Spinal cord firearm wound debridement

Spinal cord firearm injuries include spinal canal injury and blind tube injury that directly damage the spinal cord by projectiles or shrapnel, and spinal cord injury caused by the pressure waves of the projectile passing through the vertebrae or paravertebral. Because the spinal cord is small, its diameter does not exceed 1cm. Once the projectile or shrapnel hits the spinal cord directly, it is often severely damaged, causing complete damage to the spinal cord. Therefore, the possibility of recovery of spinal cord function in patients is small. Spinal cord firearm injury is an open injury. Metallic foreign bodies are polluted. Sometimes the projectile first passes through the intestinal tract and then damages the spinal cord, or first passes through the dura mater and spinal cord and then through the intestinal tract, so that the spinal canal communicates with the intestinal tract. Secondary infections are more likely to require debridement and repair. Treatment of diseases: spinal cord injury Indication Spinal cord firearm wound debridement is applicable to: 1, the projectile through the spinal canal, damage the dura mater and spinal cord, should be debridement in the spinal canal. 2. After the injury, the patient's limb movement and sensory symptoms gradually worsen. Laminectomy should be performed. 3, the wound has a large amount of cerebrospinal fluid outflow, should be repaired and repaired. 4, there are bullets or shrapnel in the spinal canal, which may cause infection or granuloma formation. 5, cauda equina injury is mostly incomplete, debridement can also repair the cauda equina. Contraindications 1. The projectile is passed by the vertebra or paravertebral. If the spinal canal is intact, it is not necessary to perform debridement in the spinal canal. It can only clean the wound or determine whether it needs to be removed according to the size and position of the metal foreign object. 2, when combined with organ damage or shock, it is not appropriate to do intraspinal surgery. Intraspinal debridement can be considered after correcting shock and treating visceral injuries. Preoperative preparation 1. General preparation of the whole body According to the condition and examination, the patient's general condition is actively improved, and various necessary supplements and corrections are given. 2, those with constipation, pre-operative laxatives, enema during the night before surgery. Those with dysuria should be catheterized before surgery and indwelling catheter. 3, postoperative need to prone, should be prone position training in advance, so that patients can adapt to this lying position. 4, sedatives before the operation, phenobarbital 0.1g. 5, fasting within 6 ~ 8h before surgery. 6, the day before surgery to prepare the surgical skin, cleaning shaving, the range should be more than 15cm around the incision. 7. Give medication before anesthesia according to the needs of anesthesia. 8, preoperative positioning should be determined before the scheduled removal of the spine position of the lamina, the easiest way is to locate according to the body surface markers. Due to the difference in body shape, the marker positioning may have an error of 1 or 2 spinous processes. In order to avoid the error, it can be positioned according to the body surface marker, and then a type of lead is glued on the body surface of the corresponding spinous process. After taking the X-ray film, the surgical site is verified from the position of the lead on the X-ray film. 9. Preoperative injection of anti-tetanus serum. Surgical procedure 1, skin incision A 10 to 12 cm midline incision was made centering on the site of the spinal canal through which the projectile passed and remained. 2, laminectomy Generally, the range of 3 to 4 laminas is revealed, and the paravertebral muscles on both sides are peeled off, and the lamina is exposed by an automatic retractor. According to the need for debridement in the spinal canal, it is sufficient to remove 2 lamina. The supraspinous and interspinous ligaments were severed, and 2 spinous processes and laminae were removed to reveal the dura mater. 3, debridement in the spinal canal Check the dural rupture, visible cerebrospinal fluid outflow, and mixed with spinal tissue fragments, the epidural free bone fragments were removed. The dura mater was cut in the midline of the back and pulled through the silk at the cutting edge to reveal the spinal cord and its injury. The inactivated spinal cord tissue and clot were removed with a small cotton pad, dura mater Broken bone fragments and metal foreign bodies should also be removed. Swelling and discoloration of the spinal cord injury, feasible midline incision, decompression or removal of intramedullary hematoma. The cauda equina rupture can be sutured with a 2 to 3 needle outer membrane with a 9-0 silk thread. The spinal epithelium was repeatedly washed with a large amount of physiological saline, and bipolar electrocoagulation was used to stop bleeding. 4, dural repair and suture The dural is tightly sutured, and the large defect can be repaired by the fascia. The dural incision is also tightly sutured. 5, incision suture Since most of the firearm injuries do not affect the stability of the spine, debridement does not require bone graft fixation or other fixation methods. The paravertebral muscles, deep fascia, subcutaneous tissue, and skin are sutured layer by layer. 6, wounded debridement Soft tissue trauma resection and suturing can be performed on the entrance and the injection of the blind injury. complication 1, spinal canal infection Most occur in the epidural space. Also seen under the subdural, surgery should remove the laminar vertebral plate for irrigation and drainage. 2, cerebrospinal fluid leakage After debridement, the dural tear or incision is not tight enough. If conservative treatment is observed for 3 to 4 days, it still cannot heal itself, and surgery should be performed again.