微创与开放手术治疗I-II度腰椎滑脱症

微创与开放手术治疗I-II度腰椎滑脱症精选课件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。”精选课件流行性病学FredricksonBE,etal.Thenaturalhistoryofspondylolysisandspondylolisthesis.JBoneJointSurgAm1984,500participants精选课件JacobsensDegenerativeLumbarSpondylolisthesis:AnEpidemiologicalPerspective.spine.2007,4151participants，M：1533、F：2618254cases(11.1%)M(1.5%):F(5.9%)M(0.7%):F(1.2%)精选课件KalichmanL，KinmDH,LiL,etal.SpondylolysisandSpondylolisthesis.PrevalenceandAssociationWithLowBackPainintheAdultCommunity-BasedPopulation.spine.2009,3529participants，CT:11.5%精选课件腰椎滑脱的Wiltse分型峡部裂性退变性创伤性病理性医源性先天性、发育不良性分型WiltseLL，NewmanPH,MacNabI.Classificationofspondylolysisandspondylolisthesis.

ClinOrthop,1976,117:23-29.精选课件腰椎滑脱程度（Meyerding分型，1932）MeyerdingHW.Spondylolisthesis:surgicaltreatmentandresults[J].SurgGynecolObstet,1932,54:371-37IIIIIIIVV精选课件症状马尾综合症精选课件滑脱进展LabelleH,Mac-ThiongJM,RoussoulyP.Spino-pelvicsagittalbalanceofspondylolisthesis:areviewandclassificationEurSpineJ,2011精选课件滑脱进展申勇.中国矫形外科杂志,200540y43y45y精选课件滑脱进展精选课件滑脱进展主要因素PIBMIAngleoflordosisBilateralparsdefectsJacobsens.spine.2007,LabelleH,EurSpineJ,2011BeutlerWJ,Spine,2003PI精选课件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精选课件手术与非手术治疗2-4年随访，LDS手术疗效优于非手术精选课件开放性手术开放性手术前路后路ALIFPLF、PLIF、TLIF、椎板间融合、单纯峡部固定、非融合前后路联合ALIF+PLIF/TLIF精选课件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精选课件微创手术微创手术前路后路ALIF、DLIFPLF、PLIF、TLIF、Coflex前后路联合ALIF+PLIF/TLIF精选课件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，视野小精选课件微创VS开放：腰椎滑脱？OpenMiniWhoisbest?精选课件（PLIF）微创VS开放：长期疗效精选课件（PLIF）微创VS开放：长期疗效精选课件（TLIF）微创VS开放：疗效Conclusion：

Minimallyinvasivesurgery（TLIF）forsevereSDS（I-IIgrade）leadstoadequateandsafedecompressionoflumbarstenosisandresultsinafasterrecoveryofsymptomsanddisabilityintheearlypostoperativeperiod.精选课件（PLF）微创VS开放：疗效Conclusion：

TheMIS-PLFutilizingapercutaneouspediclescrewsystemhadlessinvasive,lesspostoperativepain,rapidimprovementofseveralfunctionalparameterscomparedtoconventionalopen-PLF.ThissuperiorityintheMIS-PLFgroupwasmaintaineduntil2yearspostoperatively,suggestingthatlessinvasivePLFoffersbettermid-termresultsintermsofreducinglowbackpainandimprovingpatients’functionalcapacityofdailyliving.精选课件（PLF）微创VS开放：疗效精选课件（ALIF+TLIF）微创VS开放：并发症Conclusion:MIS(ALIF+TLIF)hadlessbloodloss,lessneedfortransfusionintheperioperativeperiod,andashorterhospitalstaythanopen(ALIF+TLIF),butthelengthofsurgery,intraoperativefluoroscopytime,malpositionedinstrumentationonpostoperativeimaging,andpostoperativecomplications,includingpulmonaryembolusandsurgicalsiteinfection

nodifference.精选课件（P/TLIF）微创VS开放：感染率Conclusions：Inthismultihospitalstudy,theMItechnique（P/TLIF）

wasassociatedwithadecreasedincidenceofperioperativeSSI(27[4.6%]vs150[7.0%],p=0.037)

in2-levelfusion.TherewasnosignificantdifferenceintheincidenceofSSIs(38[4.5%]vs77[4.8%],p=0.77)

betweentheopenandMIcohortsfor1-levelfusionprocedures.

精选课件(PLIF)微创VS开放：多裂肌损伤精选课件微创VS开放：多裂肌损伤精选课件微创VS开放：费效分析CONCLUSIONS:MISTLIFresultedinreducedoperativebloodloss,hospitalstayand2-yearcost,andacceleratedreturntowork.Surgicalmorbidity,hospitalreadmission,andshort-andlong-termclinicaleffectivenessweresimilarbetweenMISandopenTLIF.MISTLIFmayrepresentavaluableandcost-savingadvancementfromasocietalandhospitalperspective.精选课件微创VS开放：住院时间短、费用少精选课件（TLIF）微创VS开放：Meta分析精选课件Mini-TLIFVSmini-ALIF：疗效精选课件Mini-TLIFVSmini-ALIF：疗效MALIFMTLIF精选课件Mini-TLIFVSmini-ALIF：疗效Conclusions：Consideringtheclinicalandradiologicaloutcomesinbothgroups,theauthorsrecommendthatinstrumentedmini-TLIFispreferableattheL4–5level,whereasinstrumentedmini-ALIFmightbepreferableattheL5–S1