病例讨论-OLIF1

病例讨论微创腰椎间融合手术（OLIF）2012.11.9宁波大学医学院附属医院脊柱外一科PRE-OP病例特点-病史女性，80岁，强迫体位，无法入眠右侧腰腿痛3年，加重伴间歇性跛行3月腰椎侧凸畸形，左/右SLR＝30°/70°右足背触痛觉减退，右伸踇肌力III级左/右膝反射＝+/+，左/右踝反射＝+/-PRE-OPX-RAYPRE-OPMRI治疗方案A保守治疗无效－症状重，难以忍受B手术治疗a单纯髓核摘除术(MED/椎间孔镜/小切口)b腰4/5髓核摘除，DYNESYS动态固定术cP-T-D-X-ALIFOR?OLIFObliqueLumbarInterbodyFusionAnatomyofKambin’sTrianglePosteriorBorder–SAPInferiorBorder–VertebralEndplateSuperiorBorder–ExitingNerveDistanceFromMidlineDiscSpacePreparationandAccessSpinalNeedleAccessBallTippedProbeAccessGuideWireAccessBluntDilatorAccess9mmWorkingCannulaAccessAllDoneThroughKambin’sTriangleWithMaximalTissuePreservationDilatorDiameteris8mmDiscDrillremovesdiscnucleusandpreparesdiscspaceforotherdiscectomyinstruments.Rotatingdiscshaperpassesthroughaccessportalandexpandsupto16mmforendplatepreparationAnimationofshaperturningindiscspacePituitaryrongeurgrabsdiscmaterialaftertherotatingDiscShaperisremovedPreparationForImplantInsertionInstrumentationAllowsaThoroughDiscectomyUniqueMinimalAccessInstrumentationAllowsRemovalofCartilaginousEndplatePreparationofaBleedingBoneBedBoneGraftingAllDoneThrougha9mmTube9mmDiscCutterexpandsasaloopcurettetodeflectleft,right,upanddownforthoroughdiscectomy.AddBonegraftmaterialWehaveacollagenspongeinfusedwithβ-TCPandHydroxyapatiteandhydratedwithbonemarrowaspirateProperplacementoftheZeus-OisachievedwhentheradiographicmarkersarelocatedonoppositesidesofthespinousprocessinanA/Pfluoroimage.INTRA-OPPostOLIFCompleteResolutionofSymptomsPostOLIFCompleteResolutionofSymptoms创伤小恢复快效果好并发症少住院周期短3-5天术后第1天AchievingFusionThroughAMinimallyInvasiveApproachSoftTissueTraumaPreservationofNormalMusculaturePreservationofNormalBonyStabilityPreservationofNormalStabilizingLigamentsViolationofEpiduralSpaceDeliveryApproach:TrulyMinimallyInvasiveDiscectomyandEndplatePreparationAreAllDoneThrough9mmAccessCannulaSurgicalApproachThroughKambin’sTriangleImplantInsertionIsThroughKambin’sTriangleDeliverySystemDecreasesComplicationRateTechniqueEasilyMasteredbyMostSurgeonsALIF:RetrogradeEjaculation,DamageGreatVessels,BowelInjuryPresacralAxialift:BowelInjury/ColostomyPLIF:NuerologicInjuryEpiduralScarringDLIF:FemoralNerveInjuryTHANKYOU