kyphosis wedge osteotomy

The characteristics of thoracolumbar spine spinal cord injury on surgical treatment: 1. The thoracolumbar spine consists of chest 11, chest 12 and waist 1. It is the junction of the thoracolumbar and the chance of injury. The paraplegia occurring here accounts for about half of the traumatic paraplegia. This part has a large range of motion, which often causes instability of the spine after spinal injury and requires internal fixation to restore stability. Commonly used in the posterior internal fixation of RF, AF, the angle between the screw and the connecting rod can help to reduce the vertebral fracture. The front road is fixed with a Z-steel plate, etc. It is easier to install than the Kaned device and has titanium, which does not hinder the MRI inspection. 2, spinal fracture and dislocation should be rectified, the purpose of the restoration is to restore the normal physiological curvature of the spine and decompression of the spinal cord, the deformation of the spinal fracture dislocation has three aspects, namely dislocation, increased posterior arch angle and vertebral compression Therefore, the criteria for reduction include: 1 complete dislocation of dislocation; 2 posterior arch angle of the spine returns to normal, within 10° of the thoracolumbar segment; 3 the height of the anterior margin of the compressed vertebral body should be restored to 80%. To achieve this standard, although the internal fixator can be used, it is best to stretch the spine up to 45°. When the over-extension is 30°, although the dislocation can be completely reset, the posterior arch angle of the spine often does not return to normal, and the anterior edge of the vertebral body is less than 80%. Therefore, when the operation is reset, the operating table needs to reach an extension of 45°. 3. The spinal cord of the thoracolumbar segment includes the lumbosacral spinal cord, the cone and the lumbosacral nerve root. The cone is compressed to cause sphincter and dysfunction. The recovery rate of nerve root injury is higher than that of spinal cord injury. For patients with incomplete paraplegia with cone and nerve root compression, decompression surgery has a good chance of recovery. Dislocation of the thoracolumbar spine can severely damage the upper spinal cord. Spinal injury can damage the root artery. In the absence of collateral circulation, spinal cord necrosis can be caused by the artery. The paraplegia planes of these two injuries are higher than the fracture dislocation plane, and the incidence can be as high as 30%. In other patients, spinal cord injury in the thoracolumbar region can affect the blood supply to the spinal cord, such as the anterior spinal cord, resulting in long-term ischemia of the spinal cord and spinal cord atrophy. MRI and selective spinal angiography can be diagnosed. Clinical neurological examination of the paraplegia plane is higher than the number of planes of the spinal cord injury, and the lower limbs become soft palate, which can be used as a basis for diagnosis. These conditions indicate that the possibility of severe recovery of spinal cord injury is very small and can be used as a reference for surgical treatment. For such patients, spinal injury should be used as the basis for selecting surgery. 4, thoracolumbar spine injury, the most common are compression fractures, fracture dislocation and burst fractures, both of the posterior or posterior vertebral compression of the spinal cord, requiring lateral decompression. 5. About bone graft fusion. Thoracolumbar fracture and dislocation or fracture with posterior ligament injury, although it can heal after reduction, but the posterior ligament rupture becomes scar healing. If there is no interbody bone bridge formation, spinal instability may occur, so the acute injury is open and reduction. When the internal fixation is performed, bone graft fusion should be performed. Treating diseases: paraplegia Indication The vertebral hunchback wedge osteotomy is suitable for the hunchback deformity of the old thoracolumbar severe compression fracture and complete paraplegia or incomplete paraplegia, with or without nerve root traction pain. Because the hunchback obviously affects the supine and sitting posture is stable. This operation is not suitable for elderly and infirm. From MRI or myelography, such patients are often accompanied by spinal cord compression, and the operation is accompanied by anterior decompression. Preoperative preparation Take a good lateral thoracolumbar X-ray to determine the extent of the wedge osteotomy. Generally, a wedge-shaped osteotomy of a vertebral body can correct the 30° kyphosis deformity. The osteotomy range is about 2 cm from the lower edge of the pedicle. The upper vertebral cortex is preserved, and the wedge is cut forward. The depth reaches the leading edge. Leading edge. The posterior segmentation range, the obstruction of the bone line extension includes the supra-arc joint and the superior sub-articular process, and the pattern is cut before surgery to understand the reduction. Prepare blood 1000~2000ml. Surgical procedure 1. Incision and lamina exposure The posterior median incision includes five upper and lower spines. The upper and lower laminae are first revealed, and the dislocation gap is finally revealed by moving to the middle. Care should be taken to remove the soft tissue of the dislocation gap. The interspinous ligament and the ligamentum flavum have been broken and the spinal dural has been exposed. The dislocation of the vertebra is shifted forward; the fractured vertebra is mostly in situ, and the shallowest in the incision reveals the transverse process on both sides. 2, wedge osteotomy According to the preoperative plan, the spinous process, lamina, superior articular process and superior subarachnoid articular process and the vertebral pedicle of the fractured vertebrae were removed. The root of the transverse process is cut and inserted into the periosteum of the periosteum to remove the vertebral periosteum to the anterior border of the vertebral body. The lower edge of the pedicle is the vertebral nerve. The nerve root is slightly inward and downward with a stripper. The lower edge of the bow is forwardly osteotomized, and the direction and depth are designed according to the design. The upper disc is separated upwards, and the upper side of the vertebral body is expected to be osteotomy, and the upper and lower osteotomy lines intersect behind the anterior edge of the vertebral body. The osteotomy block is gradually removed, and the two sides are connected to each other, and the osteotomy surface is smooth and sufficient. Deeply, the vertebral body in front of the epidural membrane is scraped from the cancellous bone surface to a thin layer of cortical bone according to the osteotomy line. Gently retract the dura mater, use the right angle device to collapse the predural cortical bone from both sides and take it out. After the osteotomy is completed, the decompression of the dura mater is completed. 3, reset internal fixation Pressing the upper and lower spine forward, and the upper part of the operating table is raised to extend the spine, so that the wedge-shaped gap can be completely closed and the orthodontic surface is completely contacted. After the internal fixation is fixed, Dick pedicle screws or other internal can be applied. fixed. Postoperative diet 1, the diet should pay attention to light, mostly with food porridge, noodle soup and other foods that are easy to digest and absorb. 2, can eat more fresh fruits and vegetables to ensure the intake of vitamins. 3, give liquid or semi-liquid food, such as a variety of porridge, rice soup and so on.