.   Results   The mean value of DBIL3V was (5.39±1.21) cm. It showed positive correlations with visceral fat tissue area (L2 level: r=0.216, umbilical level: r=0.212), visceral-to-subcutaneous fat tissue area ratio (L2 level: r=0.323, umbilical level: r=0.200), psoas major muscle area (r=0.226), and oblique anteroposterior diameter (r=0.258) (all P<0.05). DBIL3V was significantly greater in males than in females (r=0.257, P=0.003), but no correlation was observed with age, vertebral parameters, or subcutaneous fat.    Conclusions    DBIL3V is influenced by visceral fat tissue content, psoas major muscle development, and gender. Clarifying these factors provides important reference value for clinical diagnosis and treatment procedures.

Objective    To measure precisely the femoral direct insertion bone area of the anterior cruciate ligament (ACL) by using CT three‑dimensional reconstruction,  to analyze its correlation with anatomical parameters such as gender and side, to evaluate its clinical guidance value for femoral tunnel positioning in anatomical single-bundle reconstruction, and to conduct a systematic comparison with the IDEAL (isometric, direct insertion, eccentrically located, anatomical, low rupture risk) point positioning method.    Methods   The 3D CT reconstruction images of knee joints of 553 adult patients (240 males, 260 females; 246 left knees, 307 right knees) admitted to our hospital from February 2024 and August 2025 were retrospectively reviewed. The images were reconstructed using Siemens syngo.via software, and the area, morphological characteristics, and spatial distribution of the femoral direct insertion bone block of ACL were measured using Bernard four-cell table method, followed by statistical analysis.   Results   The bone block area at the femoral direct attachment site of ACL was (49.86±8.99) mm², concentrated between the posterior cartilage margin and the resident's ridge on the medial surface of lateral femoral condyle. The termination point morphology was mainly of the concave type (89.9%), and the spatial distribution was mainly in zone b (upper front quadrant, 40.5%) and zone d (front lower quadrant, 34.2%), accounting for a combined total of 74.7%. The bone block area in males (52.14±8.63 mm²) was significantly larger than that in females (48.12±8.83 mm²) (P<0.001), with no significant difference in the area between the left and right knee sides.    Conclusions   CT 3D reconstruction can clearly display the anatomical structure of the direct femoral attachment point of ACL, providing reliable imaging support for ACL reconstruction surgery. The distribution area of the stop point core is consistent with IDEAL point positioning concept, and there are significant gender anatomical differences, therefore, individualized localization principles must be followed during surgery. This study provides anatomical and imaging evidence for the clinical localization of the IDEAL point positioning method.

Objective   To explore the correlation between radiological anatomical factors of scapula and non-traumatic rotator cuff tear. Methods The shoulder joint anteroposterior and "Y" position X-ray films of 50 patients confirmed by surgery with non-traumatic rotator cuff tear and 48 normal adults were retrospectively analyzed. Lateral acromion angle, critical shoulder angle, acromion index, and glenoid inclination of two groups were measured. And sharpened lateral acromion morphology, acromion morphology, acromioclavicular joint osteophyte, subacromial bone sclerosis were observed. The statistical differences between imaging anatomical parameters of two groups were compared. Logistic regression was used to analyze independent influencing factors for non-traumatic rotator cuff tears. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of independent influencing factors for non-traumatic rotator cuff tear.    Results    There were no statistical differences in age, gender, side, body mass index (BMI), manual worker, acromion morphology, and acromioclavicular joint osteophyte between two groups (P>0.05). However, there were statistical differences in lateral acromion angle, critical shoulder angle, acromion index, glenoid inclination, sharpened lateral acromion morphology, and subacromial bone sclerosis (P<0.05). The lateral acromion angle of the rotator cuff tear group was lower than that of control group, while critical shoulder angle, acromion index, glenoid inclination, sharpened lateral acromion morphology, and subacromial bone sclerosis were higher than those of control group. Lateral acromial angle was a protective factor for non-traumatic rotator cuff tear, while the acromion index and glenoid inclination were independent risk factors. The area under ROC curve of lateral acromial angle was 0.793, with sensitivity of 62.5% and specificity of 90.0%. The area under ROC curve of acromion index was 0.749, with sensitivity of 78.0% and specificity of 60.4%. The area under ROC curve of glenoid inclination was 0.756, with sensitivity of 72.0% and specificity of 77.1%. The area under ROC curve of combined diagnosis was 0.897, with sensitivity of 89.6% and specificity of 76.0%.   Conclusions   Lateral acromion angle, critical shoulder angle, acromion index, glenoid inclination, sharpened lateral acromion morphology, and subacromial bone sclerosis are correlated with non-traumatic rotator cuff tear. Lateral acromial angle is a protective factor for non-traumatic rotator cuff tear, while the acromion index and glenoid inclination are independent risk factors.

