Percutaneous vertebroplasty (PVP) is a relative new interventional technique, which is widely used in treatment of vertebral collapse caused by vertebral neoplasms and osteoporotic compression fractures. The general technical considerations of PVP techniques are discussed based on authors' experience obtained over 400 patients in the past years in this article, including preparation of PMMA, instrument of PVP, guidance and puncture approaches, and technique of the procedure, etc. The conclusion is that PVP is a safe procedure if the physicians handle it properly.

经皮椎间孔入路全内镜技术治疗腰椎间盘突出症

一、前言
　　腰椎间盘突出症是一种常见病、多发病，手术治疗方法可以分为传统开放手术和微创手术两大类。近些年来，微创脊柱外科以其创伤小、恢复快等优点，取得了快速的发展进步，在腰椎间盘突出症的治疗中获得了显著疗效。其中经皮内镜椎间盘摘除技术是目前创伤小的镜下椎间盘摘除术式。经皮内镜技术通过带工作通道的硬杆状内窥镜在生理盐水持续灌洗下进行，可在直视下对病变椎间盘进行操作，因其操作全程在内窥镜下完成，故又称为全内镜技术。根据经皮穿刺入路不同，该技术分为经皮椎间孔入路全内镜下腰椎间盘摘除术(transforaminalpercutaneousendoscopiclumberdiscectomy，TF-PELD)和经皮椎板间入路全内镜下腰椎间盘摘除术(interlaminarpercutaneousendoscopiclumberdiscectomy，IL-PELD)。其中TF-PELD技术开展早，近年来随着微创理念和器械革新的不断推动，该技术的适应证和临床需求逐渐扩大，为更好地掌握和推广该项技术，现就其技术操作及相关临床问题综述如下。

经皮完全内镜下脊柱手术技术的发展与现状

现代经皮内镜下脊柱手术技术的发展是建立在Yeung [1]发明的YESS ( yeung endoscopic spine system )脊柱内镜系统及YESS技术基础之上的。Ruetten，Hoogland等[2-3]在YESS脊柱内镜系统基础上进行改进，并提出完全内镜技术( full-endoscopic technique )及TESSYS ( transforaminal endoscopic surgical system )等概念。但这些脊柱内镜系统都是使用带工作通道的硬杆状内镜在持续生理盐水灌洗下进行的微创脊柱手术，只是手术技术上不断改进以适应更复杂的病例，所以都可以称为完全内镜下手术技术。目前主要用于颈、腰椎间盘突出症、颈椎管狭窄症、腰椎管狭窄症及慢性腰痛等疾病的治疗。

经皮内镜椎板间入路腰椎间盘切除术

Kambin 及 Gellman [1]在1973年首次报道使用脊柱内镜，经皮从后外侧入路摘除压迫神经的椎间盘髓核组织。Yeung [2]发明了 YESS 系统，经后外侧椎间孔入路切除椎间盘髓核组织，成为早的经皮内镜腰椎间盘切除术( percutaneous endoscopic lumbar discectomy，PELD )。YESS ( yeung endoscopic spine system )脊柱内镜系统的发明及其相应的 YESS 技术为现代经皮腰椎内镜技术的发展奠定了基础。Ruetten 等[3]和 Hoogland 等[4]对 YESS 技术做出了改进，并由此发展为完全内镜技术( full-endoscopic technique )及 TESSYS 系统( transforaminal endoscopic surgical system )。PELD 以其创伤小，出血少，恢复快等优点，为椎间盘突出患者带来了福音。其微创性、有效性及良好的卫生经济学价值已被国内外众多从事脊柱内镜的学者证实[5]。常使用的是经皮内镜椎间孔入路腰椎间盘切除术( percutaneous endoscopic transforaminal discectomy， PETD )，其适应证包括旁中央型、椎间孔型、极外侧型椎间盘突出症。但在经椎间孔入路治疗L5～S1椎间盘突出，尤其是脱垂型及腋下型突出时，高髂嵴、肥大翼化的 L5横突、椎间孔骨性周界的阻挡、背根神经节及由椎间孔出行的神经根限制了工作管道的充分移动，致摘除突出的髓核组织非常困难。为了避免PETD摘除椎间盘髓核组织时遇到的困难，Ruetten 采用经皮内镜椎板间入路腰椎间盘切除术( percutaneous endoscopic interlaminar discectomy， ；PEID )摘除突出的椎间盘髓核组织[6]。PEID具有手术入路解剖为脊柱外科医生熟悉，术中透视少，不受高髂嵴、椎间孔周界、背根神经节及出行神经根限制等优点[7]，其与PETD一起进一步扩大了经皮内镜的手术适应范围。

Objective　To study the efficacy and safety of cutting balloons in coronary interventions.Methods　Twenty-two patients with 23 narrowed coronary arteries and 25 lesions enrolled the study, 17 of whom had 18 diseased coronary arteries and 18 lesions were in-stent restenosis. The average time from previous stenting was 7.60±3.53 months. The lesions were dilated with cutting balloons. Results　All of the lesions were dilated successfully by 5.16±2.30 inflations of a cutting balloon. The mean total duration of balloon inflation was 233.96±94.83 seconds at pressures up to 9.40±1.96 bars. The severity of vascular stenosis was lessened substantially (89.64±8.65% vs 17.60±17.15%， P=0.000) without severe complications. Three restenotic lesions were further dilated with conventional balloons, another one was stented again because of a dissection distal to the previous stent. Three primary lesions were stented for dissection or residual stenosis. Angina pectoris reoccurred in two patients in a mean follow-up period of 7.42±6.87 (range 0.5-20) months. Conclusion　Cutting balloon dilation is an effective and safe choice in interventions for coronary disease especially for in-stent restenosis.

Objective: To evaluate the feasibility and satefy of transcatheter aortic valve implantation in animals by using a new balloon-expanding valved stent.
Methods: The balloon-expandable stent is made from cobalt-based alloy material and designed with a tubular, slotted structure. Fresh bovine pericardium was treated, sutured and fixed on the balloon-expandable stent. Ten healthy sheep (five males and five females), weighing an average of (25.16 ± 1.83) kg, were selected to undergo transcatheter implantation of the valve stents. The function of the valve stent was evaluated by angiography, echocardiography, and histology six months after the procedure.
Results: Of the ten experimental sheep, two sheep died during the operation because the higher position of the artificial valve affected the opening of the coronary artery. We successfully implanted the aortic valve stent in other eight sheep;however, one sheep died of heart failure two weeks after the operation due to the lower position of the valve stent. The valve stents were implanted in the desired position in seven sheep. Ascending aortic angiographic and autoptic findings immediately after the operation confirmed the satisfactory location and function of the valved stent. Echocardiography, angiography, and histology at six post-operative months confirmed the satisfactory location and function of the valve stent.
Conclusion: We successfully implanted our new valve stent as a replacement of native aortic valve via the transcatheter route with satisfactory outcome.
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