Objective To evaluate the imaging status of the paraspinal muscle in patients with cervical spondylotic myelopathy(CSM) and explore the effects on cervical sagittal balance and cervical range of motion with cervical MRI.Methods Thirty patients with cervical spondylotic myelopathy admitted to the Department of Orthopedics of the 83rd Group Military Hospital of the Army from January 2019 to January 2022 and 42 healthy people who underwent physical examination at the same time were selected as the observation group and the control group.In the observation group，there were 21 males and 9 females.The average age was (59.9±12.2) years，ranging from 30 to 78 years.In the control group，there were 23 males and 19 females.The average age was (55.7±10.1) years，ranging from 33 to 76 years.Based on the cervical MRI of the two groups of people，the cervical multifidus(MF)，cervical semispinalis cervicis(Scer) and cervical semispinalis capitis(Scap) were measured  by Image J software，respectively.Cross sectional area(CSA) of Scap，splenius capitis(SPL)，and longus colli(LC) muscles，Effective crosssectional area(ECSA)，Relative cross-sectional area(RCSA) and fat infiltration(FI).15 cases of repeated measurement in two groups were selected for methodological research.Cervical sagittal balance parameters and cervical motion were measured based on standard cervical spine anterolateral and hyperextension and flexion X-ray films of patients in the observation group.A bilateral random model with intralcass correlation coefficient(ICC) was used to evaluate the consistency of Image J’s measurement of the level of paracyclinal muscle degeneration.The two-sample t test was used to compare the level of paracyclinal muscle degeneration between the two groups.Pearson correlation coefficient was used to evaluate the influence of cervical paracyclinal muscle degeneration on cervical imaging indexes in the observation group.Results The total range of intergroup and intragroup ICC measured by CSA and FI of cervical paravertebral muscle in observation group and control group was 0.771~0.956.The mean values of CSA and RCSA of multifidus muscle，semitinous capitis muscle and capicular pinus muscle in the observation group were significantly higher than those in the control group(P＜0.05)，but there was no significant difference in the average value of ECSA compared with the control group(P＞0.05).There was no significant difference in CSA，RCSA and ECSA between the observation group and the control group(P＞0.05).Compared with the control group，the average FI of multifidus muscle，cervical semispectinus muscle，cephalic semispectinus muscle and cervical longus muscle in the observation group were significantly higher(P＜0.05).ECSA of pinus capitis muscle was negatively correlated with cervical flexion angle(P＜0.05).There was no significant correlation between the other cervical paraspinal muscles and the sagittal parameters of the cervical spine.There was a significant negative correlation between CSA，ECSA and cervical lordosis angle(P＜0.05)，CSA and ECSA were significantly negatively correlated with cervical hyperextension angle and flexion extension angle(P＜0.05).The cervical longus muscle FI was significantly positively correlated with C_2~7 SVA of cervical spine(P＜0.05).Conclusion The Image J software measurement method based on cervical MRI can effectively reflect the imaging function of the paracyclinal muscles.The degeneration of the paracyclinal muscles in patients with cervical spondylotic myelopathy is mainly manifested by hypertrophy and fatty changes of the paracyclinal muscles，in which the degeneration of the capitis hemispinosus and the capitis clipper muscles is the most significant.The degeneration of the longus cervical muscle is closely related to sagittal disequilibrium of the cervical spine and limited hyperextension range of motion.

Objective To explore and compare the clinical efficacy and surgical safety of osteotomy and subtalar arthroplasty in the treatment of childhood flexible flatfoot.