Objective    To measure the imaging parameters related to patellar instability based on knee MRI images of teenagers, comparatively analyze the morphological and signal changes of peripatellar fat pads on MRI between teenagers with patellar instability and those with normal patellofemoral joint relationships. This study aims to explore the diagnostic significance of MRI abnormal signs of peripatellar fat pads for patellar instability in teenagers and provide references for early diagnosis.   Methods    All subjects of this study were selected from teenagers aged 10-17 years who underwent knee MRI examinations at the Second Hospital of Ningbo from October 2020 to October 2023. After inclusion and exclusion criteria were applied, imaging parameters related to patellar instability were measured. The subjects were divided into a case group and a control group. The number of peripatellar fat pad edema cases in both groups was counted, and data analysis was performed using statistical software SPSS 20 (IBM Corp) and R4.1.2.   Results   Among 340 knee MRI examinations, 162 cases, 204 cases, and 106 cases presented with infrapatellar fat pad edema, suprapatellar fat pad edema, and anterior femoral fat pad edema, respectively，respectively. There were no significant differences in age, gender, side and chief complaints between the case group and the control group (P>0.05). The incidence of peripatellar fat pad edema in the case group was significantly higher than that in the control group (P<0.05), and the proportion of multifocal edema in the case group was significantly higher than that in the control group (35.00% vs 11.11%, P<0.001). In the case group, the majority of patients had patella alta, followed by patellar lateral displacement, and no patient showed abnormal tibial tuberosity-trochlear groove (TT-TG) distances.    Conclusions    Compared with the control group, teenagers with patellar instability have a higher probability of developing peripatellar fat pad edema, and patella alta accounts for the vast majority of contributing factors in these patients. Paying attention to the status of peripatellar fat pads during knee MRI interpretation can assist in the early diagnosis and clinical treatment of patellar instability.

 Objective    To investigate the effect of lumbar sympathectomy on collateral vessel formation and angiogenesis in a rat model of hindlimb ischemia. Methods A femoral artery ligation-induced hindlimb ischemia model was established in Sprague-Dawley rats, which were randomly divided into a control group and a sympathectomy group. The latter underwent bilateral lumbar sympathectomy. On postoperative day 14, collateral vessel formation in the ischemic limb was assessed by X-ray angiography and Micro-CT three-dimensional reconstruction, and vessel diameters were measured. Immunofluorescence double staining with α-SMA and CD31 was performed to visualize vascular structures, and Ki67 staining was used to evaluate the proliferative activity of vascular smooth muscle cells, thereby comprehensively analyzing vascular repair and regeneration. Blood perfusion in the plantar region was assessed on postoperative days 3, 7, and 14 using laser speckle imaging. On day 30, hematoxylin and eosin (H&E) staining was used to measure gastrocnemius fiber cross-sectional area, count CD31-positive microvessels, and detect VEGFA protein expression (day 3). On day 7, flow cytometry was performed to analyze the polarization ratio of M1/M2 macrophages in the adductor muscle group. Results Compared with the control group, the sympathectomy group exhibited a significantly larger mean collateral vessel diameter (0.52±0.09 mm vs. 0.38±0.07 mm, P<0.01) and increased numbers of α-SMA⁺/Ki67⁺ cells (5.38±0.87 vs. 2.22±0.64, P<0.01). Blood perfusion recovery rates on postoperative days 3, 7, and 14 were significantly improved (P<0.05). By day 30, gastrocnemius fiber cross-sectional area was markedly enlarged (1706±92 μm² vs. 1145±132 μm², P<0.001), CD31-positive microvessel counts were increased (171±19 vs. 93±8, P<0.001), and VEGFA expression was significantly upregulated (P<0.01). Moreover, the proportion of M2 macrophages was significantly elevated (28.7±3.0% vs. 17.8±2.2%, P<0.01), while the proportion of M1 macrophages showed no significant difference.   Conclusions   Lumbar sympathectomy effectively promotes collateral vessel growth and angiogenesis in ischemic rat hindlimbs. The underlying mechanism may involve the induction of macrophage polarization toward the M2 phenotype and upregulation of VEGFA expression.

