脊柱截骨专业知识宣讲

脊柱畸形截骨术成人严重旳僵硬旳脊柱畸形，涉及冠状位和失状位旳畸形。经过截骨最终取得失状位和冠状位旳平衡，缓解疼痛，结实旳融合及预防进一步畸形。

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゜

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)Ponteosteotomy,Smith-Petersenosteotomy(SPO)removalofposteriorligamentsandfacetswidefacetectomytopreventnerverootimpingementosteotomysitecanbedoneasymmetricallytocorrectcoronalimbalanceaswellassagittalimbalance9.3–10.7perlevel.substantialcorrection,itmaybenecessarytograftthediscspaceanteriorlyType1along,rounded,smoothkyphosisSVAintherangeof6–8cmpositive.easierandsaferthanotherosteotomies;Pediclesubtractionosteotomy(PSO)Thomasenin1985.Heiningetaleggshellosteotomy.30to40correctionthroughallthreecolumns,whileavoidingstretchvesselsandvisceraanteriortothespine;Ifperformedinanasymmetricfashion,providesignificantcoronalcorrectionaswell;type2sagittaldeformity(SVA>12cm),sharp,angularkyphosisetl；AwidelaminectomyisperformedOsteotomylinehorizontaltothesacrumPlacingthetemporaryrodclosedovertherodswhilethehipsandkneesarehyperextendedInterbodyfusioncanbedoneaseitheraTLIForanALIFprocedureBone-disc-boneosteotomy(BDBO)

correctionrates35°to60°Themainindicationsaredeformitieswiththediscspaceastheapexorcenterofrotationalaxis(CORA)andseveresagittalplanedeformitiesType1bone-disc-boneosteotomy(BDBO).Type2BDBO.Type3BDBO.pediclescrewsatleasttwolevelsbelowandthreelevelsaboveAtitaniummeshcagecanbeplacedanteriorlyifdesired.Vertebralcolumnresection（VCR）in1922byMacLennanindicatedforrigidmultiplanardeformities,

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