该研究由北京市自然科学基金-海淀原始创新联合基金 （L232054） 和首都健康发展研究专项基金 （NO.2024-2024） 资助。

本研究经首都医科大学附属北京友谊医院伦理委员会批准。该方法将通过回顾性案例研究引入，仅使用患者的术前俯卧位计算机断层扫描 （CT） 成像数据。与传统方法相比，辅助经皮椎体成形术 （PVP） 中的“九格面积划分法”提供了一种更简单、更有效的方法，从而减少了手术和辐射暴露时间。这种技术可能有助于更容易识别穿刺点并可能缩短 PVP 程序的学习曲线，从而使年轻居民受益，值得进一步研究。这里描述的个体是一名 68 岁的女性。
1. 使用 X 射线透视、磁共振图像 （MRI）、骨闪烁显像和症状诊断骨质疏松性椎体压缩骨折 （OVCF）
<ol><li>在有背痛、棘突压痛和背部椎旁肌肉等症状的老年患者中确定患有 OVCF 的患者。利用后前 X 射线透视评估 L1 水平是否存在椎体压缩性骨折（图2A）。采用 MRI 成像确认新发腰椎压缩性骨折的诊断，并确定受影响的特定椎骨，确定为 L1（图2B）。</li>
</ol>2. 术前获取患者俯卧位 CT 成像
<ol><li>将患者置于俯卧位，对患者进行俯卧位 CT。通过 X 射线透视和身体检查患者背部确认目标区域，同时按压最痛苦的部位。</li>
	<li>让患者俯卧在手术台上，俯卧位 CT 扫描前将梯度器放在患者的背部，记录患者的体位，然后取下梯度器（图 3）。</li>
	<li>将 CT 图像（1 毫米扫描层厚度、1 毫米层间距以及 90 个切片 （常规扫描）或 400 个切片 （薄切片扫描）保存为 DICOM 格式。</li>
</ol>3. 建立 3D 模型并在医学成像处理软件中模拟操作
<ol><li>通过单击 “新建项目”，将 DICOM 格式的 CT 图像导出到医学成像处理软件中。选择所需的切片以重建压缩的椎骨。</li>
	<li>利用 阈值分割 工具调整目标椎骨的阈值范围，特别是在 125-3071 H 的范围内以创建蒙版。使用 Duplicate Mask 函数生成两个单独的蒙版， 即 Mask A 和 Mask B。</li>
	<li>利用 Mask Edit 功能从 Mask A 中删除目标椎骨。随后，利用布尔运算工具从蒙版 B 中减去蒙版 A，从而形成新的蒙版 C。最后，激活 Calculate 3-D 功能以使用 Mask C 重建目标椎骨;将此 3-D 模型命名为 L1（图 4A）。</li>
	<li>右键单击 Objects 界面中的 New，选择 Draw，然后选择 Cylinder。确保圆柱体的尺寸与穿刺针相同，长度为 12.5 毫米，半径为 1.25 毫米。</li>
	<li>使用 Move 和 Rotate 功能调整圆柱体的位置以达到理想位置（图 4B）。在整个模拟过程中，注意保持针轨迹与既定原则一致：穿刺针必须能够穿过椎弓根，最好在其上半部分，并且尖端的最佳定位是在侧视图上椎体的前三分之一内。</li>
	<li>右键单击 Objects 界面中的 L1，选择 Export STL （导出 STL），然后以 STL 格式导出文件。</li>
</ol>4. 在 3D 逆向工程生产软件中打磨 3D 模型
<ol><li>通过单击 Import（导入），将导出的椎体实体文件导入到 3-D 逆向工程生产软件中。因此，使用 Mesh Doctor 功能来消除模型中的扭曲和尖峰。</li>
	<li>由于 Grid Doctor 功能可能会错误地将正常的解剖结构识别为扭曲或尖峰，因此请注意彻底检查粗略模型以识别任何内部空隙，并按照步骤 4.1 适当填充它们（图 5A）。</li>
