经皮椎弓根钉固定结合腰椎间融合术临床应用课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,1/19/2020,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/1/19,尹知训,yinzhixun,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/1/19,尹知训,yinzhixun,#,经皮椎弓根钉固定结合,微创腰椎间融合术的临床应,用,尹知训，何二兴,经皮椎弓根钉固定结合微创腰椎间融合术的临床应用,1,经皮椎弓根钉固定,分类,经皮椎弓根钉,外,固定,经皮椎弓根钉,内,固定,应用,单独,/,联合,经皮椎弓根植,骨,联合微创椎间融合术,2024/8/7,尹知训,yinzhixun,2,经皮椎弓根钉固定分类2023/8/2尹知训 yinzhixu,国外,Medt,Sextant(Medtronic),r),2024/8/7,尹知训,yinzhixun,3,国外MedtSextant(Medtronic)r)20,国外,Apollon(solco),r),2024/8/7,尹知训,yinzhixun,4,国外Apollon(solco)r)2023/8/2尹知,seregeti retractor system(K2M),r),2024/8/7,尹知训,yinzhixun,5,seregeti retractor system(K2,国外,Viper system(Depuy),r),2024/8/7,尹知训,yinzhixun,6,国外Viper system(Depuy)r)2023/,国产,大博经皮长臂椎弓根钉棒系统,2024/8/7,尹知训,yinzhixun,7,国产大博经皮长臂椎弓根钉棒系统2023/8/2尹知训 yi,微创置钉方法,小切口：手指引导穿刺,2024/8/7,尹知训,yinzhixun,8,微创置钉方法小切口：手指引导穿刺2023/8/2尹知训 yi,微创置钉方法,镜下可视穿刺、置钉,2024/8/7,尹知训,yinzhixun,9,微创置钉方法镜下可视穿刺、置钉2023/8/2尹知训 yin,微创置钉方法,经皮穿刺、置钉,2024/8/7,尹知训,yinzhixun,10,微创置钉方法经皮穿刺、置钉2023/8/2尹知训 yinzh,微创椎间融合术,椎间融合：处理椎间盘、植骨、植入融合器,Axia,/,ALIF,DLIF/XLIF,MIS-TLIF/PLIF,微创椎间,融合器,窄,前端尖,2024/8/7,尹知训,yinzhixun,11,微创椎间融合术椎间融合：处理椎间盘、植骨、植入融合器2023,A,xial,L,umbar,I,nterbodv,F,usion,轴向腰椎间融合术,ALIF,入路,：,经骶骨前直肠后间隙,融合节段,：,L5,/S1,单节段,融合,L5/,S1,、,L4/5,双节段,适应证：退变、不稳、,轻度滑脱、翻修,Cragg,A,et,a1.J,Spinal Disord Tech,2004,17(1):2128.,2024/8/7,尹知训,yinzhixun,12,Axial Lumbar Interbodv Fusion轴,A,xial,L,umbar,I,nterbodv,F,usion,轴向腰椎间融合术,ALIF,优点,：,避免暴露脊柱前方、后方及侧,方的结构；,无需进入,腹腔,剪切应力、抗移位和抗弯曲,/,伸展能力,。,并发症：直肠损伤、神经根激惹,2024/8/7,尹知训,yinzhixun,13,Axial Lumbar Interbodv Fusion轴,A,nterior,L,umbar,I,nterbody,F,usion,前路,腰椎间融合术,ALIF,入路,：,镜下经腹膜腔；,1994,年吴岳嵩,镜下腹膜后；,999,年,Olinger,等。,融合节段：,L5,/S1,单节段,融合,。