Objective To investigate the knowledge,clinical application and training needs of Chinese anesthesiologists for ultrasound-guided intrathecal puncture technique.Methods The survey objects were anesthesiology clinicians in China. The questionnaire was designed by ourselves, and the survey time was from October to November 2023. Questionnaires were sent through wechat platform.The questionnaire was divided into three parts: general demographic information, application of intraspinal puncture, application of intraspinal puncture under ultrasound guidance, and training needs for intraspinal puncture under ultrasound guidance.The influencing factors were analyzed by ordered Logistic regression.Results A total of 1001 questionnaires were collected with a valid ratio was 94.2% (942/1 001).The respondents’ knowledge of ultrasound-guided intrathecal puncture was 3.21±1.03,while the clinical application level was 2.43±1.25 (P<0.01).According to ordinal logistic regression analysis,senior doctor (OR=0.312,95%CI 0.117-0.829,P=0.019),male (OR=0.658,95%CI 0.511~0.846,P=0.001),central region (OR=0.690,95%CI 0.523-0.911,P=0.009) and percentage of neuraxial anesthesia less than 20% (OR=0.426,95%CI 0.200-0.905,P=0.026) were significantly negatively correlated with the knowledge of ultrasound-guided intrathecal puncture technique.The main obstacle for the clinical application was unfamiliarity of the technique (83.9%) and the equipment (54.6%).The key technical challenges were finding the correct ultrasound views (69.6%),recognizing anatomical structures (69.2%) and poor ultrasound imaging(63.0%).The preferred training methods were simulation training (87.4%) and clinical instruction based on cases (90.0%).Conclusion There is still room for improvement in the understanding and clinical application of ultrasound-guided intrathecal puncture technique for the Chinese anesthesiologists.In the future,more training on ultrasound-guided intrathecal puncture technique could be provided according to our survey.

Objective This study compared the effects of intraoperative intercostal nerve block (ICNB) and preoperative ultrasound-guided paravertebral block (US-PVB) on postoperative complications in patients undergoing thoracoscopic lung surgery.Methods Data from 240 patients who underwent video-assisted thoracoscopic lung surgery under general anesthesia between January 2019 and December 2020 was retrospectively collected.These patients either received intraoperative intercostal nerve block (ICNB) （202 cases)or pre-operative ultrasound-guided paravertebral block (US-PVB)(38 cases).The incidence rates of overall postoperative complications,postoperative pulmonary complications,postoperative cardiac complications,postoperative cerebral complications,other postoperative complications,remedial analgesia requirement in the PACU,intraoperative fentanyl consumption,postoperative oral morphine equivalent (OME),perioperative OME,duration of postoperative drainage tube,postoperative ICU stay,and postoperative hospital stay were compared between the ICNB group and the US-PVB group.Univariate and multivariate regression were used to analyze the effects of different analgesia methods on postoperative complicationsResults There was no statistically significant difference in postoperative overall complications between the ICNB group and the US-PVB group(P>0.05).In the univariate analysis,no significant difference was found in the overall postoperative complications between the ICNB group (16.3%) and the US-PVB group (13.2%)(OR=0.642,95%CI 0.239-1.786;P=0.404.Multivariate analysis also did not reveal any differences between the two groups (OR=0.843,95%CI 0.299-2.377;P=0746).For the analysis of secondary outcomes,according to multivariate analysis,there was no significant difference between the two groups in postoperative pulmonary complications,postoperative cardiac complications,other postoperative complications,remedial analgesia requirement in the PACU,intraoperative fentanyl consumption,postoperative OME,perioperative OME,duration of postoperative drainage tube,postoperative ICU stay or postoperative hospital stay(P>0.05).Conclusion In this study,we found no difference in postoperative complications between intraoperative ICNB and preoperative US-PVB.