	<li>使用 精确表面 功能将实体模型转换为三角形网格表面，选择 有机几何材料 （图 5B）。等待自动表面构建过程完成，然后以 STP 格式导出文件。</li>
</ol>5. 在 3-D 建模设计软件中重建椎体工程模型并确认椎弓根投影的安全进入区域
<ol><li>将精确表面文档的 STP 格式导入 3-D 建模设计软件中，以单击 Open 重建椎体工程模型。使用 剖面视图 功能检查椎弓根在水平、矢状和冠状方向的形态，提供对椎弓根形态和结构的初步观察（图 6A）。</li>
	<li>在 Section View 面板中，调整截面的角度以实现最佳可视化效果。通过使用 透明截面体，观察椎弓根的最窄点（图 6B）并记录左侧面板第 1 部分 的角度参数。</li>
	<li>要调整椎体模型的角度，请单击 插入-特征-移动/复制 功能，然后选择位于左侧面板底部的 平移/旋转 按钮。重新访问 Section View 面板，并将 Section 1 中的 view angle 参数调整为 0。</li>
	<li>在 Section 1 面板中微调位移参数以获得令人满意的椎弓根截面视图。重新定向以获得改进的透视，以观察椎弓根截面。在面板中记录确认的位移参数（图 7）。</li>
	<li>利用上述 Move/Copy 功能来操纵椎体模型的位置。在左侧面板中指定位移参数。使用 Corner Rectangle 工具来包含整个椎体。</li>
	<li>首先，导航到 Features-Reference Geometry-Plane 选项，并将剖视图指定为 First Reference。相应地修改 偏移距离 参数，以将新创建的平面重新定位到椎体的前三分之一。</li>
	<li>继续 在上述 平面上生成草图，并在椎体的中点绘制一个 点 ，表示穿刺的终止点。</li>
	<li>使用 Extruded Cut 功能执行模型的切割。将生成的矩形草图指定为 Selected Contours。</li>
	<li>调整方向和深度，将椎体模型分为两半，即 椎体的一半 和 椎板的一半 （图 8A）。以 SLDPRT 格式保存工程文件，特别是作为该过程的一部分。</li>
	<li>打开包含 椎体零件的文件，然后基于剖切面创建草图。使用 Convert Entities 功能将左椎弓根投影转换为曲线草图。</li>
	<li>对右椎弓根投影重复上述步骤，从而获取另一个曲线草图。使用 填充表面 功能将曲线草图转换为表面，以左右椎弓根投影曲线草图作为边界（图 8B）。</li>
	<li>显示隐藏椎骨后的结果表面。在 特征 面板上选择 放样凸台/基体 功能。</li>
	<li>左椎弓根表面的优越定位，将穿刺终点指定为 轮廓，将产生一个圆锥形结构，描绘出椎弓根穿刺的路径。使用左侧作为参考进行说明，在右侧复制相同的过程。</li>
	<li>使用 Scale 函数放大双边圆锥形结构，质心作为缩放中心点， 比例因子 为 2。使用 Move/Copy Body 功能单独重新定位圆锥结构。</li>
	<li>在 “配合设置 ”面板界面中，选择 结构的顶点 和 穿刺终点，并将匹配模式设置为 “重合”。随后使用 Delete/Keep Body 功能消除椎体（图 9A）。</li>
	<li>双锥形结构是双侧椎弓根穿刺路径的汇编，以 SLDPRT 格式保存。使用 Insert Part 功能，使用椎弓根穿刺装置重新组装椎板部分和椎体部分。只需按下 OK 按钮，即可自动将零件的插入位置与原点对齐（图 9B）。</li>
	<li>使用 Combine Body 函数对各种组件执行 布尔 运算。通过从椎板的一半中减去穿刺组同时保留所有椎板成分的过程，随后的分析表明 ，理想的骨穿刺区域 包括左侧的区域 1、4 和 7（图 9C）。</li>
</ol>

