醫(yī)學(xué)交流課件：Anterior Stabilisation of the Spine

AnteriorStabilisationoftheSpineApproachOpenMicrosurgicalMiniTTAThoracoscopicMiaspasTLMACSTLTwinScrewHMAPolyaxialHMAMonoaxialMACSTLConceptDepending

upontheindicationMACSTLComponentsRodsMono-/BisegmentalStabilisationStabilisationPlatesRodsTwin-ScrewHMA-Poly.MultisegmentalStabilisationHMA-Monoaxial

Approach

OpenMicrosurgicalMiaspasMiniTTARetractorMiaspasMiniTTAInstrumentsThoracoscopicMiaspasTLEndoscopicTower

T5-T10

MiniTTA

Rib/LungBlade =>RetractionballoonT11-L2

MiniTTA Rib/DiaphragmBlade =>FixationPinforDiaphragmBladeL2-L5 Mini-ALIF RetroperitonealL5-S1 MiniALIF Transperitoneal(MiniTTAFrame)Th8RL

ApproachMicrosurgical-MiniTTA

SetConfigurationMiniTTARetractor (BV148) (SameRetractorasMiaspasmini-ALIF)

MiniTTAInstruments (FG050)

ApproachMicrosurgical-MiniTTA

Disposables1xBV182P Pumpforretractionballon1xBV184P Retractionballon,Size?S“1xBV185P Retractionballon,Size?M“1xBV186P Retractionballon,Size?L“1xBV173S FixationPinforDiaphragmBlade,Size?S“1xBV174S FixationPinforDiaphragmBlade,Size?M“1xBV175S FixationPinforDiaphragmBlade,Size?L“

ApproachMicrosurgical-MiniTTA

ApproachMicrosurgical-MiniTTA

MiaspasTL-?Set“Specificinstrumentsforthoracoscopicapproach configuratedbyDr.Beisse/Dr.Potulski,BGMurnau