Objective To evaluate the effect of modified and traditional subcostal and anterior quadratus lumborum block on postoperative analgesia in patients with laparoscopic nephrectomy.Methods 46 patients underwent laparoscopic nephrectomy.They were randomly divided into two groups:traditional subcostal quadratus lumborum block(group T) and modified subcostal quadratus lumborum block(group M),with 23 cases in each group.Before anesthesia induction,the T group was subjected to the traditional subcostal and anterior quadratus lumborum block under ultrasound guidance,and the M group was subjected to the modified subcostal quadratus lumborum block under ultrasound guidance.All were given 0.5% ropivacaine 20 ml.Patients controlled intravenous analgesia(PCIA) was performed in both groups.The dermatomal levels of 5min,10 min and 15min after block was recorded.VAS pain scores at rest and cough were recorded at 6,24 and 48 h after the block.The dosage of Sufentanil,the number of analgesic pump compressions and the flurbiprofen rescue were recorded 24 h after surgery.Results The number of block plane segments in group M at 5, 10 and 15 minutes after block were 6(4,8), 8(6, 9) and 8(6, 9), respectively,which were significantly more than the T group[4(2,6), 6(2,9), 6(2,9)] (P<0.05).The VAS pain scores of patients in group M were (1.6±0.5) points at rest and (3.7±0.6) points at cough 6 hours after block,24 hours after the block were (2.3±0.4) points and (3.4±0.4) points, respectively,48 hours after the block were (2.5±0.8) min and (3.2±0.7) min, respectively.The VAS pain scores of and at rest and cough 6 hours after block in T group were (2.5±0.7) points and (5.6±0.8) points, respectively,24 hours after the block were (3.1±0.5) points and (4.5±0.7) points, respectively,48 hours after the block were (3.3±0.6) min and (4.2±0.6) min, respectively.Group M was lower than group T(P<0.05).In group M, the dosage of sufentanil, the times of analgesic pump and the rate of analgesic relief 24 hours after operation were (23.1±4.3)μg, 5(4,7) times and 4.3%, respectively,which were significantly lower than those in T group[(34.7±6.8)μg,11(9，12)times,21.7%](P<0.05).Conclusion Ultrasound-guided modified subcostal and anterior quadratus lumborum block has better analgesic effect than traditional technique in patients undergoing laparoscopic nephrectomy,which can reduce the amount of postoperative analgesic drugs and effectively relieve postoperative pain.

Objective In order to optimize the perioperative anesthesia management for ESDR patients undergoing arteriovenous fistula,we compared the impact of brachial plexus nerve block and other anesthesia methods on the long-term patency rate of arteriovenous fistula after surgery.Methods In this study,2 parts of work were conducted.Part I,a retrospective cohort study:ESRD patients who underwent arteriovenous fistulas in the First Affiliated Hospital of Sun Yat-sen University from January 1,2017 to August 30,2022 were selected.According to the method of anesthesia, patients were divided into BPB group (180 cases) and local anesthesia（LA） group(332 cases).The basic characteristics,postoperative follow-up,fistula patency rate and postoperative complications were collected and statistically analyzed.Part II: Meta-analysis: All relevant literatures from CNKI, Wanfang, PubMed, Web of Science, Cochrane Library and Scopus databases were searched up to April 2024，literature screening and data extraction were conducted according to inclusion and exclusion criteria, and data analysis was performed using RevMan 5.3.Results The first part of the retrospective study showed that the primary patency rate in the BPB group was significantly different from that in the local anesthesia group at 1 month and 12 months postsurgery (96.6% vs 91.7%，P<0.05;68.3% vs 59.0%,P<0.05),and the patency rate after intervention was significantly different at 1 month,3 months and 12 months (100.0% vs 95.5%，P<0.05;96.5% vs 86.3%,P<0.05；85.0% vs 70.8%,P<0.05).There was no significant difference in postoperative infection,thrombosis and hematoma complications (P＞0.05).The second part of the Meta-analysis results showed that there was a statistically significant difference in the primary patency rate of BPB compared with other anesthesia methods(SMD=1.51,95%CI:1.17~1.96,P<0.05),and there was no statistically significant difference in postoperative infection and thrombosis complications(P＞0.05).Conclusion As a consequence,BPB has obvious advantages over other anesthesia methods in maintaining long-term patency of upper limb arteriovenous fistula,and it has comparable safety with other anesthesia methods.