通过 3D 建模和九宫格法提高椎弓根穿刺精度

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作者对本研究中描述的任何药物、材料或设备没有利益冲突。

经皮椎体成形术 （PVP） 在治疗疼痛性骨质疏松性椎体压缩骨折 （OVCF） 方面显示出良好的临床疗效9。外科医生利用精确的经皮椎弓根穿刺技术在确定穿刺针的最佳插入点、方向和深度方面起着至关重要的作用，从而显着减少并发症的发生10。目前，C 臂 X 光机广泛用于传统 PVP 手术的国内外实践，以方便调整穿刺针的手术路径11。关键方面在?...

骨质疏松性椎体压缩骨折 （OVCF） 是骨质疏松性骨折中最普遍的骨折类型，在当代医疗保健中构成了重要的临床问题1。根据目前的指南，经皮椎体成形术被认为是 OVCF2 最有效的微创治疗方式之一。进行经皮椎体成形术 （PVP） 的主要方法涉及椎弓根穿刺方法，它包括三个关键参数：骨穿刺入口点的识别、穿刺角度和穿刺深度。在这些参数中，骨穿刺入口点的选择被认为是最关键的。
目前，C 臂 X 光机广泛用于传统 PVP 手术的国内外实践，以方便穿刺针手术路径的调整。关键方面在于确定“理想的骨穿刺点”，该点通常位于腰椎椎弓根的“左 10 点，右 2 点”的投影处（图 1A）3。尽管他们经验丰富，但即使是经验丰富的外科医生在仅根据个人经验确定合适的穿刺点时也可能会犯错误。这可能导致与穿刺相关的并发症，例如骨水泥渗漏到周围组织、神经根损伤和椎管内血肿 4,5,6。此外，近一半的患者因传统 PVP 而出现局部并发症，其中 95% 的并发症归因于骨水泥渗漏到周围组织或椎旁静脉栓塞7。我们的初步研究发现，腰椎中实际的 PVP 骨穿刺点并不总是位于理想的椎弓根投影“左 10 点和右 2 点”8。一些实际穿刺点也可以在“理想骨穿刺点”附近取得满意的穿刺效果，这不会影响手术的安全性和准确性。
基于上述假设，我们首次提出了腰椎PVP的“理想骨穿刺区域”的概念，并将椎弓根的投影划分为“九宫区”。 理想骨穿刺区域 的概念与穿刺入口点可以通过椎弓根成功安全地到达穿刺理想终点的特定解剖区域有关。术语 “九格区域划分法” 是指 X 射线前后图像中的一种技术，其中椎弓根投影的最长和最短直径被分成三个相等的部分，从而将区域划分为九个区域（图1B）。这些区域从 1 到 9 按顺序编号，从最外层到最内层，从上到下。以腰椎弓根的 X 射线投影作为解剖标志，我们通过“九格面积划分法”建立 PVP 的“理想骨穿刺区域”，而不是局限于单个点。我们使用计算机模拟在穿刺过程中探索安全的穿刺路径。
因此，我们建议实施“九格面积划分法”作为提高 PVP 手术中辅助穿刺技术的便利性、效率和安全性的潜在方法，以提高手术准确性并最大限度地减少穿刺相关并发症。值得注意的是，本研究提出了一种理论方法，需要通过广泛的研究进行验证，以确定其有效性和安全性。

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			<td>Computer tomography&#160;</td>
			<td>Company GE</td>
			<td></td>
			<td>machine</td>
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			<td>Geomagic Wrap (3-D reverse engineering production software)</td>
			<td>Oqton software</td>
			<td></td>
			<td>software</td>
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			<td>Magnetic resonance image machine</td>
			<td>Company GE</td>
			<td></td>
			<td>machine</td>
		</tr>
		<tr>
			<td>&#160;Materialise Interactive Medical Image Control System (medical imaging processing software)</td>
			<td>Materialise Company</td>
			<td></td>
			<td>software</td>
		</tr>
		<tr>
			<td>Solidworks (3-D modeling design software)</td>
			<td>Dassault Syst&#232;mes&#160;-&#160;SolidWorks Corporation</td>
			<td></td>
			<td>software</td>
		</tr>
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			<td>Spirit Level Plus</td>
			<td>IOS App store</td>
			<td></td>
			<td>gradientor</td>
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			<td>X-ray machine</td>
			<td>Company Philips</td>
			<td></td>
			<td>machine</td>
		</tr>
	</tbody>
</table>

nine-grid area division method: a new ideal bone puncture region for percutaneous vertebroplasty in lumbar spine

