脊柱截骨的教案

脊柱截骨的教案第1頁/共22頁

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第3頁/共22頁失狀位失衡1、節(jié)段性tape1（segmental）:SVA<5cm2、整體性tape2（global）:SVA>5cmwithoutkneeflexionorhiphyperextension

IdealsagittalalignmentisdescribedasSVA<50mm,PT<25゜,PI–LL=10゜

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失狀位失衡截骨方式Posterior-only

1、Smith-Petersenosteotomy(SPO)2、pediclesubtractionosteotomy(PSO)3、bone-disc-boneosteotomy(BDBO)4、vertebralcolumnresection(VCR)第5頁/共22頁Ponteosteotomy,Smith-Petersenosteotomy(SPO)removalofposteriorligamentsandfacets第6頁/共22頁widefacetectomytopreventnerverootimpingementosteotomysitecanbedoneasymmetricallytocorrectcoronalimbalanceaswellassagittalimbalance第7頁/共22頁9.3–10.7perlevel.substantialcorrection,itmaybenecessarytograftthediscspaceanteriorlyType1along,rounded,smoothkyphosisSVAintherangeof6–8cmpositive.easierandsaferthanotherosteotomies;第8頁/共22頁Pediclesubtractionosteotomy(PSO)Thomasenin1985.Heiningetaleggshellosteotomy.第9頁/共22頁30to40correctionthroughallthreecolumns,whileavoidingstretchvesselsandvisceraanteriortothespine;Ifperformedinanasymmetricfashion,providesignificantcoronalcorrectionaswell;第10頁/共22頁type2sagittaldeformity(SVA>12cm),sharp,angularkyphosisetl；第11頁/共22頁AwidelaminectomyisperformedOsteotomylinehorizontaltothesacrumPlacingthetemporaryrodclosedovertherodswhilethehipsandkneesarehyperextended第12頁/共22頁InterbodyfusioncanbedoneaseitheraTLIForanALIFprocedure第13頁/共22頁Bone-disc-boneosteotomy(BDBO)

correctionrates35°to60°Themainindicationsaredeformitieswiththediscspaceastheapexorcenterofrotationalaxis(CORA)andseveresagittalplanedeformities第14頁/共22頁Type1bone-disc-boneosteotomy(BDBO).第15頁/共22頁Type2BDBO.第16頁/共22頁Type3BDBO.第17頁/共22頁pediclescrewsatleasttwolevelsbelowandthreelevelsaboveAtitaniummeshcagecanbeplacedanteriorlyifdesired.第18頁/共22頁Vertebralcolumnresection（VCR）in1922byMacLennanindicatedforrigidmultiplanardeformities,

sharpangulateddeformities,emivertebraresections,resectablespinaltumours,p