Objective The present study aimed to evaluate the anti-sympathetic and vasodilator effects of continuous brachial plexus block(CBPB) on the prevention of vascular crisis after finger replantation.Methods Sixty patients who underwent amputation finger replantation in our hospital from January 2023 to December 2023 were selected and divided into control group(30 cases,40 fingers,patient controlled intravenous analgesia) and study group(30 cases,44 fingers,continuous brachial plexus block analgesia) according to the postoperative analgesia.The skin temperature of the replantation finger and the hemodynamics parameters of the brachial artery of the affected limb were compared immediately,24 hours and 48 hours after replantation.The incidence of vascular crisis was compared between the two groups.Results Skin temperature of replanted fingers in the study group was (31.29±2.14)℃ and (32.16±2.34)℃ at 24h and 48h after surgery,respectively,which were significantly higher than that in the control group[(28.93±1.98)℃ and (30.03±2.52)℃,P<0.05].In terms of humeral arterial hemodynamics of the study group,the peak systolic velocity at 24 hours and 48 hours after operation was (91.45±.32.13)cm/s and（90.34±.30.86）cm/s,respectively,the data of end-diastolic velocity was （20.87±9.95）cm/s and（21.35±9.74）cm/s,respectively,the mean velocity was （38.63±12.53）cm/s and（40.53±13.30）cm/s,respectively,the blood flow was（8.95±2.57）ml/s and（8.10±2.18）ml/s,respectively,the artery area was（0.23±0.08）cm² and（0.21±0.06）cm²],respectively,the drag index was (0.73±0.23) and (0.75±0.34),respectively.While,in the control group,the ,the peak systolic velocity was (53.50±.19.24)cm/s and（52.64±.17.89）cm/s,respectively,the data of end-diastolic velocity was （13.62±3.16）cm/s and（15.38±4.33）cm/s,respectively,the mean velocity was （20.26±8.64）cm/s and（21.36±8.36）cm/s,respectively,the blood flow was （3.95±1.49）ml/s and（4.23±1.35）ml/s,respectively,the artery area was （0.18±0.05）cm² and（0.17±0.05）cm²,respectively,the drag index was (0.89±0.21) and (0.90±0.28),respectively.The difference between the two groups was statistically significant(P<0.05).The incidence of vascular crisis within 48 hours after surgery was 4.55% in the study group,which was significantly lower than 35.00% in the control group(P<0.05).Conclusion CBPB can increase blood perfusion of replanted fingers and reduce the incidence of vascular crisis.

Objective To observe the effects of different surgical approaches on the complications and tumor markers of patients undergoing radical resection of esophageal cancer.Method A prospective study was conducted on 100 patients with esophageal cancer who underwent radical surgery in our hospital from October 2019 to October 2022.They were randomly divided into an observation group and a control group using a random number table method,with 50 patients in each group,he right thoracic approach was used in the observation group and the left thoracic approach was used in the control group.Perioperative indexes,inflammatory factors [Substance P (SP),hypersensitive C-reactive protein (hs-CRP),interleukin6 (IL-6)],tumor markers [cytokeratin 19 fragment antigen (CYFRA21-1),squamous cell carcinoma antigen (SCC-Ag) and carbohydrate antigen 199 (CA199)] and lung function of the two groups were compared before and after surgery Indicators [vital capacity (VC),forced vital capacity (FVC),and forced expiratory volume in the first second (FEV₁)] and complication rate.Result The operating time,blood loss,indwelling time,hospitalization time,and number of lymph node dissection in the observation group were (247.65±27.33) minutes,(211.82±25.49) ml,(6.97 ± 2.12) days,(16.11±3.81)days ,and (19.67±5.21),respectively,which were higher than those in the control group[(217.63±23.69)minutes,（175.67±22.13）ml,（5.43±1.80）days,（12.68±3.24）days,（15.45±4.12）] (P<0.05).On average,there was a significant increase in SP,hs CRP,and IL-6 levels in both groups 3 days after surgery (P<0.05).The levels of SP,hs CRP,and IL-6 in the observation group were (273.96±35.45) ng/L,(11.35±2.12) mg/L,and (8.19±1.67)μg/ml,respectively,which were lower than the control group [（298.33±38.42）ng/L,（14.29±2.68）mg/L,（10.35±1.82）μg/ml](P<0.05);One month after surgery,there was a significant decrease in CYFRA21-1,SCC-Ag,and CA199 in both groups (P<0.05),and in the observation group,the data of CYFRA21-1,SCC-Ag,and CA199 were (2.59±0.37)μg/L,(45.62±6.18) μg/L and (59.37±6.12) U/ml,respectively,which were lower than those in the control group [（3.12±0.43）μg/L,（60.27±7.35）μg/L,（63.28±6.49）U/ml](P<0.05);One month after surgery,there was a significant decrease in VC,FVC,and FEV₁ in both groups (P<0.05).However,the VC,FVC,and FEV₁ in the observation group were (67.21±8.69)%,(70.33±9.41)%,and (72.88±10.12)%,respectively,which were higher than those in the control group [（54.35±8.27）%,（61.65±8.79）%,（65.37±9.24）%](P<0.05).There was no significant difference in the incidence of complications between the two groups (P>0.05).Conclusion Both approaches can effectively treat esophageal cancer.Among them,the right chest approach can significantly improve the effect of lymph node dissection,inhibit inflammatory reactions,reduce tumor marker levels,and have less impact on lung function,without significantly increasing the risk of complications.However,the surgical time,bleeding volume,and postoperative recovery time are relatively long.Therefore,a suitable approach should be selected in clinical practice based on the patient’s actual situation.