经皮椎体成形术 （PVP） 被广泛认为是缓解骨质疏松性椎体压缩性骨折引起的腰痛的有效干预措施。理想的骨穿刺点通常位于腰椎椎弓根的“左 10 点，右 2 点”的投影处。确定最佳骨穿刺点是一项关键而复杂的挑战。经皮椎体成形术 （PVP） 的准确性主要受手术外科医生的熟练程度和常规手术中多荧光镜的使用影响。全球已有穿刺相关并发症的发生率记录。为了提高手术技术的精准度，减少穿刺相关并发症的发生，我们的团队在腰椎应用了 PVP 的「九格分区法」，以改变传统手术方式。有可能减少穿刺次数、辐射暴露剂量和外科手术的持续时间。
该协议引入了“九网格面积划分法”的定义，并描述了在医学成像处理软件中对目标椎骨 DICOM 成像数据进行建模的过程，在 3-D 模型中模拟操作，使用逆向工程生产软件完善 3-D 模型，在 3-D 建模设计软件中重建椎体工程模型，并利用手术数据确定椎弓根投影的安全进入区域。通过采用这种方法，外科医生可以有效、精确和轻松地识别合适的穿刺点，从而减少与穿刺相关的复杂性并提高外科手术的整体准确性。

CT 成像和数字建模在医院进行。从 CT 图像构建 3-D 模型需要 30 分钟，在 3-D 逆向工程生产软件中抛光 3-D 模型需要 ~10 分钟，重建椎体工程模型需要 15 分钟，并在 3-D 建模设计软件中确认椎弓根投影的安全进入区域。在这种情况下， 理想的骨穿刺区域 包括左侧的区域 1、4 和 7。 理想骨穿刺区域 的概念是指不同的解剖区域，其中穿刺的入口点可以通过椎弓根有效且安全地?...

作者聚焦：通过先进的穿刺技术提高经皮椎体成形术手术的准确性和效率

在此，我们提出了一种用于经皮椎体成形术的“九格面积划分法”。选择一名 L1 椎体压缩骨折患者作为案例研究。

九格面积划分法：腰椎经皮椎体成形术新的理想骨穿刺区域 

Percutaneous vertebroplasty (PVP) is widely recognized as an efficacious intervention for alleviating low back pain resulting from osteoporotic vertebral ...

nine-grid-area-division-method-new-ideal-bone-puncture-region-for

Research

JoVE Journal

Medicine

Nine-Grid Area Division Method: A New Ideal Bone Puncture Region for Percutaneous Vertebroplasty in Lumbar Spine

158 次观看.  Capital Medical University. 我们的研究是关于 PVP 手术中的穿刺技术。我们正在努力回答如何在 PVP 手术中提高手术准确性并最大限度地减少穿刺相关并发症。随着新技术的 MGC，各种穿刺技术正在迅速发展，例如导航系统兑换创建引导模板，因此学习使用医学成像软件有一个学习曲线。此外，必须进行更大规模的研究来验证这一建立的可靠性和实用性。采用这种方法，外?...

视频: 作者聚焦：通过先进的穿刺技术提高经皮椎体成形术手术的准确性和效率

An In Vitro Dormancy Model of Estrogen-sensitive Breast Cancer in the Bone Marrow: A Tool for Molecular Mechanism Studies and Hypothesis Generation

