迷你偏侧椎板切除术

Mini-Hemilaminectomy迷你偏侧椎板切除术for

thoracolumbar

intervertebral

disc

disease用于胸腰椎椎间盘疾病Thomas

FlegelDACVIM

(Neurology),

DECVNUNIVERSITY

of LEIPZIG,

GERMANYDepartment

of

Small

Animal

MedicineMarie-Kerstin

MüllerDo

youwant

to

play

with

me?想来一起玩嘛？Don‘t

you

not

want

to:1.play

soccer

踢足球你难道不想eat

icecream

吃冰激凌watch

TV

看电视A:only

1

and

2

are

correct

只有1和2是对的B:only

3

is

correct

只有3是对的C:all

answers

are

wrong

所有答案都错Do

you

remember

anything

of

yesterday?还记得昨天的东西吗？When

should

you

switch

to

a

diamond

burr

head

duringdrillingof

the

hemilaminectomy

opening?在钻磨偏侧椎板切除术的开口时，何时更换

钻头？Aduring

the

entire

process

of

drilling

if

you

are

a

beginner如果是新手，应在整个钻磨的过程中once

the

outer

cortical

layer

has

been

drilled

away当最外层的皮质骨磨走之后once

the

layer

of

cancellous

bone

has

been

drilled

away当松质骨被磨去之后once

the

layerof

inner

cortical

bone

has

been

drilled

away当内层的皮质骨被磨去之后BCDWhen

should

you

switch

to

a

diamond

burr

head

duringdrillingof

the

hemilaminectomy

opening?在钻磨偏侧椎板切除术的开口时，何时更换

钻头？Aduring

the

entire

process

of

drilling

if

you

are

a

beginner如果是新手，应在整个钻磨的过程中once

the

outer

cortical

layer

has

been

drilled

away当最外层的皮质骨磨走之后once

the

layer

of

cancellous

bone

has

been

drilled

away当松质骨被磨去之后once

the

layer

of

inner

corical

bone

has

been

drilled

away当内层的皮质骨被磨去之后BCDThomas

FlegelDACVIM

(Neurology),

DECVNUNIVERSITY

of LEIPZIG,

GERMANYDepartment

of

Small

Animal

MedicineMarie-Kerstin

MüllerMini-Hemilaminectomy迷你偏侧椎板切除术for

thoracolumbar

intervertebral

disc

disease用于胸腰椎椎间盘疾病Mini-hemilaminectomy

迷你偏侧椎板切除术••Mini-hemilaminectomy

迷你偏侧椎板切除术hemilaminectomy偏侧椎板切除术removal

of

articular

facet

andpartially

one

site

of

the

vertebrallamina

(vertebral

arch)去除关节面和椎板的一部分（椎弓）mini-hemilaminectomy迷你偏侧椎板切除术one

site

of

the

vertebral

lamina(vertebral

arch)

only仅去除椎板一部分（椎弓）Mini-hemilaminectomy迷你偏侧椎板切除术dorsal

spinal

processus背侧棘突articular

facet关节面transverse

process横突mini-hemilaminectomy迷你偏侧椎板切除术Required

level

of

expertise

专业技术要求Atlantoaxial

stabilisationSpinal

fracture/luxation

repairCervical

distraction/fusionLumbosacral

foraminotomyPartial

lateral

corpectomyVentral

slotDorsal

laminectomyMini-hemilaminectomyHemilaminectomy寰枢椎稳定术脊椎骨折／脱位修复颈椎牵引／融合腰骶椎间孔切开术部分侧椎体次全切除术腹侧开窗术背侧椎板切除术迷你偏侧椎板切除术偏侧椎板切除术Mini-hemilaminectomy:

pros

and

conscompared

to

hemilaminectomy迷你偏侧椎板切除术与偏侧椎板切除术相比的优缺点Pro:more

ventral

access

to

the

spinal

c and

therefore

easier

toremove

ventrally

located

material更接近于椎管的腹侧，从而可较容易的去除腹侧的椎间盘物质easier

to

perform

sufficient

disc

fenestration

from

that

approach这一方法更容易获得足够的进入椎间盘的入路slightly

less

tissue

trauma组织

较少less

spinal

instability

(?)更少脊柱不稳定性（？）Con:slightly

more

demanding

than

hemilaminectomy技术要求较高poorer

visualisation

of

the

surgical

area

than

in

hemilaminectomy术野较差Mini-hemilaminectomy

–

hemilaminectomy迷你偏侧椎板切除术——偏侧椎板切除术residual

discmaterial

notremoved

bysurgery:手术无法去除的椎间盘物质残余量hemilaminectomy:13.6%偏侧椎板切除术mini-hemilamin.:7.7%迷你偏侧椎板切除术no

statisticaldifference无统计学差异Surgery:

