【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术

MinimallyInvasiveTransforaminalLumbarInterbodyFusion(TLIF)

DRSEANG-BENGTAN

HEAD,DEPTOFORTHOPAEDICS

DIRECTOR,SPINESERVICE

SINGAPOREGENERALHOSPITAL

微创经椎间孔入路腰椎体间融合术

新加坡中央医院MinimallyInvasiveTransforaAimofMIS

微创的目的Accomplishsurgicalgoalsthroughsmallincisionsandminimaldisruptionofnormaltissues以小切口达到手术的目的，并对正常组织造成最少的伤害。AimofMIS

微创的目的AccomplishsurPrinciplesofMinimallyInvasiveSpinalSurgery

微创脊椎手术的原则DecompressandstabilizethespineReducethe“surgicalinjury”tonormaltissuesLimitretractionofmuscle减压并保持脊椎稳定减少对正常组织的伤害减少对肌肉的拉扯PrinciplesofMinimallyInvasiReducebloodlossImproverecoverybyreducingpostoperativepain减少失血量减轻术后疼痛，以使病人尽快康复。PrinciplesofMinimallyInvasiveSpinalSurgery

微创脊椎手术的原则ReducebloodlossPrinciplesofNewAdvancesinTLIF

经椎间孔入路腰椎体间融合术的最新动向PercutaneousdecompressionandcageplacementwithPipelineandothertubesystemsPercutaneouspediclescrewfixationusingViper,Sextant,Pathfinder经皮穿刺减压和利用工作通道来放置椎间融合器利用Viper,Sextant,Pathfinder，经皮植入椎弓根螺钉。NewAdvancesinTLIF

经椎间孔入路腰椎体StrategiestoAvoidComplicationswithMIS

微创手术中减少并发症的策略Training培训Patientselection选择适当的病人Setup设备Access入路Pediclescrewplacement椎弓根螺钉的植入Misc

其他策略StrategiestoAvoidComplicatiTraining

培训THEREISALEARNINGCURVE!!学习的过程CadaverworkshopsViewcaseswithsurgeonwelltrainedinapplyingthesetechniquesStartslowlyandworkuptomorecomplexcases在尸体上练习在熟练医生进行这类手术时观摩循序渐进，慢慢地过渡到复杂的手术。Training

培训THEREISALEARNINGTraining

培训Startbigandmovesmaller-graduallyreduceincisionsizeStartinthelumbarspineBecomecomfortablewithmicrodiscectomyfirstLearnkyphoplasty由大的切口开始，慢慢地缩小切口由腰椎开始先从熟悉显微椎间盘切除术入手学习球囊扩张椎体后凸成形术Training

培训StartbigandmovePatientSelection

选择适当的病人MISfusionpatients–primarilyonesegmentdiseaseDDD–somediscspacepreservationGrade1tolowGrade2spondylolisthesisBewareofL5-S1(sacrumsometimehardtovisualizepediclescrewtargeting)微创融合术的病人–由单间隙的病患开始椎间盘退化-椎间距离不宜太小第一级的腰椎滑脱或轻微第二级的腰椎滑脱小心L5-S1间隙（在骶骨植入椎弓根螺钉会比较困难）PatientSelection

选择适当的病人MISfStartwithrelativelythinindividualswithgoodbonequalityObesityandosteoporosis–difficulttovisualizebonyanatomyadequately从骨质相对比较好和较廋的病人开始肥胖和骨质疏松症–使骨骼较难充分暴露PatientSelection

选择适当的病人Startwithrelativelythinind【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术TLIFAccess

椎间融合器入路WorkingZone操作区域Accessosteotomy入路截骨TLIFAccess

椎间融合器入路WorkingZonDecompresstheipsilateralside,thenputinthelargestcage,beforedecompressingcontralateralside.

同侧减压先。然后，在另一侧减压前，植入最大的椎间融合器。Decompresstheipsilateralsid【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术Nerve神经Pediclescrewplacement植入椎弓根螺钉NervePediclescrewplacementPercutaneousScrewAngulation经皮调整螺钉的角度MOVELATERAL!向外侧移动！PercutaneousScrewAngulationMStartingPoint起点StartingPointPedicleMidPoint植入椎弓中途PedicleMidPointThruthePedicle完全植入ThruthePedicle【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术Ensurescrewheadsareatthesamelevel

螺钉头要固定在同一水平线上Ensurescrewheadsareatthe【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术微创和开放性经椎间孔入路腰椎体间融合术的