Objective    To investigate the effect of SC79, an AKT activator, on axonal regeneration and functional recovery following sciatic nerve crush injury in mice.    Methods   Mouse models of sciatic nerve crush injury were established and randomly divided into a control group and an SC79 group (40 mg/kg, intraperitoneal injection). Dorsal root ganglion (DRG) explant axotomy models were also established, and SC79 (4 mg/ml) was added to the culture medium. Western blot was used to detect the activation of the AKT signaling pathway. Immunofluorescence was applied to evaluate axonal regeneration, Schwann cell proliferation, and myelin regeneration. Neural circuit reconstruction and functional recovery were assessed by cholera toxin subunit B (CTB) retrograde tracing, neuromuscular junction staining, gastrocnemius morphological analysis, and the sciatic functional index (SFI).   Results   At 3 days after sciatic nerve crush injury, the p-AKT/AKT ratio in the sciatic nerve and lumbosacral spinal cord was significantly higher in the SC79 group than in the control group (P<0.05). At 7 days post-injury, SC79 significantly increased the density of distal regenerated axons and the proportion of S-100β/Ki67 double-positive Schwann cells (P<0.001). At 30 days post-injury, SC79 markedly increased axonal cross-sectional area, myelin thickness, and the number of CTB-positive spinal anterior horn neurons (P<0.001). In vitro, SC79 significantly promoted DRG axonal regeneration (P<0.001) and partially reversed growth cone collapse. Functional assessments showed that SC79 significantly improved neuromuscular junction reinnervation, gastrocnemius wet weight ratio, and SFI (P<0.05).   Conclusion   SC79 promotes axonal regeneration, neural circuit reconstruction, and functional recovery after sciatic nerve crush injury in mice by activating the AKT pathway. Immediate administration yields the optimal effect, indicating that SC79 is a promising candidate for peripheral nerve injury repair.

Objective    To investigate the protective effects and mechanisms of N-acetylcysteine (NAC) as an antioxidant in ischemia-reperfusion injury in the mouse brain.   Methods    Mice were randomly divided into 3 groups: sham group, model group and NAC group (150 mg/kg), with 18 mice in each group. The model and NAC groups underwent middle cerebral artery occlusion (MCAO) followed by reperfusion, while the sham group underwent the same procedure without vessel occlusion. The NAC group received an intraperitoneal injection of NAC (150 mg/kg) immediately after reperfusion, whereas the sham and model groups received an equal volume of 0.9% sodium chloride solution. Neurological function was evaluated by behavioral tests 24 hours after reperfusion. Cerebral blood flow was assessed using laser speckle contrast imaging. Infarct volume was detected by 2,3,5-triphenyltetrazolium chloride staining. Superoxide dismutase (SOD) and malondialdehyde (MDA) levels were measured by ELISA. Reactive oxygen species (ROS) levels in brain tissue were detected using ROS fluorescent probes. The expression and colocalization of NeuN, Nrf2, and HO-1 proteins in brain tissue were examined by immunofluorescence. The protein levels of Nrf2 and HO-1 in brain tissue were analyzed by Western blot.    Results    NAC significantly reduced neurological function scores, increased cerebral blood flow, decreased infarct volume, elevated SOD levels, and reduced MDA content. The rate of NeuN-positive cells increased, and ROS levels decreased. The protein levels of Nrf2 and HO-1 increased (P<0.05), and Nrf2 and HO-1 colocalized with NeuN.    Conclusions    NAC effectively alleviates cerebral ischemia-reperfusion injury in mice, attenuates oxidative stress, and rescues damaged neurons, potentially through modulation of Nrf2/HO-1 signaling pathway.