Objective To detect and analyze the expression levels of serum microRNA(miR)-455 and miR-383 in patients with non-small cell lung cancer (NSCLC),and to explore their clinical diagnostic value.Methods A total of 98 NSCLC patients in our hospital from March 2020 to January 2023 were regarded as the NSCLC group,98 patients with benign lung diseases admitted during the same period were regarded as the benign lung disease group,and another 98 healthy volunteers who underwent physical examination in our hospital during the same period were collected as the health group.Real-time fluorescence quantitative PCR (RT-qPCR) method was applied to detect the expression levels of miR-455 and miR-383 in serum.Pearson was applied to analyze the correlation between serum miR-455 expression level and miR-383 level in NSCLC patients;multivariate Logistic regression and ROC curve was applied to analyze the influencing factors and diagnostic value of NSCLC occurrence.Results The expression levels of miR-455 and miR-383 in the serum of the healthy group,benign lung disease group,and NSCLC group decreased sequentially.Pearson analysis showed there was a positive correlation between serum miR-455 expression level and miR-383 level in NSCLC patients (r=0.582,P＜0.05).Logistic analysis found that low expression levels of miR-455 and miR-383 were risk factors for the occurrence of NSCLC (P＜0.05).ROC curve analysis showed that the AUC of NSCLC diagnosed by the combination of miR-455 and miR-383 was obviously higher than that diagnosed by miR-455 alone (Z=3.604,P=0.000) and miR-383 alone (Z=2.594,P=0.010).Conclusion The relative expression levels of miR-455 and miR-383 in serum of NSCLC patients are obviously down-regulated.The combined detection of the two has high diagnostic value for NSCLC.

Objective To explore the comparison of the clinical efficacy of laparoscopic cholecystectomy based on propensity score matching through the umbilical single hole method and three holes method in the treatment of acute cholecystitis.Methods 106 patients with acute cholecystitis who underwent laparoscopic cholecystectomy in our hospital from January 2020 to December 2022 were selected as research subjects.According to different treatment methods,they were divided into the study group (n=64) and the control group (n=42).The patients in the study group were treated with single port via umbilical laparoscopic cholecystectomy,while the control group was treated with three port laparoscopic cholecystectomy.Compare the surgical related indicators,postoperative recovery,and postoperative complications between the two groups of patients.Results Comparing the general information of the two groups of patients,there was no significant difference in body mass index (BMI),BMI,and gallbladder ultrasound results (P>0.05),but the average age of the study group patients was greater than that of the control group patients (P<0.05).By comparing the general data of the two groups of patients after propensity score matching,it was found that there was no significant difference in gender,age,BMI,and gallbladder ultrasonography results between the two groups (P>0.05).The surgical time for the study group patients was (61.48±10.24) minutes,while for the control group,it was (40.42±8.35) minutes;And the visual analog scale (VAS) scores at 6 and 24 hours after surgery were (5.63±1.04) and (3.42±0.65) for the study group,respectively,while (7.22±1.61) and (5.48±1.02) for the control group.The pain sensation was more pronounced (P<0.05);However,there was no statistically significant difference in blood loss during surgery between the two groups of patients (P>0.05).The hospitalization time and gastrointestinal function recovery time of the study group patients were (2.05±0.42) days and (33.46±4.30) hours,respectively,while the control group was (3.95±1.02) days and (47.58±7.62) hours,respectively;And the satisfaction score of the study group patients with incision scars was (4.58±0.42) points,while the control group was (3.02±0.38) points (P<0.05).The total incidence of complications in the study group was 2.78%,while in the control group it was 16.67%,significantly lower in the study group (P<0.05).Conclusion Patients with acute cholecystitis treated with the umbilical single hole method have significantly lower postoperative pain,shorter hospital stay,and recovery time of gastrointestinal function compared to the three hole method.Patients also have higher scores of satisfaction with incision scars,and the overall incidence of postoperative complications is also lower.

