rib transverse process resection

The rib transverse process is used for the surgical treatment of spinal tuberculosis. There are two ways to clear the thoracic tuberculosis, through extrapleural and transthoracic surgery. Transthoracic surgery has a great influence on cardiopulmonary function, and surgical indications should be strictly controlled. Transthoracic surgery is the removal of one side of the rib and the transverse process into the lesion, which is less common in cardiopulmonary function and is therefore more commonly used. Treatment of diseases: spinal tuberculosis, simple spinal tuberculosis, contraindications There are serious organic diseases, poor physical fitness can not afford surgery, such as coronary heart disease, open tuberculosis, liver and kidney dysfunction, severe diabetes. Preoperative preparation 1. Exclusion of inactive open tuberculosis by examination. 2. Anti-tuberculosis treatment is performed for 3 to 4 weeks before surgery to make the blood settle to below 20mm/h. 3. The lung ventilation function should be measured before surgery. Surgical procedure 1. Incision: Take the diseased vertebra as the center and make an arc-shaped incision 2 to 3 cm from the spinous process. In the direction of the incision, cut the skin and shallow, deep fascia. 2. Cut the trapezius muscle, large and small rhomboid muscle (upper thoracic vertebra) or latissimus dorsi and lower posterior serratus (lower thoracic vertebra) along the incision. The sacral spine muscle is exposed, retracted to both sides, and the transverse process and the posterior segment of the rib are stripped. Generally, four transverse processes, three ribs, and two transverse processes in the middle should be exposed. The periosteum of the posterior segment of the rib was removed by the periosteal stripper on the principle of shun down and reverse. Use the periosteal stripper to pick up the free ribs, cut the ribs, and cut the acute angle at the distal end to prevent puncture of the pleura, lift the proximal ribs, cut the rib cage, remove the rib cage, and remove the rib cage. The rib head is used to remove the other rib by the same method. 2 or 3 ribs are generally removed according to the damage of the diseased vertebra. Find the intercostal blood vessels and nerves, ligature and cut the blood vessels, and retain the nerves. 3. Clear the lesion: first turn the operating table and then tilt it 60°. After finding the abscess, if the tension is large, you can puncture the pus first, then make a longitudinal incision at the apex of the abscess, and suck all the pus with the suction device. Then expand the abscess mouth, use a small curette to find the vertebral bone hole, and use the periosteal stripper to gradually move forward along the longitudinal axis of the vertebral body, and peel off under the periosteum, so that the periosteum and posterior mediastinum move forward and fully reveal the lesion. After draining the pus, the necrotic intervertebral disc, the cheese-like tissue and the dead bone are scraped under direct vision, and the adjacent normal vertebrae are chiseled in a trough shape, and the intervertebral body is implanted with the ribs. Put streptomycin 1g, isoniazid 200mg and fill in gelatin sponge. If a single vertebral body is removed, the pedicled iliac spine muscle flap can be used for filling. The isotonic saline is then used to rinse and suture the wound, and the drainage strip is generally not placed. complication Pneumothorax or blood pneumothorax Most cases occur when the rib periosteum and rib head are removed, and the pleura is also pierced at the distal end of the rib. Therefore, when the subperiosteal peeling is performed, the operation must be gentle. If the pleural rupture is caused, closed drainage is feasible, and the drainage tube is removed 24 to 48 hours after operation. 2. Dural tear It often occurs when the dead bone invades the spinal canal. When the bone is removed by the rongeur, the bone block adheres to the dura mater, causing the dura tear. After using the nerve stripper to fully dissipate the nerve root or dura mater and the bone block, Remove the dead bone, and do not use the rongeur to tear off the bone to prevent the dura tear. Once it occurs, it should be sutured in time to prevent cerebrospinal fluid leakage or lesions from invading the subarachnoid space. 3. Spinal cord injury Tuberculosis is heavier and the vertebral body is severely damaged. When the necrotic disc and cheese-like substance are scraped off with a curette, the exact position of the spinal cord is not clear, resulting in accidental injury. Careful operation is generally avoided.