Segmental Spinal Instrumentation Orthopedics

Treating diseases: spinal deformity Indication Segmental spinal instrument orthopedics are suitable for: 1. Non-surgical treatment is ineffective, and spinal deformity continues to increase, requiring surgical treatment. Because spinal fusion will hinder the growth of the length of the spine, if the spinal deformity is not serious or non-surgical treatment can control the development of the deformity, the time of surgical fusion should be delayed as far as possible to the mature stage of the spine. However, due to thoracic scoliosis, secondary rib thoracic deformity may have a greater impact on cardiopulmonary function, and the appearance of deformity is obvious. Thoracic deformity is limited by the ribs and surrounding structures, and the effect of surgical orthopedics is poor, so early surgical treatment should be considered. 2. Young patients with obvious scoliosis deformity. In general, the obvious scoliosis refers to the lateral curvature of 40 ° ~ 45 ° before the developmental maturity, and the lateral curvature of the mature period of 50 ° ~ 60 °, and those who continue to develop should be actively treated. Preoperative preparation 1. In addition to routine preoperative preparation, the patient's cardiopulmonary function should be checked. Understand whether the patient has heart palpitations, cyanosis, and asthma when exercising more vigorously or going up and down the stairs. ECG examination mainly observed the presence or absence of right heart cardiac hypertrophy; pulmonary function measurement included lung volume and ventilation function, and assessed the degree of lung function damage. 2. Detailed examination of the patient's nervous system with or without lower extremity numbness, weakness, gait instability. Lower extremity muscle strength, presence or absence of hyperreflexia and pathological reflex. If necessary, perform myelography or CT and MRI to understand the location of the spinal cord in the spinal canal and whether there is any deformity. 3. X-ray inspection (1) The full-length positive phase of the standing spine is measured to measure the curvature and rotation of the spine, and the scoliosis is correctly classified and classified. In order to understand whether the spine is accompanied by lordosis or kyphosis, the positive side phase of the vertebral body should be taken. (2) The lateral position of the spine or the suspended phase is bilaterally curved. The significance is: to understand whether scoliosis is structural or non-structural; to understand the extent of structural scoliosis (primary scoliosis) to determine the extent of vertebral body fusion; to understand the elasticity of deformed spine, to estimate intraoperative instruments Orthopedic can reach angles. The angle of the structural side bend changes when bending to the side convex side, which is approximately the same as the angle that can be achieved by the orthopedic instrument during surgery. (3) In severe cases of scoliosis and kyphosis, due to the rotation of the spine, the common anterior and posterior slices are difficult to distinguish between congenital or idiopathic scoliosis. It is necessary to take the spine anti-rotation phase, which clearly shows the main side bend. A segment. 4. Myelography, CT and MRI: Myelography can clearly show disc herniation, spinal stenosis, space occupying lesions in the spinal canal, and some malformations of the spinal cord itself. CT and MRI examinations can show the lesions of bone and soft tissue, depending on the specific case. Surgical procedure Incision According to the fusion segment determined before surgery, a midline incision is made between the upper and lower fusion vertebrae. If the scoliosis is severe, a curved incision to the convex side can be made a little, and the arcuate incision should not be made along the spinous process or the arcuate incision to avoid orthopedics. After the impact of beauty. Cut the skin and subcutaneous superficial fascia along the incision line, and make a proper blunt dissection on the convex side to reveal the spinous process tip. 2. Reveal Cut along the superior ligament of the spine, revealing to the spinous process, and separating the concave side of the spine. Using the Cobb stripper with the spinous process as the fulcrum, the paraspinal tissue was pushed out to the outside of the spinous process and the lamina bone until the articular process, and the hemorrhage was filled with gauze while peeling, and the adjacent lamina was separated and revealed. The thoracic vertebrae were exposed to both sides of the transverse process, and the convex and concave sides were extensively loosened. The transverse intersegmental ligaments and muscles were removed, and the thoracolumbar spine was subjected to arthrotomy. 3. Yellow ligament opening window (1) lumbar vertebrae: the interspinous ligament is removed, and the spinous process of the upper and lower vertebrae is lifted with a cloth towel clamp to help reveal the interlaminar space. The rongeur bite slightly removes the vertebral bone of the spinous process root and enlarges the bone hole to see To the ligamentum flavum on both sides and its central gap. Use a sharp-necked rongeur to bite off the ligamentum flavum in small pieces and small pieces until the epidural fat is revealed. Use the stripper to poke into the ligamentum flavum and gently push away to separate the dura mater and the ligamentum flavum. At this time, use a small laminar forceps to carefully penetrate the deep ligament of the ligamentum flavum to enlarge the ligamentum flavum, to the intervertebral plate. Expand to a diameter of 5 to 8 mm. The whole operation process should be careful not to damage the dura mater. Use a cotton pad to gently fill the bone hole to reduce the flow of surrounding blood into the epidural space. (2) Thoracic vertebrae: In addition to the removal of the interspinous ligament of the thoracic spine, it is necessary to bite the spinous process covering the interlaminar space to perform ligamentum flavum fenestration. Because the thoracic intervertebral space is relatively narrow, it is often necessary to bite part of the lamina to enlarge the bone hole. In the interlaminar space near the top of the main curve, the convex side lamina can be wedge-shaped to the articular process to facilitate orthopedic alignment. 4. Lace plate under the wire Take a 30cm long medical wire (diameter 1mm), fold it in half to form a double strand, and bend the blunt end of the fold into a semi-arc with a radius of 3cm. Insert the blunt end into the ligamentum flavum window and use both hands to make the wire close to the lamina below the lamina. After the blunt end of the wire is exposed by the yellow ligament window of the upper vertebral plate, clamp the blunt end of the wire with a needle clamp and lift the wire. Tension, the steel wire is pulled out from the lamina to the lamina, and the upper and lower ends of the wire are equal in length, and the upper and lower wires are crossed on the lamina to prevent the wire from moving into the spinal canal to compress the dura. 5. The spine process of the base of the spinous process This is another wire fixing method. Because of the convenient operation, it is not easy to damage the spinal cord. However, the spinous process is not strong and is only suitable for the lumbar spinous process of young patients. Juvenile patients or thoracic vertebrae should be carefully applied due to the easy to fracture of the spinous process. The spinous process puncture forceps are used to punch the base of the spinous process, and the double-stranded steel wire is passed through the bone hole of the three-hole spacer at the same time. After the steel wire is tightened, the pre-bent alloy rod is placed between the steel wires, and the steel wire is placed. Tighten and fix it.

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