脊柱截骨.ppt

脊柱畸形截骨术 成人严重的僵硬的脊柱畸形 包括冠状位和失状位的畸形 通过截骨最终取得失状位和冠状位的平衡 缓解疼痛 坚固的融合及预防进一步畸形 失状位失衡 1 节段性tape1 segmental SVA5cmwithoutkneeflexionorhiphyperextensionIdealsagittalalignmentisdescribedasSVA 50mm PT 25 PI LL 10 失状位失衡截骨方式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