extraperitoneal debridement

Extraperitoneal lesion removal for lumbar 5, 1 vertebral tuberculosis lesions. Treatment of diseases: spinal tuberculosis Incision The lower abdomen is inverted with an "eight" incision, and the upper and lower inward and downward movements are 10 to 15 cm long. It is best to choose the right approach, because the left and right iliac arteriovenous anatomical locations are different. 2. revealing the lesion Same as the 3~5 tuberculosis lesions of lumbar vertebrae, but because of the low position of the incision, be careful not to damage the inferior epigastric vessels when cutting the 3 layers of abdominal muscles, except to push the peritoneum, ureter, spermatic cord or ovarian blood vessels to the midline and lateral side. The bladder and uterus should also be pulled down until the triangle that completely reveals the lower part of the large vessel bifurcation. 3. Lesion removal First use the fingers to carefully understand the lower part and the sides of the triangle, determine the position of the humerus and the large blood vessels and their relationship, and then use the slender needle to pulsate the medial side of the right common iliac artery from top to bottom, from right to left. Puncture the puncture in the triangle area, point the line to locate, retract whether there is pus or blood, carefully cut the anterior ligament and periosteum of the vertebral body, and perform subperiosteal separation to reveal the humerus and the lumbosacral space above it. . It is found that the abscess should be cut open and scraped. In the peeling, the blood vessels in the middle of the sacral sinus are inadvertently injured. When bleeding occurs, it can be directly ligated, burned by electric burning or gauze pressed to stop bleeding. Find and expose bone lesions, enlarge bone holes, and remove bone lesions. If necessary, vertebral anterior humeral interbody fusion can be performed. 4. Close the incision. complication Macrovascular injury Commonly, the large veins are as follows: the vena cava, the common iliac vein, and the branches. Its blood vessel wall is thin, lacks elasticity, and has no pulsation, so it is easily damaged. Because the wall of the aorta is thick and pulsating, it is not easy to be injured. The cause of the damage is mostly caused by excessive pulling and mistaken peeling. Once damaged, it can cause massive bleeding and must be actively treated. The treatment method is the same as described above. 2. Lumbar nerve injury When the anterior vertebral body is approached, it is susceptible to injury when the abscess is scraped off. If it is cut, it should be sutured immediately.

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