Objective    To design and develop a novel low-profile anatomical plate for posterior malleolus, and analyze its biomechanical properties.   Methods    Three-dimensional reconstructed CT data of 100 cases of non-fractured ankles from April 2018 to May 2021 in the imaging database of Dongguan Houjie Hospital were collected to obtain posterior malleolus anatomical parameters. A dedicated low-profile anatomical plate for posterior malleolus fracture (referred to as the novel posterior malleolus plate) was designed. Twelve adult ankle cadaver specimens were used to establish posterior malleolus fracture models and divided into two groups according to CT values. The novel posterior malleolus plate and the conventional T-shaped posterior malleolus plate (control plate) were fixed respectively, followed by biomechanical testing and data analysis. Three-dimensional finite element analysis was performed to compare the biomechanical characteristics between the novel plate fixation model and the control plate fixation model.    Results Compared with the control plate, biomechanical tests showed there were no significant differences in vertical compression and torsion tests in the novel plate (P>0.05), while significant difference was observed in maximum load test (P<0.05). Finite element analysis confirmed that the novel posterior malleolus plate exhibited significantly better biomechanical stability, closer bone surface fitting, easier operation, and lower risk of screw penetration into the joint.   Conclusions   The novel low-profile anatomical plate for posterior malleolus features excellent anatomical matching, convenient operation, and superior biomechanical performance.

Objective   To explore the effect of digital support fixation combined with minimally invasive osteotomy technique based on 3D printing technology for the treatment of hallux valgus (HAV).   Methods   HAV patients admitted to the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from June 2023 to November 2024 were selected as the research subjects. A retrospective analysis was conducted, and patients were divided into the group A and the group B in a 1:1 ratio based on different fixed methods, with 39 cases in each group, for a total of 78 cases. The patients of group A received conventional fixation, while the patients of group B received brace fixation based on 3D printing technology. Both groups of patients were followed up for 6 months after surgery. The excellent and good rate, pain levels, ankle function and radiographic indicators, as well as complications of two groups were compared.    Results    At 3 and 6 months after surgery, the visual analog scale (VAS) scores of the patients in group B were lower (P<0.05). At 6 months after surgery, the ankle function scores in the patients in group B was higher; The hallux valgus angle (HVA), first and second metatarsal angles (IMA), and distal metatarsal articular angle (DMAA) were lower. The length of the first metatarsal bone was longer (P<0.05).    Conclusions    The use of 3D printing technology-based braces for fixation had no significant impact on the therapeutic effect of minimally invasive osteotomy technique and manual reduction for patients with HAV. However, it might help to alleviate pain, improve imaging indicators, enhance ankle function, and have good safety and good safety.

Objective   To investigate the clinical efficacy and significance of a modified unilateral puncture percutaneous kyphoplasty (PKP) using personalized 3D-printed guides.   Methods   A retrospective analysis was performed on 110 patients with osteoporotic vertebral compression fractures (from June 2020 to June 2024). Based on the intraoperative use of a personalized 3D-printed guide, patients were divided into a 3D-printed guide group (n=55) and a traditional PKP group (n=55). The general information of the patients and perioperative parameters were compared between the two groups, including intraoperative bone cement leakage and dispersion patterns. Pain relief was evaluated using the Visual Analogue Scale (VAS) postoperatively.   Results  The 3D-printed guide group showed significantly shorter operative time, fewer fluoroscopies, less cement leakage, and better cement dispersion than the control group (all P<0.05). The postoperative VAS scores in both the 3D-printed guide group and control groups were significantly lower than the preoperative scores (P<0.05). All patients in both groups were followed up for at least 3 months. There was no significant difference in the incident of adjacent vertebral refracture.   Conclusions   The application of using personalized 3D-printed guides in a modified unilateral puncture percutaneous kyphoplasty  significantly reduces surgical time and intraoperative fluoroscopy exposure compared to the conventional group, improves cement distribution, and lowers the cement leakage rate, making it a safe and effective approach.

