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1、微创与开放手术治疗I-II度腰椎滑脱症,1,微创与开放手术治疗I-II度腰椎滑脱症,微创与开放手术治疗I-II度腰椎滑脱症,2,历史沿革,来自希腊语： spondylo(椎体)和Listhesis(滑移)集合而成。 1782年 Herbinlaux最先描述了腰5椎体前滑脱病例。 1854年 Kilian首先定义脊柱滑脱症(spondylisthesis):“一椎体在另一椎体上部分或完全的滑移”。 1957年 Taillard将脊柱滑脱症定义为“由于关节突间连续断裂或延长而引起椎体与其椎弓根、横突和上关节突一同向前滑移。”,微创与开放手术治疗I-II度腰椎滑脱症,3,流行性病学,Fredrick
2、son BE, et al. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am 1984, 500 participants,微创与开放手术治疗I-II度腰椎滑脱症,4,Jacobsen s Degenerative Lumbar Spondylolisthesis:An Epidemiological Perspective. spine. 2007, 4151 participants ，M ：1533、F：2618 254cases(11.1%),M(1.5%):F(5.9%)
3、,M(0.7%):F(1.2%),微创与开放手术治疗I-II度腰椎滑脱症,5,Kalichman L，Kinm DH, Li L, etal. Spondylolysis and Spondylolisthesis.Prevalence and Association With Low Back Pain in the Adult Community-Based Population. spine. 2009, 3529 participants ，CT :11.5%,微创与开放手术治疗I-II度腰椎滑脱症,6,腰椎滑脱的Wiltse分型,Wiltse LL，Newman PH, MacNab
4、 I. Classification of spondylolysis and spondylolisthesis. Clin Orthop,1976,117:23-29.,微创与开放手术治疗I-II度腰椎滑脱症,7,腰椎滑脱程度（Meyerding分型，1932）,Meyerding HW. Spondylolisthesis: surgical treatment and resultsJ. Surg Gynecol Obstet, 1932, 54: 371-37,I,II,III,IV,V,微创与开放手术治疗I-II度腰椎滑脱症,8,症状,马尾综合症,微创与开放手术治疗I-II度腰椎滑
5、脱症,9,滑脱进展,Labelle H, Mac-Thiong JM, Roussouly P. Spino-pelvic sagittal balance of spondylolisthesis: a review and classication Eur Spine J,2011,微创与开放手术治疗I-II度腰椎滑脱症,10,滑脱进展,申勇.中国矫形外科杂志 ,2005,40y,43y,45y,微创与开放手术治疗I-II度腰椎滑脱症,11,滑脱进展,微创与开放手术治疗I-II度腰椎滑脱症,12,滑脱进展主要因素,PI BMI Angle of lordosis Bilateral par
6、s defects,Jacobsen s. spine. 2007, Labelle H, Eur Spine J,2011 Beutler WJ, Spine,2003,PI,微创与开放手术治疗I-II度腰椎滑脱症,13,手术治疗指征,持续或反复发作的腰腿痛、间歇性跛行, 严重影响日常生活, 经合理的非手术治疗 ( 3个月或 3个月以上 ) 无效者; 神经功能障碍进行性加重者; 出现大小便功能异常者,微创与开放手术治疗I-II度腰椎滑脱症,14,手术与非手术治疗,2-4年随访，LDS手术疗效优于非手术,微创与开放手术治疗I-II度腰椎滑脱症,15,开放性手术,微创与开放手术治疗I-II度腰椎
7、滑脱症,16,开放手术,优点 学习曲线短 显露充分、视野大,缺点 椎旁肌肉损伤多 住院时间长 出血多 创伤大 风险高,微创与开放手术治疗I-II度腰椎滑脱症,17,微创手术,微创与开放手术治疗I-II度腰椎滑脱症,18,微创手术,优点 创伤小 住院时间短 出血小 术后疼痛轻 康复快 并发症少,缺点 学习曲线长，难掌握 对手术者技术要求高，手术难度大 要求手术者有良好的三维解剖知识 需要专用器械，增加手术成本 暴露不充分，视野小,微创与开放手术治疗I-II度腰椎滑脱症,19,微创 VS 开放：腰椎滑脱？,Open,Mini,Who is best?,微创与开放手术治疗I-II度腰椎滑脱症,20,
8、（PLIF）微创 VS 开放： 长期疗效,微创与开放手术治疗I-II度腰椎滑脱症,21,（PLIF）微创 VS 开放： 长期疗效,微创与开放手术治疗I-II度腰椎滑脱症,22,（TLIF）微创 VS 开放： 疗效,Conclusion： Minimally invasive surgery（TLIF） for severe SDS（I-II grade） leads to adequate and safe decompression of lumbar stenosis and results in a faster recovery of symptoms and disability i