,适应证：退变、不稳、,轻度滑脱、翻修,吴岳,嵩,.,第二军医大学学报,1994,15(1):6.,Oliner A,et,a1.,Surg endose,1999,13,(12):1215,一,1219.,2024/8/7,尹知训,yinzhixun,14,Anterior Lumbar Interbody Fusi,e,X,treme/,D,irect,L,ateral,I,nterbody,F,usion,极外侧人路腰椎椎体间融合术,X/DLIF,2024/8/7,尹知训,yinzhixun,15,入路：扩张管经腰大肌,适应证：,L1-5,节段需融合疾病（腰椎退行性侧弯）,严重的 椎管狭窄、旋转性脊柱侧凸、中到重度的脊椎滑脱、位于,L5Sl,水平的疾病,Ozgur,B,et a1.,Spine J,2006,6(4):435443.,eXtreme/Direct Lateral Interbo,e,X,treme/,D,irect,L,ateral,I,nterbody,F,usion,极外侧人路腰椎椎体间融合术,X/DLIF,2024/8/7,尹知训,yinzhixun,16,优点,：,不剥离腹膜、大血管；,不损伤脊柱前后方结构；,可用大融合器；,eXtreme/Direct Lateral Interbo,e,X,treme/,D,irect,L,ateral,I,nterbody,F,usion,极外侧人路腰椎椎体间融合术,X/DLIF,2024/8/7,尹知训,yinzhixun,17,风险：损伤腰丛,;,防护,：,EMG,实时监测,.,；,屈髋体位；,椎间中点偏前入路,eXtreme/Direct Lateral Interbo,后入路椎间融合术,软组织入路,椎管椎间隙入路,Mis,-,PLIF,Mis-TLIF,改良,mis-TLIF,E-TLIF,2024/8/7,尹知训,yinzhixun,18,后入路椎间融合术软组织入路2023/8/2尹知训 yinzh,2024/8/7,尹知训,yinzhixun,19,2023/8/2尹知训 yinzhixun19,2024/8/7,尹知训,yinzhixun,20,2023/8/2尹知训 yinzhixun20,2024/8/7,尹知训,yinzhixun,21,A-Wilts,入路,B-,多裂肌束入路,C-LIMP,入路,D-Watkins,入路,2023/8/2尹知训 yinzhixun21A-Wilts,后路通道,管状通道：,MED,、,2.5cm,工作导管,可扩张通道,枢法模公司：,METRx,-tube/MAST,Quadrant,强生,公司：,PIPELINE,；,史塞克,公司：,LUXOR,国产：,M,ini,Spine,脊柱微创手术牵开器,拉钩：三叶拉钩,2024/8/7,尹知训,yinzhixun,22,后路通道管状通道：MED、2.5cm工作导管2023/8/2,METRx-tube,可扩张牵开器,切口：,同侧椎,弓根,中点的连线，,3,c,m,长,通道：口小：,2.5cm,；,底大：,4,c,m,2024/8/7,尹知训,yinzhixun,23,METRx-tube可扩张牵开器切口：同侧椎弓根中点的连线，,METRx-tube,可扩张牵开器,优点：,管道化显露、直视化操作、也可内镜辅助,同时行,PLIF/TLIF,、单节段椎弓根钉固定,2024/8/7,尹知训,yinzhixun,24,METRx-tube可扩张牵开器优点：2023/8/2尹知训,MAST,Quadrant,可扩张牵开器,入路,：,皮肤正中切口，位于上、下椎弓根连线与正中线交点间,Wiltse,入路：旁开,2.5,c,m,经多裂肌与最长肌间达关节突关节,2024/8/7,尹知训,yinzhixun,25,MAST Quadrant可扩张牵开器入路：2023/8/2,MAST,Quadrant,可扩张牵开器,优点：,冷光照明、四面牵引、视野清晰、直视操作,同时行双节段,P/TLIF,、椎弓根钉固定,2024/8/7,尹知训,yinzhixun,26,MAST Quadrant可扩张牵开器优点：2023/8/2,Pipeline,可扩张系统,2024/8/7,尹知训,yinzhixun,27,Pipeline可扩张系统2023/8/2尹知训 yinzh,三叶拉钩,2024/8/7,尹知训,yinzhixun,28,三叶拉钩2023/8/2尹知训 yinzhixun28,改良,mis-TLIF,入路：,切除下关节突,上关节突内侧,部分椎板。,目的：,扩大了中央管减压；,保留了部分上关节突；,2024/8/7,尹知训,yinzhixun,29,改良mis-TLIF入路：2023/8/2尹知训 yinzh,E-TLIF,E,xtreme,lateral,T,ransforaminal,L,umbar,I,nterbody,F,usion,入路：,经上关节突,k,ambin,安全三角进入椎间隙。,中华创伤骨科杂,志,2013,年,1,月第,15,卷第,1,期,2024/8/7,尹知训,yinzhixun,30,E-TLIFExtreme lateral Transfor,T,ransforaminal,L,umbar,I,nterbody,F,usion,微创经后路,腰椎椎体间融合术,MIS,-,P,LIF,2024/8/7,尹知训,yinzhixun,31,入路：,皮肤切口：棘突中线旁开,2,-3cm,；,肌肉；经多裂肌束；,一侧椎板、黄韧带、椎管达椎间盘。