Objective    To explore the application value of a special proximal femoral static lifting device in closed reduction and intramedullary nail surgery for the elderly with femoral intertrochanteric fractures.   Methods  A retrospective analysis was performed on the case data of 157 elderly patients with femoral intertrochanteric fractures who underwent closed reduction and intramedullary nail fixation in the hospital between January 2024 and December 2025. According to intraoperative use of the special proximal femoral static lifting device, patients were divided into a control group (78 cases, January-December 2024) and a study group (79 cases, January-December 2025). The perioperative indexes (intraoperative blood loss, intraoperative prying rate, operation time, postoperative stability), fracture reduction (good reduction rate, positive support rate), postoperative rehabilitation (pain, the first leaving bed time, hip function) and complications were compared between the two groups.    Results    The intraoperative blood loss, intraoperative prying rate and operation time in the study group were lower than those in the control group, and score of postoperative stability was higher than that in control group (P<0.05). The good reduction rate and positive support rate in the study group were higher than those in the control group (P<0.05). VAS score at 1d after surgery and the first leaving bed time in the study group were lower than those in the control group, and Harris score at 1 month after surgery was higher than that in the control group (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05).   Conclusions   The application of a special proximal femoral static lifting device in closed reduction and intramedullary nail surgery for the elderly with femoral intertrochanteric fractures can optimize perioperative indexes and promote fracture reduction, which is beneficial to improve early postoperative rehabilitation status.

Objective    To explore the clinical effect of Ganz approach (surgical dislocation approach of hip joint) in the treatment of Pipkin Ⅳ femoral head fracture.    Methods    From January 2021 to February 2024, 8 patients with Pipkin Ⅳ femoral head fracture were treated by Ganz approach. The operation time, intraoperative blood loss, fracture healing time and postoperative complications were recorded. Harris hip score was used to evaluate the functional recovery of hip joint before operation and one year after operation. Results    All 8 patients were successfully completed the operation, and 2 of them were treated conservatively because the fracture of acetabular posterior wall was too small. The intraoperative blood loss was (150-450) mL, with an average of (318.7±96.1) mL. The operation time was (140-170) min, with an average of (151.2±10.3) min. Matta evaluation index was used to evaluate the satisfaction of fracture reduction. Eight patients were followed up for (12-45) months with an average of (18.8±10.1) months. Harris score of hip joint before operation and one year after operation was (50.5±7.8) and (89.6±4.3), respectively. The difference was statistically significant (P<0.05). X-ray reexamination showed that the osteotomy of greater trochanter and the fractures of femoral head and acetabulum all achieved bone healing, and no complications such as nonunion, heterotopic ossification and avascular necrosis of femoral head occurred.    Conclusions    Ganz approach in the treatment of Pipkin type IV femoral head fracture can not only fully expose the hip joint and femoral head, but also protect the blood supply of femoral head and reduce the occurrence of avascular necrosis of femoral head. The clinical effect is satisfactory and it is worthy of clinical promotion.

Objective    To evaluate the clinical efficacy and safety of neuroendoscopic hematoma evacuation versus middle meningeal artery (MMA) embolization in the treatment of chronic subdural hematoma (CSDH).    Methods    A retrospective analysis was conducted on the clinical data of 120 patients with chronic subdural hematoma admitted to our hospital between January 2020 to December 2024. According to the surgical approach, patients were allocated into Group A (Endoscopy group, n=60) and Group B (Embolization group, n=60). The operative time, estimated blood loss, hospitalization duration, postoperative complications (including pneumocephalus, epileptic seizures, acute hemorrhage, brain tissue injury and puncture site hematoma), and the 6-month recurrence rate were compared between the two groups.   Results    All procedures were successfully completed in both groups. Group B demonstrated statistically significant superiority over Group A in terms of operative time, estimated blood loss, and length of hospital stay (P<0.05). Regarding postoperative complications, Group A had 10 cases (16.67%) of pneumocephalus and 2 cases (3.33%) of epileptic seizures. Group B experienced 3 cases (5.00%) of puncture site hematoma in the groin area. There was statistically significant difference in overall complication rate between the two groups (P<0.05). During the 6-month follow-up period, the recurrence rate was 8 cases (13.33%) in Group A and 2 cases (3.33%) in Group B, with a statistically significant difference (P<0.05).    Conclusions    Neuroendoscopy enables rapid hematoma evacuation, septation management, and electrocoagulation under close visualization, achieving immediate decompression. However, it is associated with craniotomy-related trauma and postoperative pneumocephalus. In contrast, MMA embolization is minimally invasive, associated with a short hospital stay, promotes spontaneous hematoma absorption, and offers fewer complications and a lower recurrence rate, demonstrating great potential for clinical application.