The study of breast cancer dormancy in the bone marrow is an exceptionally difficult undertaking due to the complexity of the interactions of dormant cells with their microenvironment, their rarity and the overwhelming excess of hematopoietic cells. Towards this end, we developed an in vitro 2D clonogenic model of dormancy of estrogen-sensitive breast cancer cells in the bone marrow. The model consists of a few key elements necessary for dormancy. These include 1) the use of estrogen sensitive breast cancer cells, which are the type likely to remain dormant for extended periods, 2) incubation of cells at clonogenic density, where the structural interaction of each cell is primarily with the substratum, 3) fibronectin, a key structural element of the marrow and 4) FGF-2, a growth factor abundantly synthesized by bone marrow stromal cells and heavily deposited in the extracellular matrix. Cells incubated with FGF-2 form dormant clones after 6 days, which consist of 12 or less cells that have a distinct flat appearance, are significantly larger and more spread out than growing cells and have large cytoplasm to nucleus ratios. In contrast, cells incubated without FGF-2 form primarily growing colonies consisting of >30 relatively small cells. Perturbations of the system with antibodies, inhibitors, peptides or nucleic acids on day 3 after incubation can significantly affect various phenotypic and molecular aspects of the dormant cells at 6 days and can be used to assess the roles of membrane-localized or intracellular molecules, factors or signaling pathways on the dormant state or survival of dormant cells. While recognizing the in vitro nature of the assay, it can function as a highly useful tool to glean significant information about the molecular mechanisms necessary for establishment and survival of dormant cells. This data can be used to generate hypotheses to be tested in vivo models.

An In Vitro Dormancy Model of Estrogen-sensitive Breast Cancer in the Bone Marrow: A Tool for Molecular Mechanism Studies and Hypothesis Generation

We developed an in vitro model of dormancy in the bone marrow for estrogen-sensitive breast cancer cells. The goal of this protocol is to demonstrate use of the model for the study of the molecular and cellular biology of dormancy and for generation of hypotheses for subsequent testing in vivo.

一个<em&gt;在体外</em&gt;对雌激素敏感的乳腺癌休眠模式在骨髓中:分子机理研究与假设生成的一个工具

The study of breast cancer dormancy in the bone marrow is an exceptionally difficult undertaking due to the complexity of the interactions of dormant ...

科研

医学

Tissue Characterization after a New Disaggregation Method for Skin Micro-Grafts Generation

Several new methods have been developed in the field of biotechnology to obtain autologous cellular suspensions during surgery, in order to provide one step treatments for acute and chronic skin lesions. Moreover, the management of chronic but also acute wounds resulting from trauma, diabetes, infections and other causes, remains challenging. In this study we describe a new method to create autologous micro-grafts from cutaneous tissue of a single patient and their clinical application. Moreover, in vitro biological characterization of cutaneous tissue derived from skin, de-epidermized dermis (Ded) and dermis of multi-organ and/or multi-tissue donors was also performed. All tissues were disaggregated by this new protocol, allowing us to obtain viable micro-grafts. In particular, we reported that this innovative protocol is able to create bio-complexes composed by autologous micro-grafts and collagen sponges ready to be applied on skin lesions. The clinical application of autologous bio-complexes on a leg lesion was also reported, showing an improvement of both re-epitalization process and softness of the lesion. Additionally, our in vitro model showed that cell viability after mechanical disaggregation with this system is maintained over time for up to seven (7) days of culture. We also observed, by flow cytometry analysis, that the pool of cells obtained from disaggregation is composed of several cell types, including mesenchymal stem cells, that exert a key role in the processes of tissue regeneration and repair, for their high regenerative potential. Finally, we demonstrated in vitro that this procedure maintains the sterility of micro-grafts when cultured in Agar dishes. In summary, we conclude that this new regenerative approach can be a promising tool for clinicians to obtain in one step viable, sterile and ready to use micro-grafts that can be applied alone or in combination with most common biological scaffolds.

The protocol describes a new method to disaggregate human tissues and to create autologous micro-grafts that, combined with collagen sponges, give rise to human bio-complexes ready to use in the treatment of skin lesions. Further, this system preserves cell viability of micro-grafts at different times after mechanical disaggregation.

后皮肤微移植生成一个新的方法解聚表征的组织

Several new methods have been developed in the field of biotechnology to obtain autologous cellular suspensions during surgery, in order to provide one ...

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

Pedicle screw fixation is the gold standard for the treatment of spinal diseases. However, many studies have reported the issue of loosening pedicle screws after spinal surgery, which is a serious concern. To address this problem, diverse types of pedicle screws have been examined to identify those with good fixation strength and osseointegration in spine bone. The porcine spine is a good alternative for the human spine in the evaluation of pedicle screws due to the anatomical size, mechanical characteristics, and cost. Although several studies have reported that pedicle screws are efficient in the porcine model, no study has described detailed protocols for the evaluation of a pedicle screw using the porcine model. Here, we describe a detailed method for evaluating transpedicular screws using an in vivo porcine lumbar spine model. The technical details for anesthesia, spine surgery, and harvest provided here will facilitate with the evaluation of the transpedicular screw fixation model.