9、n the early postoperative period.,微创与开放手术治疗I-II度腰椎滑脱症,23,（PLF）微创 VS 开放： 疗效,Conclusion： The MIS-PLF utilizing a percutaneous pedicle screw system had less invasive, less postoperative pain, rapid improvement of several functional parameters compared to conventional open-PLF. This superiority in the M
10、IS-PLF group was maintained until 2 years postoperatively, suggesting that less invasive PLF offers better mid-term results in terms of reducing low back pain and improving patients functional capacity of daily living.,微创与开放手术治疗I-II度腰椎滑脱症,24,（PLF）微创 VS 开放： 疗效,微创与开放手术治疗I-II度腰椎滑脱症,25,（ALIF+TLIF）微创 VS
11、开放：并发症,Conclusion: MIS(ALIF+TLIF) had less blood loss, less need for transfusion in the perioperative period, and a shorter hospital stay than open(ALIF+TLIF), but the length of surgery, intraoperative uoroscopy time, malpositioned instrumentation on postoperative imaging, and postoperative complica
12、tions, including pulmonary embolus and surgical site infection no difference.,微创与开放手术治疗I-II度腰椎滑脱症,26,（P/TLIF）微创 VS 开放：感染率,Conclusions： In this multihospital study, the MI technique（P/TLIF） was associated with a decreased incidence of perioperative SSI (27 4.6% vs 150 7.0%, p = 0.037) in 2-level fusi
13、on. There was no significant difference in the incidence of SSIs (38 4.5% vs 77 4.8%, p = 0.77) between the open and MI cohorts for 1-level fusion procedures.,微创与开放手术治疗I-II度腰椎滑脱症,27,(PLIF)微创 VS 开放：多裂肌损伤,微创与开放手术治疗I-II度腰椎滑脱症,28,微创 VS 开放：多裂肌损伤,微创与开放手术治疗I-II度腰椎滑脱症,29,微创 VS 开放： 费效分析,CONCLUSIONS: MIS TLIF
14、 resulted in reduced operative blood loss, hospital stay and 2-year cost, and accelerated return to work. Surgical morbidity, hospital readmission, and short- and long-term clinical effectiveness were similar between MIS and open TLIF. MIS TLIF may represent a valuable and cost-saving advancement fr
15、om a societal and hospital perspective.,微创与开放手术治疗I-II度腰椎滑脱症,30,微创 VS 开放：住院时间短、费用少,微创与开放手术治疗I-II度腰椎滑脱症,31,（TLIF）微创 VS 开放： Meta分析,微创与开放手术治疗I-II度腰椎滑脱症,32,Mini-TLIF VS mini-ALIF：疗效,微创与开放手术治疗I-II度腰椎滑脱症,33,Mini-TLIF VS mini-ALIF：疗效,MALIF,MTLIF,微创与开放手术治疗I-II度腰椎滑脱症,34,Mini-TLIF VS mini-ALIF：疗效,Conclusions：C
16、onsidering the clinical and radiological outcomes in both groups, the authors recommend that instrumented mini-TLIF is preferable at the L45 level, whereas instrumented mini-ALIF might be preferable at the L5S1 level for the treatment of unstable isthmic spondylolisthesis.,微创与开放手术治疗I-II度腰椎滑脱症,35,正确掌握腰椎滑脱的治疗原则(侯树勋),不是所有的腰椎滑脱都需要治疗 伴有腰痛的腰椎滑脱并非都需要手术 根据滑脱的严重程度选择适当的手术方式 滑脱椎体的融合是手术治疗的最终目的,微创与开放手术治疗I-II度腰椎滑脱症,36,Thanks for your attention,