 Objective    To explore the efficacy of biliary physiological reconstruction with the Da Vinci Robot in treating biliary strictures following biliary trauma.    Methods    From October 2014 to October 2025, patients with biliary strictures following biliary tract injuries were admitted to our center. Among them, 17 cases underwent biliary physiological reconstruction using the da Vinci robotic system, were designated as the robotic surgery group. Another 17 cases of open surgery for biliary reconstruction in the same period and surgery group were selected as control group. The surgical procedures, postoperative complications, recovery status, and follow-up outcomes were compared and analyzed between two groups.   Results    The average biliary reconstruction time in the robotic surgery group was longer than that in the open surgery group (P<0.05), but the overall surgical time, intraoperative blood loss, postoperative bed rest time, and postoperative hospital stay were significantly shorter than those in the open surgery group (P<0.05). There was no significant difference in the incidence of postoperative bile leakage between two groups of patients (P>0.05). The restenosis rate of biliary tract within 3 years was 0 in both groups of cases.   Conclusions   Da Vinci robotic biliary physiological reconstruction surgery is a safe, effective, and feasible surgical method that can shorten surgical time, minimize abdominal wall trauma, and accelerate postoperative recovery.

Objective    To investigate the application of multimodal intraoperative neuromonitoring (IONM) in transpsoas extreme lateral interbody fusion (XLIF) for degenerative scoliosis.   Methods   A retrospective analysis was conducted on clinical data from 19 patients with degenerative scoliosis who underwent XLIF surgery with multimodal IONM at the Third Affiliated Hospital of Guangzhou Medical University, between January 2021 and December 2023.    Results    All patients were successfully completed the surgery, with an average operative time of (262 ± 94) min. Postoperative coronal Cobb angle of the major curve was (8 ± 6) °, achieving a correction rate of (73 ± 13) %. Multimodal monitoring triggered alerts in 3 cases: Postoperative muscle weakness happened in 2 patients, who gradually resolved after treatment, while 1 patient showed no neurological deficits. The sensitivity of multimodal IONM was 100%, and specificity was 94.1%.    Conclusions   Multimodal IONM compensates for the limitations of single-mode monitoring, improves diagnostic accuracy, reduces the risk of neurological injury in XLIF procedures, and facilitates the technical promotion and expanded application of XLIF.

Tuina is an effective treatment for migraine, and its acupoint specificity is a primary focus of clinical interest. To elucidate its scientific underpinnings from a clinical anatomy perspective, this paper analyzes the deep anatomical structures of commonly used acupoints, such as Fengchi and Taiyang, and explores their correlation with the core pathological pathway of migraine: Trigeminocervical Complex (TCC). The analysis reveals that these acupoints anatomically correspond to the emergence points of critical nerve trunks or cutaneous branches, the pathways of neurovascular bundles, or points of concentrated myofascial tension. Its therapeutic mechanism may involve two aspects: neuromodulation of the afferent pathways of TCC and biomechanical regulation of myofascial-derived pain. This paper posits that integrating the "points" of traditional acupoints with the functional "planes" revealed by modern anatomy (such as nerve distribution and myofascial planes) can promote the development of Tuina techniques and enhance clinical efficacy. This "point-plane integration" approach not only affirms the significant clinical value of traditional meridian and acupoint theory, but also demonstrates that modern anatomical knowledge can endow traditional acupoints with new scientific connotations. Furthermore, the integration of Tuina and clinical anatomy should be strengthened to develop acupressure points and techniques with improved therapeutic effects.