Objectives:To evaluate the biomechanical effects of transforaminal endoscopic lumbar discectomy(TELD)combined with a spinal dynamic stabilization system(SDSS)on the surgical segment using three-dimen-sional finite element(FE)analysis.Methods:The CT scan data from the lumbar spine of a healthy volunteer was selected.FE methods were employed to construct normal L3-S1 model(FE),as well as L3-S1 TELD and TELD+SDSS surgical models,with the surgical segment simulated at L4/5.After validating the models' effec tiveness through computational accuracy(ACC),a hybrid loading method was applied.An axial load of 150N was applied to the top of the L1 vertebral body,along with gradually increasing constraint torque.Range of motion(ROM)values were extracted to ensure the three models achieved the following ROM:flexion(15°),ex-tension(10°),lateral bending(5°),and rotation(3°).The ROM,peak stress at the intervertebral disc and pos-terior annulus fibrosus,and shear stress in the annulus fibrosus at the L4/5 segment under these six direc-tional conditions were compared across the three models.Results:The ROM values of L3-S1 segments under different loading conditions in flexion,extension,and rotation were compared with previous in vitro tests,with ACC exceeding 90％,validating the model's effectiveness.For L4/5 ROM:in TELD model,it was 4.47°(flex-ion),3.3°(extension),1.72°(left bending),1.73°(right bending),0.94°(left rotation),and 0.92°(right rotation);In TELD+SDSS model,it was 2.15°,1.21°,1.38°,1.43°,0.67°,0.67° respectively.The ROM in TELD model increased by 5％in flexion and 7％in extension,which in TELD+SDSS model reduced by 19-61％in all di-rections.For L4/5 disc stress:in TELD model,the peak stress was 14.58MPa,15.08MPa,7.92MPa,5.32MPa,0.9MPa,and 0.65MPa respectively under flexion,extension,left bending,right bending,left rotation,right ro-tation conditions;In TELD+SDSS model,it was 5.35MPa,1.77MPa,3.45MPa,3.42MPa,0.55MPa,and 0.48MPa.The peak stress of L4/5 disc in TELD model increased by 36％and 45％in extension and bend-ing,which in TELD+SDSS model reduced by 27-84％in all directions.For posterior annulus stress:the peak stress in TELD model was 2.04MPa,2.08MPa,1.44MPa,0.99MPa,0.41 MPa,and 0.29MPa respectively under flexion,extension,left bending,right bending,left rotation,right rotation conditions;In TELD+SDSS model,it was 0.54MPa,0.23MPa,0.72MPa,0.7MPa,0.21 MPa,and 0.18MPa.The peak stress at posterior annulus in TELD increased by 10-99％in flexion,extension,and lateral bending,while in TELD+SDSS model it reduced by 20-63％in all directions.For annulus shear stress:in TELD model,it was 0.4MPa,0.32MPa,and 0.2MPa in extension and left and right bending,which increased by 17％,76％,and 85％,while in TELD+SDSS mod-el,it reduced by 12-98％in all directions.Conclusions:TELD+SDSS retains certain lumbar motion,affecting lumbar stability less compared to TELD,and provides a low-pressure stress environment.

Objective To evaluate the clinical efficacy of robot-assisted navigation with percutaneous lag screw treatment for Hangman's fracture.Methods We retrospectively analyzed the clinical data of 5 patients treated with robot-assisted C2 percutaneous lag screw for Hangman's fracture in our hospital from September 2021 to August 2023.Patients were positioned with moderate head-neck flexion in a Mayfield head clamp.After closed reduction with manual traction under general anesthesia,the C2 percutaneous lag screws were implanted under TINAVI orthopedic surgical robot assistance.Postoperative cervical CT scans were used to assess screw placement accuracy and fracture healing quality.Clinical efficacy was evaluated by the Odom grading system.Results All the 5 patients were operated successfully without vertebral artery injury or neurological complications.A total of 10 screws were implanted.According to the Gertzbein-Robbins standard,9 screws belonged to the grade A,and 1 belonged to the grade B,with an accuracy of 90％(9/10)and an excellent rate of 100％(10/10).The neck incision length ranged 20-30 mm(mean,27 mm).The operation time was 86-160 min(mean,112.8 min).The intraoperative blood loss was 10-50 ml(mean,30 ml).The postoperative hospitalization was5-18 d(mean,8 d).The patients were followed up for 12-34 months(mean,23.6 months).All fractures healed without screw breakage or loosening.According to the Odom grading,4 cases were excellent,and 1 case was good.Conclusion Robot-assisted navigation C2 percutaneous lag screw treatment for Hangman's fracture is accurate and minimally invasive,safe and effective.