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

Here, we introduce a method to evaluate transpedicular screws by using an in vivo porcine lumbar spine model.

用于评估椎弓根螺钉的麻醉，手术和收获方法<em&gt;体内</em&gt;猪腰椎模型

Pedicle screw fixation is the gold standard for the treatment of spinal diseases. However, many studies have reported the issue of loosening pedicle ...

Surgical Angiogenesis in Porcine Tibial Allotransplantation: A New Large Animal Bone Vascularized Composite Allotransplantation Model

Segmental bone loss resulting from trauma, infection malignancy and congenital anomaly remains a major reconstructive challenge. Current therapeutic options have significant risk of failure and substantial morbidity.
Use of bone vascularized composite allotransplantation (VCA) would offer both a close match of resected bone size and shape and the healing and remodeling potential of living bone. At present, life-long drug immunosuppression (IS) is required. Organ toxicity, opportunistic infection and neoplasm risks are of concern to treat such non-lethal indications.
We have previously demonstrated that bone and joint VCA viability may be maintained in rats and rabbits without the need of long-term-immunosuppression by implantation of recipient derived vessels within the VCA. It generates an autogenous, neoangiogenic circulation with measurable flow and active bone remodeling, requiring only 2 weeks of IS. As small animals differ from man substantially in anatomy, bone physiology and immunology, we have developed a porcine bone VCA model to evaluate this technique before clinical application is undertaken. Miniature swine are currently widely used for allotransplantation research, given their immunologic, anatomic, physiologic and size similarities to man. Here, we describe a new porcine orthotopic tibial bone VCA model to test the role of autogenous surgical angiogenesis to maintain VCA viability.
The model reconstructs segmental tibial bone defects using size- and shape-matched allogeneic tibial bone segments, transplanted across a major swine leukocyte antigen (SLA) mismatch in Yucatan miniature swine. Nutrient vessel repair and implantation of recipient derived autogenous vessels into the medullary canal of allogeneic tibial bone segments is performed in combination with simultaneous short-term IS. This permits a neoangiogenic autogenous circulation to develop from the implanted tissue, maintaining flow through the allogeneic nutrient vessels for a short time. Once established, the new autogenous circulation maintains bone viability following cessation of drug therapy and subsequent nutrient vessel thrombosis.

Currently any kind of vascularized composite allotransplantation depends on long-term-immunosuppression, difficult to support for non-life-critical indications. We present a new porcine tibial VCA model that can be used to study bone VCA and demonstrate the use of surgical angiogenesis to maintain bone viability without the need of long-term immune-modulation.

猪胫骨移植术后血管生成的动物模型

Segmental bone loss resulting from trauma, infection malignancy and congenital anomaly remains a major reconstructive challenge. Current therapeutic ...

A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are two techniques for the introduction of a working cannula with respect to disc&#8212;outside-in and inside-out. The aim of this prospective study is to describe the technical aspects of a novel mobile outside-in method in dealing with different types of disc prolapse. A total of 184 consecutive patients with unilateral lower limb radiculopathy due to lumbar disc prolapse were operated on with the mobile outside-in technique of PETLD. Their clinical outcomes were evaluated based on the type of disc prolapse they had, a visual analog scale (VAS) leg pain score, the Oswestry Disability Index (ODI), and the Macnab criteria. The completeness of the decompression was documented with a postoperative magnetic resonance imaging. The mean age of the patients was 50 &#177; 16 years and the male/female ratio was 2:1. The mean follow-up was 19 &#177; 6 months. A total of 190 lumbar levels were operated on (L1&#8211;L2: n = 4, L2&#8211;L3: n = 17, L3&#8211;L4: n = 27, L4&#8211;5: n = 123, and L5&#8211;S1: n = 19). Divided into types, the patient distribution was central: n = 14, paracentral: n = 74, foraminal: n = 28, far lateral: n = 13, superior-migrated: n = 8, inferior migrated: n = 38, and high canal compromise: n = 9. The mean operative time was 35 &#177; 12 (25 - 56) min and the mean hospital stay was 1.2 &#177; 0.5 (1&#8211;3) days. The VAS score for leg pain improved from 7.5 &#177; 1 to 1.7 &#177; 0.9. The ODI improved from 70 &#177; 8.3 to 23 &#177; 5. According to the Macnab criteria, 75 patients (40.8%) had excellent results, 104 patients (56.5%) had good results, and 5 patients (2.7%) had fair results. Recurrence (including early and late) was seen in 15 out of the 190 levels that were operated on (7.89%). This article presents a novel outside-in approach that relies on a precise landing within the foramen in a mobile manner and does not solely depend upon the enlargement of the foramen. It is more versatile in application and useful in the management of all types of disc prolapse, even in severe canal compromise and high migration.

