Hibbs method and its modified fusion

Treatment of diseases: lower lumbar instability of spinal fractures Indication The Hibbs method and its improved fusion technique apply to: 1. After the removal of spinal tuberculosis lesions, the spinal column of the lesion segment is unstable, or some patients who do not need to be treated with lesions can directly apply bone graft fusion. 2. Spinal fracture dislocation is unstable, or clinical instability after non-surgical treatment, often painful and affects life and labor. 3. Lumbar vertebra deformity, after the instrument is corrected, in order to maintain its bone stability, often bone grafting is performed at the same time as internal fixation. 4. After the removal of some lumbar disc herniation, or the original lumbar instability, interbody fusion should be performed. 5. The lower lumbar instability caused by various reasons. Preoperative preparation According to different lesions for the corresponding preoperative preparation, such as tuberculosis, fracture and dislocation must be accurately positioned before surgery, especially those without spinous process deformity, C-arm X-ray machine perspective positioning before surgery. Surgical procedure Spinal or epidural anesthesia may be used, but general anesthesia is generally used. Common prone position. Incision The midline of the lumbar region was made with the spinous process of the lesion as the center. Its length depends on the needs of the operation. 2. Exposure of lamina and facet joints Cut the skin and deep fascia, cut the lumbar fascia from the side of the supraspinous ligament and deepen the muscles. Use the periosteal stripper to separate the spinous process from the spinous process and lamina, and fill the dry gauze strip to stop bleeding. . Peel the opposite side with the same method. The stripped muscles were retracted with an automatic hook to reveal the spinous processes, the lamina and the medial part of the facet joint. 3. Preparation of bone grafting bed According to the lesion and the scope of fusion, a curved osteotome or a small flat chisel is used to remove part of the lower joint of the superior vertebra, and the cartilage surface of the joint joint is partially excised to reveal the new bone surface. From the spinous processes, lamina and facet joints, the fish scales are made of cancellous bone, and then the bone flap is reversed so that the cancellous bone faces upward, and the fish scales overlap. 4. Bone graft Take the autogenous humerus to make a bone piece or a bone strip, cover it vertically, or cut the exposed spinous process, lamina and joints into a rough bone surface, and trim the bone graft into a matchstick shape. The surface of the bone bed. 5. Fixed Internal fixation may be used as appropriate depending on the original stability of the lesion. Currently, short-segment pedicle screws are most commonly used and effective. complication Non-union of the bone graft or pseudoarthrosis is one of the late complications, which is actually a failure of the fusion surgery. The reasons include: insufficient preparation of the bone grafting bed, insufficient bone grafting or insufficient bone grafting; premature load-bearing from the bed, no stable environment for bone fusion, and long-term non-brake dynamics of the bone graft fusion segment Under conditions, it directly affects bone graft fusion.

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