CD Horizon System Spinal Orthopedics

CDHorizon system spinal orthopedic surgery for the treatment of idiopathic scoliosis. Scoliosis is one of the most common spinal deformities. It means that one or several segments of the spine are bent laterally off the midline in the coronal plane, forming a curvature of the spine with a curvature of 10°. Diagnostic criteria, usually accompanied by an increase or decrease in the rotation of the spine and physiological lordosis and kyphosis in the sagittal plane. Lonstein et al. in the United States, Minnesota census, children aged 12 to 14 years old, 1.47 million people, found that there are scoliosis accounted for 1.1%, China Peking Union Medical College Hospital in Beijing 8 to 14 years old school age children, the incidence of scoliosis was 1.06%, Guangzhou Sun Yixian Memorial Hospital conducted a general survey of 7-19 year old students in some urban and rural areas in Guangdong, and found that the incidence of scoliosis was 0.75%. Scoliosis is a clinical diagnosis rather than an etiological diagnosis that can be caused by many diseases and can be divided into two broad categories depending on its cause. The first category is scoliosis, which is also known as idiopathic scoliosis. The initial onset age is mostly 10 to 13 years old. The diagnosis depends on medical history, symptoms, signs and necessary imaging studies. Current studies suggest that idiopathic scoliosis may be related to the following factors: 1 genetic factors; 2 hormone effects; 3 growth and development asymmetry; 4 connective tissue dysplasia; 5 neuro-equilibrium system dysfunction; 6 neuroendocrine system abnormalities; Others, such as older mother offspring and abnormal copper metabolism. The second category is scoliosis with known causes, including congenital scoliosis and neuromuscular scoliosis. Congenital scoliosis is a lateral curvature of the spine resulting from an imbalance in the longitudinal growth of the spine caused by vertebral malformations. The critical period of embryonic spine development is the fifth to sixth week of pregnancy, which is the time of the spine segmentation. Spinal deformity occurs in the first 6 weeks of pregnancy. The diagnosis of congenital scoliosis can only be made if an abnormality is observed on the radiograph of the spine. Neuromuscular scoliosis is a group of conditions characterized by loss of normal function in the brain, spinal cord, peripheral nerves, neuromuscular junctions, or muscles. It is generally believed that the loss of muscle strength or control of voluntary muscles, or loss of sensory function such as proprioception in young children with soft spine and rapid development is a factor in such lateral curvature. Most neuromuscular scoliosis is a longer "C" shape, involving the humerus, and common pelvic tilt, even small neuromuscular scoliosis continues to develop after skeletal maturity, many neuromuscular scoliosis Bending deformities require surgery. For idiopathic scoliosis, the degree of rotation of the vertebral body can be determined and measured by lateral displacement of the position of the spinous process or by displacement of the pedicle. According to the spinal range of the thoracic scoliosis and the functional structural state of the distal compensatory curve, King divided the thoracic scoliosis with structural scoliosis into the following types: 1King type I, the chest bend and the waist bend both exceeded the midline. "S" shape, the flexibility of the chest bend is greater than the waist bend; 2King II type, the chest bend and the waist bend are beyond the midline, showing an "S" shape, the Cobb angle and rotation of the chest bend are larger than the waist bend, and the waist bend is soft. More than the chest bend, the stable vertebra is often T12 or T11 or L1; 3King III type, the waist bend accompanied by the chest bend does not exceed the midline, and the waist bend is non-structural, generally no rotation in the standing position; 4King IV type, is a Long chest bend involving more spine, the vertebral vertebra usually enters the long thoracic curve at T10, L4, the appearance is abnormal, but L5 is still located in the center of the humerus; 5King V type, the upper and lower chest bends are structural, T1 upward chest The concave side of the bend is inclined, and T6 is often the boundary vertebra of the two bends. This classification system is mainly used to guide the selection of the level of fusion during orthopedic surgery. The pathological changes of scoliosis mainly show the lateral curvature of the spine. The first part of the curvature is called the primary side bend, and the opposite direction of the upper and lower bends is the compensatory side bend. In the intervertebral space within each bend, the concave side is significantly narrowed, and the convex side is widened, wherein the most convex portion, that is, the widest point of the convex side intervertebral space is the apex of the curvature. As the lesion progresses, spine rotation deformities are usually combined, and the development of the vertebral body, lamina, and pedicle is affected on the concave side. The soft tissue on both sides of the spine will also change, showing that the soft tissue on the concave side is