Luque Rod Spinal Orthopedics

Scoliosis refers to the lateral bending deformity of the spine. Scoliosis can be divided into secondary, non-progressive, non-structural scoliosis and primary, progressive, structural scoliosis according to its etiology. The former is scoliosis caused by abnormalities other than the spine, such as postural scoliosis; the latter is caused by changes in the inner vertebral body and its supporting structure of the spine, such as idiopathic scoliosis. Curves curved to the sides of structural scoliosis are often asymmetrical, while non-structural scoliosis is mostly symmetrical. Idiopathic scoliosis is a lateral lordosis, which accounts for about 75% to 85% of the total number of scoliosis. This section only covers the surgical treatment of idiopathic scoliosis. The cause of idiopathic scoliosis is unclear. Many scholars believe that idiopathic scoliosis is not due to asymmetric bone growth, but is due to factors other than bone growth, which may be related to genetic factors, based on a large number of demographic and clinical observations. According to the onset time, it is divided into three types: 1 infant type: before the age of 3, mainly in the thoracic vertebra, 92% protrude to the left side. This type of side bend can self-resolve or continue to develop. The former situation stops developing or gradually decreases as the child ages, and no treatment is needed; the latter gradually increases with age, and if it is not actively treated, it can develop into a serious deformity. 2 juvenile type: age from 3 years old to puberty, the patient is in a period of vigorous growth and development, the scoliosis development is faster, this type of female is more common, more prominent to the right side. 3 youth: after puberty. In China, the adolescent type is more common, and the curvature of the side bend is obviously developed during the puberty development period, and gradually relieves after the mature period of the spine bone. Therefore, patients with scoliosis should be followed up regularly, according to the occurrence of humeral epiphysis and vertebral annular epiphysis; breast development, pubic hair and menarche time; height growth and tibia distal tarsal fusion Determine the maturity of the spine and estimate whether the deformity is further developed. The significance of scoliosis treatment is: 1. Reduce cardiopulmonary complications caused by severe scoliosis. 2. Reduce the incidence of low back pain in the late stage. 3. Improve the shape. 4. Relieve the patient's psychological burden and solve some problems such as unemployment and marriage caused by scoliosis. In general, bracing and electrical stimulation therapy can only control deformities and prevent mild scoliosis, but not the angle of the more obvious side bends. Treating diseases: scoliosis Indication Luque rod orthopedic surgery is suitable for: 1. Non-surgical treatment is ineffective, and spinal deformity continues to increase, requiring surgical treatment. Because spinal fusion will hinder the growth of the length of the spine, if the spinal deformity is not serious or non-surgical treatment can control the development of the deformity, the time of surgical fusion should be delayed as far as possible to the mature stage of the spine. However, due to thoracic scoliosis, secondary rib thoracic deformity may have a greater impact on cardiopulmonary function, and the appearance of deformity is obvious. Thoracic deformity is limited by the ribs and surrounding structures, and the effect of surgical orthopedics is poor, so early surgical treatment should be considered. 2. Young patients with obvious scoliosis deformity. In general, the obvious scoliosis refers to the lateral curvature of 40 ° ~ 45 ° before the developmental maturity, and the lateral curvature of the mature period of 50 ° ~ 60 °, and those who continue to develop should be actively treated. Surgical treatment can not be measured only by Cobb angle, other factors must be considered, the patient's age, growth ability and the possibility of scoliosis development. For example, the 45° side bend of an 11-year-old girl before menarche is likely to continue to develop; and the patient after the maturity of the same angle of lateral bending will not develop again. Clinical manifestations are also important, with rotational scoliosis and thoracic lordosis or kyphosis, non-surgical treatment is ineffective, and significant spinal compensation imbalance, even 35° scoliosis should also be treated surgically. Preoperative preparation According to the anterior and posterior radiographs taken under the longitudinal axis of the spine or the flexion of the two sides of the spine, it is estimated that the corrected angle can be obtained. The curved Luque rod can be bent slightly more than the predicted correction angle, but should not exceed 10°. The Luque rod is bent out of the lumbar anterior convex curvature, so as to prevent the lumbar lordosis from disappearing after the L-shaped rod is fixed, resulting in standing and walking instability. Surgical procedure 1. Lace plate under the wire See memory alloy rod orthopedics. 2. Fix Luque rod Place the Luque rod on the lamina on the side of the lateral curvature. The L-shaped part of the rod is placed on the lamina or across the root of the spinous process to reach the contralateral facet joint. It should not be placed in the interlamellar space. When the rod rotates, it hurts the spinal nerves. First tighten the fixed wire at the proximal end and the distal end of the concave side rod. At this time, the middle part of the rod cannot be attached to the lamina, and then tighten the fixed wire later. Then place another Luque rod on the convex side lamina, and the distal horizontal rod is also placed between the spinous processes. First tighten the proximal rod of the rod to fix the Luque rod, and then gradually press the part below the corner of the Luque rod. Close to the center line. At the same time, the steel wire is tightened one by one from far to far, so that the pressure of the Luque rod on the opposite corner of the corner is gradually corrected, and the scoliosis is gradually corrected. After the wire at the distal rod end is tightened, tighten the wire in the middle of the concave side rod. In this way, the fixed steel wires of the concave side and the convex side are alternately screwed, so that the Luque rod and the spinal lamina are closely attached, and the excessively loose steel wire can cause the steel wires to be unevenly deformed, which may cause the steel wire to break, thereby causing the operation to fail. If the lumbosacral segment has a C-shaped lateral deformity and there is a pelvic tilt, the Luque rod should be bent out of the lumbar convex curvature, and the L-shaped short rods of the Luque rods on both sides should be inserted into the contralateral sacral sac. You can first drill with a Sterling needle to insert the rod. The steel wire is fixed on the 1 lamina at the intersection of the rods on both sides, and the fixed wires are sequentially tightened. If 1 has a recessive spina bifida, the Galveston technique is adopted, that is, the Luque rods on both sides are inserted into the ipsilateral tibia and the lateral tibia. 3. Bone graft The bone graft was planted on the vertebral plates on both sides of the Luque rod. complication 1. The bone graft does not heal to form a pseudo joint The rod covers the lamina and takes up part of the bone graft surface, which can form a pseudo joint due to the scarring of the bone around the steel wire. During the operation, the osteocortex of the facet joint must be removed, and the bone graft should also be placed in the joint process, and the amount of bone graft should be sufficient. 2. Wire breakage More common. Excessive tightening during the operation can cause the wire to break. Generally speaking, the wire is screwed until the rod does not move, and it should not be too tight; the direction of the wire should be the same, and the steel wire should be inspected thoroughly after the wire is finished. Postoperative wire breaks often occur when the bone graft is not healed. Therefore, as little activity as possible after surgery, the degree of activity is determined after reviewing the X-ray film. 3. Neurological damage Luque reported a temporary spinal cord injury of 4.6% and a permanent injury of 0.6%. Wear steel wire and wire take care should be very careful and skillful.