Objective To observe the efficacy,safety and defecation function of laparoscopic modified Soave short muscle sheath in the treatment of children with Hirschcolon (HD).Methods A total of 91 children with HD admitted to our hospital from January 2018 to May 2023 were selected for the study,and were divided into observation group (modified laparoscopic Soave short muscle sheath operation,41 cases) and control group (traditional laparoscopic Soave Hirschacolon radical resection,50 cases) according to random number table method.Operation time,postoperative blood loss,postoperative defecation time,postoperative hospital stay,length of resection intestine and preoperative enema time were compared between the two groups.White blood cell count (WBC) and C-reactive protein (CRP) levels before and after operation were compared between the two groups,and pain scores were compared between the two groups 12h,24h,36h and 48h after operation.Postoperative defecation function and postoperative complications were compared between the two groups.Results The operation time[（134.07±22.08）min],postoperative blood loss[（5.17±0.87）ml],postoperative defecation time[（2.10±0.32）d],postoperative hospital stay[（7.59±1.25）d],length of intestinal tube resection[（15.24±2.25）cm] and preoperative enema time[（13.61±2.14）min] in observation group were all lower than those in control group[(159.78±25.44)min,（7.61±1.41）ml,（2.46±0.53）d,（10.59±1.84）d,（16.67±2.54）cm and（16.44±2.57）min](P<0.05).After operation,the serum WBC and CRP levels of the two groups were significantly increased,but the serum WBC and CRP levels of the observation group were lower than those of the control group (P<0.05).The pain scores of the observation group（3.42±0.69,3.17±0.64,2.52±0.58,2.06±0.53） at 12h,24h,36h and 48h were lower than those of the control group（4.47±0.76,3.78±0.72,3.31±0.66,2.83±0.64）(P<0.05).There was no significant difference in defecation function between the two groups (P>0.05).The total incidence of postoperative complications was 17.07% in the observation group,which was lower than 34.00% in the control group (P<0.05).Conclusion The effect of laparoscopic modified Soave short muscle sheath in HD children is better,which can effectively improve various clinical indicators and defecation function,relieve postoperative pain,reduce the degree of infection,reduce postoperative complications,and have higher safety.

Objective To construct a prediction model of postoperative poor anastomotic healing in colorectal patients based on LASSO variable selection,and analyze the prediction efficiency of this model for anastomotic prognosis.Methods 215 patients with colorectal cancer who were treated in our hospital from March 2018 to January 2023 were prospectively included as the research object.All patients underwent laparoscopic radical resection of colorectal cancer,and all patients were followed up for 30 days after operation.They were divided into the poor healing group(24 cases) and the good healing group(191 cases) according to whether there was anastomotic malunion.The general data and clinical data of all patients were collected,and the characteristic factors with non-zero coefficient were screened by using LASSO regression model.Lasso-Logistics regression model was constructed to analyze the related factors leading to poor anastomosis healing,and the receiver operating characteristic curve (ROC) was drawn to calculate the area under receiver operating characteristic curve curve (AUC),sensitivity and specificity.Bootdtrap method was used to carry out 500 repeated sampling for verification.Results The number of male cases in poor healing group was significantly higher than that in good healing group.The levels of white blood cell WBC and C-reactive protein CRP in poor healing group were higher than those in good healing group (P<0.05).The operation time in the group with poor healing was longer than that in the group with good healing,the tumor diameter was more than 4cm,the distance between the lower edge of the tumor and the perianal region was less than ≤7cm,there were neoadjuvant chemotherapy before operation,and the number of patients with Ⅲ - Ⅳ was significantly higher than that in the group with good healing (P<0.05).Logistics regression screen showed that the operation time,preoperative neoadjuvant chemotherapy,the distance between the lower margin of tumor and perianal region and the growth of peripheral tumor were the predictive factors of poor anastomosis healing.According to Logistics regression,the ROC curve was drawn,and the AUC was 0.892 (95% CI:0.813 ~ 0.945),the sensitivity was 75.81%,and the specificity was 89.47%.Youden index is 0.6528;Using Bootdtrap technology to draw the calibration curve of the model shows that the model has good prediction efficiency.Conclusion Long operation time,preoperative neoadjuvant chemotherapy,the distance between the lower edge of tumor and perianal region < 7cm,and the growth of peripheral tumor are the risk factors for postoperative patients with colorectal cancer with poor anastomotic healing.The prediction model can be used to screen people with poor anastomotic healing and has good prediction efficiency.