Objectives:To evaluate the biomechanical effects of transforaminal endoscopic lumbar discectomy(TELD)combined with a spinal dynamic stabilization system(SDSS)on the surgical segment using three-dimen-sional finite element(FE)analysis.Methods:The CT scan data from the lumbar spine of a healthy volunteer was selected.FE methods were employed to construct normal L3-S1 model(FE),as well as L3-S1 TELD and TELD+SDSS surgical models,with the surgical segment simulated at L4/5.After validating the models' effec tiveness through computational accuracy(ACC),a hybrid loading method was applied.An axial load of 150N was applied to the top of the L1 vertebral body,along with gradually increasing constraint torque.Range of motion(ROM)values were extracted to ensure the three models achieved the following ROM:flexion(15°),ex-tension(10°),lateral bending(5°),and rotation(3°).The ROM,peak stress at the intervertebral disc and pos-terior annulus fibrosus,and shear stress in the annulus fibrosus at the L4/5 segment under these six direc-tional conditions were compared across the three models.Results:The ROM values of L3-S1 segments under different loading conditions in flexion,extension,and rotation were compared with previous in vitro tests,with ACC exceeding 90％,validating the model's effectiveness.For L4/5 ROM:in TELD model,it was 4.47°(flex-ion),3.3°(extension),1.72°(left bending),1.73°(right bending),0.94°(left rotation),and 0.92°(right rotation);In TELD+SDSS model,it was 2.15°,1.21°,1.38°,1.43°,0.67°,0.67° respectively.The ROM in TELD model increased by 5％in flexion and 7％in extension,which in TELD+SDSS model reduced by 19-61％in all di-rections.For L4/5 disc stress:in TELD model,the peak stress was 14.58MPa,15.08MPa,7.92MPa,5.32MPa,0.9MPa,and 0.65MPa respectively under flexion,extension,left bending,right bending,left rotation,right ro-tation conditions;In TELD+SDSS model,it was 5.35MPa,1.77MPa,3.45MPa,3.42MPa,0.55MPa,and 0.48MPa.The peak stress of L4/5 disc in TELD model increased by 36％and 45％in extension and bend-ing,which in TELD+SDSS model reduced by 27-84％in all directions.For posterior annulus stress:the peak stress in TELD model was 2.04MPa,2.08MPa,1.44MPa,0.99MPa,0.41 MPa,and 0.29MPa respectively under flexion,extension,left bending,right bending,left rotation,right rotation conditions;In TELD+SDSS model,it was 0.54MPa,0.23MPa,0.72MPa,0.7MPa,0.21 MPa,and 0.18MPa.The peak stress at posterior annulus in TELD increased by 10-99％in flexion,extension,and lateral bending,while in TELD+SDSS model it reduced by 20-63％in all directions.For annulus shear stress:in TELD model,it was 0.4MPa,0.32MPa,and 0.2MPa in extension and left and right bending,which increased by 17％,76％,and 85％,while in TELD+SDSS mod-el,it reduced by 12-98％in all directions.Conclusions:TELD+SDSS retains certain lumbar motion,affecting lumbar stability less compared to TELD,and provides a low-pressure stress environment.

