脊柱截骨.ppt

脊柱畸形截骨術(shù) 成人嚴(yán)重的僵硬的脊柱畸形 包括冠狀位和失狀位的畸形 通過(guò)截骨最終取得失狀位和冠狀位的平衡 緩解疼痛 堅(jiān)固的融合及預(yù)防進(jìn)一步畸形 失狀位失衡 1 節(jié)段性tape1 segmental SVA5cmwithoutkneeflexionorhiphyperextensionIdealsagittalalignmentisdescribedasSVA 50mm PT 25 PI LL 10 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 Ponteosteotomy Smith Petersenosteotomy SPO removalofposteriorligamentsandfacets widefacetectomytopreventnerverootimpingementosteotomysitecanbedoneasymmetricallytocorrectcoronalimbalanceaswellassagittalimbalance 9 3 10 7perlevel substantialcorrection itmaybenecessarytograftthediscspaceanteriorlyType1along rounded smoothkyphosisSVAintherangeof6 8cmpositive easierandsaferthanotherosteotomies Pediclesubtractionosteotomy PSO Thomasenin1985 Heiningetaleggshellosteotomy 30to40correctionthroughallthreecolumns whileavoidingstretchvesselsandvisceraanteriortothespine Ifperformedinanasymmetricfashion providesignificantcoronalcorrectionaswell type2sagittaldeformity SVA 12cm sharp angularkyphosisetl AwidelaminectomyisperformedOsteotomylinehorizontaltothesacrumPlacingthetemporaryrodclosedovertherodswhilethehipsandkneesarehyperextended InterbodyfusioncanbedoneaseitheraTLIForanALIFprocedure Bone disc boneosteotomy BDBO correctionrates35 to60 Themainindicationsaredeformitieswiththediscspaceastheapexorcenterofrotationalaxis CORA andseveresagittalplanedeformities Type1bone disc boneosteotomy BDBO Type2BDBO Type3BDBO pediclescrewsatleasttwolevelsbelowandthreelevelsaboveAtitaniummeshcagecanbeplacedanteriorlyifdesired Vertebralcolumnresection VCR in1922byMacLennanindicatedforrigidmultiplanardeformities sharpangulateddeformities