Resection of tuberculosis foci through rib and transverse process

Rib and transverse process are long-established names, but they cannot be said to be a route, nor the purpose of surgery. Therefore, it is more appropriate to remove tuberculosis by ribs and transverse process. Treatment of diseases: intraductal tuberculosis, spinal tuberculosis Indication Thoracic tuberculosis. Contraindications 1. Active tuberculosis lesions in other parts of the body, such as invasive tuberculosis, tuberculous meningitis, etc., should be considered as surgical contraindications. However, surgical treatment can still be considered if the treatment is cured or stabilized. 2. After treatment with anti-tuberculosis drugs such as streptomycin, there is no improvement in symptoms of systemic poisoning. 3. Poor overall condition or infants, the elderly, and those who are difficult to tolerate surgery should suspend surgery and switch to other methods. Preoperative preparation 1. Acquire patient cooperation: Bone and joint tuberculosis is a chronic disease with a long course of treatment and often has a certain degree of dysfunction after treatment. Therefore, most patients have irritable mood and ideological burden. Before the operation, we must thoroughly explain the work, and truthfully seek the treatment plan and consequences (including the number of operations, external fixation and bed time, medication time and possible dysfunction) to the patient and their families to obtain cooperation. 2. Perform the necessary examinations: Careful examination and chest fluoroscopy should be performed before surgery to find out if there are other tuberculosis lesions in the body. For patients with long disease period and many sinus secretions, liver and kidney function should be checked. X-ray examination should be performed on the lesions. If necessary, spinal tuberculosis and paraplegia should be performed by CT examination to understand the lesions for surgical design. 3. Improve the general condition: bed rest should be taken immediately after admission, and bed defecation training should be carried out to avoid difficulty in defecation due to unaccustomed postoperative. In general, TB patients have poor appetite and should seek to improve their appetite before surgery. Strengthen nutrition as much as possible to improve the general condition. 4. Drug treatment: The application of anti-tuberculosis drugs is an important part of preoperative preparation, mainly to prevent the spread of lesions. Once the diagnosis is confirmed. Anti-tuberculosis drugs should be applied. Single drug treatment is not effective, and it is easy to cause bacterial resistance. In general, streptomycin is used in combination with isoniazid. The amount of streptomycin varies depending on the age, 0.25g per day for children under 5 years old, 0.33g for 5 to 10 years old, 0.5 to 1.0g for adults, and intramuscular injection once or twice. Isoniazid is taken daily for 5 to 10 mg/kg, orally or in three divided doses. After 1 week of anti-tuberculosis drugs, the symptoms of tuberculosis poisoning can begin to improve; in about 2 weeks, most patients have improved symptoms and can be operated on. Sodium salicylate is easy to cause gastrointestinal symptoms, affect appetite, and is less clinically applicable. However, when the efficacy of streptomycin or isoniazid is not good, sodium salicylate can be added in an amount of 8 to 10 g per day, orally or intravenously. For patients with drug resistance, kanamycin can be applied twice daily, 0.5g intramuscular injection; rifampicin orally, adult 450-600mg daily, 1 time or 3 times, ethambutol The alcohol was taken daily at 25 mg/kg, and the subsequent reduction was 15 mg/kg per day. If combined with streptomycin and isoniazid, the effect is better. 5. Local Brake: Patients with spinal tuberculosis should be placed in a hard bed or plaster bed, tuberculosis in the extremities, especially those with joint pain or severe muscle spasm, which should be externally fixed or pulled to relieve pain and paralysis. Rest, and can prevent pathological dislocation or gradually correct deformity, reducing the difficulty of surgical operation. 6. Destroy the severely caster bed. Surgical procedure 1. Position: Take the side and front tilt position, so that the abdominal wall and the operating table are at an angle of 60°. Most of the vertebral body is heavier and the side of the abscess is larger. A soft pillow is placed under the chest to prevent the blood vessels and nerves of the ankle from being compressed. Extend the upper limbs and place them on the upper limb rest. The lower limbs of the healthy side are straightened, and the lower limbs of the diseased side are flexed. The front and back of the trunk are fixed with support or sandbags. 2. Incision, exposure: Thoracic spine incision, exposure and removal of ribs, transverse process, after the pleural surface is fully exposed. 3. Clear the lesion: Shake the operating table so that the patient leans back and at an angle of 60° to the ground for surgery. Absorb pus under direct vision, scrape tuberculous granulation, necrotic tissue, remove dead bones and necrotic intervertebral discs. Sometimes the dead bone is deep in the vertebral body, and only a small bone pupil is seen on the surface, which is easy to ignore. It should be positioned according to the x-ray film, ct film and intraoperative findings, and then the pupil is enlarged by chiseling to remove the dead bone. If the dead bone is behind the vertebral body, in order to prevent damage to the spinal cord, it is advisable to remove the lesion by using the method of removing the lesion from the side wall of the spinal canal and clear all the lesions on the contralateral side. 4. Interbody fusion: If the lesion is completely removed, there is a defect between the vertebral bodies; or the stability of the spine is poor, and the patient's general condition is good, and the lesion has no mixed infection, the vertebral body retractor can be used to treat both ends of the vertebra The body is retracted, and the interbody fusion bone filling defect is performed to prevent and correct part of the posterior deformity, promote the healing of the lesion, strengthen the stability of the spine, and exempt the second fusion operation. Use the osteotome to cut the bone groove with a width of about 1 to 1.5 cm on the side of two or more diseased vertebrae. The upper and lower ends must reach normal bone. If there is intervertebral disc and cartilage tissue in the bone groove, it should be removed. The removed normal ribs are longitudinally cut into two halves, cut into sections slightly longer than the length of the bone groove, and overlapped together to bind the implanted bone groove with the gut. A correspondingly sized bone implant can also be taken from the tibia. When implanted, the surgeon can also hold the posterior vertebral body with his hand. The assistant pushes the trunk slowly back, enlarges the intervertebral space, and then inserts the bone into the bone groove. When the external force is removed, the bone graft is tightly clamped in the intervertebral space, and no bone graft displacement occurs after surgery. 5. Stitching: After the operation is completed, the wound is washed with physiological saline. After the streptomycin powder is filled with 1 g of the lesion, the muscle, fascia and skin are sutured layer by layer without drainage. complication Skeletal deformity.

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