脊柱截骨的教案

脊柱截骨的教案第1页/共22页

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第3页/共22页失状位失衡1、节段性tape1（segmental）:SVA<5cm2、整体性tape2（global）:SVA>5cmwithoutkneeflexionorhiphyperextension

IdealsagittalalignmentisdescribedasSVA<50mm,PT<25゜,PI–LL=10゜

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失状位失衡截骨方式Posterior-only

1、Smith-Petersenosteotomy(SPO)2、pediclesubtractionosteotomy(PSO)3、bone-disc-boneosteotomy(BDBO)4、vertebralcolumnresection(VCR)第5页/共22页Ponteosteotomy,Smith-Petersenosteotomy(SPO)removalofposteriorligamentsandfacets第6页/共22页widefacetectomytopreventnerverootimpingementosteotomysitecanbedoneasymmetricallytocorrectcoronalimbalanceaswellassagittalimbalance第7页/共22页9.3–10.7perlevel.substantialcorrection,itmaybenecessarytograftthediscspaceanteriorlyType1along,rounded,smoothkyphosisSVAintherangeof6–8cmpositive.easierandsaferthanotherosteotomies;第8页/共22页Pediclesubtractionosteotomy(PSO)Thomasenin1985.Heiningetaleggshellosteotomy.第9页/共22页30to40correctionthroughallthreecolumns,whileavoidingstretchvesselsandvisceraanteriortothespine;Ifperformedinanasymmetricfashion,providesignificantcoronalcorrectionaswell;第10页/共22页type2sagittaldeformity(SVA>12cm),sharp,angularkyphosisetl；第11页/共22页AwidelaminectomyisperformedOsteotomylinehorizontaltothesacrumPlacingthetemporaryrodclosedovertherodswhilethehipsandkneesarehyperextended第12页/共22页InterbodyfusioncanbedoneaseitheraTLIForanALIFprocedure第13页/共22页Bone-disc-boneosteotomy(BDBO)

correctionrates35°to60°Themainindicationsaredeformitieswiththediscspaceastheapexorcenterofrotationalaxis(CORA)andseveresagittalplanedeformities第14页/共22页Type1bone-disc-boneosteotomy(BDBO).第15页/共22页Type2BDBO.第16页/共22页Type3BDBO.第17页/共22页pediclescrewsatleasttwolevelsbelowandthreelevelsaboveAtitaniummeshcagecanbeplacedanteriorlyifdesired.第18页/共22页Vertebralcolumnresection（VCR）in1922byMacLennanindicatedforrigidmultiplanardeformities,

sharpangulateddeformities,emivertebraresections,resectablespinaltumours,p