脊髓电刺激治疗的研究进展课件.pptVIP

脊髓电刺激治疗的研究进展;脊髓电刺激（spinal cord stimulation，SCS）;SCS历史;SCS作用原理;闸门学说;脊髓背角分层;脊髓节段性调制部位;闸门;闸门理论能完全解释吗？非也;SCS手术注意事项;SCS适应症;SCS治疗FBSS;;成功远远大于失败 :顽固性心绞痛 、PVD－痉挛，梗阻 成功大于失败 :CRPSⅠ、CRPS Ⅱ、周围神经损伤、糖尿病性周围神经病、臂丛神经损伤、 FBSS--腿疼、马尾损伤（马尾神经综合症）、疼痛的神经病理性膀胱、残肢痛、关节病变综合症、肌痉挛、癌痛 不稳定的成功 :幻肢痛、 部分脊髓损伤、PHN、FBSS－背痛 失败大于成功 :肛周、生殖器痛、肋间神经痛（不包括PHN） 失败远远大于成功 :脑卒中后中枢痛、 完全性脊髓损伤、面部麻木性痛、 严重的伤害性疼痛（除外缺血性疼痛） 不确切 “腹部、盆腔等脏痛、完全性神经根丛抽出术 注：PVD-周围血管性疾病，PHN-带状疱疹后遗神经痛，FBSS-腰椎术后疼痛综合征，CPRS-复杂性局部痛综合症。;高频脊髓电刺激（high frequency spinal cordstimulation, HFSCS）;HFSCS作用原理;Comparison of HF10 SCS with traditional SCS System HF10 SCS Traditional SCS Typical pulse width(μsec) 30 400 Typical stimulation rate(Hz) 10,000 40 Typical stimulation location for back pain T9-T10 T8 Typical stimulation location for neck and arm pain C2-C4 C2-C7 Typical amplitude for back pain (mA) 1–5 4–6 Implant procedure Leads placed by anatomical landmarks Leads placed based on verbal Patient under continual sedation patient feedback Patient provides feedback on paresthesia coverage Intraoperative programming and lead repositioning often required Stimulation trial Clinical goal is to reduce pain Clinical goal is to reduce pain by