病例讨论-英文版课件.ppt

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1、CaseDiscussionZhenLiu,YongQiu,ZezhangZhu,FengZhu,BinWang,YangYu,BangpingQian南京鼓楼医院脊柱外科NF-1,Type3(Dystrophic)#7995,M,5yrsFeaturesofdystrophiccurveScalloping>3mmT-spine>4mmL-SpineShortcurveKyphosisSpontaneousdislocationPseudarthrosisRibpencilingDuralectasiaPost-op1.5y-opIndexsurg

2、eryatlocalhospitalNoneurologicalsymptomsQ1:Revision?Conservative?RevisionindicatedQ2:Posterior-only?Anteriorfollowedbyposterior?Posteriorfollowedbyanterior?Revision:Instrumentation+FusionPosteriorfixationfollowedbyanteriorfusionIstage:PosteriorReductionRealignmentQ3:IIstage:Ant

3、eriorFusionwithcage?Autografts?Allografts?AnteriorFusionwithFibulaGraftPost-opPost-op3m-opExcellentfusionduringfollow-up3y-op1.5y-op1y-op6m-opDiscussion:Whatshouldbedoneatfirstvisit?Thesame!Posteriorfixation+AnteriorsupportwithfibulaSmallpedicleandlowaccuracySolution:3DO-armnav

4、igationAbnormalbonemetabolisminNF-1LowBMD:LumbarspineZscore:>2SDbelowmeanHighNon-unionrateCollapseandkyphosisLowserum25-hydroxyvitaminDIncreasedserumparathyroidhormoneIncreasedboneresorptionDumanetal.Bonemetabolismmarkersandbonemineraldensityinchildrenwithneurofibromatosistype-

5、1.BrainDev2008;30:584–588.3y-opOptionofbonegraftsinreconstruction:SupportandSolidFusionAnteriorstrutgrafting:FibulaRibWintersetal.Theuseoffreevascularisedbonegraftsinspinalreconstruction.JPlastReconstrAesthetSurg.2010Mar;63(3):516-23VascularisedFibula#11341F11yrs3m-op5m-op#1139

6、4M11yrsO-ArmNavigation!Insufficientanteriorsupportleadtoimplantfailure#6264ConclusionSurgicalapproach:posteriorfixationfollowedbyanteriorsupportSolidfusionisnecessaryBecarefulwheninsertscrewsinNF-1patients.NavigationispreferredThankYou