脊柱截骨【一类严选】

1、脊柱畸形截骨术,成人严重的僵硬的脊柱畸形，包括冠状位和失状位的畸形。 通过截骨最终取得失状位和冠状位的平衡，缓解疼痛，坚固的融合及预防进一步畸形。,1,行业相关,2,行业相关,3,行业相关,失状位失衡,1、节段性tape1（segmental）:SVA5cm without knee flexion or hip hyperextension Ideal sagittal alignment is described as SVA50 mm, PT 25 , PILL = 10 ,4,行业相关,失状位失衡截骨方式Posterior-only,1、Smith-Petersen osteotomy

2、 (SPO) 2、pedicle subtraction osteotomy (PSO) 3、bone-disc-bone osteotomy (BDBO) 4、vertebral column resection (VCR),5,行业相关,Ponte osteotomy, Smith-Petersen osteotomy (SPO),removal of posterior ligaments and facets,6,行业相关,wide facetectomy to prevent nerve root impingement osteotomy site can be done asym

3、metrically to correct coronal imbalance as well as sagittal imbalance,7,行业相关,9.310.7 per level. substantial correction, it may be necessary to graft the disc space anteriorly Type 1 a long, rounded,smooth kyphosis SVA in the range of 68 cm positive. easier and safer than other osteotomies;,8,行业相关,Pe

4、dicle subtraction osteotomy(PSO),Thomasen in 1985. Heining et al eggshell osteotomy.,9,行业相关,30 to 40 correction through all three columns, while avoiding stretch vessels and viscera anterior to the spine; If performed in an asymmetric fashion, provide significant coronal correction as well;,10,行业相关,

5、type 2 sagittal deformity (SVA12 cm), sharp, angular kyphosis etl；,11,行业相关,A wide laminectomy is performed Osteotomy line horizontal to the sacrum Placing the temporary rod closed over the rods while the hips and knees are hyperextended,12,行业相关,Interbody fusion can be done as either a TLIF or an ALI

6、F procedure,13,行业相关,Bone-disc-bone osteotomy (BDBO),correction rates 35 to 60 The main indications are deformities with the disc space as the apex or center of rotational axis (CORA) and severe sagittal plane deformities,14,行业相关,Type 1 bone-disc-bone osteotomy (BDBO).,15,行业相关,Type 2 BDBO.,16,行业相关,Type 3 BDBO.,17,行业相关,pedicle screws at least two levels below and three levels above A titanium mesh cage can be placed anteriorly if desired.,18,行业相关,Vertebral column resection（VCR）,in 1922 by MacLennan indicated for rigid multiplanar deformities, sharp angulated deformities, emivertebra