Objective To evaluate the clinical efficacy of robot-assisted navigation with percutaneous lag screw treatment for Hangman's fracture.Methods We retrospectively analyzed the clinical data of 5 patients treated with robot-assisted C2 percutaneous lag screw for Hangman's fracture in our hospital from September 2021 to August 2023.Patients were positioned with moderate head-neck flexion in a Mayfield head clamp.After closed reduction with manual traction under general anesthesia,the C2 percutaneous lag screws were implanted under TINAVI orthopedic surgical robot assistance.Postoperative cervical CT scans were used to assess screw placement accuracy and fracture healing quality.Clinical efficacy was evaluated by the Odom grading system.Results All the 5 patients were operated successfully without vertebral artery injury or neurological complications.A total of 10 screws were implanted.According to the Gertzbein-Robbins standard,9 screws belonged to the grade A,and 1 belonged to the grade B,with an accuracy of 90％(9/10)and an excellent rate of 100％(10/10).The neck incision length ranged 20-30 mm(mean,27 mm).The operation time was 86-160 min(mean,112.8 min).The intraoperative blood loss was 10-50 ml(mean,30 ml).The postoperative hospitalization was5-18 d(mean,8 d).The patients were followed up for 12-34 months(mean,23.6 months).All fractures healed without screw breakage or loosening.According to the Odom grading,4 cases were excellent,and 1 case was good.Conclusion Robot-assisted navigation C2 percutaneous lag screw treatment for Hangman's fracture is accurate and minimally invasive,safe and effective.

Research on the mechanisms of depression is currently a focus of the field of neuroscience.The degeneration of brain plasticity(e.g.,decrease in volume,structural degradation,and functional disorder of the hippocampus,PFC,and CG)leads to depression.Exercise is an important means of improving the symptoms of depression.Current research confirms the importance of improving the volume,structure,and function of the hippocampus,PFC,and CG,in this process,but related research has focused solely on changes to the volume of certain brain regions or connectivity functions.Thus,we lack a comprehensive understanding of the antidepressant mechanisms that improve brain plasticity with exercise.Therefore,this study aimed to explore the roles of brain plasticity in the occurrence of depression and improvements to depression through exercise,promoting a more comprehensive understanding the role of brain plasticity in depression.We also provide new ideas for exercise intervention in depression.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Objective To summarize the diagnosis and treatment experience of surgical site infection(SSI)after percutaneous endoscopic lumbar discectomy(PELD).Methods A retrospective analysis was made on 11 cases of postoperative SSI after PELD from January 2016 to December 2022.After PELD surgery,severe lower back or lower limb pain occurred in all the patients,with a Visual Analog Scale(VAS)score of 7-9(average,8.1).The erythrocyte sedimentation rate(ESR)was 17-114 mm/h(average,54.4 mm/h),and the level of C-reactive protein(CRP)was 8-151 mg/L(average,56.5 mg/L).The MRI showed changes of inflammatory signals in the intervertebral space of the surgical area.The SSI was diagnosed at 2-17 d(average,9.5 d)after PELD surgery.All the cases were treated with antibiotics(4 cases with empiric antibiotic therapy and 7 cases with sensitive antibiotic treatment),8 of which underwent combined surgery,including percutaneous endoscopic lesion removal,catheter irrigation and drainage in 4 cases,posterior lesion removal in 2 cases,and posterior lesion removal combined with internal fixation in 2 cases.Results The patients were followed up for 14-75 months(average,36.8 months).According to the modified MacNab criteria,5 cases were excellent,4 cases were good,and 2 cases were fair.Conclusions SSI after PELD is characterized by acute onset,recurrent severe lower back or lower limb pain,elevated inflammatory markers,and characteristic imaging features.Standardized antibiotic treatment combined with surgery can achieve good therapeutic effects.