ApproachThoracoscopic-MiaspasTL

=higherdemands=easyperformance=outofreachTh3L2Th6L4Th8RL

ApproachThoracoscopic-MiaspasTL

Workingportal

ApproachThoracoscopic-MiaspasTL

OpticchannelRetractorSuction/IrrigationTwinScrew-ConceptMACSTLComponentsClampingElementPolyaxialAnteriorStabilisationScrewStabilisationPlatePolyaxialScrewNutLockingScrewMACSTLComponentsHMAPolyaxialScrewNutLockingScrewStabilisationPlateHMAPolyaxialMACSTLComponentsHMAMonoaxialScrewNutSSESingleRodHMAMonoaxialScrewsFracturesT8-L3AO-classification(Magerl)A-fractureswithlossofanteriorvertebralbodyheight>50%A2.3,A3BandCfractureswithposteriorinstrumentationStenosisTumorsDeformitiesMACSTLIndicationsM,24YA3.1L12CasePresentationTwinScrewa-plateralPre-OpPost-OpCasePresentationTwinScrewa-platerala-plateralCasePresentationHMA-PolyaxialM,52YearsPathologicfractureMACSTLStrengthsCHOICE-DifferentapproachesleadtothegoalOpenapproachMicrosurgicalapproachwithMiniTTAEndoscopicapproachwithMiaspasTLSTABILITY-NomatterwhattheanglePolyaxialmechanism,15°screwmotionRigiddualscrewreinforcementMonocorticalscrewinsertionACCURACY-SafescrewpositioningCannulatedInstrumentsCannulatedImplantsSpecificK-wirefortheendoscopictechniqueAESTHETICS-FormandfunctionLowprofilecompactdesignRoundedgesColorcodedimplantsVERSATILITY-ChooseduetoindicationHMAorTwinScrewconceptPlatessizedfrom45mmto100mmlengthRods,adaptableonpatient’sanatomySOLIDARITY-ConfluenceofapproachandindicationCompatibleapproachandstabilizationsystemOptimizedstockmanagementEconomicpackagesolutionMACSTLStrengthsDr.Beisse/Dr.Potulski/Prof.Bühren BGUMurnau,GermanyDr.Mayer München-Harlaching,GermanyProf.Kinzl UniversityofUlm,GermanyDr.Marnay Montpellier,FranceMACSTLDevelopmentTeamInstrumentsPreparation FW346Insertion FW344ATTENTION:SpecificinstrumentshavetobeorderedseparatelyMACSTLOperationTechniqueStep1AssemblyofK-wireinsertioninstrumentMACSTLOperationTechniqueUsedInstruments:FW330R InsertionInstrumentforK-WireFW338SK-Wire,threadedStep2ReamingofCortexMACSTLOperationTechniqueUsedInstruments:FW339R CanulatedPunch(f.TwinScrews)FW332RCorticalDrill(f.HMA)Step3PreassemblyofPolyaxialScrew/CentraliserMACSTLOperationTechniqueUsedInstruments:FW317R CentralizerFW337RHex-KeyforCentralizerStep4ConnectionofInsertionInstr.MACSTLOperationTechniqueUsedInstruments:FW318R InsertionSleeveFW316RHandlef.InsertionSleeveFW319RCanulatedScrewdriverFW400RRatchetHandleMACSTLOperationTechniqueStep5ScrewInsertion-PositioningofTwinScrewD:7,0mmD:6,5mm1010MACSTLOperationTechniqueStep5ScrewInsertion-PositioningofHMAScrewD:12mm1015Step5ScrewInsertionMACSTLOperationTechniqueUsedInstruments:FW318R InsertionSleeveFW316RHandlef.InsertionSleeveFW319RCanulatedScrewdriverFW400RRatchetHandleStep6K-WireRemovalMACSTLOperationTechniqueUsedInstruments:FW327R RemovalInstrumentforK-WireStep7DisconnectionofInsertionDevice.MACSTLOperationTechniqueStep8DistractionMACSTLOperationTechniqueUsedInstruments:FW323R DistracorRatchetFW324RDistractionBar,shortorFW325RDistractionBar,longFW329R DistractionForcepsStep9Measuring/PlatePositioning.MACSTLOperationTechniqueUsedInstruments:FG045R BoneGraftMeasurementInstr.FW326RHoldingInstr.forRod/PlateStep10aNutPlacementMACSTLOperationTechniqueFW318R InsertionSleeveFW320RNutDriverFW321RHandleforNutDriverStep10bNutTighteningMACSTLOperationTechniqueUsedInstruments:FW316R HandleforInsertionSleeveFW331RTorqueWrenchStep11CentralizerRemovalMACSTLOperationTechniqueUsedInstruments:FW318R InsertionSleeveFW316RHandleforInsertionSleeveFW337RHex-KeyforCentralizerStep12AssemblyinFinalPosition/ScrewInsertionMACSTLOperationTechniqueUsedInstruments:FW319R CanulatedScrewdriverStep13aAttachementofTargetingInstrumentMACSTLOperationTechniqueUsedInstruments:FW335R ScrewGuidingSleeveFW318R InsertionSleeveFW316RHandleforInsertionSleeveFW337RHex-KeyforCentralizerStep13bInsertionofStabilisationScrewMACSTLOperationTechniqueUsedInstruments:FW322R ScrewdriverwithretainingclipFW400R RatchetHandleStep13cRemovalofTargetingInstrumentMACSTLOperationTechniqueUsedInstruments:FW335R ScrewGuidingSleeveFW318R InsertionSleeveFW316RHandleforInsertionSleeveFW337RHex-KeyforCentralizerStep14InsertionofLockingScrewMACSTLOperationTechniqueUsedInstruments:FW322R ScrewdriverwithretainingclipFW400R RatchetHandleFW331RTorqueWrench10NmFinalPositionMACSTLOperationTechniqueBrochure Engl./German/FrenchInstrumentation Engl./GermanVideo

TwinScrew/Thoracoscopic Engl./GermanPublication Engl.

MinimallyInvasiveSpineSurgery H.M.Mayer ISBN3-540-65631-6 =>186(Beisse,Potulski,Bühren)CommunicationBGUMurnauLive-OPWorkshopstation-EndoscopicApproachSuportfromTuttlingenifnecessaryCoordination/KarinKeller

Communication