Anterior spinal mobilization

Anterior spinal mobilization is used for the surgical 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. 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. Treating diseases: scoliosis Indication Spinal anterior mobilization is suitable for patients with scoliosis and kyphosis, especially those with severe deformity or stiffer spine. The first stage is to do the posterior approach to open the Harrington instrument and other internal fixation. The effect is not good. Two phases of surgery. In the first stage, the thoracotomy or thoracoabdominal (peritoneal) incision was performed first, and the anterior spinal mobilization was performed first. After 2 to 3 weeks, the second posterior approach was used to correct the internal fixation. Contraindications The deformity is not heavy or the spine is softer. Preoperative preparation 1. Take the full-length positive X-ray of the spine and the full-spine positive position of the suspension. According to the X-ray film, the degree of lateral curvature and vertebral body rotation were measured, and compared with the hanging position, the natural correction rate was measured to understand the maximum limit of surgical correction. 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 Those with conditions can perform electromyography or spinal cord evoked potential examination of paraspinal muscles and lower limbs. In order to understand whether there is spinal nerve damage, and as a control for intraoperative spinal cord monitoring. 3, lung function test Understand the degree of lung function, such as the vital capacity of less than 60%, due to spinal surgery often reduce the original lung function by 15% to 20%, which 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 The normal value of blood CPK is 2~130U/L. If it is obviously increased, especially in the anesthesia above 1000U/L, it is easy to develop malignant hyperthermia. Check blood potassium, sodium, chlorine and liver and kidney function, blood gas analysis, etc. A comprehensive understanding of the situation. 5, spinal traction Traction for 2 weeks before surgery, the paravertebral muscles, ligaments and small joint capsules were relaxed, so that the intraoperative deformity was 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 toilet training After admission, the patient is trained to urinate in the bed to prevent urinary retention and constipation due to unaccustomed postoperative conditions. At the same time, the patient can learn the correct axial turning method after surgery. 7, the application of antibiotics Intramuscular injection or intravenous administration of a sufficient amount of broad-spectrum antibiotics 24 hours before surgery 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 method of preparation. 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, preoperative positioning After routine disinfection of the skin, the injection needle was inserted into the side of the spinous process at 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, preparation for blood Prepare blood for 800 to 1000ml. Surgical procedure 1. Incision Generally, the convex side of the scoliosis is made into a slit. Open chest (thoracic scoliosis) or chest and abdomen combined incision (thoracic and lumbar scoliosis). 2, revealed and loose Extend the thoracic incision with a chest expander, and block the lung tissue with a wet gauze pad to reveal the curved spine. Cut the parietal pleura (or lumbar anterior fascia) overlying it and push it away from the sides with a "peanut"-like gauze ball. Use a right angle vascular clamp to separate the ligature and cut the segmental blood vessels, and then open all the intervertebral disc fiber rings that need to be loosened. Use the rongeur and pituitary rongeur to remove the intervertebral disc tissue, and then use the curette to end the vertebral body. The cartilage of the plate is scraped off (do not deep into the cancellous bone to avoid bleeding). After the disc is removed, use the Harrington rod to open the forceps and open it for looseness. After each section is removed, hemostasis is filled with gauze or gelatin sponge. When there is more bleeding, you can also apply bone wax to stop bleeding. After the loosening is completed, the ribs removed when the chest is opened are bitten into the size of the broken rice, planted in the gap, mainly on the concave side of the scoliosis, and then the wound is washed, and the pleural wall layer is sutured, and the intercostal wall is interposed between the 8th and 9th. Place a closed chest tube at the back line and close the chest layer by layer. complication 1. Spinal nerve injury. 2, segmental blood vessels and chest, abdominal aorta and inferior vena cava damage.