Here we present a protocol of a novel outside-in technique of transforaminal endoscopic discectomy for lumbar disc herniations. The technical aspects of the technique, the wide indications of use, and the results of the treatment in 184 patients are described in detail.

腰椎间盘椎间盘经神经孔腰椎内窥镜的移动外技术

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are ...

An Enzyme-free Method for Isolation and Expansion of Human Adipose-derived Mesenchymal Stem Cells

Mesenchymal stem cells (MSCs) are a population of multipotent cells that can be isolated from various adult and fetal tissues, including adipose tissue. As a clinically relevant cell type, optimal methods are needed to isolate and expand these cells in vitro. Most methods to isolate adipose-derived MSCs (ADSCs) rely on harsh enzymes, such as collagenase, to digest the adipose tissue. However, while effective at breaking down the adipose tissue and yielding a high ADSC recovery, these enzymes are expensive and can have detrimental effect on the ADSCs &#8212; including the risks of using xenogeneic components in clinical applications. This protocol details a method to isolate ADSCs from fresh lipoaspirate and abdominoplasty samples without enzymes. Briefly, this method relies on mechanical disassociation of any bulk tissue followed by an explant-type culture system. The ADSCs are permitted to migrate out of tissue and onto the tissue culture plate, after which the ADSCs can be cultured and expanded in vitro for any number of research and/or clinical applications.

This protocol provides an enzyme-free method for isolating mesenchymal stem cells from abdominoplasty and lipoaspirate samples using an explant method. The absence of harsh enzymes or centrifugation steps provides for clinically relevant stem cells that can be used for studies in vitro or transferred back to the clinic.

一种分离和扩增人类脂肪衍生的美源性干细胞的无酶方法

Mesenchymal stem cells (MSCs) are a population of multipotent cells that can be isolated from various adult and fetal tissues, including adipose tissue. ...

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty (PVP)

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The accuracy of PVP mainly depends on the surgeons&#39; experience and multiple fluoroscopes during a traditional procedure. Puncture related complications were reported all over the world. To make the surgical procedure more precise and decrease the rate of puncture-related complications, our team applied a three-dimensional printing guide template to PVP to modify the traditional procedure. This protocol introduces how to model target vertebrae DICOM imaging data into three-dimensions in the software, how to simulate operation in this 3-D model, and how to use all of the surgical data to reconstruct a patient specific template for application. Using this template, surgeons can identify suitable puncture points accurately to improve the accuracy of the operation. The whole protocol includes: 1) diagnosis of the osteoporotic vertebral compression fracture; 2) acquisition of CT imaging of the target vertebra; 3) simulation of the operation in the software; 4) design and fabrication of the 3-D printing guide template; and 5) application of the template into an operation procedure.

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty PVP

Herein, we present a three-dimensional printing guide template for percutaneous vertebraplasty. A patient with a T11 vertebral compression fracture was selected as a case study.

三维打印指南模板辅助皮椎间盘（PVP）

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The ...