,适应证：腰椎盘源性疾病、退变、滑脱、不稳、侧弯,Harms J,Z Orthop Ihre Grenzgeb,1982,120(3):343-347.,Foley KT,et al.,Spine,2003,28(15 Suppl):S26-S35.,Transforaminal Lumbar Interbod,T,ransforaminal,L,umbar,I,nterbody,F,usion,微创经椎间孔,腰椎椎体间融合术,MIS,-,TLIF,2024/8/7,尹知训,yinzhixun,32,入路：,皮肤切口：棘突旁开,4-5cm,肌肉；经,wilts,、,limp,入路,小关节突、椎间孔,适应证：腰椎盘源性疾病、退变、滑脱、不稳、侧弯,优点：,避免过渡牵拉神经根、硬脊膜囊；,保留了棘上、棘间和前后纵韧带，棘突、椎板、对侧关节突；,不剥离椎旁肌。,Harms J,Z Orthop Ihre Grenzgeb,1982,120(3):343-347.,Foley KT,et al.,Spine,2003,28(15 Suppl):S26-S35.,Transforaminal Lumbar Interbod,MIS-T/,P,LIF+,经皮椎弓根钉内固定,单枚,cage,（,MIS-T/PLIF,）,+,单侧经皮椎弓根钉内固定,+,双,侧经皮椎弓根钉内固定,2024/8/7,尹知训,yinzhixun,33,MIS-T/PLIF+经皮椎弓根钉内固定单枚cage（MIS,MIS-T/PLIF,联合经皮椎弓根钉内固定临床应用,腰椎间盘突出,腰椎退行不稳,椎管狭窄,狭部裂,腰椎滑脱,退行性侧弯,2024/8/7,尹知训,yinzhixun,34,MIS-T/PLIF联合经皮椎弓根钉内固定临床应用腰椎间盘突,腰椎间盘突出症,临床病例,1-,突出型,(,单节段,),2024/8/7,尹知训,yinzhixun,35,腰椎间盘突出症临床病例1-突出型(单节段)2023/8/2,腰椎间盘突出症,临床病例,1,-,突出型,(,单节段,),2024/8/7,尹知训,yinzhixun,36,腰椎间盘突出症临床病例1-突出型(单节段)2023/8/2,腰椎间盘突出症,临,床病例,2,-,突出型,(,多节段,),2024/8/7,尹知训,yinzhixun,37,腰椎间盘突出症临床病例2-突出型(多节段)2023/8/2,腰椎间盘突出症,临床病例,1,-,突出型,(,多节段,),2024/8/7,尹知训,yinzhixun,38,腰椎间盘突出症临床病例1-突出型(多节段)2023/8/2,腰椎间盘突出症,临床病例,3,-,脱出型,2024/8/7,尹知训,yinzhixun,39,腰椎间盘突出症临床病例3-脱出型2023/8/2尹知训 y,腰椎间盘突出症,临床病例,3,-,脱出型,2024/8/7,尹知训,yinzhixun,40,腰椎间盘突出症临床病例3-脱出型2023/8/2尹知训 y,腰椎间盘突出症,临床病例,4,-,伴椎管狭窄、椎间不稳,2024/8/7,尹知训,yinzhixun,41,腰椎间盘突出症临床病例4-伴椎管狭窄、椎间不稳2023/8,腰椎间盘突出症,临床病例,4-,伴椎管狭窄、椎间不稳,2024/8/7,尹知训,yinzhixun,42,腰椎间盘突出症临床病例4-伴椎管狭窄、椎间不稳2023/8,腰椎管狭窄症,临床病例,1-,发育性椎管狭窄,2024/8/7,尹知训,yinzhixun,43,腰椎管狭窄症临床病例1-发育性椎管狭窄2023/8/2尹知,腰椎管狭窄症,临床病例,1,-,发育性椎管狭窄,2024/8/7,尹知训,yinzhixun,44,腰椎管狭窄症临床病例1-发育性椎管狭窄2023/8/2尹知,MIS-T/PLIF,联合经皮椎弓根钉内固定治疗,腰椎退行性不稳,临床病例,2024/8/7,尹知训,yinzhixun,45,MIS-T/PLIF联合经皮椎弓根钉内固定治疗腰椎退行性不,MIS-T/PLIF,联合经皮椎弓根钉内固定治疗,腰椎退行性不稳,临床病例,2024/8/7,尹知训,yinzhixun,46,MIS-T/PLIF联合经皮椎弓根钉内固定治疗腰椎退行性不,MIS-T/PLIF,联合经皮椎弓根钉内固定治疗,腰椎狭部裂,临床病例,2024/8/7,尹知训,yinzhixun,47,MIS-T/PLIF联合经皮椎弓根钉内固定治疗腰椎狭部裂,