Name: modified posterior vertebral column resection for patients with thoracolumbar kyphotic deformity
Uploaded: 2022-09-16T15:00:00
Description: Watch this Scientific Journal Video about Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity at JoVE.com

该方案遵循河北医科大学第三医院伦理委员会的指导方针。从患者那里获得了知情同意，以包括他们和作为本研究一部分生成的数据。
1.术前准备
<ol><li>根据以下纳入和排除标准选择患者。对于接受手术的患者，纳入标准如下：1）胸腰椎后凸引起的神经压迫，2）脊柱后凸引起的严重腰痛，3）Kummell病患者，4）治愈传染病留下的脊柱后凸畸形。排除标准如下：1?...

<ol>
	<li>Petitt, J. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Failure+of+conservatively+managed+traumatic+vertebral+compression+fractures:+A+systematic+review.">Failure of conservatively managed traumatic vertebral compression fractures: A systematic review.</a> World Neurosurgery. 165, 81-88 (2022).</li><li>Li, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Influence+of+lumbar+sagittal+profile+on+pelvic+orientation+and+pelvic+motion+during+postural+changes+in+patients+with+ankylosing+spondylitis-related+thoracolumbar+kyphosis+following+pedicle+subtraction+osteotomy.">Influence of lumbar sagittal profile on pelvic orientation and pelvic motion during postural changes in patients with ankylosing spondylitis-related thoracolumbar kyphosis following pedicle subtraction osteotomy.</a> Journal of Neurosurgery Spine. 36 (4), 624-631 (2022).</li><li>Khanna, K., Sabharwal, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spinal+tuberculosis:+A+comprehensive+review+for+the+modern+spine+surgeon.">Spinal tuberculosis: A comprehensive review for the modern spine surgeon.</a> The Spine Journal. 19 (11), 1858-1870 (2019).</li><li>Zhang, H. Q., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deformed+complex+vertebral+osteotomy+technique+for+management+of+severe+congenital+spinal+angular+kyphotic+deformity.">Deformed complex vertebral osteotomy technique for management of severe congenital spinal angular kyphotic deformity.</a> Orthopaedic Surgery. 13 (3), 1016-1025 (2021).</li><li>Schwab, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+comprehensive+anatomical+spinal+osteotomy+classification.">The comprehensive anatomical spinal osteotomy classification.</a> Neurosurgery. 74 (1), 112-120 (2014).</li><li>Tarawneh, A. M., Venkatesan, M., Pasku, D., Singh, J., Quraishi, N. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+pedicle+subtraction+osteotomy+on+health-related+quality+of+life+(HRQOL)+measures+in+patients+undergoing+surgery+for+adult+spinal+deformity:+A+systematic+review+and+meta-analysis.">Impact of pedicle subtraction osteotomy on health-related quality of life (HRQOL) measures in patients undergoing surgery for adult spinal deformity: A systematic review and meta-analysis.</a> European Spine Journal. 29 (12), 2953-2959 (2020).</li><li>Kose, K. C., Bozduman, O., Yenigul, A. E., Igrek, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spinal+osteotomies:+Indications,+limits+and+pitfalls.">Spinal osteotomies: Indications, limits and pitfalls.</a> EFORT Open Reviews. 2 (3), 73-82 (2017).</li><li>Liu, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Expanded+eggshell+procedure+combined+with+closing-opening+technique+(a+modified+vertebral+column+resection)+for+the+treatment+of+thoracic+and+thoracolumbar+angular+kyphosis.">Expanded eggshell procedure combined with closing-opening technique (a modified vertebral column resection) for the treatment of thoracic and thoracolumbar angular kyphosis.</a> Journal of Neurosurgery: Spine. 23 (1), 42-48 (2015).</li><li>Yang, D. L., Yang, S. D., Chen, Q., Shen, Y., Ding, W. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+treatment+evaluation+for+osteoporotic+Kummell+disease+by+modified+posterior+vertebral+column+resection:+Minimum+of+one-year+follow-up.">The treatment evaluation for osteoporotic Kummell disease by modified posterior vertebral column resection: Minimum of one-year follow-up.</a> Medical Science Monitor. 23, 606-612 (2017).</li><li>Fennell, V. S., Palejwala, S., Skoch, J., Stidd, D. A., Baaj, A. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Freehand+thoracic+pedicle+screw+technique+using+a+uniform+entry+point+and+sagittal+trajectory+for+all+levels:+Preliminary+clinical+experience.">Freehand thoracic pedicle screw technique using a uniform entry point and sagittal trajectory for all levels: Preliminary clinical experience.</a> Journal of Neurosurgery: Spine. 21 (5), 778-784 (2014).</li><li>Wang, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+clinical+and+radiological+improvement+between+the+modified+trephine+and+high-speed+drill+as+main+osteotomy+instrument+in+pedicle+subtraction+osteotomy.">Comparison of clinical and radiological improvement between the modified trephine and high-speed drill as main osteotomy instrument in pedicle subtraction osteotomy.</a> Medicine. 94 (45), 2027 (2015).</li><li>Li, X., Ding, W., Zhao, R., Yang, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Risk+factors+of+total+blood+loss+and+hidden+blood+loss+in+patients+with+adolescent+idiopathic+scoliosis:+A+retrospective+study.">Risk factors of total blood loss and hidden blood loss in patients with adolescent idiopathic scoliosis: A retrospective study.</a> BioMed Research International. 2022, 9305190 (2022).</li><li>Wang, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Unilateral+posterior+vertebral+column+resection+for+severe+thoracolumbar+kyphotic+deformity+caused+by+old+compressive+vertebrae+fracture:+A+technical+improvement.">Unilateral posterior vertebral column resection for severe thoracolumbar kyphotic deformity caused by old compressive vertebrae fracture: A technical improvement.</a> International Journal of Clinical and Experimental Medicine. 8 (3), 3579-3584 (2015).</li><li>Liu, F. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modified+posterior+vertebral+column+resection+for+Kummell+disease:+Case+report.">Modified posterior vertebral column resection for Kummell disease: Case report.</a> Medicine. 96 (5), 5955 (2017).</li><li>Policicchio, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pedicled+multifidus+muscle+flap+to+treat+inaccessible+dural+tear+in+spine+surgery:+Technical+note+and+preliminary+experience.">Pedicled multifidus muscle flap to treat inaccessible dural tear in spine surgery: Technical note and preliminary experience.</a> World Neurosurgery. 145, 267-277 (2021).</li><li>Yang, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Posterior+vertebral+column+resection+in+spinal+deformity:+A+systematic+review.">Posterior vertebral column resection in spinal deformity: A systematic review.</a> European Spine Journal. 25 (8), 2368-2375 (2016).</li><li>Tang, H. Z., Xu, H., Yao, X. D., Lin, S. Q. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Single-stage+posterior+vertebral+column+resection+and+internal+fixation+for+old+fracture-dislocations+of+thoracolumbar+spine:+A+case+series+and+systematic+review.">Single-stage posterior vertebral column resection and internal fixation for old fracture-dislocations of thoracolumbar spine: A case series and systematic review.</a> European Spine Journal. 25 (8), 2497-2513 (2016).</li></ol>