contracted and thickened, while the convex side is elongated, thereby aggravating the vertebral deformity. Because the thoracic vertebra is a part of the thoracic spine, the thoracic and thoracolumbar scoliosis, the thoracic and ribs are also deformed accordingly, and the convex rib angle is increased to make the posterior chest wall a "razor back" deformity, and the concave side rib is horizontal. The side chest wall protrudes forward. Due to the above changes, the chest volume becomes smaller, and the internal organs are suppressed or displaced, so the cardiopulmonary function is affected to some extent, and the severe condition even causes the spinal cord to be compressed, causing spinal cord injury. An abnormality of the thoracic kyphosis of the spine over 50° is abnormal. If the anterior column of the spine is unable to withstand the pressure, causing the anterior column to contract, a kyphosis will occur. The posterior column of the spine is broken, and the inability to resist tension can also cause the posterior column to be relatively elongated. Abnormal kyphosis can be corrected by shortening the posterior column or extending the anterior column, or shortening the posterior column and extending the anterior column. Congenital kyphosis can be divided into three types, congenital vertebral body formation disorder (type I), congenital vertebral body segmentation disorder (type II) and mixed (type III). The CD Horizon spinal fixation system is currently one of the most widely used spinal fixation systems. It includes the CD Horizon spinal fixation system, the MAS universal screw system, and the low-cut transverse connector. This series of products can be used in combination for the neck, thoracic and lumbosacral segments, either in the anterior or posterior approach. Compared with the CD system, the CD Horizon system is more convenient to operate, more biomechanically reasonable, and the principle of surgical orthosis remains unchanged. Here is a description of the posterior approach orthopedic surgery of the CD Horizon. Treating diseases: scoliosis Indication CD Horizon system spinal orthopedics can be used to correct various types of scoliosis, but congenital scoliosis and severely stiff scoliosis, it is best not to use, or only for the side of the side of the concave side, no rotation correction. Refer to the indications for Harrington spinal orthopedic surgery. Contraindications 1. The primary scoliosis is below 40°, and the balance between the primary curve and the compensation curve (ie, the compensation is complete). 2. After non-surgical treatment, the scoliosis is increased within 2 ° per year, and the deformity is not obvious. 3. Congenital scoliosis combined with dural bulging. Preoperative preparation 1. Take the full-length positive X-ray of the spine and the full-spine full-shoulder slice to measure the degree of lateral curvature and vertebral rotation according to the X-ray film, and compare the suture position to measure the natural correction rate to understand the operation. Correct the maximum limit. For congenital malformations, especially those with suspected spinal cord longitudinal fissure should be performed first, and those with conditions can do CT scan or MRI. If it is confirmed that this disease is the first intraspinal bone septal resection. 2. Electrophysiological examination can be performed on the paraspinal muscle and lower extremity electromyography or spinal cord evoked potential examination. In order to understand whether there is spinal nerve damage, and as a control for intraoperative spinal cord monitoring. 3. Pulmonary function test to understand the extent of lung function, such as lung capacity below 60%, due to spinal surgery often reduce the original lung function by 15% to 20%, will lead to significant hypoxia. Therefore, lung function training must be performed before surgery, and the patient should perform deep exhalation training in the balloon. 4 to 5 times a day for 10 minutes each time, continuous 2 weeks will significantly improve lung capacity. 4. Blood biochemical examination blood CPK normal value is 2 ~ 130U / L, such as increased significantly, especially in the anesthesia above 1000U / L is prone to malignant hyperthermia, check blood potassium, sodium, chlorine and liver and kidney function, blood gas analysis, etc. Can fully understand the basic situation of the whole body. 5. Traction for 2 weeks before spinal traction surgery, the paravertebral muscles, ligaments and small joint capsules are relaxed, so that the intraoperative deformity can be corrected to the maximum allowable amount. In addition, for patients with congenital scoliosis or suspected intraspinal lesions, it can be understood whether there are neurological symptoms appearing or aggravating, and the correction rate in the operation is well known. 6. Bed and toilet training After admission, the patient is trained to bed and urinate in bed, which can prevent urinary retention and constipation due to unaccustomed postoperative operation, and at the same time enable the patient to learn the correct axial turning method after surgery. 