腰椎间融合技术和比PPT文档.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,二级,三级,四级,五级,*,*,Lumbar interbody fusion:,Techniques,and comparison,1,Introduction,Lumbar interbody fusion(LIF),：,placement of an implant(cage,spacer or structural,graft)within the intervertebral space after discectomy and,endplate preparation.,Five main approaches,Interbody fusion,：,lower rates of,postoperative complications and,pseudoarthrosis,2,Technique review,PLIF,One of the original approaches,Initial description of the PLIF technique by,Briggs and Milligan in 1944,3,PLIF,PLIF,4,Technique review,5,Technique review,6,Technique review,TLIF,Opening the neural,foramen on one side only.,Harms,and Rolinger reported in 1982,Direct,unilateral,access to the intervertebral foraminal space whilst,reducing direct dissection,and,dural,tears.,7,TLIF,TLIF,8,Preserves,ligamentous structures which are instrumental to restoring,biomechanical stability of the segment and adjacent,structures,A single unilateral incision,is able to provide bilateral anterior column support,9,10,Technique review,ALIF,Anterior access corridors for lumbar fusion have been used and,developed since they were introduced by Carpenter in 1932.,The anterior retroperitoneal approach to the,ventral surface of the exposed,disc,allowing comprehensive discectomy and direct implant,insertion.,Suitable,for levels L4/L5 and L5/S1,11,ALIF,ALIF,12,13,14,15,Disadvantages,Retrograde,ejaculation,visceral and vascular injury,16,Technique review,LLIF,Described by Ozgur et al.in 2006,Suitable for T12 to,L5.This technique is not suitable for the L5/S1 level.,Neuromonitoring is essential,Suitable for all degenerative,indications.Especially,for sagittal and coronal,deformity correction,lumbar degenerative,scoliosis with laterolisthesis.,Not be suitable for severe central canal,stenosis,bony lateral recess stenosis and high-grade,spondylolisthesis,Not be suitable for prior,retroperitoneal surgery or with retroperitoneal abscess,as,well as patients with abnormal vascular anatomy.,17,LLIF,18,Advantage:,MIS,muscle-splitting approach that,can,be,performed with rapid postoperative,mobilization.,Aggressive,deformity correction can be achieved with,high,fusion,rates and comprehensive disc space,clearance.,Disadvantages:,P,otential,risks of lumbar,plexus,psoas,muscle and bowel injury,particularly at the,L4/5,level.,Vascular,injury,if it occurs,may be difficult,to,control.,19,Technique review,OLIF,First described by Michael,Mayer in 1997 and involves an MIS access to the,disc space via a corridor between the peritoneum and,psoas muscle,The phrase“oblique lumbar interbody fusion”or OLIF was first,coined by Silvestre in 2012,Similarly to an LLIF approach,OLIF does not require posterior surgery,laminectomy,facetectomy or stripping of spinal or paraspinal musculature.,OLIF technique does not dissect or traverse the psoas,muscle,and,neuromonitoring is not,necessary.,OLIF technique is suitable,for levels L1-S1.,Indications and,contraindications,are,similar to LLIF,20,OLIF,OLIF,21,Advantage:,LLIF+less,risk,of,lumbar,plexus,and,psoas,muscle,damage.,Disadvantages:,Potential,risks of,include sympathetic,dysfunction,and vascular injury,22,Silvestre C,Mac-Thiong JM,Hilmi R,et al.Complications and morbidities ofmini-open anterior retroperitoneal lumbar interbody fusion:oblique lumbarinterbody fusion in 179 patients.Asian Spine J 2012;6:8997.,23,24,25,26,27,28,29,30,31,32,33,34,35,