Scapula excision

It is suitable for children aged 3-7 years with severe scapular deformity and obvious dysfunction. The principle of surgery is to loosen the soft tissue around the scapula, lower the scapula to the normal position, remove the bony and muscular connections that hinder the decline of the scapula, and avoid the damage of blood vessels and nerves. Applicable to those with severe malformation combined with dysfunction or bilateral deformity. Treatment of diseases: scapula fractures Indication 1 The age of surgery is better when the age is 3 to 7 years old. If the age is too small, the operation cannot be tolerated. For those over 8 years old, the surgery pays too much attention to correcting the deformity, which often causes the brachial plexus to pull and cause damage. At the same time, the tissue development is close to maturity, lack of elasticity, and the adaptability to the change of the position of the scapula is poor. Therefore, the function improvement has little effect and should be carefully considered. . 2 deformity is severely combined with dysfunction. 3 bilateral asymmetry is asymmetrical. Contraindications There is no dysfunction and only the appearance is deformed. Malformation is symmetrical. If there are other severe deformities of the spine and ribs, it is estimated that the postoperative function is not improved and should not be treated surgically. Preoperative preparation 1. Review the medical history, do a good job in blood and urine routine examination and heart, lung, liver and kidney function tests, and strive to obtain biopsy pathological tissue confirmation and review X-ray photos. 2. Fully preoperative discussion, if necessary, invite radiation, pathology, anesthesia related physicians to participate. Determine the diagnosis, surgical plan, etc. 3. According to the scope of surgery (partial, sub-total, total resection) with adequate blood and blood transfusion. 4. Malignant bone tumors, especially the resection of high-malignant bone tumors, should be performed 1 to 3 chemotherapy courses before surgery, and then scapular bone resection. Surgical procedure Several common surgical methods: (1) Scapular vertebral bridge resection in the upper part of the scapula General anesthesia, prone position, a transverse incision on the affected side of the scapula, the incision from the upper part of the trapezius muscle fiber, outside the shoulder peak. The trapezius muscle above the upper edge of the scapula is separated and the upper part of the scapula and the shoulder vertebral bridge are prominent. Cut the levator scapula and rhomboid attachment points on the scapula. How much the scapula is removed varies from patient to patient. The principle must include the upper part of the scapula, the medial end of the scapula and the nodule protruding at the medial edge of the scapula, so the nodule may interfere with the spinous process. When removing part of the shoulder blade, it must be removed together with the periosteum to prevent bone regeneration and affect the postoperative efficacy. Finally, the vertebral bridge is removed, and the scapula can be lowered to varying degrees after the soft tissue of the scapula is maintained. (B) most of the scapula resection Most of the scapula is removed, leaving only the joints and condyles, but the stability of the shoulder blades to the shoulder joints must be adequately maintained. This method is used to treat patients with severe deformities. The main shortcomings are: severe trauma, more bleeding, and a certain degree of postoperative function. Due to the removal of most of the scapula, the shape is not beautiful. (three) scapula under the fixation The main step is to cut off the bone bridge and the bone protrusion attached to the upper scapula and the upper inner corner of the scapula, and move the shoulder blade down and fix it. This method is currently used more clinically. General anesthesia, prone position, a median incision from the spinous process of the first cervical spine to the ninth thoracic spine, cutting off the starting point of the trapezius and the rhomboid muscle on the spinous process, then turning the free muscle flap to reveal the scapula The shoulder bridge or the fiber band attached to the upper corner of the scapula, together with the periosteal resection of the shoulder vertebra bridge, such as the boneless bridge, cut the fiber band or the contracted scapula levator muscle, and care should be taken to prevent damage to the superior scapular nerve and the scapular transverse artery. If the upper inner corner of the shoulder blade is bent forward beyond the top of the thorax, the inner upper corner should be removed. After the above treatment, the scapula can be easily pushed down to the normal position, so that the shoulder scapula and the healthy scapula are at the same level. At this time, the wire can be fixed to the posterior superior iliac spine or the rib periosteum through the scapula to the lower corner. After stabilizing the scapula at this correct position, the trapezius and rhomboid muscles are sutured back to the spinous process below the original starting point, and the lower part of the trapezius muscle should have excess. complication Targeted and timely and effective care for complications that occur after surgery. Results Through a series of targeted nursing measures for patients, all patients' postoperative complications disappeared and they were discharged from hospital.

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