Objective To explore the clinical diagnostic value of peripheral blood procalcitonin(PCT) and neutrophil lymphocyte ratio(NLR) levels in elderly patients with strangulated inguinal hernia.Methods The clinical data of 112 elderly patients with acute incarcerated inguinal hernia from January 2019 to December 2022 were retrospectively analyzed,and were divided into strangulated group and non-strangulated group according to the intraoperative exploration.Multivariate Logistic regression analysis of risk factors of strangulated inguinal hernia in the elderly.Evaluation of PCT and NLR levels in peripheral blood by ROC curve in the clinical diagnosis of strangulated inguinal hernia in the elderly.Results The NLR and PCT in the strangulation group[(4.54±1.67) and (6.74±2.42)ng/ml] were higher than those in the non-strangulation group[(3.78±1.48) and (4.97±2.53)ng/ml] (P<0.05).Multivariate Logistic regression analysis showed that preoperative NLR and PCT levels were risk factors for strangulated inguinal hernia in the elderly (P<0.05).Both NLR and PCT have high clinical diagnostic value for strangulated inguinal hernia in the elderly (AUC＞0.7),and the combined detection of NLR and PCT can improve the diagnostic efficiency (AUC=0.792).Conclusion PCT and NLR levels in peripheral blood have high clinical diagnostic value for strangulated inguinal hernia in the elderly,and combined detection of NLR and PCT can improve the diagnostic efficiency.

Objective To investigate the difference between structured triglyceride(STG) and Non- structured triglyceride(NSTG) in nutritional support for perioperative patients.Methods A nationwide survey was conducted through online questionnaire.The questionnaire consisted of four modules:questionnaire information,patient information,prescription investigation and postoperative observation.SPSS 24.0 software was used for statistical analysis.Results Before and after parenteral nutrition(PN),the average levels of albumin(ALB) increased in both groups(P<0.01),while the levels of C-reactive protein(CRP) and alanine aminotransferase(ALT) decreased(P<0.01).The difference in serum triglyceride(TG) levels in the STG group was not statistically significant,while there was a decrease in the NSTG group(P<0.05).Generalized linear equation analysis of repeated measurements showed that compared to the NSTG group,the increase in ALB levels in the STG group patients was more significant(P<0.001),CRP and ALT decreases were more pronounced(P<0.001),but the impact on TG was smaller.Conclusions For perioperative patients with parenteral nutrition,STG supplementation can bring significant clinical benefits.STG should be used according to the organ function and economic situation of patients.

Objective To compare the short-term clinical effects of unilateral dual-channel endoscopic discectomy (UBED) and percutaneous endoscopic intervertebral discectomy (PEID) in the treatment of L₅S₁ Lumbar disc herniation,LDH.Methods From January 2019 to January 2021,a total of 57 cases of L₅S₁ LDH treated by UBED or PEID were analyzed retrospectively,including 30 cases in UBED group and 27 cases in PEID group.The operation time,intraoperative fluoroscopy times,postoperative hospitalization days and surgical complications were compared between the two groups.The visual analogue scale (VAS) and oswestry disability index (ODI) were used to compare the postoperative quality of life of the two groups,and the modified MacNab criteria was used to evaluate the clinical efficacy in the last follow-up.Results The operation time of UBED group and PEID group was (75.30±8.44) minutes and (68.37±4.63) minutes, respectively, and the difference between the two groups was statistically significant (P<0.05).VAS and ODI of 1 week, 3 months, 1 year and 1.5 years after surgery in 2 groups were significantly decreased compared with those before surgery, with statistical significance (P<0.05).The VAS score of low back pain in UBED group was higher than that in PEID group [(3.87±1.14) points vs (2.70±0.67) points] at 1 week after surgery (P<0.05), and there was no significant difference in VAS and ODI at the other time points (P>0.05).There was no statistical difference in the results of modified MacNab criteria in the last follow-up (P>0.05).There were 2 cases of dural tear in PEID group,1 case of dural tear in UBED group and 1 case of temporary nerve root injury in PEID group after operation,all of which were cured after symptomatic treatment.Conclusion Compared with PEID,UBED has a longer operation time,more trauma and more obvious low back pain in the short term after operation.The short-term curative effect of the two operations on L₅S₁LDH is similar,the incidence of complications is low,and the times of fluoroscopy are few.Both operations are safe and effective.