协议中提到的放置临时固定杆的步骤和畸形矫正是手术过程中的关键步骤。通过保留椎弓根的一侧并加载临时固定杆，可以在截骨术过程中保持稳定性。在畸形矫正的手术过程中，必须保护神经根，以防止严重的术后神经系统并发症。如果外科医生不确定神经根的位置，则需要在切除椎板和关节过程后暴露神经根。当切除椎管壁时，由于静脉丛，失血量可能很大。虽然使用双极电凝止血可以减少?...

胸腰椎后凸畸形是原发性或继发性疾病，通常由椎骨骨折、椎体发育、强直性脊柱炎和脊柱结核1，2，3，4引起。严重的后凸畸形通常诱发脊髓压迫或严重的腰痛。一旦保守治疗无效，由于畸形引起的并发症，有必要采用手术方法。然而，适当的手术治疗仍然存在争议。
治疗严重后凸畸形的手术方法通常需要 3 级或更高的5 级截骨术。椎弓根减影截骨术（PSO）是一种可以实现三柱截骨术的技术，据报道矫正在30°至40°6之间。当后凸畸形超过40°时，建议进行椎柱切除术，但可缩短脊柱并诱发脊髓体积7。部分椎体和椎间盘切除术（BDBO;4级）和后椎柱切除术（PVCR;5级）需要完全截留脊柱的前柱和中柱，这可能会对脊柱造成巨大损伤，并因手术中的脊柱不稳定或术后种植体沉降而引起严重的神经系统并发症7，8.对于一般操作者来说，该技术很难掌握，手术对患者的伤害是巨大的。因此，需要一种更容易执行且损坏更小的方法。
在本报告中，我们介绍了一种改进的手术技术，即改良环钻，通过单侧切除椎间盘和相邻椎间盘并在同一侧放置带有自体骨的钛网来治疗胸腰椎后凸。该技术旨在最大限度地减少对患者的伤害，同时取得良好的效果。在我们之前的研究中，精细的外科手术显示出显着更大的结果，并通过保留对侧椎弓根和部分椎体来减少对脊柱的损害9。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Adhesive</td>
			<td>Biatain</td>
			<td>3420</td>
			<td>12.5 cm x 12.5 cm</td>
		</tr>
		<tr>
			<td>Bipolar electrocoagulation tweezers</td>
			<td>Juan&#39;en Medical Devices Co.Ltd</td>
			<td>BZN-Q-B-S</td>
			<td>1.2 mm x 190 mm</td>
		</tr>
		<tr>
			<td>Bone wax</td>
			<td>ETHICON</td>
			<td>W810T</td>
			<td>2.5g</td>
		</tr>
		<tr>
			<td>Curette</td>
			<td>Qingniu</td>
			<td>20739.01</td>
			<td>300 x &#216;9 x 5&#176;</td>
		</tr>
		<tr>
			<td>Double jointed forceps</td>
			<td>SHINVA</td>
			<td>286920</td>
			<td>240 mm x 8 mm</td>
		</tr>
		<tr>
			<td>High frequency active electrodes</td>
			<td>ZhongBangTianCheng</td>
			<td>GD-BZ</td>
			<td>GD-BZ-J1</td>
		</tr>
		<tr>
			<td>Laminectomy rongeur</td>
			<td>Qingniu</td>
			<td>2054.03</td>
			<td>220 x 3.0 x 130&#176;</td>
		</tr>
		<tr>
			<td>Laminectomy rongeur</td>
			<td>Qingniu</td>
			<td>2058.03</td>
			<td>220 x 5.0 x 130&#176;</td>
		</tr>
		<tr>
			<td>Pedicle screw</td>
			<td>WEGO</td>
			<td>800386545</td>
			<td>6.5 mm x 45 mm</td>
		</tr>
		<tr>
			<td>Pedicle screw</td>
			<td>WEGO</td>
			<td>800386550</td>
			<td>6.5 mm x 50 mm</td>
		</tr>
		<tr>
			<td>Pituitary&#160;rongeur</td>
			<td>Qingniu</td>
			<td>2028.01</td>
			<td>220 mm x 3.0 mm</td>
		</tr>
		<tr>
			<td>Pituitary&#160;rongeur</td>
			<td>Qingniu</td>
			<td>2028.02</td>
			<td>220 mm x 3.0 mm</td>
		</tr>
		<tr>
			<td>Rod</td>
			<td>WEGO</td>
			<td>800386040</td>
			<td>5.5 mm x 500 mm</td>
		</tr>
		<tr>
			<td>Surgical drainage catheter set</td>
			<td>BAINUS MEDICAL</td>
			<td>SY-Fr16-C</td>
			<td>100-400 mL</td>
		</tr>
		<tr>
			<td>Surgical film</td>
			<td>3L</td>
			<td>SP4530</td>
			<td>45 cm x 30 cm</td>
		</tr>
		<tr>
			<td>Titanium&#160;cage</td>
			<td>WEGO</td>
			<td>9051228</td>
			<td>19 mm x 80 mm</td>
		</tr>
		<tr>
			<td>Trephine</td>
			<td>NATON MEDICAL GROUP</td>
			<td>DJD04130</td>
			<td>12 mm/10 mm</td>
		</tr>
	</tbody>
</table>

modified posterior vertebral column resection for patients with thoracolumbar kyphotic deformity

