医药-脊柱截骨.ppt

脊柱畸形截骨术 成人严重的僵硬的脊柱畸形，包括冠状位和失状位的畸形。 通过截骨最终取得失状位和冠状位的平衡，缓解疼痛，坚固的融合及预防进一步畸形。     失状位失衡 1、节段性tape1（segmental）:SVA5cm 2、整体性tape2（global）:SVA 5cm without knee flexion or hip hyperextension Ideal sagittal alignment is described as SVA50 mm, PT 25 ゜, PI–LL = 10 ゜   失状位失衡截骨方式Posterior-only  1、Smith-Petersen osteotomy (SPO) 2、pedicle subtraction osteotomy (PSO) 3、bone-disc-bone osteotomy (BDBO) 4、vertebral column resection (VCR) Ponte osteotomy, Smith-Petersen osteotomy (SPO) removal of posterior ligaments and facets wide facetectomy to prevent nerve root impingement osteotomy site can be done asymmetrically to correct coronal imbalance as well as sagittal imbalance 9.3–10.7 per level. substantial correction, it may be necessary to graft the disc space anteriorly Type 1 a long, rounded,smooth kyphosis SVA in the range of 6–8 cm positive. easier and safer than other osteotomies; Pedicle subtraction osteotomy(PSO) Thomasen in 1985. Heining et al eggshell osteotomy. 30 to 40 correction through all three columns, while avoiding stretch vessels and viscera anterior to the spine; If performed in an asymmetric fashion, provide significant coronal correction as well; type 2 sagittal deformity (SVA12 cm), sharp, angular kyphosis etl； A wide laminectomy is performed Osteotomy line horizontal to the sacrum Placing the temporary rod closed over the rods while the hips and knees are hyperextended Interbody fusion can be done as either a TLIF or an ALIF procedure Bone-disc-bone osteotomy (BDBO) correction rates 35° to 60° The main indications are deformities with the disc space as the apex or center of rotational axis (CORA) and severe sagittal plane deformities Type 1 bone-disc-bone osteotomy (BDBO). Type 2 BDBO. Type 3 BDBO. pedicle screws at least two levels below and three levels above A titanium mesh cage can be placed anteriorly if desired. Vertebral column resection（VCR） in 1922 by MacLennan indicated for