MISS治疗成人退变性脊柱侧弯.ppt

微创手术治疗成人退变性脊柱侧弯 是否可以改善脊柱平衡 主讲人 成人退变性脊柱侧弯 疼痛 腰痛 根性疼痛功能障碍后凸畸形 AIS 成人退变性脊柱侧弯 缓解神经根性疼痛压迫部位直接 间接减压缓解腰痛局部不稳定 腰椎滑脱 侧向滑移 脊柱整体不稳定改善畸形矢状面失平衡冠状面失平衡改善外观 成人退变性脊柱侧弯的治疗目的 Addingfusiontodecompressiongivesbetterresultsthandecompressionalone Correctingcoronaldeformityisnotasimportantascorrectingsagittaldeformityandmaynotimpactqualityoflife 我们需要矫正多少 LL PI TK 45 20 5cm 0 4 5cm withinSIjoints SagittalImbalance CoronalImbalance Sagittal Coronal 那些是最需要纠正的问题 开放手术的治疗路线图 成人退变性脊柱侧弯 临床结果 成人退变性脊柱侧弯 问题与挑战 骨骼僵硬骨质疏松内科合并症体质虚弱其他关节疾病 29 39 42 AnMISprocedureisonethatbyvirtueoftheextentandmeansofsurgicaltechniqueresultsinlesscollateraltissuedamagedecreaseinmorbiditymorerapidfunctionalrecoverywithoutdifferentiationintheintendedsurgicalgoalMcAfeePC etal Spine2010 s271 MinimallyInvasiveSpineSurgery MIS能不能有效的治疗成人脊柱侧弯 侧方入路治疗成人退变性脊柱侧弯的临床疗效 Conclusions Directlateralinterbodyfusionsignificantlyimprovessegmental regional andglobalcoronalplanealignmentinpatientswithdegenerativelumbardisease AlthoughDLIFincreasesthesegmentalsagittalCobbangleatthelevelofinstrumentation itdoesnotimproveregionallumbarlordosisorglobalsagittalalignment MISDEF路线图 Case1TYF F64 EOS CobbT 6 CobbL 46 C7PL 4 1cm TK 13 1 LL 23 SVA 14 3cm PT 25 SS 37 PI 62 PI LL 39 ClassIIISVA 14 3cmPT 25 LL PIMismatch 39 CobbAngle 43 Stage1DLIF Stage1 DLIF Stage2PPS facetfusion RuijinSpine RuijinSpine RuijinSpine POSTSVA 5 5cmPT 15 LL PIMismatch 22 CobbAngle 14 DLIF pPSF ClassIIISVA 14 3cmPT 25 LL PIMismatch 39 CobbAngle 43 ClassIISVA 8 9cmPT 20 LL PIMismatch 24 CobbAngle 34 12mfollow up Case2YAMF61 CobbT 19 CobbL 30 PO 1 6 C7PL 1 8cmTK 37 4 LL 21 3 SVA 12cmPT 29 SS 25 PI 54 PI LL 32 7 ClassIIISVA 12cmPT 29 LL PIMismatch 32 7 CobbAngle 30 L3 4 L4 5 CobbT 8 CobbL 11 PO 1 5 C7PL 3cmTK 30 LL 30 SVA 5 6cmPT 25 5 SS 23 PI 48 5 PI LL 18 5 CobbT 6 8 CobbL 4 PO 1 9 C7PL 3 4cmTK 22 4 LL 36 SVA 5 2cmPT 19 SS 24 PI 43 PI LL 7 Post 2ndop Case3LJH F71 CobbT 33 CobbL 34 PO 1 6 TK 25 LL 15 SVA 2 1cmPT 22 SS 18 PI 41 PI LL 26C7PL5 0cm Stage1DLIF CobbT 16 CobbL 19 TK 19 LL 21 SVA 4 1cmPT 1 SS 39 PI 38 PI LL 17C7PL3 0cm CobbT 18 CobbL 16 TK 18 LL 40 SVA 1 5cmPT 2 SS 39 PI 41 PI LL 1C7PL1 0cm Yes MIS与开放手术结合 杂交手术 PICsbyMWang Hybridsurgery CasebyTaha Summary 对于适用的患者 MISS可以有效的改善退变性侧弯