陈年压迫椎骨骨折或先天性脊柱后侧凸伴椎体发育异常等侵入脊柱的疾病，可引起严重的胸腰椎后凸畸形，常伴有顽固性腰痛或脊髓受压，导致严重的神经系统症状甚至瘫痪。如果保守治疗不能缓解症状或矫正畸形，通常需要手术治疗。对于严重的后凸畸形，生理曲率的重建和刚性固定决定了患者的预后。截骨术和骨科是前柱和中柱严重受压的畸形的标准程序，但对患者的创伤很大，手术时间长，大量失血。为了避免这些缺点，我们开发了一种改良技术来单方面切除患病的椎骨。在这种技术中，我们使用改良的环钻来切除椎体柱，就像在椎弓根螺钉技术中一样，通过添加可以限制环钻的锁定器械来降低截骨术的风险并缩短手术时间和失血量。

使用单侧PVCR技术可以实现约330°减压。需要切除横突和肋骨头，以确保外展角足以切除对侧骨。
通过使用改良的环钻，可以通过以轻微的压力旋转来轻松去除患病椎骨的骨骼。当环钻被锁定时，应将环钻和探头一起拉出，然后可以获得一圆柱体的松质骨（图2）。
并非所有患者都需要在截骨术段植入椎弓根螺钉。对于一些轻度椎体?...

Watch this Scientific Journal Video about Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity at JoVE.com

Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity

我们描述了一种基于改良环钻单侧切除后椎柱的改良技术，用于胸腰椎后凸畸形患者。

胸腰椎后凸畸形患者改良后椎柱切除术

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may ...

该协议可以帮助外科医生掌握改良技术的外科手术。单侧后椎柱切除术，改良环钻，用于治疗胸腰椎后凸畸形。这种技术可以减少手术时间，失血，手术过程中对患者的创伤，并且该技术易于学习。首先，用手术刀在患病椎骨上做一个正中背切口，覆盖上方和下方的两个椎体。为确保椎弓根螺钉可以放置，请保持切口长度比每侧病变相邻的两个椎骨长。使用手术刀沿标记垂直切割皮肤和皮下组织。然后，使用双极凝血止血。使用电凝电切开术沿肌肉附着点分离背阔肌和多裂肌，直到露出后棘突和椎板。使用骨钳切除病变上方和下方两块椎骨的部分小关节，直到关节表面完全暴露。然后，在C-ARM引导下使用定位针确认椎弓根螺钉的正确位置。选择入口点，0.3毫升到胸椎横突的交界处。腰椎的入口点是横突中点的水平线与上关节突的垂直线的交点。使用扩孔探头在上段和下段双向插入八个椎弓根螺钉以扩展路径。根据疾病，在病变节段的一侧插入另一个椎弓根螺钉。如果患者患有骨质疏松症，请使用骨水泥注射的空心椎弓根螺钉来加强椎体。将临时固定杆放在椎弓根螺帽上截骨侧对面，然后固定螺母。然后使用圆锥切除病变的节段棘突。接下来，使用椎板切除术切除截骨侧棘突和下关节突附近的椎板。按照这些步骤，使用圆锥切断同一侧的横向过程。使用改良的环钻在手术中进行截骨术。首先，将椎弓根探头插入病变的椎骨中。然后使用改良的环钻通过将手柄扭入椎骨来去除骨头。当环钻的顶部到达探针的尖端时，锁定装置将限制其运动并防止锯齿状顶部损伤前组织。抓住环钻和探针，然后慢慢将它们拉出并收集环钻中的松质骨以备后用。然后重复相同的过程以快速去除骨头。有时骨头可能不会随着环钻出来。使用髓核夹将其取出。通过改变探头的角度来去除对侧骨，并确保环钻不会损伤神经，保留椎弓和部分骨。接下来，使用椎板切除术rongeur和髓核夹去除剩余的小松质骨碎片和椎间盘，然后用刮匙刮擦上下端板软骨。当空间足够大以植入钛网时，截骨术将完成。在神经解剖器隔离硬脑膜的情况下，使用反向刮匙和截骨术去除椎骨的后壁。一旦对脊髓的压迫解除，轻轻地将脊髓拉到可以安全植入钛笼的位置。注意不要损坏脊髓硬脑膜，以免脑脊液渗漏。取下临时固定杆，并放置一根预先矫正到适当曲率的矫形杆。拧紧并固定截骨术另一侧的螺母。用截肢的自体骨填充适当大小的钛笼。然后将其放置在正确的位置，以防止脊柱向前屈曲。在外周植入自体碎骨。将另一根曲率与先前放置在截骨侧的杆相同的固定杆，然后拧紧螺母。使用大量生理盐水冲洗手术区域，并通过双极电凝术阻止活动性出血。然后，用明胶海绵填充空隙，并插入一个或两个封闭的抽吸引流管，以防止术后血肿。逐层关闭切口，并确保每一层都没有缝合到引流管上。使用间断的可吸收缝合线缝合肌肉，使用连续可吸收缝合线闭合筋膜。使用皮肤吻合器关闭皮肤。结合单侧PVCR技术和改良环钻，可以去除Kummell病患者的病变并重建脊柱稳定性，特别是对于脊柱后凸畸形和明显神经压迫症状的患者。必须保护神经根和脊髓，以防止手术过程中出现严重的后神经并发症。

