脊柱截骨-課件

脊柱畸形截骨術成人嚴重的僵硬的脊柱畸形，包括冠狀位和失狀位的畸形。通過截骨最終取得失狀位和冠狀位的平衡，緩解疼痛，堅固的融合及預防進一步畸形。

脊柱畸形截骨術成人嚴重的僵硬的脊柱畸形，包括

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゜

失狀位失衡1、節(jié)段性tape1（segmental）:SVA

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)

失狀位失衡截骨方式Posterior-only

Ponteosteotomy,Smith-Petersenosteotomy(SPO)removalofposteriorligamentsandfacetsPonteosteotomy,Smith-Peterwidefacetectomytopreventnerverootimpingementosteotomysitecanbedoneasymmetricallytocorrectcoronalimbalanceaswellassagittalimbalancewidefacetectomytopreventne9.3–10.7perlevel.substantialcorrection,itmaybenecessarytograftthediscspaceanteriorlyType1along,rounded,smoothkyphosisSVAintherangeof6–8cmpositive.easierandsaferthanotherosteotomies;9.3–10.7perlevel.Pediclesubtractionosteotomy(PSO)Thomasenin1985.Heiningetaleggshellosteotomy.Pediclesubtractionosteotomy30to40correctionthroughallthreecolumns,whileavoidingstretchvesselsandvisceraanteriortothespine;Ifperformedinanasymmetricfashion,providesignificantcoronalcorrectionaswell;30to40correctiontype2sagittaldeformity(SVA>12cm),sharp,angularkyphosisetl；type2sagittaldeformity(SVAAwidelaminectomyisperformedOsteotomylinehorizontaltothesacrumPlacingthetemporaryrodclosedovertherodswhilethehipsandkneesarehyperextendedAwidelaminectomyisperformInterbodyfusioncanbedoneaseitheraTLIForanALIFprocedureInterbodyfusioncanbedoneaBone-disc-boneosteotomy(BDBO)

correctionrates35°to60°Themainindicationsaredeformitieswiththediscspaceastheapexorcenterofrotationalaxis(CORA)andseveresagittalplanedeformitiesBone-disc-boneosteotomy(BDBOType1bone-disc-boneosteotomy(BDBO).Type1bone-disc-boneosteotomType2BDBO.Type2BDBO.Type3BDBO.Type3BDBO.pediclescrewsatleasttwolevelsbelowandthreelevelsaboveAtitaniummeshcagecanbeplacedanteriorlyifdesired.pediclescrewsatleasttwoleVertebralcolumnresection（VCR）in1922byMacLennanindicatedforrigidmultiplanardeformities,

sharpangulateddeformities,emivertebraresections,resectablespinaltumours,posttraumaticdeformities,andspondyloptosis.

Vertebralcolumnresection（VCR脊柱截骨-課件

脊柱畸形截骨術成人嚴重的僵硬的脊柱畸形，包括冠狀位和失狀位的畸形。通過截骨最終取得失狀位和冠狀位的平衡，緩解疼痛，堅固的融合及預防進一步畸形。

脊柱畸形截骨術成人嚴重的僵硬的脊柱畸形，包括

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゜

失狀位失衡1、節(jié)段性tape1（segmental）:SVA

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)

失狀位失衡截骨方式Posterior-only

Ponteosteotomy,Smith-Petersenosteotomy(SPO)removalofposteriorligamentsandfacetsPonteosteotomy,Smith-Peterwidefacetectomytopreventnerverootimpingementosteotomysitecanbedoneasymmetricallytocorrectcoronalimbalanceaswellassagittalimbalancewidefacetectomytopreventne9.3–10.7perlevel.substantialcorrection,itmaybenecessarytograftthediscspaceanteriorlyType1along,rounded,smoothkyphosisSVAintherangeof6–8cmpositive.easierandsaferthanotherosteotomies;9.3–10.7perlevel.Pediclesubtractionosteotomy(PSO)Thomasenin1985.Heiningetaleggshellosteotomy.Pediclesubtractionosteotomy30to40correctionthroughallthreecolumns,whileavoidingstretchvesselsandvisceraanteriortothespine;Ifperformedinanasymmetricfashion,providesignificantcoronalcorrectionaswell;30to40correctiontype2sagittaldeformity(SVA>12cm),sharp,angularkyphosisetl；type2sagittaldeformity(SVAAwidelaminectomyisperformedOsteotomylinehorizontaltothesacrumPlacingthetemporaryrodclosedovertherodswhilethehipsandkneesarehyperextendedAwidelaminectomyisperformInterbodyfusioncanbedoneaseitheraTLIForanALIFprocedureInterbodyfusioncanbedoneaBone-disc-boneosteotomy(BDBO)

correctionrates35°to60°Themainindicationsaredeformitieswiththediscspaceastheapexorcenterofrotationalaxis(CORA)andseveresagittalplanedeformitiesBone-disc-boneosteotomy(BDBOType1bone-disc-boneosteotomy(BDBO).Type1bone-disc-boneosteotomType2BDBO.Type2BDBO.Type3BDBO.Type3BDBO.pediclescrewsatleasttwolevelsbelowandthreelevelsaboveAtitaniummeshcagecanbeplacedanteriorlyifdesired.pediclescrewsatleasttwoleVerteb