Posterior Approach for Debridement of the Psoas Abscess

This method focuses on outlining a safe zone for irrigation and debridement of a psoas abscess through a posterior approach. Initially, an anterior approach to the spine was performed to ensure that the anterior longitudinal ligament and the psoas muscle could be visualized. All the abdominal organs were removed. Subsequently, a posterior approach was performed to remove the paraspinal muscles from L1&#8211;L5. The transverse processes, pars interarticularis and lamina of L1&#8211;L5 were identified. The exiting nerve root was identified between the transverse processes and followed into the substance of the psoas muscle. Using the anterior and posterior approach, the lumbar plexus was isolated from the substance of the psoas muscle. Before and after various steps of dissection, digital photographs were obtained. These images were uploaded into ImageJ and multiple measurements, including the distance between the lateral superior and inferior tip of each TP to the most lateral region of the plexus, the distance between the lateral superior and inferior tip of the TP to the lateral edge of the psoas, and the width of the lumbar plexus were recorded. The safe zone for entering the substance of the psoas muscle was defined between the lateral edge of the psoas muscle and the lateral edge of the lumbar plexus. The relationship of this interval to the tip of the transverse process at each level was measured and reported.

This is a cadaveric study investigating the landmarks for the posterior approach for irrigation and debridement of the psoas abscess. The interval between the transverse processes (TP) was used to access the substance of the psoas muscle.

切除普索阿脓肿的后向方法

This method focuses on outlining a safe zone for irrigation and debridement of a psoas abscess through a posterior approach. Initially, an anterior ...

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Cardiogenic shock is defined as persistent hypotension, accompanied by evidence of end organ hypo-perfusion. Percutaneous ventricular assist devices (PVADs) are used for the treatment of cardiogenic shock in an effort to improve hemodynamics. Impella is currently the most common PVAD and actively pumps blood from the left ventricle into the aorta. PVADs unload the left ventricle, increase cardiac output and improve coronary perfusion. PVADs are typically placed in the cardiac catheterization laboratory under fluoroscopic guidance via the femoral artery when feasible. In cases of severe peripheral arterial disease, PVADs can be implanted through an alternative access. In this article, we summarize the mechanism of action of PVAD and the data supporting their use in the treatment of cardiogenic shock.

Percutaneous ventricular assist devices are increasingly being utilized in patients with acute myocardial infarction and cardiogenic shock. Herein, we discuss the mechanism of action and hemodynamic effects of such devices. We also review algorithms and best practices for the implantation, management and weaning of these complex devices.

经皮心室辅助装置治疗急性心肌梗死并发心源性休克

Cardiogenic shock is defined as persistent hypotension, accompanied by evidence of end organ hypo-perfusion. Percutaneous ventricular assist devices ...

A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy

Intrahepatic and extrahepatic choledocholithiasis is a challenge in the field of biliary surgery. We present our experience using a two-step percutaneous transhepatic choledochoscopic lithotomy (PTCSL) procedure to treat challenging biliary stones. We retrospectively reviewed 81 patients with intrahepatic and extrahepatic choledocholithiasis treated using this two-step PTCSL from January 2013 to January 2020, including 40 males and 41 females, with an average age of 66 years. In contrast to traditional percutaneous transhepatic cholangioscopy (PTCS), a channel was established directly through a 16F Amplatz sheath, and the stone in the channel was removed with the aid of a nephroscope. The clinical efficacy and complications of all patients were analyzed. Eighty-one patients (81/81, 100%) had their biliary stones successfully removed; 62/81 patients (76.5%) had biliary stones completely removed after the first operation; 17/81 patients (21%) underwent a second operation; 2/81 patients (2.5%) needed a third operation to completely remove the stones. The incidence of severe bleeding during the operation was 0%, and there were no deaths. The use of the two-step PTCSL method is safe and efficacious, and contributes to a better prognosis of intrahepatic and extrahepatic choledocholithiasis.

This "two-step method" significantly improved the success rate of percutaneous transhepatic choledochoscopy and achieved a better prognosis of intrahepatic and extrahepatic choledocholithiasis.

经皮经肝胆胆镜截石术的两步法

Intrahepatic and extrahepatic choledocholithiasis is a challenge in the field of biliary surgery. We present our experience using a two-step percutaneous ...