In recent years， with the changes of population structure and the aggravation of aging， the prevalence of osteoporosis is increasing year by year. Osteoporosis poses great impacts on the body and family life of the patients and increases the burden on the society. Therefore， the research on osteoporosis is urgent and significant. The imbalance between osteoblasts， osteocytes， and osteoclasts causes abnormal bone metabolism， which destroys the fine structure of bone and increases bone fragility， thus increasing the risk of fracture. Although the pathogenesis of osteoporosis is complex， researchers have confirmed that the imbalance of the endocrine system directly or indirectly promotes the occurrence and development of osteoporosis. Traditional Chinese medicine （TCM） is a treasure of Chinese traditional culture and plays a key role in safeguarding the public health. With unique therapeutic effects and advantages， TCM has been widely accepted. Chinese medicines， moxibustion， acupuncture and other TCM therapies have play a unique role in the treatment of osteoporosis. Particularly， TCM prevention and treatment of osteoporosis by regulating the endocrine system has received extensive attention. By reviewing relevant literature， this paper introduces the research progress in the TCM modulation of bone metabolism and alleviation of bone loss by regulating estrogen， calcitonin， and parathyroid hormone in the endocrine system and affecting the hypothalamus capable of regulating these hormones， aiming to provide ideas for the TCM treatment of osteoporosis.

Objective    To investigate the effect of in vitro fenestration on reconstruction of left subclavian artery in endovascular treatment of aortic dissection. Methods    A total of 89 patients with aortic dissection involving left subclavian artery were treated by endovascular treatment in the Second Affiliated Hospital of Fujian Medical University from February 2017 to January 2020. There were 44 patients in the test group, including 36 males and 8 females, with an average age of 58.02±13.58 years. There were 45 patients in the control group, including 35 males and 10 females, with an average age of 54.10±12.32 years. The left subclavian artery was reconstructed by in vitro fenestration in the test group and by chimney technique in the control group. The clinical data were compared between the two groups. Results    The operation time of the test group was longer than that of the control group (126.16±7.53 min vs. 96.49±6.52 min, P<0.01). The median follow-up time was 31 (13-48) months. The incidence of endoleak in the test group (4.7%) was lower than that in the control group (18.6%, P=0.04) during the follow-up. There was no statistical difference in the incidence of stroke, myocardial infarction, false lumen thrombosis, retrograde aortic dissection or left subclavian artery occlusion between the two groups (P>0.05). Conclusion     In vitro fenestration for reconstructing left subclavian artery in thoracic endovascular aortic repair of aortic dissection is safe and feasible, which is worthy of further clinical promotion.

Objective To compare the difference between four-axis positioning 3D printing guide assisted puncture and manual puncture percutaneous vertebroplasty,to clarify the clinical efficacy of 3D printing guide assisted percutaneous vertebroplasty,and to explore its clinical application value.Methods A total of 70 patients who underwent single-segment vertebroplasty for osteoporotic vertebral compression fractures in our hospital were randomly divided into a manual group(control group)and a guide plate group(observation group).Thirty-five patients in the control group underwent PVP under the traditional manual puncture,and 35 patients in the observa-tion group underwent PVP under the four-axis positioning 3D printing guide assisted puncture.The general data,perioperative data,imaging data,preoperative and postoperative functional scores of the two groups were collected and compared.Results In terms of intraoperative fluoroscopy times,operation time,and postoperative adverse reactions,the observation group was significantly lower than the control group,and the difference was statistically significant(P<0.05).However,there was no significant difference between the two groups in intraoperative blood loss,bone cement leakage,and whether bone cement perfusion included fracture sites.In terms of clinical efficacy,the ratio of anterior vertebral height,postoperative VAS score and postoperative JOA score of the two groups were significantly better than those before operation,and the difference was statistically significant(P<0.05).At the same time point before and after operation,there was no significant difference in the height ratio of the anterior edge of the injured vertebra,VAS score and JOA score between the two groups(P>0.05).Conclusion The clinical efficacy of four-axis positioning 3D printing guide plate-assisted puncture is the same as that of experienced clinicians with free hand puncture for PVP,which can quickly relieve pain and improve dysfunction.However,guide plate assistance can shorten the operation time,reduce the number of fluoroscopy and postoperative adverse reactions,and make vertebroplasty faster and safer.