微创与开放手术治疗I-II度腰椎滑脱症PPT参考幻灯片

,广州中医药大学第一附属医院脊柱专科,微创与开放手术治疗I-II度腰椎滑脱症,1,历史沿革,来自希腊语：spondylo(椎体)和Listhesis(滑移)集合而成。1782年Herbinlaux最先描述了腰5椎体前滑脱病例。1854年Kilian首先定义脊柱滑脱症(spondylisthesis):“一椎体在另一椎体上部分或完全的滑移”。1957年Taillard将脊柱滑脱症定义为“由于关节突间连续断裂或延长而引起椎体与其椎弓根、横突和上关节突一同向前滑移。”,2,流行性病学,FredricksonBE,etal.Thenaturalhistoryofspondylolysisandspondylolisthesis.JBoneJointSurgAm1984,500participants,3,JacobsensDegenerativeLumbarSpondylolisthesis:AnEpidemiologicalPerspective.spine.2007,4151participants，M：1533、F：2618254cases(11.1%),M(1.5%):F(5.9%),M(0.7%):F(1.2%),4,KalichmanL，KinmDH,LiL,etal.SpondylolysisandSpondylolisthesis.PrevalenceandAssociationWithLowBackPainintheAdultCommunity-BasedPopulation.spine.2009,3529participants，CT:11.5%,5,腰椎滑脱的Wiltse分型,WiltseLL，NewmanPH,MacNabI.Classificationofspondylolysisandspondylolisthesis.ClinOrthop,1976,117:23-29.,6,腰椎滑脱程度（Meyerding分型，1932）,MeyerdingHW.Spondylolisthesis:surgicaltreatmentandresultsJ.SurgGynecolObstet,1932,54:371-37,I,II,III,IV,V,7,症状,马尾综合症,8,滑脱进展,LabelleH,Mac-ThiongJM,RoussoulyP.Spino-pelvicsagittalbalanceofspondylolisthesis:areviewandclassicationEurSpineJ,2011,9,滑脱进展,申勇.中国矫形外科杂志,2005,40y,43y,45y,10,滑脱进展,11,滑脱进展主要因素,PIBMIAngleoflordosisBilateralparsdefects,Jacobsens.spine.2007,LabelleH,EurSpineJ,2011BeutlerWJ,Spine,2003,PI,12,手术治疗指征,持续或反复发作的腰腿痛、间歇性跛行,严重影响日常生活,经合理的非手术治疗(3个月或3个月以上)无效者;神经功能障碍进行性加重者;出现大小便功能异常者,13,手术与非手术治疗,2-4年随访，LDS手术疗效优于非手术,14,开放性手术,15,开放手术,优点学习曲线短显露充分、视野大,缺点椎旁肌肉损伤多住院时间长出血多创伤大风险高,16,微创手术,17,微创手术,优点创伤小住院时间短出血小术后疼痛轻康复快并发症少,缺点学习曲线长，难掌握对手术者技术要求高，手术难度大要求手术者有良好的三维解剖知识需要专用器械，增加手术成本暴露不充分，视野小,18,微创VS开放：腰椎滑脱？,Open,Mini,Whoisbest?,19,（PLIF）微创VS开放：长期疗效,20,（PLIF）微创VS开放：长期疗效,21,（TLIF）微创VS开放：疗效,Conclusion：Minimallyinvasivesurgery（TLIF）forsevereSDS（I-IIgrade）leadstoadequateandsafedecompressionoflumbarstenosisandresultsinafasterrecoveryofsymptomsanddisabilityintheearlypostoperativeperiod.,22,（PLF）微创VS开放：疗效,Conclusion：TheMIS-PLFutilizingapercutaneouspediclescrewsystemhadlessinvasive,lesspostoperativepain,rapidimprovementofseveralfunctionalparameterscomparedtoconventionalopen-PLF.ThissuperiorityintheMIS-PLFgroupwasmaintaineduntil2yearspostoperatively,suggestingthatlessinvasivePLFoffersbettermid-termresultsintermsofreducinglowbackpainandimprovingpatientsfunctionalcapacityofdailyliving.,23,（PLF）微创VS开放：疗效,24,（ALIF+TLIF）微创VS开放：并发症,Conclusion:MIS(ALIF+TLIF)hadlessbloodloss,lessneedfortransfusionintheperioperativeperiod,andashorterhospitalstaythanopen(ALIF+TLIF),butthelengthofsurgery,intraoperativeuoroscopytime,malpositionedinstrumentationonpostoperativeimaging,andpostoperativecomplications,includingpulmonaryembolusandsurgicalsiteinfectionnodifference.,25,（P/TLIF）微创VS开放：感染率,Conclusions：Inthismultihospitalstudy,theMItechnique（P/TLIF）wasassociatedwithadecreasedincidenceofperioperativeSSI(274.6%vs1507.0%,p=0.037)in2-levelfusion.TherewasnosignificantdifferenceintheincidenceofSSIs(384.5%vs774.8%,p=0.77)betweentheopenandMIcohortsfor1-levelfusionprocedures.,26,(PLIF)微创VS开放：多裂肌损伤,27,微创VS开放：多裂肌损伤,28,微创VS开放：费效分析,CONCLUSIONS:MISTLIFresultedinreducedoperativebloodloss,hospitalstayand2-yearcost,andacceleratedreturntowork.Surgicalmorbidity,hospitalreadmission,andshort-andlong-termclinicaleffectivenessweresimilarbetweenMISandopenTLIF.MISTLIFmayrepresentavaluableandcost-savingadvancementfromasocietalandhospitalperspective.,29,微创VS开放：住院时间短、费用少,30,（TLIF）微创VS开放：Meta分析,31,Mini-TLIFVSmini-ALIF：疗效,32,Mini-TLIFVSmini-ALIF：疗效,MALIF,MTLIF,33,Mini-TLIFVSmini-ALIF：疗效,Conclusions：Consideringtheclinicalandradiologicaloutcomesinbothgroups,theauthorsrecommendthatinstrumentedmini-TLIFispreferableattheL45level,whereasinstrumentedmini-ALIFmightbeprefe