Dick nail internal fixation

Dick nail fixation is used for the treatment of spinal fracture and dislocation. Treatment of diseases: lumbar spondylolisthesis Indication Dick nail fixation is suitable for: 1. Early unstable thoracolumbar fracture or fracture dislocation. 2. Late thoracolumbar traumatic deformity and instability. 3. Spinal instability caused by degeneration of the spine after laminectomy. 4. Spine slippage. 5. Vertebral tumors. Preoperative preparation Prepare Dick fixtures and screw-in and snap-offs. Surgical procedure 9.1 1. Cut and reveal Take the posterior median incision, centering on the fractured vertebral body, generally should expose the upper and lower spinous processes, cut the skin and subcutaneous tissue and the supraspinous ligament, and use the periosteal stripper to sequentially reveal the spinous processes and lamina and transverse processes. The full disclosure of the transverse process is conducive to the positioning of the pedicle. 9.2 2. Positioning After determining the damaged vertebral body, the pedicle position of the upper and lower vertebral bodies is determined, that is, the screw is screwed into the point. According to Dick's experience, in the lumbar spine, the midpoint of the transverse process is generally horizontal, the dorsal side of the superior articular process is the longitudinal axis, and the two lines intersect inward by 10° to 15° as the entry point. In the thoracic vertebrae, it is generally close to the superior vertebral body articular process, 3 mm outward from the midpoint of the joint, and 10 ° to 15 ° inward from the base of the transverse process as the entry point (Fig. 3.26.5.19-3, 3.26.5.19-4). Removal of the transverse process with a rongeur in the thoracic spine facilitates positioning. 3. Screw in the screw After determining the entry point, use a 2mm Kirschner wire parallel to the vertebral endplate, enter the vertebral body 30mm inward 10°15°, and locate the X-ray through the operation. After the position is ideal, change the threaded rod of 5mm thick and screw in. Before entering, only need to use a 3.5mm drill bit to ream the hole 5~10mm. The ideal depth of the threaded rod is screwed into the front wall of the vertebral body. It is safe to screw it into 40mm. It is best to monitor it in the TV X-ray machine during operation. The lower operation, because the front wall of the vertebral body is thin, the breakthrough feeling is not obvious, and the front wall of the vertebral body is not easily felt. The threaded rod is the pedicle cortex into the vertebral body and has a strong fixation effect. 4. Longitudinal rod connection Each side of the spinous process is connected by a longitudinal rod 10 cm long and 7 mm in diameter. Taking a burst fracture as an example, the tail of the long threaded rod is first pressed together to correct the kyphosis. However, when the lamina has a fracture, it should first be opened to prevent further damage to the posterior structure of the lamina and vertebral body. 5. Further correct the deformity Through the compression of the threaded rod, the kyphosis is corrected, the physiological lordosis is restored, and the side nut is tightened to maintain the corrected angle. Rotate the nut to both ends to restore the height of the vertebral body. Then tighten the nuts at both ends and cut off the excess threaded rods. 6. Transpedicular bone grafting After the height of the vertebral body is restored, the free bone mass is taken from the humerus and smashed into a slurry. The special pedicle bone grafting device is used to implant the bone through the pedicle to the injured vertebral body. Generally, there is no need for posterior bone graft fusion. 7. Irrigation of the wound with isotonic saline, indwelling the vacuum suction tube, and suturing the incision in layers.