脊柱截骨的教案

脊柱截骨的教案第1頁(yè)/共22頁(yè)

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第3頁(yè)/共22頁(yè)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(yè)/共22頁(yè)P(yáng)onteosteotomy,Smith-Petersenosteotomy(SPO)removalofposteriorligamentsandfacets第6頁(yè)/共22頁(yè)widefacetectomytopreventnerverootimpingementosteotomysitecanbedoneasymmetricallytocorrectcoronalimbalanceaswellassagittalimbalance第7頁(yè)/共22頁(yè)9.3–10.7perlevel.substantialcorrection,itmaybenecessarytograftthediscspaceanteriorlyType1along,rounded,smoothkyphosisSVAintherangeof6–8cmpositive.easierandsaferthanotherosteotomies;第8頁(yè)/共22頁(yè)P(yáng)ediclesubtractionosteotomy(PSO)Thomasenin1985.Heiningetaleggshellosteotomy.第9頁(yè)/共22頁(yè)30to40correctionthroughallthreecolumns,whileavoidingstretchvesselsandvisceraanteriortothespine;Ifperformedinanasymmetricfashion,providesignificantcoronalcorrectionaswell;第10頁(yè)/共22頁(yè)type2sagittaldeformity(SVA>12cm),sharp,angularkyphosisetl；第11頁(yè)/共22頁(yè)AwidelaminectomyisperformedOsteotomylinehorizontaltothesacrumPlacingthetemporaryrodclosedovertherodswhilethehipsandkneesarehyperextended第12頁(yè)/共22頁(yè)InterbodyfusioncanbedoneaseitheraTLIForanALIFprocedure第13頁(yè)/共22頁(yè)Bone-disc-boneosteotomy(BDBO)

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

sharpangulateddeformities,emivertebraresections,resectablespinaltumours,p