常见的MISS治疗成人退变性脊柱侧弯.ppt

 微创手术治疗成人退变性脊柱侧弯--是否可以改善脊柱平衡 上海交通大学医学院附属瑞金医院骨科 吴文坚 梁裕 成人退变性脊柱侧弯 疼痛 ：腰痛，根性疼痛 功能障碍 后凸畸形 ≠AIS！ 成人退变性脊柱侧弯 缓解神经根性疼痛 压迫部位 直接/间接减压 缓解腰痛 局部不稳定 (腰椎滑脱, 侧向滑移) 脊柱整体不稳定 改善畸形 矢状面失平衡 冠状面失平衡 改善外观 成人退变性脊柱侧弯的治疗目的 Adding fusion to decompression gives better results than decompression alone Correcting coronal deformity is not as important as correcting sagittal deformity and may not impact quality of life 我们需要矫正多少? LL=PI+TK-45° 20° 5cm 0° 4-5cm, within SI joints Sagittal Imbalance Coronal Imbalance Significant Sagittal alignment Thoracolumbar alignment Lumbar lordosis Spondylolisthesis Coronal imbalance 4-5cm Lateral listhesis 7mm Not significant Coronal cobb Age Adolescent vs. de-novo scoliosis Sagittal Coronal 那些是最需要纠正的问题? 开放手术的治疗路线图 Symptom Level I Level II Level III Level IV Level V Level VI Radicular + + + + + + Back Pain minimal ± + + + + Ant Osteophytes, 2mm sublux + - - - - - Olisthesis ≥6mm - - + + + + Coronal Cobb 30° - - + + + + Lumbar Kyphosis - - - + + + Global Imbalance - - - - + (flexible) + (stiff) (30% correction) Surgical Treatment No fusion Fuse Levels decomp Fuse all lumbar curve Ant/Post fusion Fuse to upper thoracic Osteotomy 成人退变性脊柱侧弯：临床结果 成人退变性脊柱侧弯：问题与挑战 骨骼僵硬 骨质疏松 内科合并症 体质虚弱 其他关节疾病 29% 39% 42% An MIS procedure is one that by virtue of the extent and means of surgical technique results in less collateral tissue damage decrease in morbidity more rapid functional recovery without differentiation in the intended surgical goal McAfee PC. et al. Spine 2010:s271 Minimally Invasive Spine Surgery 12 MIS能不能有效的治疗成人脊柱侧弯? 侧方入路治疗成人退变性脊柱侧弯的临床疗效 Conclusions. Direct lateral interbody fusion significantly improves segmental, regional, and global coronal plane alignment in patients with degenerative lumbar disease. Although DLIF increases the segmental sagittal Cobb angle at the level of instrumentation, it does not improve regional lumbar lordosis or global sagittal alignment. MISDEF 路线图 Case 1 TYF, F64 EOS C