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Assessment of Vascular Function in Patients With Chronic Kidney Disease

血管功能在慢性肾脏疾病的评估

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this ...

Murine Ileocolic Bowel Resection with Primary Anastomosis

鼠回结肠肠管切除原发性吻合

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn&#8217;s disease and colon cancer ...

Rat Model of Photochemically-Induced Posterior Ischemic Optic Neuropathy

光化学诱导后部缺血性视神经病变的大鼠模型

Posterior Ischemic optic neuropathy (PION) is a sight-devastating disease in clinical practice. However, its pathogenesis and natural history ...

Apical Resection Mouse Model to Study Early Mammalian Heart Regeneration

根尖切除小鼠模型来研究早期哺乳动物心脏再生

Cardiovascular disease plagues the whole world due to intensive lifestyle changes. Heart regeneration holds great promise for repairing and restoring ...

MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor

MRI 引导下聚焦超声丘脑治疗难治性原发性震颤

Essential tremor (ET) is the most common type of tremor in adults. While ET does not result in decreased life expectancy, the disabilities associated with ...

Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

内镜下鼻中隔成形术有限双线切除: 间隔偏差微创手术

Endoscopic septoplasty is a surgical procedure in otolaryngology that is commonly performed to treat nasal airway obstruction caused by nasal septal ...

Semi-quantitative Assessment Using [18F]FDG Tracer in Patients with Severe Brain Injury

Semi-quantitative Assessment Using [18F]FDG Tracer in Patients with Severe Brain Injury

[18f] fdg 示踪剂在重型颅脑损伤患者中的半定量评价

Patients with severe traumatic brain injury (sTBI) have difficulty knowing whether they are accurately expressing their thoughts and emotions because of ...

Posterior Approach for Debridement of the Psoas Abscess

切除普索阿脓肿的后向方法

This method focuses on outlining a safe zone for irrigation and debridement of a psoas abscess through a posterior approach. Initially, an anterior ...

Fertility Preservation in Patients with Severe Ovarian Dysfunction

严重卵巢功能障碍患者的生育保护

Ovarian function progressively declines during aging and in some pathophysiological conditions including karyotype abnormality, autoimmune diseases, ...