occipital neck fusion

There are many specific surgical methods for occipitocervical fusion. The ideal occipitocervical fixation is not only fixed and reliable, but also requires the neck to be as short as possible. At the same time, there must be sufficient bone grafting area, which is difficult for spinal surgery. High-risk surgery. Treatment of diseases: atlantoaxial dislocation Indication 1. The posterior arch comminuted fracture of the ring. 2. The instability of the annulus caused by rheumatoid diseases, etc., is not suitable for patients undergoing abaxial fusion. 3. Congenital malformation in the neck pillow area, posterior decompression. 4. It is difficult to reset the dislocation of the axon. Contraindications 1. Poor general condition, malignant tumor with multiple organ dysfunction, can not tolerate the operator. 2. Local inflammation. 3. The vertebral lamina and spinous process anatomy of the bone graft bed are incomplete or damaged. 4. Upper cervical instability combined with severe spinal cord compression, it is not suitable for simple occipitocervical fusion before decompression. Preoperative preparation 1. After this operation, the rotation function of the head will be limited, and it should be clearly explained to the patient before surgery. 2. In order to maintain stability, it is sometimes necessary to perform surgery under the traction of the skull. Surgical procedure 1. Position: In the prone position, support the forehead with the head frame so that it does not affect the breathing. Sometimes it is necessary to perform surgery under the traction of the skull, shoulders and ankle pads, and do not press the chest and abdomen to facilitate breathing. 2. Incision: posterior median incision, from occipital nodules to cervical 5 spinous processes. Sometimes it is difficult to enter the suboccipital region. A t(cushing) incision can be used, which has a longitudinal length of about 10 cm and a transverse line of about 7 cm. 3. Exposing the occipital bone and the upper cervical vertebra: the midline cuts the skin, the subcutaneous tissue and the ligament, and the submucosa peels off the spinous processes and the attached muscles and soft tissues on the lamina, and the gauze is used to block the compression and stop bleeding. The occipital nodules and the neck 2 and 3 spinous processes are exposed to the largest of the 2 spinous processes, which can be used as a positioning marker. Carefully expose the posterior tuberosity of the ring vertebrae. Be careful not to peel off the area 1.5 cm away from the midline of the vertebral arch to avoid damage to the vertebral artery. 4. Take the iliac bone graft: another instrument is used to make an incision along the posterior superior iliac spine to the humeral wing. The periosteum is peeled off and the posterior tibia is exposed. According to the distance from the occipital tuberosity to the neck 3 spinous process, the length and the width of the cervical vertebrae were taken as the tibial plate. The outer bone plate and part of the cancellous bone are chiseled into a curved bone piece, and then some small strips of bone are taken for use. The bone surface was sutured with bone wax to stop bleeding. 5. Bone grafting and fixation: Drill two holes at a distance of about 2 cm on both sides of the occipital tuberosity with a special safety drill bit. The drilling depth should not exceed 4 mm, only pass through the skull outer plate, and reach the skull plate barrier in two holes. The warp barrier passes through a wire. Then punch holes in the posterior arch of the ring and pass through the other wire. The occipital region and the bone grafting region behind the annulus are chiseled, and the h-shaped bone graft is prepared on the occipital bone, and part of the bone is concave. The removed large tibial piece was made into an h-shape, and two holes were drilled in each of the corresponding portions of the skull and the posterior arch of the annulus. Then, the thin steel wire passing through the skull and the ring vertebra is drilled through the bone graft, the cancellous bone surface is facing forward, the lower end of the bone piece is aligned with the second cervical spinous process, and the upper end is embedded in the occipital concavity area. . Put the head in the normal position, tighten the upper and lower wires, and firmly fasten the occipital bone and the back of the cervical spine. Then fill the sides of the h bone with small strips of bone to enhance fusion. If it is necessary to strengthen the internal fixation, it is also possible to use a steel plate that is bent at a right angle along the axis and a bone grafting method using screws or wires. complication 1. Cervical spinal cord or medullary injury; 2. The bone graft does not heal; 3. Bone fractures.

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