Methods A retrospective analysis was conducted on the clinical data of 41(61 feet) children with flexible flatfoot who underwent either osteotomy or subtalar arthroereisis at the Department of Foot and Ankle Surgery，in The Affiliated Honghui Hospital of Xi’an Jiaotong University from February 2014 to September 2020.The osteotomy group consisted of 21 cases(31 feet)，including 11 males and 10 females，with 11 cases of unilateral and 10 cases of bilateral involvement，15 cases of left foot and 16 cases of right foot.The average age of patients was(12.87±1.12) years.The subtalar arthroereisis group consisted of 20 cases(30 feet)，including 12 males and 8 females，with 10 cases of unilateral and 10 cases of bilateral involvement，17 cases of left foot and 13 cases of right foot.The average age of patients was(11.56±1.73) years.Anteroposterior，lateral，and hindfoot alignment radiological images were measured in the Xray weight-bearing position，including anteroposterior view upper talar 1st metatarsal angle (T1MT) and talonavicular coverage angle (TNCA)，lateral view upper talus-first metatarsal angle (Meary’s angle)，calcaneal pitch angle(CPA).Calcaneus valgus angle (CVA) at Saltzman position on the hindfoot line.Clinical assessment was performed using the visual analogue scale (VAS) and the American orthopaedic foot and ankle society (AOFAS) ankleposterior foot function score.The clinical efficacy of these two kinds of surgery in the treatment of children’s flexible flat foot was compared and analyzed.Results All the 41 patients were effectively followed up for 12~24 months，with an average of(18.1±7.3) months.The improvement amplitude of calcaneal inclination angle and calcaneal eversion angle in osteotomy and orthopaedic group was significantly different from that in subtalar joint braking group(P＜0.05)，but no significant difference was found in other indexes(P＞0.05).Conclusion Osteotomy and subtalar arthroplasty are effective in the treatment of flexible flat feet in children.

Objective To explore the clinical efficacy of Scarf+Akin osteotomy(Scarf+Akin osteotomy，SAO) combined with first metatarsal head subsidence(FMHS) in the treatment of moderate to severe hallux valgus with metastatic metatarsalgia.Methods From October 2019 to October 2021，51 patients (62 feets) with hallux valgus were treated with SAO combined with FMHS，including 6 males and 45 females.The patients aged from 26 to 69 years，with an average age of (46.40±13.69) years.The images of hallux valgus angle (HVA)，intermetatarsal angle(IMA)，distal metatarsal articular angle (DMAA) and first metatarsal angle (FMA) shown in weight-bearing anteroposterior X-ray films of the affected foot before operation and at the last follow-up were analyzed and changes in study results were compared.The efficacy was evaluated by American Orthopedic Foot and Ankle Society(AOFAS) thumb joint scoring system.The visual analogue scale (VAS) was used to evaluate the pain of plantar callus.Results All 51 patients were followed up for 12 to 36 (19.85±4.26) months.No postoperative complications such as deformity recurrence，hallux varus，over-orthopedic，infection，etc.were found.In the last follow-up，there were 4 case(4 feet) with metatarsal bone metastases Pain，2 cases(2 feet)skin numbness at the edge of the medial incision，4 cases (5 feet) postoperative stiffness of the metatarsophalangeal joint.At the last follow-up，HVA，IMA，DMAA，and FMA were significantly improved compared with those before operation，and the difference was statistically significant (P＜0.001).The AOFAS score increased from preoperative (57.25±13.62) to (88.20±6.96)，and the difference was statistically significant (t＝－12.77，P＜0.001).Among them，52 feet were excellent，7 feet were good，and 3 feet were fair.The excellent rate was 95.16%.The VAS score decreased from preoperative (5.40±1.00) to (1.30±0.98)，and the difference was statistically significant(t＝17.96，P＜0.001). Conclusion SAO combined with FMHS can effectively treat patients with moderate to severe hallux valgus with metastatic metatarsalgia，and can significantly improve the symptoms of plantar pain in patients with good postoperative recovery，which is worthy of popularization.

