椎间孔镜入路_1课件.pptVIP

椎间孔镜技术治疗腰椎间盘突出症 内容 1. 椎间孔镜的历史及现状 2. 椎间孔镜的手术操作 3. 病例分享 4. 讨论 Approach Strategies手术入路的策略 Intradiscal: nucleotomy disc collapse 椎间盘内：髓核切除---针对椎间盘破裂 Extradiscal: nuclear residual re-herniation 椎间盘外：髓核残留---针对再次膨出 Transforaminal (posterolateral) 后外侧椎间孔途径 Transforaminal + Foraminoplasty 椎间孔途径+椎间孔成型 Transforaminal Far Lateral (horizontal) 远外侧椎间孔途径（水平方向穿刺） Interlaminar 椎板间途径 Yeung’s Transforaminal In-Out Technique 杨式In—Out技术 Ruetten’s Interlaminar Technique Ruetten教授的椎板间入路技术 Hoogland’s Lateral Technique Hoogland教授的侧方入路技术 YEUNG Local anesthesia 局麻 Easy technique 容易掌握 Easy needle placement 穿刺器械简单 Intradiscal approach 盘内穿刺入路 Difficult epidural access 暴露硬膜嚢困难 Blind reaming 扩孔盲目，不可视 Annullus aggression 损伤纤维环 Ganglion proximity 靠近神经 RüTTEN General anesthesia 全麻 Difficult technique 技术掌握困难 Advanced needle placement 穿刺器械先进 Extradiscal approach 盘外入路 Optimal epidural access 最佳的暴露硬膜途径 Difficult reaming 扩孔困难 Difficult intradiscal access 进入椎间盘困难 Unconfortable surgeon position 医生手术体位不舒适 HOOGLAND Local anesthesia 局麻 Difficult technique 技术掌握困难 Difficult needle placement 穿刺困难 Extradiscal approach 盘外入路 Progressive dilatation 逐级扩张 Guided reaming 有引导的扩孔 Difficult intradiscal access 进入椎间盘困难 Exiting root proximity 靠近外侧神经根 YEUNG Local anesthesia 局部麻醉 Easy technique 技术容易 Easy needle placement 简单的穿刺设备 Intradiscal approach 盘内入路 RüTTEN Advanced needle placement 先进的穿刺设备 Extradiscal approach 盘外入路 Optimal epidural access 最佳的硬膜暴露途径 HOOGLAND Local anesthesia 局部麻醉 Extradiscal approach 盘外入路 Progressive dilatation 逐级扩张 Guided reaming 有引导的扩孔 Kambin’s Safety Triangle 安全三角 ●前界为出口神经根 ●下界为下椎体的上终板 ●内界延伸为行走神经根