医学交流课件：椎体成形术的规范治疗英文

VertebroplastyConcept

of

Minimally

InvasiveOrthopaedic

SurgeryIt

is

a

new

technology

and

new

science

byapplication

of

new

apparatus

such

as

endoscope

,computer

,

X-ray

,

special

puncture

needle

,

fixatiand

et

al

to

get

a

outcome

of

minimal

incision,

lesstissue

damage,

more

exactitude,

more

reliable

effeand

faster

recovery.ConnotationApplication

of

new

medical

apparatusLess

tissue

and

mental

damageFaster

recovery

,

shorter

hospitalization and

lower

costBetter

effect

than

conventional

treatmentHistoryVertebroplasty198419951997France

C2

vertebral

haemangiomaAmerica

beginningAmerica

first

paper

(Jensen)osteoporotic

compression

fracturesExcellent

and

good

rate:

90%VertebroplastyOpen

operation,

injectbone

cement

to

the vertebrae

through

the

pediclePercutaneous

puncture

by

CT

guidancePercutaneous

vertebropuncture

and

inject bone

cement

by

common

c-arm

x-ray

(PVP)PVP

in

ChinaBegin

in

2000

(2nd

Affiliated

Hospital

of SYSU)Fast

developmentExcellent

and

good

rate>70%Not

standardPVP

in

China（2000年）Evaluation

of

PVPReviewed

400

cases

（47

cases

in

our hospital）70～80%

pain

releaseLow

rate

of

failureEarly

monvement¿Can

not

move

endplate¿Bad

correction

of

defomity,

remain

kyphosi¿Can

not

make

space

before

injection¿

High

pressure

injection,

leakage

of

cemenDisadvantage

of

PVPPercutaneous

Kyphosis

(PKP)1999

Berkeley&Mark

ReileyBalloon

expansion

in

the

compressed

verteb

make

a

empty

cavity

and

decrease

the

pressure

injection.Five

steps：①

Inject

guide

needle②

Establish

work

canal③

Expand

work

canal④

Expand

baloonInject

cementKyphoplastySignificantly

decrease

cement

leakage rateOver

50%

correction

of

kyphosisMarthis

reported

80%

cases

were excellent

and

goodPercutaneous

kyphoplasty，PKPAdvantageRecover

vertebral height,correct kyphosisLow

cement

leakage rateDisadvantage¿

Directly

uncontrolledexpander¿

Over

expand

in

the

adjacentpart¿

20%

baloon

rupture¿

Only

used

in

fresh

fracture¿

ExpensiveExpander

vertebroplastyIn

china

(2004)CharacteristicsMutiple

directionStable

expanderBetter

pain

release·Made

by

high

molecular

weightpolymerMutiple

direction

expanderoriginal

diameter4.8mm

expanderdiameter16mmCementvolume: 2-4mLEffective

pain

releaseSKY

Bone

Expander

SystemMechanismOperative

procedureOperative

procedureSky

bone

expanderOperative

procedureAfter

operationTechnique

characteristics

of

SKYMinimal

invasive

operationControlled

expander,

recover

vertebral height,establish

space

to

inject

cementExpand

in

the

vertebral

height,no

pressur on

side,decrease

the

nerve

and

vessel

injNo

residual

baloonAccurately

expand,

recover

vertebral

hei effectivelyLow

cement

leakage

riskTechnique

characteristics

of

SKConfidence

System（2006）Cement

inject

systemHydraulic

PumpExtension

TubeReservoirAccess

NeedleCurved

NeedleStandard

NeedleIndicationVertebral

haemangiomaSome

vertebral

metastasis

tumorSome

vertebral

benign

tumor,

not

fit

foopen

operationMultiple

myelomaOsteoporotic

compression

vertebralfractures

(OCVF)Case

selection

for

OCVFcompression

less

than

70%

height

of

vertebrae,

no fracture

in

posterior

edgeNo

nerve

root

and

spinal

cord

compressionOver

60

years

old

Endurance

of

local

anaesthesia

and

over

half

an

hoprostration

Be

careful

for

the

patients

with

severe

cardiovascdiseaseContraindicationCompression

fracture

without

osteoporosisCompression

fracture

with

nerve

system symptomPosterior

edge

fracture

of

vertebraeComplicated

with

infectionCan

not

endure

operationL1

fracturePreopeative

PreparationRoutine

check-up

of

heart、lung、renal functionTreatment

of

combined

diseaseCT

scanTraining

of

prostrationPsychologyRequirement

of

operator

andopration

roomExperienced

spinal

surgeonMonitor

machine

of

heart

,

lung

and

blood pressureGood

c-arm

x-ray

machine

Staffs

and

apparatus

to

perform

conventionspinal

surgeryKey

pionts

of

operationRoutine

prostrationC-arm

machine

orientation

and

make

marker

i the

skinRoutine

sterilizationC-arm

machine

orientation

once

more， injection

of

1%

lidocaine

for

local

anaestPositionSkin

markerMake

sure

the

correct

pedicle

positionPuncture

to

2/3

of

vertebraC-arm

:

Ap

and

lateral

view

to

confirm

thepuncture

positionInject

cement

directly（PVP）or

implantbaloon(SKY)then

inject

cement

3～6mLWithdraw

needle

after

cement

frozen,

then

stitchand

monitor

the

vascular

and

nerve

system

for

6hPostoperative

treatmentLocal

symptom

caused

by

puncture

and

ce