微创与开放手术治疗I-II度腰椎滑脱症.ppt
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微创与开放手术治疗I-II度腰椎滑脱症.ppt
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,广州中医药大学第一附属医院脊柱专科,微创与开放手术治疗I-II度腰椎滑脱症,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。
”,流行性病学,FredricksonBE,etal.Thenaturalhistoryofspondylolysisandspondylolisthesis.JBoneJointSurgAm1984,500participants,JacobsensDegenerativeLumbarSpondylolisthesis:
AnEpidemiologicalPerspective.spine.2007,4151participants,M:
1533、F:
2618254cases(11.1%),M(1.5%):
F(5.9%),M(0.7%):
F(1.2%),KalichmanL,KinmDH,LiL,etal.SpondylolysisandSpondylolisthesis.PrevalenceandAssociationWithLowBackPainintheAdultCommunity-BasedPopulation.spine.2009,3529participants,CT:
11.5%,腰椎滑脱的Wiltse分型,WiltseLL,NewmanPH,MacNabI.Classificationofspondylolysisandspondylolisthesis.ClinOrthop,1976,117:
23-29.,腰椎滑脱程度(Meyerding分型,1932),MeyerdingHW.Spondylolisthesis:
surgicaltreatmentandresultsJ.SurgGynecolObstet,1932,54:
371-37,I,II,III,IV,V,症状,马尾综合症,滑脱进展,LabelleH,Mac-ThiongJM,RoussoulyP.Spino-pelvicsagittalbalanceofspondylolisthesis:
areviewandclassicationEurSpineJ,2011,滑脱进展,申勇.中国矫形外科杂志,2005,40y,43y,45y,滑脱进展,滑脱进展主要因素,PIBMIAngleoflordosisBilateralparsdefects,Jacobsens.spine.2007,LabelleH,EurSpineJ,2011BeutlerWJ,Spine,2003,PI,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,手术与非手术治疗,2-4年随访,LDS手术疗效优于非手术,开放性手术,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,微创手术,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,微创VS开放:
腰椎滑脱?
Open,Mini,Whoisbest?
(PLIF)微创VS开放:
长期疗效,(PLIF)微创VS开放:
长期疗效,(TLIF)微创VS开放:
疗效,Conclusion:
Minimallyinvasivesurgery(TLIF)forsevereSDS(I-IIgrade)leadstoadequateandsafedecompressionoflumbarstenosisandresultsinafasterrecoveryofsymptomsanddisabilityintheearlypostoperativeperiod.,(PLF)微创VS开放:
疗效,Conclusion:
TheMIS-PLFutilizingapercutaneouspediclescrewsystemhadlessinvasive,lesspostoperativepain,rapidimprovementofseveralfunctionalparameterscomparedtoconventionalopen-PLF.ThissuperiorityintheMIS-PLFgroupwasmaintaineduntil2yearspostoperatively,suggestingthatlessinvasivePLFoffersbettermid-termresultsintermsofreducinglowbackpainandimprovingpatientsfunctionalcapacityofdailyliving.,(PLF)微创VS开放:
疗效,(ALIF+TLIF)微创VS开放:
并发症,Conclusion:
MIS(ALIF+TLIF)hadlessbloodloss,lessneedfortransfusionintheperioperativeperiod,andashorterhospitalstaythanopen(ALIF+TLIF),butthelengthofsurgery,intraoperativeuoroscopytime,malpositionedinstrumentationonpostoperativeimaging,andpostoperativecomplications,includingpulmonaryembolusandsurgicalsiteinfectionnodifference.,(P/TLIF)微创VS开放:
感染率,Conclusions:
Inthismultihospitalstudy,theMItechnique(P/TLIF)wasassociatedwithadecreasedincidenceofperioperativeSSI(274.6%vs1507.0%,p=0.037)in2-levelfusion.TherewasnosignificantdifferenceintheincidenceofSSIs(384.5%vs774.8%,p=0.77)betweentheopenandMIcohortsfor1-levelfusionprocedures.,(PLIF)微创VS开放:
多裂肌损伤,微创VS开放:
多裂肌损伤,微创VS开放:
费效分析,CONCLUSIONS:
MISTLIFresultedinreducedoperativebloodloss,hospitalstayand2-yearcost,andacceleratedreturntowork.Surgicalmorbidity,hospitalreadmission,andshort-andlong-termclinicaleffectivenessweresimilarbetweenMISandopenTLIF.MISTLIFmayrepresentavaluableandcost-savingadvancementfromasocietalandhospitalperspective.,微创VS开放:
住院时间短、费用少,(TLIF)微创VS开放:
Meta分析,Mini-TLIFVSmini-ALIF:
疗效,Mini-TLIFVSmini-ALIF:
疗效,MALIF,MTLIF,Mini-TLIFVSmini-ALIF:
疗效,Conclusions:
Consideringtheclinicalandradiologicaloutcomesinbothgroups,theauthorsrecommendthatinstrumentedmini-TLIFispreferableattheL45level,whereasinstrumentedmini-ALIFmightbepreferableattheL5S1levelforthetreatmentofunstableisthmicspondylolisthesis.,正确掌握腰椎滑脱的治疗原则(侯树勋),不是所有的腰椎滑脱都需要治疗伴有腰痛的腰椎滑脱并非都需要手术根据滑脱的严重程度选择适当的手术方式滑脱椎体的融合是手术治疗的最终目的,Thanksforyourattention,
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- 关 键 词:
- 开放 手术 治疗 II 腰椎 滑脱
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