2

different

approaches手术：两种不同的入路Surgery:

positioning

on

the

table手术：动物摆位lateral

recumbency侧卧保定table

tilted

towardssurgeon手术台向术者倾斜lateral

recumbency侧卧保定patient‘s

backelevated

usingcushions用垫子将患畜的背部抬高sternal

recumbency俯卧保定Patient

supported

onboth

sides

usingcushions用垫子支持患畜两侧table

tilted

away

fromsurgeon手术台远离术者倾斜Surgery:

positioning

on

the

table手术：手术台上的保定•••••Surgery:

preparation

and

skin

incision手术：准备和皮肤切开••••Surgery:

preparation

and

skin

incision手术：准备和皮肤切开•Surgery:

preparation

and

skin

incision手术：准备和皮肤切开Surgery:

fat

separation手术：脂肪分离•Surgery:

fat

separation手术：脂肪分离••Surgery:check

correct

disc手术：检查正确的椎间盘Surgery:

fascia

incision手术：筋膜切开•••Surgery:

muscle

preparation手术：肌肉准备aim or

theaccessoryprocess找到并定位副突Surgery:

muscle

preparation手术：肌肉准备aim or

theaccessoryprocess找到并定位副突Surgery:

place

retractors手术：放置牵开器lateral

surface

ofvertebral

body椎体的外侧面tendon

of

longissmusmuscle

inserting

at

theaccessory

process背最长肌的肌腱在副突位置的附着点spinal

nerve

脊神经accessoryprocess副突articular

facet关节面Surgery:

place

retractors手术：放置牵开器lateral

surface

ofvertebral

body椎体的外侧面tendon

of

longissmusmuscle

inserting

at

theaccessory

process背最长肌的肌腱在副突位置的附着点spinal

nerve

脊神经accessoryprocess副突articular

facet关节面Surgery:

accessory

process手术：附属步骤•Surgery:

handling

of

the

burr手术：钻头的操作•••Surgery:

flushing

and

suction手术：冲洗和吸引Surgery:

start

drilling手术：开始钻磨outline

your

anticipated

opening

using

a

rose

head

burr用球钻头勾勒出计划进行的开口轮廓dorsal

limit:

remove

the

accesssory

process,

but

leave

thearticuar

facet

intact背侧界限：去除副突，但要保留完整的关节面Surgery:

start

drilling手术：开始钻磨outline

your

anticipated

opening

using

a

rose

head

burr用球钻头勾勒出计划进行的开口轮廓dorsal

limit:

remove

the

accesssory

process,

but

leave

thearticuar

facet

intact背侧界限：去除副突，但要保留完整的关节面Surgery:

keep

drilling手术：继续钻磨••Surgery:

removal

of

accessory

process手术：切除副突y

using

the

drill

or

a

rongeurremove

accessory

process

comple用钻头或咬骨钳将副突完全去除if

you

don‘t

do

so,

you

may

risk

a

fracture

and

concurrent

spinalcord

compression

later如果不怎么做，可能会有骨折以及并发脊髓

的风险Surgery:

removing

final

bone

shelf手术：去除最内层骨••Surgery:

removing

final

bone

shelf手术：去除最内层骨••Surgery:

removing

herniated

disc手术：去除脱出的椎间盘••Surgery:

coverage

of

the

spinalcord手术：脊髓覆盖••Surgery:

closure手术：创口闭合••Surgery:

closure手术：创口闭合subcutis:

simple

interrupted

suture,

absorbable皮下组织：单纯间断缝合，可吸收缝线follow

the

following

principle

in

order

to

burry

the

knot

deepinsight:

遵从下列原则以将线结埋藏于创口深部from

inside

to

outside

on

one

side and

from

outside

to

insideon

the

other

side创口的一侧缝线自内向外穿出，并在另一侧自外向内穿入Surgery:

closure手术：创口闭合•Surgery:

what

about

additional

fenestrations?手术：需要进行额外的开窗术嘛？在治疗犬胸腰椎椎间盘疝时进行单一开窗术和多位点开窗术的复发率比较结论：对于小型犬的IVDH而言，采取多重开窗术可降低复发率Mini-hemilaminectomy

迷你偏侧椎板切除术hemilaminectomy偏侧椎板切除术mini-hemilaminectomy迷你偏侧椎板切除术Morelius

et

al.2007

(JSAP)Surgery:

How

to

perform

fenestration?手术：如何进行开窗术？the

disc

is

located

directly

cranial

of

thebase

of

the

transverse

process

and

cranialof

the

nerve椎间盘位于横突基部正前方，脊神经的头侧identify

the

disc

onthe

lateral

surface

ofthe

vertebral

body

using

a

needle

(were

isit

soft?)用注射针头在椎体的外侧面确定椎间盘的位置（柔软的地方）remove

the

muscle

attaching

lateral

to

thevertebral

body

in

that

area

asmuch

aspossible

using

a

periostal

elevator用骨膜剥离器尽可能的去除这一区域内附着于椎体的肌肉Surgery:

How

to

perform

fenestration?手术：如何进行开窗术make

a

square

incisionin