Objective To compare the effect of three different positioning methods in closed reduction and cannulated screw internal fixation of femoral neck fracture. Methods The data of 90 patients with femoral neck fracture from January 2018 to January 2021 were retrospectively analyzed，including 41 males and 49 females.The age ranged from 24 to 65 years，with an average of(47.7±3.6) years.According to different intraoperative positioning methods，they were divided into three groups：guided positioning group(30 cases，positioning with new three dimensional honeycomb Guide)，small incision positioning group(30 cases，exposure positioning of small incision on the outside of greater trochanter)，and unarmed positioning group(30 cases，percutaneous puncture and unarmed positioning).All patients underwent closed reduction and internal fixation with three cannulated screws.There was no significant difference in preoperative general data among the three groups(P＞0.05).The operation time，fluoroscopy times，needle puncture times，screw spacing，screw coverage area，parallelism between screws，fracture healing time and Harris function score of hip joint at the last follow-up were recorded.Results  All patients were followed up for 18~54 months，with an average of(34.9±5.9) months.There was no significant difference in fluoroscopy times，fracture healing time and Harris score at the last follow-up among the three groups(P＞0.05).The times of needle puncture and the deviation of parallelism between screws in the guide positioning group were less than those in the small incision positioning group and the unarmed positioning group.The operation time of small incision localization group was longer than that of guided localization group and free hand localization group.The screw spacing and screw coverage area of the guide positioning group were larger than those of the small incision positioning group and the free hand positioning group，and the small incision positioning group was larger than that of the free hand positioning group.The above differences were statistically significant(P＜0.05).Nonunion occurred in 2 cases in the small incision positioning group and 3 cases in the free hand positioning group.And the fractures of the remaining 85 patients healed.One case of femoral head necrosis occurred in the free hand positioning group.During the follow-up period，there were no complications such as infection，neurovascular injury，deep vein thrombosis，screw penetration，screw breakage and refracture.Conclusion The new three-dimensional honeycomb guide positioning method has significant advantages in small incision and unarmed positioning，which can effectively reduce puncture injury and improve the accuracy of positioning.

Objective To investigate the effect of postoperative hypocalcemia on the postoperative occult blood loss and blood transfusion ratio in elderly patients with hip fractures.Methods We collected elderly patients with hip fractures who were transferred to ICU after surgery at Beijing Jishuitan Hospital from January 2022 to January 2023.A total of 148 patients were included in the study，including 51 males and 97 females.The patient age ranged from 67 to 97 years，with an average age of (84.3±8.1) years.We corrected blood calcium concentration based on albumin.Blood calcium below 2.11 mmol/L was defined as hypocalcemia.50% of the patients transferred to ICU (148 cases) developed hypocalcemia (74 cases).Blood samples (hemoglobin and hematocrit) were collected immediately after the patient was transfered to the ICU after surgery，and blood transfusion volume during and two days after surgery was recorded.According to the calculation formula，the patient’s implicit blood loss within two days after surgery was calculated.Single factor and multiple factor linear regression were used to further analyze risk factors.Results A total of 148 patients were included.There was no significant difference in hemoglobin and hematocrit between the hypocalcemia group and the normal group.The blood transfusion ratio in the low calcium group (87.8%) was significantly higher than that in the normal group (51.4%)，P＜0.001.The occult blood loss in the low calcium group was 523.8 (159.6，993.8) mL，which was significantly higher than the 357.3(80.7，594.8) mL in the normal group(P＝0.005).The blood transfusion volume in the normal group was 200 mL(0，400).The blood transfusion volume in the hypocalcemia group was 400 mL(400，400) mL，which was significantly higher than that in the normal group(P＜0.001).The ICU hospitalization time in the low calcium group was significantly longer than that in the normal group(P＝0.043).Analysis of risk factors related to postoperative occult blood loss showed that the independent risk factors associated with increased postoperative blood loss were fracture type(intertrochanteric fracture of the femur)，blood transfusion volume，and hypocalcemia(P＜0.05).Conclusion Postoperative patients with hypocalcemia have significantly increased occult blood loss，higher blood transfusion rates and volumes，and significantly prolonged ICU hospitalization.Fracture type(intertrochanteric fracture) and hypocalcemia are independent risk factors for increased postoperative blood loss.The results remind clinicians to pay attention to postoperative hypocalcemia，pay attention to intraoperative calcium supplementation，and optimize perioperative management for elderly patients with hip fracture.