7. Application of antibiotics 24 hours before surgery, intramuscular injection or intravenous administration of a sufficient amount of broad-spectrum antibiotics can maintain the effective antibiotic concentration in the blood during surgery, and play a positive role in preventing postoperative infection. 8. Skin preparation Because the patient's back is uneven, it is necessary to master the skin preparation method. Do not shave the skin. For those with folliculitis, 2.5% iodine is applied locally. In severe cases, it can be treated with reasonable treatment. All the folliculitis can be treated before it can be treated. 9. After preoperative localization of the disinfected skin, the injection needle was inserted into the side of the spinous process in the center of the predetermined incision, and the vertebral body was confirmed by X-ray film, and then 0.5 ml of 1% methylene blue solution was injected. When the surgery is to be performed on the next day, the extent of the lamina can be accurately revealed. If the methylene blue solution has been absorbed during surgery (no injection of methylene blue solution into the periosteal tissue), it is best to further locate the intraoperative film. 10. Prepare blood for 800 to 1000ml. Surgical procedure 1. The incision and the incision are made longer than the predetermined fusion zone, and the skin and subcutaneous tissue are sequentially cut, the blood is stopped, the deep fascia is cut, and the transverse process is exposed to both sides. 2. Implantation of the pedicle hook to bite the lower articular process of the upper vertebral body, it can be found that the articular cartilage of the articular surface of the lower vertebral body is located in front of the bitten lower articular process; placed along the surface of the articular cartilage The pedicle probe can be found in the pedicle; the pedicle hook is inserted along the same path as the pedicle probe, and the pedicle hook can be fixed by gently tapping the hook with a hammer. 3. The direction of the hook of the hook on the lamina is usually toward the caudal side. The small part of the vertebral plate is bitten off and the ligamentum flavum is cut. Separate the ligamentum flavum and lamina with a laminator. The number of vertebral bones that are bitten off is determined by the size of the hook selected. It is also possible to bite off the lower edge of a portion of the upper lamina to facilitate implantation of the hook. Use a straight or elbow hook (nail) pliers to implant the hook. If necessary, use a small laminar spreader to enlarge the insertion port when inserting the hook. 4. The direction of the implant hook of the lower lamina is usually toward the head side and is suitable for segments of T10 or below. Similarly, a small portion of the lamina must be bitten and the ligamentum flavum removed. Use the laminar distractor to organize the position of the hook. Use a hook feeder to assist the hook clamp to insert the hook. 5. The insertion of the transverse hook usually uses a wide blade hook and adopts a hook structure. It can be headed or tailed, usually towards the tail. The soft tissue above the transverse process is scraped off using a transverse puller at the pre-planted hook position. Hold and implant the hook with a hook (nail) pliers. 6. The bent rod and the implanted rod are sheared in vitro according to the measured size. In order to obtain a suitable camber in the sagittal plane, the rod must be bent gradually with a curved barcer. At the same time, go to the cortex and bone graft. Place the stick from the top of the hook, either on the side of the head or on the side of the tail. Hold and implant the rod with a suitable bar clamp. If the rod is placed at the bottom of the hook top, use a screw driver to screw the plug into the top of the hook. First turn the screw driver counterclockwise until the screw plug is in place and then screw it clockwise to avoid slipping. The rod can also be pushed into the hook top groove by a pressure bar. In this process, you must hold the hook. It is particularly convenient to hold the hook with a lateral hook (nail) pliers when pushing the rod into the bottom of the hook. When the hook is held by a side hook (nail) pliers or an elbow holding hook (nail) pliers, the screw plug can be screwed into the hook top groove. 7. A screw plug guide can be used when extra force is required to push the rod into the bottom of the hook. The introducer is placed on the rod and the "wing" of the introducer is parallel to the rod. The fork portion of the lower end of the introducer is positioned on the rod and the hook. Place the introducer sleeve clockwise to press the rod and hook into the fork of the introducer (check to make sure the rod and hook are fully engaged with the introducer. Connect one or two screw presses to On the wing of the guide, then push the rod into the bottom of the hook. Check if the rod is fully in place, visually or insert the temporary tightening screwdriver into the hollow guide, check if the sign engraved on the handle is temporarily tightened. Enter the hollow part of the introducer. If the mark does not fully enter the introducer, the screw presser must be further rotated down until the rod is fully seated. Once the mark has been fully entered into the introducer, the starter can be removed. 