Objective To explore the evaluation on the curative effect of digital subtraction angiography (DSA)-guided radiofrequency ablation in patients with lumbar disc herniation (LDH) based on infrared thermal imaging technology.Methods A total of 90 patients with LDH treated in the hospital were enrolled as the research objects between February 2019 and February 2022.According to different treatment methods,they were divided into observation group (n=45) and control group (n=45).The control group was treated with radiofrequency ablation,while observation group was treated with DSA-guided radiofrequency ablation.The scores of visual analogue scale (VAS),Oswestry disability index (ODI) and Japanese Orthopaedic Association (JOA),and levels of serologic indexes [interleukin-1β (IL-1β),interleukin-6 (IL-6),tumor necrosis factor-α (TNF-α)] were compared between the two groups before treatment and at 1 month and 3 months after treatment.The skin temperature of lesions was detected by infrared thermal imaging,and its correlation with VAS,ODI and JOA scores was analyzed by Pearson correlation analysis.Results Before treatment,there was no significant difference in VAS score between the two groups (P>0.05).At 1 month and 3 months after treatment,VAS scores in both groups were decreased,which were lower in observation group than control group (P＜0.05).Before treatment,there was no significant difference in ODI and JOA scores between the two groups (P>0.05).At 1 month and 3 months after treatment,ODI scores in both groups were decreased,which were lower in observation group than control group,while JOA scores were increased,which were higher in observation group than control group (P＜0.05).Before treatment,there was no significant difference in levels of serum IL-1β,IL-6 and TNF-α between the two groups (P>0.05).At 1 month and 3 months after treatment,levels of serum IL-1β,IL-6 and TNF-α in both groups were decreased,which were lower in observation group than control group (P＜0.05).Before treatment,there was no significant difference in skin temperature of lesions between the two groups (P>0.05).At 1 month and 3 months after treatment,skin temperature of lesions in both groups was decreased,which was lower in observation group than control group (P＜0.05).Pearson correlation analysis showed that skin temperature of lesions was positively correlated with VAS,ODI and JOA scores at 1 month and 3 months after treatment (r=0.455,0.502,0.523,0.675,0.659,0.611,P＜0.05).Conclusion Curative effect of DSA-guided radiofrequency ablation is good on LDH patients,and infrared thermal imaging can effectively evaluate the curative effect.

Objective To analyse the risk factors for postoperative infection in traumatic tibial plateau fractures and to construct a Nomogram prediction model.Methods One hundred and forty-eight patients with traumatic tibial plateau fractures who underwent surgery in our hospital from October 2019 to August 2021 were selected for the study,and were divided into an infected group (n=20) and an uninfected group (n=128) according to whether they developed infection after surgery.The general data of the two groups were compared；the predictive value of statistically significant continuous variables was analysed using the ROC experiment；the risk factors affecting postoperative infection in traumatic tibial plateau fractures were analysed using the logistic regression experiment；and the clinical efficacy of the Nomogram model was verified using internal data.Results In the comparison of general data such as age and gender between the two groups,the differences were not statistically significant(P>0.05).Compared with the uninfected group,patients in the infected group had a higher percentage of diabetes mellitus,open fracture type,and osteofascial compartment syndrome,and longer operative time and hospital stay(P<0.05)；diabetes (yes),fracture type (open),osteofascial compartment syndrome (yes),and operative time (>3 h) were risk factors affecting postoperative infection in traumatic tibial plateau fractures.The AUCs for operative time and hospital stay were not 0.792 and 0.651；the optimal stage values were not 3 h and 13 d(P<0.05)；the Nomogram model predicted a C-index of 0.744 (0.651-0.807) for the risk of postoperative infection in traumatic tibial plateau fractures.The model predicted the risk of infection after traumatic tibial plateau fracture at a threshold of > 0.09.Conclusion Diabetes mellitus (yes),fracture type (open),osteofascial compartment syndrome (yes),and operative time (>3 h) were risk factors affecting postoperative infection in traumatic tibial plateau fractures,and the Nomogram model constructed based on the above variables had good predictive value.

