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Perkutane minimalinvasive Instrumentierung der Wirbelsäule

Percutaneous minimally invasive stabilization for treatment of spinal fractures

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Nach Etablierung der minimalinvasiven ventralen Zugänge erfolgt die dorsale Instrumentierung der Wirbelsäule unter Nutzung neuer Implantate zunehmend in perkutaner minimalinvasiver Technik. Hauptvorteil dabei sind die Schonung der autochthonen Rückenmuskulatur sowie ein deutlich reduzierter intraoperativer Blutverlust, wodurch sich eine raschere Rehabilitationsfähigkeit ergibt. Die perkutane Instrumentierung der Wirbelsäule ist zur Versorgung traumatischer Wirbelsäulenverletzungen, der operativen Stabilisierung bei Spondylitis/Spondylodiszitis sowie bei Instabilitäten der Wirbelsäule aufgrund von Metastasen und Tumoren geeignet. Sie ist über den gesamten Bereich Wirbelsäule möglich. Für den oberen Brustwirbelsäulenbereich muss die präzise Draht- und Schraubenplatzierung intraoperativ durch dreidimensionale Bildgebung kontrolliert werden. Die Reposition erfolgt bei dieser Technik nicht durch Hebelwirkung über die eingebrachten Schrauben, sondern indirekt. Außer Luxationsverletzungen und hochinstabilen Rotationsverletzungen lassen sich alle Fehlstellungen reponieren und minimalinvasiv perkutan instrumentieren. Eine evtl. erforderliche spinale Dekompression erfolgt über eine separate mediane Inzision zur Laminektomie.

Abstract

Having established minimally invasive anterior approaches in spinal surgery, dorsal stabilization of the spine is now also increasingly being performed using percutaneous minimally invasive techniques and newly designed implants. The main advantages of this method include protection of the back muscles as well as a significant reduction of intraoperative blood loss. The percutaneous technique is appropriate for the stabilization of traumatic spinal injuries, spondylitis/spondylodiscitis or spine instability caused by metastases or tumors. Percutaneous insertion of the screws can be performed in the entire spinal region from the thoracic (Th1) to the sacral (S1) spine. For the cranial parts of the thoracic spine (Th1-Th4) three-dimensional imaging is required intraoperatively to ensure the correct positioning of the K-wires and the screws. In contrast to the open technique, reduction is achieved indirectly and not by a leverage effect of the inserted screws. With the exception of luxation injuries and highly unstable rotation injuries all malpositions can be corrected by closed reduction and percutaneous minimally invasive stabilization. If required, spinal decompression can be performed using a separate median incision for laminectomy.

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Matschke, S. Perkutane minimalinvasive Instrumentierung der Wirbelsäule. Trauma Berufskrankh 13, 253–259 (2011). https://doi.org/10.1007/s10039-011-1805-1

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  • DOI: https://doi.org/10.1007/s10039-011-1805-1

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