Laminar fusion

Due to joint trauma, inflammation, degeneration, etc., the joint surface is disproportionate, causing severe joint dysfunction, or stubborn joint pain, affecting work and life, non-surgical treatment is not effective, and is not suitable for other surgery to retain For joint mobility, joint fusion should be performed. Treatment of diseases: spinal deformity scoliosis Indication 1. Due to joint trauma, inflammation, degeneration, etc., the joint surface is disproportionate, causing severe joint dysfunction, or stubborn joint pain, affecting work and life, non-surgical treatment is invalid, and other surgery is not suitable. To maintain joint mobility, joint fusion should be performed. For example, severe arthritis caused by intra-articular fractures of the lower extremities, and there are a large number of scars in the surrounding soft tissue after septic arthritis, and it is not suitable for surgery such as arthroplasty. 2. Adult all-tubular tuberculosis, joint surface destruction, it is estimated that the joint function can not be preserved, joint fusion can be performed at the same time as the lesion is removed; and there are deformities, which can correct the deformity at the same time. 3. Muscle spasm caused by neuropathy or injury, causing severe instability of the joint, affecting the whole limb function, and simple tendon metastasis is not enough to maintain joint stability and restore sufficient effective function. Fixing local joint can improve limb function. Perform joint fusion. For example, after the anterior horn polio of the spinal cord, the upper limbs can not be lifted. If the shoulder joint is fixed in the functional position, the function of the upper limb can be improved by sliding the shoulder between the shoulders. 4. Congenital or acquired spinal deformity (such as hemivertebra, scoliosis, lumbar spondylolisthesis, etc.), in order to prevent the development of deformity, early laminectomy can be performed, or after deformity correction. Contraindications In addition to the general contraindications for elective surgery, the following conditions should also be contraindicated: 1. Patients with osteoarthritis adjacent to the joint should not be used for arthrodesis. If the hip joint is fused, its activity can be compensated by the normal lumbar spine and knee joint to meet the needs of work and life activities. If the lower lumbar or knee joint is already stiff, hip fusion will cause great difficulty to the patient. 2. Among the same joints of the limbs, one side has a strong straight, and the contralateral side should not be subjected to arthrodesis. If the hip joints are fused on both sides, it will be very difficult to get up, lie, walk and sit. 3. Children's articular cartilage is rich, joint fusion is not easy to cause bone fusion, but also easy to damage the epiphysis, affecting growth and development; at the same time, children in the limb development stage and muscle sustained action, the fusion joint can be deformed again. Therefore, children under the age of 12 should not undergo arthrodesis. Preoperative preparation Brachial plexus anesthesia or general anesthesia for upper extremity arthrodesis; spinal anesthesia or epidural anesthesia for lower extremities; epidural anesthesia or local anesthesia for spinal fusion, general anesthesia if needed. Surgical procedure 1. Position: In the prone position, the head turns to one side, and the pillows are high on both sides of the trunk to facilitate breathing. Patients with poor breathing can also use the lateral position. 2. Incision and exposure: See the anterior side of the cervical spine. 3. Positioning: The lamina of the diseased vertebral body is the fusion center and needs precise positioning. Commonly used positioning methods are: (1) If the spine has a kyphosis, the most obvious vertebral body of the spinous process is the diseased vertebra. Control the x-ray film to count the lamina that needs to be fused. (2) If the deformity is not obvious, the diseased vertebra can be determined by the injection method of the body blue on the day of surgery. That is, after disinfecting the local skin, insert a common needle into the spinous process or lamina of the ward, take a x-ray lateral slice, determine which vertebral body the spinous process or lamina of the needle belongs to, and then inject 0.2 ml of Meilan. When the surgery is revealed, the spinous processes or lamina with stained with methylene blue can be used and positioned against the x-ray film. 4. Chiseling lamina: The predetermined fusion spinous process is first cut from its root, and the bone piece is reserved for bone grafting. Start with the osteotome from the cortical bone of the root of the spinous process, and open the cortical bone of the two sides of the lamina to the sides, until the vicinity of the articular process, but do not cut it. The bone flap is turned to the sides to form a bone groove. When using the chisel, face down, face up, and gently tap to avoid deep damage to the spinal cord. You can also use the eyebrow to cut the scales of the fish scales and open them up and down. 5. Bone graft: The bone piece taken from the tibia and the cut spinous process are removed, the soft tissue is removed, and the strip is cut into small strips and evenly spread on the rough surface of the lamina. The amount of bone graft should not be too small, so as not to break in the future. Especially in the activities of the cervical vertebrae, lumbar vertebrae, cervical thoracic segments and thoracolumbar segments with large tensile stress, the amount of bone grafting is larger. Cover with gauze, use the chisel handle to gently tighten the bone graft to make it in close contact, then remove the gauze and layer it.