【Objective】 To analyze the effect of different range and location of foramen formation on the biomechanics of lumbar spine by three-dimensional finite element analysis （D-FEA）. 【Methods】 A complete model of the lumbar spine （L5）， M0， was developed using the finite element method， and the models M1， M2， M3， M4 and M5 were obtained by sequentially simulating the apical， medial 1/4， 2/4， 3/4 and 4/4 graded resections of the left superior articular process of L5 under a lateral posterior approach with full spinal endoscopy. The displacements were recorded in six conditions： forward flexion， back extension， left and right lateral bending， and left and right lateral rotation. The results were compared between the resected models and the unresected group M0. 【Results】 The three-dimensional finite model of the L4-L5 segment developed in this experiment was valid. Compared with the unresected group M0， the differences in ROM were statistically significant for M1 under forward flexion load （all P<0.05）， M2 under forward flexion and back extension load （all P<0.05）， M3 and M4 under forward flexion， back extension and left and right lateral bending load （all P<0.05）. The differences were statistically significant for M3 and M4 under anterior flexion， posterior extension， left and right lateral flexion， and right rotation loads （all P<0.05）； and for M5 under anterior flexion， posterior extension， left and right lateral flexion and right rotation loads （all P<0.05）. Compared with M0 in the unresected group， the differences were statistically significant for M1 under anterior flexion loads （all P<0.05）， M2 under anterior flexion and left and right rotation loads （all P<0.05）. The differences were statistically significant for M3， M4 and M5 in forward flexion and extension， left and right lateral flexion， and left and right rotational loading （all P<0.05）. 【Conclusion】 In the process of foramen formation， removal of the tip or the medial quarter of the unilateral single segment of the upper articular process of the lumbar spine will affect the stability of the lumbar spine， and increase the maximum value of the stress of the intervertebral disc during the activities of the lumbar spine. Removal of one half or more will significantly damage the biomechanics of the lumbar spine. In order to avoid damaging the normal biomechanics of the lumbar spine， the upper articular process should be protected as much as possible during the whole spinal endoscopic foraminal reconstruction.

【Objective】 To observe the short-term clinical effect of selective nerve block combined with percutaneous posterior endoscopic cervical discectomy （PPECD） in the treatment of cervical spondylotic radiculopathy. 【Methods】 We reviewed 22 patients who received selective nerve block combined with percutaneous posterior endoscopic cervical discectomy （PPECD） for cervical spondylotic radiculopathy from June 2018 to January 2020. We recorded Japanese Orthopaedic Association （JOA） score for treatment evaluation， visual analogue scale （VAS）， the neck disability index score （NDI） preoperative 1 day， postoperative 1 day， 1 month， 3 months， 6 months and 1 year. All data were imported into SPSS26.0 software for analysis and processing. Quantitative data are expressed as mean ± standard deviation. The scores of neck VAS， arm VAS， JOA and NDI were compared at different time points by repeated measurement analysis of variance. Paired t-test was used to compare each time point after operation and the first day before operation. P<0.05 was considered statistically significant， and the modified MacNab standard was used to evaluate the clinical effect at the last follow-up. 【Results】 All operations were successfully completed under ultrasound-guided selective nerve block combined with endoscopic operation. The average operation time was 125.6 minutes. The intraoperative blood loss was 2-100 mL and the average blood loss was 19.1 mL. All patients were followed up for 15-33 months， with an average follow-up of 24.1 months. No patients had spinal cord， nerve root and vascular injury， dural tear or other complications. Compared with the preoperative VAS score， the VAS score of neck and upper arm decreased significantly （P<0.05）， while the JOA score increased significantly （P<0.05）， and the preoperative NDI score decreased significantly （P<0.05）. At the last follow-up， the modified Macnab criteria showed there were 15 excellent cases， 5 good cases， 2 medium cases and 0 poor case. The excellence rate was 91%. Postoperative magnetic resonance imaging and 3D computed tomography reconstruction of the cervical spine showed that the disc had been fully removed and the nerve root compression at the surgical segment was relieved. 【Conclusion】 Ultrasound-guided selective nerve block combined with percutaneous posterior endoscopic cervical discectomy is a safe and effective minimally invasive surgical method for the treatment of cervical spondylotic radiculopathy with reliable short-term efficacy.

Objective To investigate the efficacy and safety of single-channel endoscopic nylon rope combined with hemostatic clip suture in the treatment of peptic ulcer and bleeding.Methods Patients in our hospital due to peptic ulcer bleeding and hospitalization emergency electronic endoscopy from January 1st,2001 to July 1st,2017 were enrolled in the study.They were treated the single-channel endoscopic nylon rope combined with hemostatic clip suture.The basic information,clinical data,surgical records combined and retrospective analysed.Results 16 patients were included in the study.Among all the patients,peptic ulcer was located in 6 cases of gastric angle,3 cases of gastric antrum,3 cases of gastric body,2 cases of duodenal bulb and stomach.Ulcer maximum 40 mm × 25 mm,an average of (23.0 ± 6.0) mm.All ulcer wounds in patients underwent single-channel endoscopic nylon rope combined with hemostatic clip pouch suture were completely closed,including 1 case of duodenal ulcer patients after bleeding,achieved hemostasis successfully when turned into our hospital intervention.The remaining 15 cases were no longer bleeding.1 cases of gastric antral and 1 cases of stomach were diagnosed as moderately differentiated adenocarcinoma and they received endoscopic resuscitation after successful elective surgery gastric antral cancer radical surgery.Conclusions Single channel endoscopic nylon rope combined with hemostatic clip sacking is a safe and effective method for the treatment of giant peptic ulcer and bleeding.It is worthy of clinical manifestation,especially for those with deep and perforated ulcer.

Objective To investigate the clinical effects of Chinese medicine for invigorating spleen and eliminating phlegm, promoting blood circulation and removing blood stasis on infertility of obesity type polycystic ovary syndrome (PCOS). Methods A total of 96 patients with obesity type PCOS infertility who were admitted to our hospital from January 2015 to May 2016 were selected, and randomLy divided into study group and control group, with 48 cases in each group. The control group was given routine treatment of western medicine, and the study group was further given Chinese medicine for invigorating spleen and eliminating phlegm, promoting blood circulation and removing blood stasis. The levels of serum estradiol(E2), luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone (T) were compared before and after the treatment, and the clinical curative effect, periodic ovulation and pregnancy situation were compared. Results The levels of serum E2 and FSH in both groups after treatment were significantly higher than those before treatment(P＜0. 05). The study group was significantly higher than the control group(P＜0. 05); serum LH and T levels after treatment in both groups were significantly lower than those before treatment(P＜0. 05), and the study group was significantly lower than the control group (P＜0. 05); there were significant differences in the distribution of clinical efficacy between the two groups(P＜0. 05), and the total effective rate in the study group was significantly higher than that in the control group(P＜0. 05); the periodic ovulation rate and pregnancy rate in the study group were significantly higher than those in the control group(P＜0. 05). Conclusion Chinese medicine for invigorating spleen and eliminating phlegm, promoting blood circulation and removing blood stasis can effectively regulate the sex hormone level in the patients with obesity type PCOS infertility, with significant curative effect, which can promote ovulation and improve pregnancy rate, and is worthy of promotion.