H-shaped bone graft

Treatment of diseases: lower lumbar instability of spinal fractures Indication H-shaped bone grafting is suitable for: 1. Lumbar spinal tuberculosis does not require lesion removal, or lesion segment instability after lesion removal. 2. The degenerative instability of the lower lumbar spine, lumbar spinal stenosis combined with lumbar instability, and the fusion was performed after decompression. 3. Failure after lumbar disc surgery, combined with surgery for lower lumbar instability. 4. Spinal fracture and dislocation after posterior decompression, reduction, fixation, need to perform fusion surgery. Contraindications 1. The lesion of the vertebral body has not been still, the intervertebral space is narrow, and the vertebral tuberculosis has a lesion of a dead bone abscess. 2. Cervical, thoracic, lumbar vertebral tuberculosis, no lesion removal. 3. Intervertebral disc posterior approach, the anterior laminectomy resection range is too large. 4. Spinal fracture and dislocation through non-surgical treatment of pain relief. Preoperative preparation Preoperative diagnosis and differential diagnosis, correct understanding of the patient's condition, detailed description of the purpose and process of the operation, in order to obtain the best cooperation of patients. Surgical procedure Reveal Spinous processes, lamina and facet joints are exposed as before. Remove the residual muscle and ligament tissue that needs to be fused, revealing the lamina that includes the upper and lower vertebrae of the lesion segment. 2. Bone bed preparation The ligament tissue between the adjacent two spinous processes is removed, and the base of the spinous process is bitten out of the gap; the lamina and articular processes are treated with osteotome or grinding to form a rough surface and deep into the cancellous bone. If partial laminectomy or spinal canal augmentation is required, the spinous processes and lamina of the diseased segment should be removed and the adjacent normal spinous processes should be trimmed for bone grafting. 3. Transplanting bone trimming Take the autogenous tibia, its size is determined according to preoperative judgment, usually 5cm × 3cm full thickness tibia. The iliac bone block is opened from the center of the cancellous bone, and a piece of thickness and size is selected as the H-shaped bone graft. At the upper and lower sides of the bone graft embedded in the base of the spinous process, each gap is bitten to make it H-shaped. 4. Bone graft The cancellous bone face of the H-shaped graft bone face down, the upper and lower gaps of the H-shape are tightly embedded with the gap of the base of the spinous process, and the two wings of the bone block are attached to the surface of the lamina and the facet joint which have been roughened. The other bone piece is trimmed into strips and placed on both sides and above and below the H-shaped bone block. complication Transplantation bone fracture and pseudoarticular formation are two major complications. Therefore, during operation, rough handling should be prevented and premature load should be avoided.