腰椎间盘摘除的微创手术_精品文档优质PPT.ppt

腰椎间盘摘除的微创手术_精品文档优质PPT.ppt

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腰椎盘摘除的微创手术杭州市红十字会医院杭州市红十字会医院费骏费骏TrendsinDiscSurgerySpineProductSegmentsSpineProductSegmentsworldmarket（surgeries）worldmarket（surgeries）Source:

@#@AESCULAPOrthopaedicsGiantStepUpdateBarcelona98SusanneMengerTrendsinDiscSurgeryAESCULAPTopTenCountriesAESCULAPTopTenCountriesDiscSurgeryDiscSurgery（SalesexAAG1997/98=38.4）（SalesexAAG1997/98=38.4）Barcelona98SusanneMengerTrendsinDiscSurgeryDiscSurgeryDiscSurgeryu目的目的减压减压解除神经根或硬膜囊的致压物解除神经根或硬膜囊的致压物降低椎间盘内压力降低椎间盘内压力uwithminimumtraumaforthepatientpreservationofstabilizingstructuresBarcelona98SusanneMengerTrendsinDiscSurgery传统方法传统方法传统方法传统方法:

@#@u开放手术开放手术伴椎板切除或半椎板切除Barcelona98SusanneMengerTrendsinDiscSurgeryBarcelona98SusanneMengerTrendsinDiscSurgeryPresent:

@#@Present:

@#@uLessinvasivetechniques:

@#@toreduceintra-operativetrauma/smallerincisionstoreduceaccess-relatedpost-operativecomplicationstoreducedielesionofthestabilizingstructures（skeleton,muscles,ligaments,toreducescartissueformationandinstabilitiestoreducedischeightlossforeasierandfastermobilizationandrehabilitationtoimprovethelong-termresults!

@#@Barcelona98SusanneMengerTrendsinDiscSurgery经皮椎间盘摘除经皮椎间盘摘除KRMER椎间盘突出分类化学溶核化学溶核微创椎间盘摘除微创椎间盘摘除1度膨隆突出但位于韧带下突出并脱垂突出并游离2度膨隆包包涵涵型型轻度非包涵型轻度非包涵型重度包涵型重度包涵型内窥镜椎间盘摘除内窥镜椎间盘摘除Barcelona98SusanneMengerTrendsinDiscSurgery化学溶核化学溶核化学溶核化学溶核Chemo-Chemo-NucleolysisNucleolysisu1964年Smithu方法:

@#@木瓜蛋白溶解酶注入椎间盘内，溶解髓核组织。

@#@Barcelona98SusanneMengerTrendsinDiscSurgeryu适应征:

@#@包涵型u禁忌症:

@#@过敏曾做过溶核手术术中椎间盘造影显示纤维环破裂Barcelona98SusanneMengerTrendsinDiscSurgery临床病例：

@#@临床病例：

@#@临床病例：

@#@临床病例：

@#@Barcelona98SusanneMengerTrendsinDiscSurgery效效效效果果果果u便宜u微创u适应征范围内有效率可达4470u过敏反应u蛋白酶漏出，出现术后剧烈疼痛，甚至损伤神经根u剂量难于掌握u适应征较窄Barcelona98SusanneMengerTrendsinDiscSurgery经皮腰椎间盘切除经皮腰椎间盘切除经皮腰椎间盘切除经皮腰椎间盘切除经皮腰椎间盘切除经皮腰椎间盘切除PercutaneousPercutaneousPercutaneousDiscectomyDiscectomyDiscectomyu1975年Hijitaka手动ManualPercutaneousDiscectomy.u1985年Onik自动AutomatedPercutaneousDiscectomyu适应征：

@#@包涵型及轻度非包涵型Barcelona98SusanneMengerTrendsinDiscSurgery通过逐级增大的工作套筒建立工作通道Barcelona98SusanneMengerTrendsinDiscSurgery方法方法方法方法“安全带安全带”后外侧入路后外侧入路Barcelona98SusanneMengerTrendsinDiscSurgery临床病例临床病例临床病例临床病例Barcelona98SusanneMengerTrendsinDiscSurgery自动切吸主要器械自动切吸主要器械Barcelona98SusanneMengerTrendsinDiscSurgery优缺点优缺点优缺点优缺点u微创u有效率达到7080u指征窄uL5S1难做，设计较好的器械用可弯曲器械解决此问题u技术要求较高Barcelona98SusanneMengerTrendsinDiscSurgery经皮椎间盘激光切除u1987年Choy,u运用于包涵型病例u有效率达到7885Barcelona98SusanneMengerTrendsinDiscSurgeryPro/Pro/ConCon（classicmedialapproachclassicmedialapproach）umicrosurgicaltechniqueuwideindicationrangeutheworld-widegoldenstandardofeffectivediscsurgeryugoodclinicallongtermresultsulossofdischeightuapproachrelatedpostoperativescartissueformationandinstabilityPostdiscectomy-SyndromeBarcelona98SusanneMengerTrendsinDiscSurgery经皮内窥镜椎间盘切除经皮内窥镜椎间盘切除EndoscopicDiscSurgeryuMedialendoscopicapproachnotreallymorelessinvasivethanMLDlimitedvisualization（scope）uTransforaminalendoscopicapproachlimitedrangeofindicationbecauseofreducedheightofintervertebralforamenBarcelona98SusanneMengerTrendsinDiscSurgeryEndoSpyIEndoSpyITransforaminalEndoscopicDiscectomyTransforaminalEndoscopicDiscectomyuEpiduralEndoscopy“Barcelona98SusanneMengerTrendsinDiscSurgeryTransforaminalApproachTransforaminalApproachBarcelona98SusanneMengerTrendsinDiscSurgeryTransforaminalApproachTransforaminalApproachEntrypointPreservationoftheligamentumflavumPreservationoftheposteriorlongitudinalligament=Preservationofthestabilizingposteriorstructures/muscles=reducedscarringandfibroustissueBarcelona98SusanneMengerTrendsinDiscSurgeryTransforaminalEndoscopicApproachTransforaminalEndoscopicApproachunoaccessrelatedscartissueformationandtraumatostabilizingstructures（reducedinstabilities）urangeofindication:

@#@lateralandmedicalprotrusions,herniationssequestration,withoutcraniallyorcaudallymigrationurelativecontra-indications:

@#@morethan50%reduceddischeight/intervertebralforamenL5/S1-Level（iliaccrest）Barcelona98SusanneMengerTrendsinDiscSurgeryTransforaminalEndoscopicApproachTransforaminalEndoscopicApproachuDirectvisualizationoftargetareaandanatomicalstructuresuContinuousflow（suctionandirrigation）uDiscectomywithRongeurs,graspingforcepsscissorsmicroknifeuORtime:

@#@approx.1,5-2h（MLD:

@#@0,75-1h）Barcelona98SusanneMengerTrendsinDiscSurgeryEndoSpyEndoSpyIIComponentsoftheSystemComponentsoftheSystemuFlexiblescopewithrigidopticsleevesuitableforgassterilizationnobulgyopticcomponentsattheORareaBarcelona98SusanneMengerTrendsinDiscSurgeryEndoSpyEndoSpyIIComponentsoftheSystemComponentsoftheSystemCrosssectionoftheopticsleeveOuterdiameter:

@#@5.0mmInnerdiameter3.3mmLightfibersOpticfibers0.8mm,30.000pxlBarcelona98SusanneMengerTrendsinDiscSurgeryEndoSpyEndoSpyIIComponentsoftheSystemComponentsoftheSystemuscissorsug