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脊柱内固定技术的回顾与进展广州市第一人民医院脊柱外科Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospital温世锋医生Dr.WENShi-feng脊柱内固定的技术水平即标志着脊柱外科的发展水平!Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospital以20世纪60年代Harrington脊柱矫形内固定器械出现为标志，脊柱内固定技术已走过40余年的历程Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospital脊柱矫形第一代内固定20世纪60年代Harrington器械在将近20年间它成为了统治脊柱外科的主要内置物Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospital脊柱矫形第二代内固定1977年Luque提出了“脊柱节段性固定”的概念增强了内固定的牢固性，但该器械缺乏纵向撑开力，椎板下钢丝增加了脊髓损伤的风险。Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalSublaminarWires脊柱矫形第三代内固定80年代中期，Cotrel和Dubeosset将棍与多种形式的钩、椎弓根螺钉及横向螺杆相结合，发展了以CD器械为代表的第三代脊柱内固定系统Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalLumbarLaminarHooksM.A.C.Connector脊柱矫形第三代内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospital目前………20世纪后叶，Roy-Camille经过对椎体进行三维定量分析,获得了椎弓根的三维定量数据首先推出椎弓根螺钉固定系统，是脊柱外科发展史上的又一重要里程碑Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalSCREWINSERTION:AWLPROBEFEELERPROBEFINDERTAP3.SURGICALTECHNIQUEINSTRUMENTS:BENDINGPLIERSROD-SCREWLINKAGEI:INSERTERANDUNIVERSALTIGHTENER植骨融合内固定技术后外侧植骨融合(椎板间、横突间）椎间植骨-----椎间骨块或Cage植骨融合后外侧植骨融合+椎间植骨（360º）Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospital后外侧植骨融合(椎板间、横突间）Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospital椎间骨块或Cage植骨融合•1stTechnique,developedbyCloward...•Riskofcollapseormigration•Donorsitepain•DifficulttoobtainformultiplelevelsBut...Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalImplant&InstrumentOverviewSpinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalSpinesurgerydepartment,Guangzhou1stmuniciplepeople,shospital目前………CDHorizon系统TSRH系统ISOLA系统MOSSMIAMI系统Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospital目前………颈椎前路后路胸椎前路后路腰骶椎前路后路Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE1颈椎前路内固定，齿状突骨折空心钉固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE1颈椎前路内固定，齿状突骨折空心钉固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE2颈椎前路内固定，椎间Solis固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalDesignFinalCervicalCageCASE2颈椎前路内固定，椎间Solis固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE2颈椎前路内固定，椎间Solis固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE3颈椎前路内固定，椎间Solis固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalG.J.Preop.MRI30.08.2004CASE3颈椎前路内固定，椎间Solis固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospital颈椎前路钛板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE4颈椎前路钛板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE4颈椎前路钛板内固定ZEPHIRSpinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE5颈椎前路钛板内固定ORIONSpinesurgerydepartment,Guangzhou1stmuniciplepeople,shospital颈椎后路内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE1颈椎后路内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE1颈椎后路内固定APOFIXSpinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE1颈椎后路内固定APOFIXSpinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE1颈椎后路内固定APOFIXSpinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE2颈椎后路枕颈融合钉棒系统内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE3颈椎后路侧块钢板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE3颈椎后路侧块钢板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE9颈椎后路侧块钢板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE9颈椎后路侧块钢板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE10颈椎一期后路侧块钢板、前路内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE10颈椎一期后路侧块钢板、前路内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE4颈椎一期后路侧块钢板、前路钛板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE4颈椎一期后路侧块钢板、前路钛板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE4颈椎一期后路侧块钢板、前路钛板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE5颈椎一期后路钉棒、前路钛板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE5颈椎一期后路钉棒、前路钛板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE5颈椎一期后路钉棒、前路钛板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE5颈椎一期后路钉棒、前路钛板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospital胸腰椎前路内固定CASE1胸腰椎前路钉板内固定•F，34ySpinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE1胸腰椎前路钉板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE1胸腰椎前路钉板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE1胸腰椎前路钉板内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE2胸腰椎前路钉棒内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE3胸腰椎前路钉棒内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalF,63yT12压缩骨折，行前路T12骨折撑开复位钛板固定、钛笼植骨融合CASE2胸腰椎前路内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE2胸腰椎前路内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE3胸腰椎前路钉棒内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeople,shospitalCASE3胸腰椎前路钉棒内固定Spinesurgerydepartment,Guangzhou1stmuniciplepeo