8. Throw the screw plug into the hollow portion of the introducer and insert the screwdriver into the hook groove from the hollow portion of the guide with a temporary tightening screwdriver and tighten the screw plug. Rotate the screwdriver counterclockwise to temporarily tighten the screwdriver until the screw plug is in place and then tighten the screw plug clockwise. This ensures that the thread of the screw plug is aligned with the thread of the hook top groove to avoid slipping. Another alternative is to use a screw driver to extract the plug and insert the hollow plug guide. First turn the screw driver counterclockwise until the feeler screw plug is in place and then tighten clockwise. The temporary tightening of the screwdriver is used to temporarily secure the rod in the hook, and the pear-shaped handle generates sufficient force to temporarily secure the rod without breaking the plug head. Temporary tightening of the screwdriver is also used where it is necessary to loosen or tighten the plug when all pressurizing/spreading or rotating rod operations are in progress. 9. Sometimes the stick will be on either side of the hook top slot and you will need to transfer. The rod can be used with the rod resetter and the matching hook rod. Positioning the fork portion of the rod reducer on one side of the hook corresponds to the position at which the lateral hook (nail) pliers are located. Hold the double sleeve and the balance bar and position the fork portion on one side of the hook with the open side facing the rod. Once the fork portion is in place, hold the balance bar to stabilize the rod reducer and slide the double sleeve down until the hook is properly jammed. After the hook is caught, turn the thread knob at least one full clockwise; at this point, the rod resetter can be used to move the rod. To move the rod on the side of the hook top groove, attach the hook to the pivot of the double sleeve, and turn the threaded knob to turn the hook to search for the grab bar. 10. Move the rod manually until the rod is on the top groove of the hook. Turn the thread knob clockwise until the rod enters the top groove of the hook to remove the hook. Continue to tighten the threaded knob until the rod is fully seated, then use a temporary tightening screwdriver to determine the position of the rod in the hook top groove. Use a screw driver to insert the screw into the top groove of the hook, place the screw driver counterclockwise until the screw plug is in place, and then tighten the screw plug clockwise with a temporary tightening screwdriver. 11. Press or open with a compression pliers or a pliers. Take care to ensure that the foot of the tool is against the hook rather than the plug, otherwise it will cause the slip between the plugs or the plug to open early. Temporary tightening of the screwdriver can be used to temporarily secure the rod/hook structure and can be used for multiple temporary fixations without damaging the threads of the plug or hook. If the screw plug is tightened to the wire, it must be removed and replaced. If necessary, use a pliers and/or a hexagonal rotary wrench to rotate the rod. The position of the hook can be fixed with a "C" ring when the rod is rotated. During the operation of the rotary rod, pay attention to check whether the position of the hook is correct. If necessary, re-fix the hook with moderate force. 12. Bone grafting and implantation of transverse ligaments Cortical and bone grafting can be performed here. Autologous cancellous bone from the tibia is the most commonly used source of graft bone. After the plug is locked by the screw plug, the plate gauge is used to determine a low-cut transverse web or an adjustable lateral web of suitable size. Extend or pressurize the rod as needed. Use a wrench to hold the appropriate low-cut transverse web or adjustable transverse web and press against the rod. Use a plate bender to change the profile of the low-cut transverse web or the adjustable web transverse web. When bending a plate, the curvature on either plane cannot exceed 20°. Use a screwdriver to tighten the preset screws with approximately 60 lb. of force and tighten from side to side to ensure uniform engagement on both sides (if using a laterally adjustable connecting plate, tighten the centering screws after tightening the preset screws on both sides) . Use two screwdrivers to tighten the preset screws on both sides to ensure that the two sides are aligned. 13. When all the implants are in place, lock and screw the plug. Insert the final tightening screwdriver into the hollow counter-wrench and place the opposing plate on the hook and the rod. The T-shaped handle provides sufficient torque to twist the plug. The handle against the plate should be gripped to prevent the entire internal structure from twisting when the plug is locked and twisted. If the plug has slipped, The built-in screw plug can be removed with a double-ended screwdriver and handle. Once removed, it should be discarded and replaced. The wound is sutured in the usual way. complication This internal fixation system is still relatively new in general, and there are no long-term clinical follow-up results reported. I refer to the main complications of CD rod spinal orthopedic surgery.