经皮椎弓根螺钉固定技术治疗胸腰椎骨折.ppt

远期cobb角丢失： 椎间盘撑开角度丢失？椎体前缘高度丢失？ 尝试：注意后方韧带复合体的完整性。 不过分撑开，对照三个椎体前缘及相邻四个椎间隙 研究表明，经皮椎弓根螺钉固定病椎前缘高度丢失大于开放组。考虑原因可能是开放手术对椎间关节及椎板的损伤可导致脊柱的自发融合，而微创手术对这些结构的影响较小，降低了脊柱自发融合的可能性，从而增加了远期椎体高度丢失。 复 位 患者严重骨质疏松患者或伤椎上下椎椎弓根或外侧壁破损者，椎弓根螺钉易松脱。 骨水泥 后期骨松系统 治疗 骨质疏松 骨质疏松 骨质疏松 病例１：单纯爆裂骨折 病例１：单纯爆裂骨折 病例２：Chance骨折 病例２：Chance骨折 病例3：跳跃骨折（T12、L3） 病例3：跳跃骨折（T12、L3） 病例3：跳跃骨折（T12、L3） 病例3：跳跃骨折（T12、L3） Thank You！ 宁斌 ningbin@sdu.edu.cn* * Fig.２Image Intensi?er radiographs of the percutaneous technique for pedicle screw insertion showing: (a) anterior/posterior (AP) view of the Jamshidi needle docked onto the lateral aspect of the pedicle – the ‘‘3 o’clock position’’; (b) AP view of advancement of the needle 20 mmto 25 mminto the vertebral body; (c) lateral view, checking the position of the Jamshidi needle in lateral view; (d) lateral view, the K- wire and tapping of the pedicle; and (e) lateral view, insertion of the pedicle screw. Fig. 3.Diagrams illustrating the anatomical principles of percutaneous pedicle screw insertion: views from top to bottom: (a) superior, (b) posterior, (c) lateral, (d) superior. First the initial skin incision is made with the patients’ body habitus in mind. Second, the Jamshidi needle is ?rst ‘‘docked’’ onto the lateral aspect of the pedicle – ‘‘position 1’’ – on the anterior/posterior image intensi?er (II) radiograph projection. Third, the Jamshidi needle is advanced 20 mm to 25 mm so that the needle is beyond the medial border of the pedicle and into the vertebral body – to ‘‘position 3’’. Finally, the position is con?rmed by lateral II radiograph projection before insertion of the K-wire. Fig. 5. 术中照片显示使用牵拉袖套避免L5/S1螺钉碰撞．可屈曲的牵引袖套便问题简单化．通常L5S1螺钉植入采用同一个切口． Fig. 7. Intra-operative photograph of skin incision for multi-level constructs. The black line is showing all four incisions along a straight trajectory – making the insertion of the rod technically much easier. The white line shows the incisions in a staggered fashion – the rod insertion here will be more