Anterior exposure debridement

The anterior-exposure approach is applicable to ankle joint tuberculosis in which the lesion is confined to the humerus or the abscess is located in the axilla. Treatment of diseases: ankle joint tuberculosis Indication The anterior-exposure approach is applicable to ankle joint tuberculosis in which the lesion is confined to the humerus or the abscess is located in the axilla. 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. Patients with bone and joint tuberculosis and sinus, need to use penicillin or other antibiotics before surgery to control suppurative infection and prevent postoperative wound infection. 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. Spine tuberculosis and hip tuberculosis lesions are more traumatic and should be matched with blood. Surgical procedure Position, incision and exposure showed laparoscopic extraperitoneal exposure, but the incision was slightly lower. The skin and abdominal wall were dissected, the retroperitoneal space was separated, and the contents of the peritoneum and abdominal cavity were pulled to the opposite side to reach the midline, and the swelled iliopsoas abscess was revealed. When cutting an abscess, care should be taken to avoid damage to large blood vessels and nerves. The lumbar plexus trunk (femoral nerve) descends along the gap between the psoas muscle and the diaphragm in the upper part, and passes to the front of the diaphragm near the ankle joint, and enters the thigh in the back of the inguinal ligament; the iliac crest and vein are located in the abscess. The front, from the inside to the outside, should be carefully identified and properly protected. Do not blindly make t-shaped or transverse incisions on the temporalis fascia. After puncture the pus in the upper part of the abscess wall, make a small longitudinal incision along the needle, suck out the pus, and carefully touch the anterior wall of the abscess with your fingers. After the cord is not pulsating or pulsating, gradually become passive. Expand the incision; if it is accessible, it should be separated and protected. Then, the granulation of the abscess wall was scraped off and the hemostatic was pressed with hot saline gauze. Extend the finger into the inner wall of the abscess to explore the sinus that communicates with the ankle joint. The small sinus can be peeled off under the periosteum, some bones are removed, and the sinus opening is enlarged to remove the lesion. If there is a anterior abscess, the peritoneum and its contents can be pulled through the midline, and an incision can be made in the abscess wall to remove the lesion. The lesion is completely removed, and the cancellous bone graft can be taken in the tibia to fuse the ankle joint. If there is abscess in the buttocks, the patient's condition is good, you can change the lateral position, and make a small incision in the buttocks. If the situation is not good, you can temporarily puncture the pus or leave the second operation.

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