成人脊柱侧凸的的治疗南京大学医学院附属鼓楼医院脊柱外...推荐.pptVIP

If deformity associated with translation, and coronal imbalance, osteotomies with resection preferable. Lumbar curvature fixed deformity and/or previous fusion * Case 1 * * * * Arthrodesis to the sacrum-indication Lumbar oblique take-off Unbalanced L/S curve with lumbar scoliosis L/S pain below lumbar curve Recommend a two-stage approach +screw fixation Fixation to pelvis---L-rod/TSRH/Isola Take intraoperative AP X-ray to insure coronal alignment while on the table －－－Key If fixed coronal deformity, resection may be necessary to achieve balance. * * 忠心感谢本文的合作者！ 马薇薇 钱邦平 王 斌 邱 勇 朱泽章 朱 锋 俞 杨 * Thank You！ * THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS THANKS * * Case 6 * 1416-1422 * * * * * * * 退变性侧凸与特发性侧凸的区别 难 ! * 鉴别线索 初诊时见顶椎区椎间盘退变 交界性不稳定＋节段性不稳定 节段性畸形呈不规则 神经压迫症状 严重双平面失偿 * * * * * Operative treatment Understand Risk/Benefit Rates！ * Indication for surgery Significant curvature Back pain Radicular pain Spinal stenosis symptoms Progression of curve Progressive loss of pulmonary function decompensation 所有这些指征在成人中很难证明 * 手术适应证(鼓楼医院 79 例) 力学性疼痛 71 （90％） 双平面失偿 69 （87％） 畸形加重 56 （70％） 椎管狭窄或根痛 18 （23％） 进行性躯干塌陷 6 （ 8％ ） * 手术结果分析（南京鼓楼） 评价指标 术前 术后 一年随访 最后一次随访 冠状面平衡（n=79） 3.8cm 0.8cm 1.0cm 1.0cm 双肩水平度（n=79） -2.5cm -0.9cm -0.9cm -0.9cm 矢状面平衡（n=79） +6cm +1.8cm +2.0cm +2.0cm 腰椎前突角（n=58） 37° 56° 56° 53° 疼痛（n=65） 7.5 4.3 4.5 * 手术治疗 手术效果不如青少年脊柱侧凸患者 缓解疼痛 60％－90％, 度数矫正 30％－50％ 肺功能 略有增加 融合率 70％－90％ 神经并发症 1％－5％ 死亡率 1％－2％ 感染率 1％－5％ * Complication Includes Pseudarthrosis Residual pain Mortality Neurologic Infection Pulmonary embolic Loss of lordosis