微创经椎间孔入路腰椎体间融合术.pptVIP

TLIF Access椎间融合器入路 Working Zone 操作区域 Access osteotomy 入路截骨 Decompress the ipsilateral side, then put in the largest cage, before decompressing contralateral side.同侧减压先。然后，在另一侧减压前，植入最大的椎间融合器。 Nerve 神经 Pedicle screw placement 植入椎弓根螺钉 Percutaneous Screw Angulation 经皮调整螺钉的角度 MOVE LATERAL! 向外侧移动！ Starting Point 起点 Pedicle Mid Point 植入椎弓中途 Thru the Pedicle 完全植入 Ensure screw heads are at the same level螺钉头要固定在同一水平线上 * * Between group, no significant difference (Repeated Measures, p=0.171, p0.05) * * * * * Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF)微创经椎间孔入路腰椎体间融合术 Aim of MIS微创的目的 Accomplish surgical goals through small incisions and minimal disruption of normal tissues 以小切口达到手术的目的， 并对正常组织造成最少的伤害。 Principles of Minimally Invasive Spinal Surgery微创脊椎手术的原则 Decompress and stabilize the spine Reduce the “surgical injury” to normal tissues Limit retraction of muscle 减压并保持脊椎稳定 减少对正常组织的伤害 减少对肌肉的拉扯 Reduce blood loss Improve recovery by reducing post operative pain 减少失血量 减轻术后疼痛，以使病人尽快康复。 Principles of Minimally Invasive Spinal Surgery微创脊椎手术的原则 New Advances in TLIF经椎间孔入路腰椎体间融合术的最新动向 Percutaneous decompression and cage placement with Pipeline and other tube systems Percutaneous pedicle screw fixation using Viper, Sextant, Pathfinder 经皮穿刺减压和利用工作通道来放置椎间融合器 利用Viper, Sextant, Pathfinder，经皮植入椎弓根螺钉。 Strategies to Avoid Complications with MIS微创手术中减少并发症的策略 Training 培训 Patient selection 选择适当的病人 Setup 设备 Access 入路 Pedicle screw placement 椎弓根螺钉的植入 Misc 其他策略 Training培训 THERE IS A LEARNING CURVE!! 学习的过程 Cadaver workshops View cases with surgeon well trained in applying these techniques Start slowly and work up to more complex cases 在尸体上练习 在熟练医生进行这类手术时观摩 循序渐进，慢慢地过渡到复杂的手术。 Training培训 Start big and move smaller-gradually reduce incision size Start in the lumbar spine Become comfortable with microdiscectomy first Learn kyphopla