6个月与2年随访调查SpineService,OrthopaedicSurgerySingaporeGeneralHospital脊椎专科，矫形外科新加坡中央医院ProspectiveTrialofMISTLIFVsOPENTLIF–6Months&2yearsResult微创和开放性经椎间孔入路腰椎体间融合术的

6个月与2年随访调

MIS微创OPEN开放型Age年龄(years)58.458.5Sex性别

(F:M)(女:男)116:6512:3Fluoroscopytime透视时间1min45secs35secsDurationofSurgery

手术时间（小时）3:19(range:2:15–4:40)2:40(range:2–3:55)Bloodloss失血量200ml500ml

MISOPENAge年龄(years)58.458.5

MIS微创OPEN开放性Lengthofhospitalisation(days)住院时间（天）4.4(range:2–9)6.0(range:5-7)VAS:POD/DISCHARGE视觉模拟疼痛评分：术后/出院5.0/1.06.0/2.6TotalMorphine(PCA,mg)吗啡(止痛药）剂量17.435.7Ambulation:Room/Ward(POD)术后第几天开始步行1.0/2.03/4

MISOPENLengthofhospitalisatNorthAmericanSpineScore

BackPain&DisabilityScore

北美脊椎协会评分标准疼痛及残疾指数BACKPAIN&DISABILITY(Range0to100)0=Nobackpainordisability100=Maximumbackpainordisability疼痛及残疾指数(0至100分)0=没有疼痛或残疾100=非常疼痛或极度残疾开放性微创术前术后六个月术后两年NorthAmericanSpineScore

BacNorthAmericanSpineScore

NeurogenicSymptomScore

北美脊椎协会评分标准

神经性症状指数NEUROGENICSYMPTOMS(Range0to100)0=Noneurogenicsymptoms100=Severeneurogenicsymptoms开放性微创术前术后六个月神经性症状指数(0至100分)0=没有神经性症状100=极度神经性症状术后两年NorthAmericanSpineScore

NeuNorthAmericanSpineScore(6mths)

北美脊椎协会评分标准

到现在为止,手术符合你的要求吗?(术后六个月)开放性微创符合多多少少不符合NorthAmericanSpineScore(6mNorthAmericanSpineScore(2yrs)

北美脊椎协会评分标准

到现在为止,手术符合你的要求吗?(术后两年)开放性微创符合多多少少不符合NorthAmericanSpineScore(2yNorthAmericanSpineScore(6mths)

北美脊椎协会评分标准

你怎样评价手术对治疗你的腿或背痛的疗效?(术后六个月)开放性微创优中差NorthAmericanSpineScore(6mNorthAmericanSpineScore(2yrs)

北美脊椎协会评分标准

你怎样评价手术对治疗你的腿或背痛的疗效?(术后两年)开放性微创优中差NorthAmericanSpineScore(2yNorthAmericanSpineScoreReturntoFullFunction

北美脊椎协会评分标准病人恢复工作能力开放性微创术后六个月术后两年NorthAmericanSpineScoreRetVisualAnaloguePainScaleBackpain

视觉模拟疼痛评分背痛开放性微创术前术后六个月平均分数术后两年VisualAnaloguePainScaleBacVisualAnaloguePainScaleLeg

pain

视觉模拟疼痛评分腿痛开放性微创术前术后六个月平均分数术后两年VisualAnaloguePainScaleLegThankYou谢谢！ThankYou

MinimallyInvasiveTransforaminalLumbarInterbodyFusion(TLIF)

DRSEANG-BENGTAN

HEAD,DEPTOFORTHOPAEDICS

DIRECTOR,SPINESERVICE

SINGAPOREGENERALHOSPITAL

微创经椎间孔入路腰椎体间融合术

新加坡中央医院MinimallyInvasiveTransforaAimofMIS

微创的目的Accomplishsurgicalgoalsthroughsmallincisionsandminimaldisruptionofnormaltissues以小切口达到手术的目的，并对正常组织造成最少的伤害。AimofMIS

微创的目的AccomplishsurPrinciplesofMinimallyInvasiveSpinalSurgery

微创脊椎手术的原则DecompressandstabilizethespineReducethe“surgicalinjury”tonormaltissuesLimitretractionofmuscle减压并保持脊椎稳定减少对正常组织的伤害减少对肌肉的拉扯PrinciplesofMinimallyInvasiReducebloodlossImproverecoverybyreducingpostoperativepain减少失血量减轻术后疼痛，以使病人尽快康复。PrinciplesofMinimallyInvasiveSpinalSurgery