Objective To investigate the clinical effect of direct extra-articular endoscopic excision of popliteal cyst using double posteromedial portals.Methods For 92 patients in our department who suffered from symptoms such as pain and discomfort in the popliteal fossa,limited knee flexion,swelling after activity,and were diagnosed with popliteal cyst based on imaging examinations from March 2017 to January 2023,we performed direct extra-articular endoscopic excision of popliteal cyst using double posteromedial portals.The recurrence of cysts was evaluated by MRI at last follow-up.The Rauschning and Lindgren classification was used to evaluate clinical outcomes.Results A total of 92 patients were included in the study.Arthroscopic examination revealed intra-articular lesions in 80 patients (86.96%),including degenerative cartilage lesion in 52 patients (56.52%),medial meniscus tear in 48 patients (52.17%),lateral meniscus tear in 28 patients (30.43%),anterior cruciate ligament injury in 17 patients (18.48%),chondromalacia patellae in 3 patients (3.26%),intra-articular loose body in 2 patients (2.17%),tibial intercondylar eminence fracture in 1 patient (1.09%),gouty arthritis in 1 patient (1.09%),synovitis in 3 patients (3.26%) and septic arthritis in 1 patient (1.09%).The average duration of symptoms was 11.71 months (0.03 to 120 months).All patients were followed up postoperatively,with an average follow-up period of 12.8 months (6 to 23 months).There were no serious complications such as deep vein thrombosis,neurovascular injury or infection.Two patients were found to have residual cysts by MRI at last follow-up.According to the Rauschning and Lindgren classification:pre-operation:13 cases of grade Ⅰ,53 cases of grade Ⅱ and 26 cases of grade Ⅲ;post-operation:74 cases of grade 0 and 18 cases of grade Ⅰ.Conclusion Direct extra-articular endoscopic excision of popliteal cyst using double posteromedial portals has several advantages,such as mini-invasion,fast recovery,short surgical time and low recurrence rate.

Objective To analyze the risk factors of lower limb deep vein thrombosis (DVT) after the closed Pilon fracture surgery,and to build a nomograph prediction model.Methods A total of 182 patients with closed Pilon fracture who underwent surgical treatment in our hospital from June 2019 to June 2022 were retrospectively analyzed,according to the occurrence of postoperative DVT, the patients were divided into two groups: 43 cases in DVT group and 139 cases in non-DVT group.Univariate and multivariate Logistic regression analysis was applied to screen the risk factors of lower limb DVT after closed Pilon fracture surgery;R software was applied to build a nomograph model for predicting lower limb DVT after closed Pilon fracture surgery,and receiver operating characteristic(ROC) and calibration curve were applied to verify the nomograph model.Results Logistic regression analysis showed that the history of diabetes mellitus, risk assessment of thrombosis as medium and high risk, and postoperative infection were independent risk factors for lower limb DVT after closed Pilon fracture surgery (P＜0.05).The area under the ROC curve was 0.716 (95%CI:0.629-0.804).The slope of calibration curve was close to 1,and H-L goodness of fit test χ²=2.556,P=0.635.Conclusion The history of diabetes,the result of thrombosis risk assessment as “medium-high risk”,and the postoperative infection occurred at the surgical site are independent risk factors for lower limb DVT after closed Pilon fracture surgery.The nomogram prediction model constructed by integrating the above three independent risk factors can effectively predict lower limb DVT after closed Pilon fracture surgery,with high differentiation and consistency.

The erector spinae plane block(ESPB) technique proposed by Forero et al.has drawn increasing attention due to its reliable effects and fewer complications in simple and safe procedures.It has been successfully applied in anesthesia management during the perioperative period.This article mainly introduces the anatomical basis,possible mechanism of action,common operating methods,and clinical applications during the perioperative period of ESPB.Starting from the advantages,disadvantages,and complications of ESPB,it compares ESPB with other common thoracolumbar analgesic methods,providing better evidence support for the perioperative application and future development of ESPB.

With the increasing awareness of the adverse effects of long-acting opioids,opioid free anesthesia (OFA) is important in clinical practice.Regional block plays an important role in reducing perioperative opioids demands due to its analgesic effect.In this article,we review the application of regional block in neurosurgery,breast surgery,and thoracic surgery to explore the clinical progress of this kind of anesthetic technique.

Nerve block is an important part of multimodal analgesia after hip surgery.Pericapsular nerve group block is a novel regional block technique designed to provide hip analgesia and preserve motor function.Recently,pericapsular block of the hip has been used in clinical practice,but its effectiveness and safety are still worth exploring.

The ultrasound-guided regional block is a critical part of multimodal analgesia.Differential nerve block refers to the selective blocking of one nerve fiber without blocking other types of nerve fibers,including pharmacological and anatomical methods,with the aim of achieving adequate analgesia and reducing or avoiding blockade of motor function.With the development of day surgery in China,we will summarize the application of differential nerve block in postoperative analgesia from two aspects:local anesthetic (type and concentration) and block location.