double-door laminoplasty

Double-door type of spinal canalplasty is suitable for sporadic or continuous cervical ligament ossification with spinal cord compression symptoms, anterior surgery is difficult to decompress and cervical spondylosis has undergone anterior decompression, and there are still spinal cord compression symptoms Cervical spondylosis involves more than three segmental lesions and has symptoms of spinal stenosis and spinal cord compression, and the purpose of decompression is achieved by surgery. Treatment of diseases: traumatic subdural effusion Indication 1. Cervical spondylosis involves more than three segmental lesions with spinal stenosis and spinal cord compression symptoms. 2. Cervical spinal canal trauma or developmental stenosis with spinal cord compression symptoms, ct tablets show that the sagittal diameter of the spinal canal is less than 10mm. 3. Scattered or continuous cervical posterior longitudinal ligament ossification has spinal cord compression symptoms, anterior surgery is difficult to decompress. 4. Cervical spondylosis has undergone anterior decompression, and there are still symptoms of spinal cord compression. Preoperative preparation 1. Preoperative surgical design is extremely important. The forming range is determined according to ct or mri or myelography. According to the ct image, the distance between the midline of the lamina and the left and right sides of the spinal canal (the value of the transverse diameter of the spinal canal) is measured, and the positioning reference of the ditching part in the operation is used. According to the site of compression of the epiphysis and the spinal cord, such as single-door laminectomy, the hinge side and the open side are determined. 2. Make a good plaster collar. Match the blood. Surgical procedure 1. Position: prone position. The head and face are placed on the headband, and the head and neck are slightly flexed, so that the skin behind the neck is free of wrinkles. The operating bed is maintained at a head height of 10° to 15°. 2. Incision: a median longitudinal incision in the posterior neck. The length depends on the exposure of the vertebrae. In order to reduce bleeding, subcutaneous and intramuscular infiltration with 1:500,000 epinephrine saline (adrenalin 1mg plus saline 500ml) is contraindicated in patients with cardiovascular disease and hypertension. 3. Laminar formation: clean the residual soft tissue on the lamina. According to the transverse diameter of the ct piece, determine the groove on the lamina and make traces. Use a micro drill or a sharp-nose rongeur to make a vertical groove on each of the two sides of the lamina. The groove is v-shaped, the width of the shallow layer is 2 to 3 mm, and the depth needs to be deep to the inner cortex of the lamina, but it does not penetrate, and the hemostasis is blocked by a small strip of gauze. The interspinous ligaments within the predetermined opening range are then removed, and the spinous processes are retained 1 to 1.5 cm long. Use a miniature electric saw or a narrow laminar rongeur to open the spine in the medial direction directly to the epidural. The ligamentum flavum of the uppermost lamina of the open segment is cut off from the ligamentum flavum at the lower edge of the lowermost lamina, and the periosteal stripper is extended from the suture of the spinous process, and the spinous process of the split is opened to the sides, similar to opening Double doors. At the same time, the midline was cut into the ligamentum flavum, and the dura mater was used to separate the adhesion between the lamina and the dura mater. A fat sheet of the same length as the dural is exposed to the outside of the epidural. 4. Bone grafting and suture: The humerus is exposed along the humerus incision, and the bone is taken from the tibia. According to the size of the trapezoidal gap that is opened to the sides of the spinous process, the dural capsule can be fully decompressed, and the bone graft is trimmed into a corresponding trapezoid, embedded in the spinous process space, at the ends of the spinous process and the bone block. Each drill hole is fixed by wire or wire, and the spinous process bones are separated by fat pieces. Take scattered bones and block the gaps in the groove on both sides of the lamina. The incision was washed with saline, and no bleeding was observed. After the cotton was not left, the incision was filled with a catheter, and a small incision was made next to the incision to induce extracorporeal drainage. Sewing layer by layer.

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