椎体成形术治疗外伤性椎体压缩性骨折(外)课件.ppt

1、Balloon Kyphoplasty in Traumatic FracturesTraumatic Vertebral Fractures Typically,younger patients without osteoporosis High blunt force fractures Fall from roof Car accidentTodays“gold standard”for treating traumatic VCFs Conservative Therapy Medication 4-6 weeks bedrest Brace for several months Su

2、rgical Treatment Rods&screws Anterior plating Vertebral body replacementWhy Kyphoplasty in Trauma?Immediate pain relief Low complication rate Minimally invasive treatment option Fast return to daily activities Preservation of disc function Prevention of disc problems and late kyphosis Kyphoplasty in

3、 TraumaImportant differences as compared to osteoporoticfractures:1.Treating normal bone2.More burst fractures 3.Filling material:not PMMA!-Instead,a CaP biomaterialFor traumatic fractures,biomaterial Filler.not PMMA!Biomaterial Calcium Phosphate Cement Viscous-toothpaste Low pressure injection High

4、 compressive strength Radiopaque Resorbs with bone ingrowthPMMATreating Traumatic Vertebral Fractures Treatment is dependent on the type of the fractureAO FractureClassificationAO ClassificationFracture Classification of the thoracic&lumbar spineA:Vertebral body injury with compressionB:Anterior&pos

5、terior elements injury with distractionC:Anterior&posterior elements injury with rotationIndications for Kyphoplasty in treating traumatic fracturesType B With indicated Type A fracture In combination with Posterior InstrumentationType ASurgical Technique Preparation Approach dependent on requested

6、balloon position Fracture location Fractures in ventral/anterior wall Position the balloon at least 2mm below/above the fracture planeSurgical Technique Higher IBT pressures then osteoporotic cases Handling characteristics of the biomaterial filler material are different than PMMA!Unstable vertebral

7、 bodies should not be treated with CaP at this time CaP should be contained completely within cancellous bone A decent void is needed for proper CaP injection-it is better to reposition and take time with IBT expansionImaging X-Ray AP Lateral CT fracture plane posterior wall MRICase StudiesL2 fx,50

8、YO maleFall,treated at 5 daysCourtesy Dr.Maestretti,Fribourg,SwitzerlandPre-op lateral X-ray Pre-op lateral CT1L2 fx,50 YO maleFall,treated at 5 days Courtesy of Dr.Maestretti,Fribourg,Switzerland1L2 fx,50 YO maleFall,treated at 5 daysCourtesy of Dr.Maestretti,Fribourg,SwitzerlandPre-op lateral Post

9、-op lateralPost-op AP1L2 fx,50 YO maleFall,treated at 5 daysCourtesy of Dr.Maestretti,Fribourg,SwitzerlandPre-op Lateral CTPost-op lateral CT1L2 fx,50 YO maleOne week post-opCourtesy of Dr.Maestretti,Fribourg,Switzerland1L2 fx,22 YO maleCar accident,treated at 4 daysCourtesy of Dr.Maestretti,Fribour

10、g,SwitzerlandPre-op lateral Post-op lateral Post-op AP2L2 fx,22 YO maleCar accident,treated at 4 daysCourtesy of Dr.Maestretti,Fribourg,SwitzerlandPre-op lateral Post-op lateral 2L2 fx,22 YO maleCar accident,treated at 4 daysCourtesy of Dr.Maestretti,Fribourg,SwitzerlandPre-op sup CTPost-op sup CT2C

11、ourtesy of Dr.Maestretti,Fribourg,SwitzerlandPre-op lateral CTPost-op superior CT L2 fx,22 YO maleCar accident,treated at 4 days2L2 fx,22 YO maleOne week post-opCourtesy of Dr.Maestretti,Fribourg,Switzerland2T12 fx,35 YO maleParasailing,treated at 5 daysCourtesy Prof.Vanderschot,University of Leuven

12、,BelgiumPre-op lateral Post-op lateral Post-op AP3T12 fx,35 YO maleParasailing,treated at 5 daysCourtesy Prof.Vanderschot,University of Leuven,BelgiumPre-op lateral Post-op lateral Post-op AP3T12 Fx,30 YO femaleFell off horse,treated at 2 daysCourtesy Prof.Vanderschot,U.Z.Leuven,BelgiumPre-op latera

13、lPost-op lateralPost-op AP4T12 Fx,30 YO femaleFell off horse,treated at 2 daysCourtesy Prof.Vanderschot,U.Z.Leuven,BelgiumPre-op lateralPost-op lateralPost-op AP4L1 fx,15 YO femaleScooter accident,treated at 3 daysCourtesy Dr.Francaviglia,Caltanissetta,ItalyPre-op lateralPost-op lateral5L1 fx,15 YO

14、female Scooter accident,treated at 3 daysCourtesy Dr.Francaviglia,Caltanissetta,ItalyPost-op 4 months follow-up5L2 fx,29 YO maleCar accident,treated at 8 daysCourtesy Prof.Giannini,University of Bologna,ItalyPre-op lateralPost-op lateralPost-op superior CT6Pre-op lateralPost-op lateralPost-op superior CTL2 fx,29 YO maleCar accident,treated at 8 daysCourtesy Prof.Giannini,University of Bologna,Italy6