微创脊椎手术的原则ReducebloodlossPrinciplesofNewAdvancesinTLIF

经椎间孔入路腰椎体间融合术的最新动向PercutaneousdecompressionandcageplacementwithPipelineandothertubesystemsPercutaneouspediclescrewfixationusingViper,Sextant,Pathfinder经皮穿刺减压和利用工作通道来放置椎间融合器利用Viper,Sextant,Pathfinder，经皮植入椎弓根螺钉。NewAdvancesinTLIF

经椎间孔入路腰椎体StrategiestoAvoidComplicationswithMIS

微创手术中减少并发症的策略Training培训Patientselection选择适当的病人Setup设备Access入路Pediclescrewplacement椎弓根螺钉的植入Misc

其他策略StrategiestoAvoidComplicatiTraining

培训THEREISALEARNINGCURVE!!学习的过程CadaverworkshopsViewcaseswithsurgeonwelltrainedinapplyingthesetechniquesStartslowlyandworkuptomorecomplexcases在尸体上练习在熟练医生进行这类手术时观摩循序渐进，慢慢地过渡到复杂的手术。Training

培训THEREISALEARNINGTraining

培训Startbigandmovesmaller-graduallyreduceincisionsizeStartinthelumbarspineBecomecomfortablewithmicrodiscectomyfirstLearnkyphoplasty由大的切口开始，慢慢地缩小切口由腰椎开始先从熟悉显微椎间盘切除术入手学习球囊扩张椎体后凸成形术Training

培训StartbigandmovePatientSelection

选择适当的病人MISfusionpatients–primarilyonesegmentdiseaseDDD–somediscspacepreservationGrade1tolowGrade2spondylolisthesisBewareofL5-S1(sacrumsometimehardtovisualizepediclescrewtargeting)微创融合术的病人–由单间隙的病患开始椎间盘退化-椎间距离不宜太小第一级的腰椎滑脱或轻微第二级的腰椎滑脱小心L5-S1间隙（在骶骨植入椎弓根螺钉会比较困难）PatientSelection

选择适当的病人MISfStartwithrelativelythinindividualswithgoodbonequalityObesityandosteoporosis–difficulttovisualizebonyanatomyadequately从骨质相对比较好和较廋的病人开始肥胖和骨质疏松症–使骨骼较难充分暴露PatientSelection

选择适当的病人Startwithrelativelythinind【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术TLIFAccess

椎间融合器入路WorkingZone操作区域Accessosteotomy入路截骨TLIFAccess

椎间融合器入路WorkingZonDecompresstheipsilateralside,thenputinthelargestcage,beforedecompressingcontralateralside.

同侧减压先。然后，在另一侧减压前，植入最大的椎间融合器。Decompresstheipsilateralsid【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术Nerve神经Pediclescrewplacement植入椎弓根螺钉NervePediclescrewplacementPercutaneousScrewAngulation经皮调整螺钉的角度MOVELATERAL!向外侧移动！PercutaneousScrewAngulationMStartingPoint起点StartingPointPedicleMidPoint植入椎弓中途PedicleMidPointThruthePedicle完全植入ThruthePedicle【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术Ensurescrewheadsareatthesamelevel

螺钉头要固定在同一水平线上Ensurescrewheadsareatthe【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术【骨科-微创-课件】微创经椎间孔入路腰椎体间融合术微创和开放性经椎间孔入路腰椎体间融合术的

6个月与2年随访调查SpineService,OrthopaedicSurgerySingaporeGeneralHospital脊椎专科，矫形外科新加坡中央医院ProspectiveTrialofMISTLIFVsOPENTLIF–6Months&2yearsResult微创和开放性经椎间孔入路腰椎体间融合术的

6个月与2年随访调

MIS微创OPEN开放型Age年龄(years)58.458.5Sex性别

(F:M)(女:男)116:6512:3Fluoroscopytime透视时间1min45secs35secsDurationofSurgery

手术时间（小时）3:19(range:2:15–4:40)2:40(range:2–3:55)Bloodloss失血量200ml500ml

MISOPENAge年龄(years)58.458.5

MIS微创OPEN开放性Lengthofhospitalisation(days)住院时间（天）4.4(range:2–9)6.0(range:5-7)VAS:POD/DISCHARGE视觉模拟疼痛评分：术后/出院5.0/1.06.0/2.6TotalMorphine(PCA,mg)吗啡(止痛药）剂量17.435.7Ambulation:Room/Ward(POD)术后第几天开始步行1.0/2.03/4

MISOPENLengthofhospitalisatNorthAmericanSpineScore

BackPain&DisabilityScore

北美脊椎协会评分标准疼痛及残疾指数BACKPAIN&DISABILITY(Range0to100)0=Nobackpainordisability100=Maximumbackpainordis