Winter anterior and posterior convex hemi-epiphyseal block and fusion

Winter anterior and posterior convex half-bone block fusion for the treatment of congenital scoliosis. Congenital scoliosis is a lateral curvature of the spine caused by vertebral deformity caused by longitudinal growth imbalance of the spine. The pathogenesis is usually divided into cervical and thoracic segments, thoracic segments, thoracolumbar segments and lumbosacral segments. It is generally believed that most congenital scoliosis is caused by non-hereditary, embryonic environmental factors, but these factors are often difficult to determine in medical history. Pathological changes in the formation of lateral curvature may be due to: 1 segmental defect, unilateral segmentation or unilateral undivisional bone bridge is more common, the resulting lateral curvature is easy to aggravate; 2 poor formation, vertebral body formation is poorer than the front And the formation of the poor is common, can be wedge-shaped vertebral body or hemivertebra deformity; 3 congenital scoliosis caused by mixed deformity, due to poor segmentation and poor formation on the frontal plane, the deformity can be unilateral undivided The bone bridge is combined with a semi-vertebral body, or it can be a semi-vertebral body with a segmental defect. Because congenital scoliosis is often stiff, it may be difficult to correct, and early detection and correct treatment are essential when the lateral curvature is small, rather than remedial surgery when the scoliosis is severe. Among all the deformities, the most obvious is the convex side hemivertebra, and the concave side of the unbranched bone bridge. The thoracic and lumbar deformity progresses most seriously. A small number of congenital scoliosis can be treated with orthopedic braces, such as long and flexible scoliosis, lateral curvature that can be corrected after traction or lateral flexion, and lateral curvature that is abnormally mixed with normal vertebral bodies. Brace treatment is ineffective for sharp and stiff short-segment sideways. 75% of congenital scoliosis is progressive, and surgery is the most fundamental treatment. Surgical methods mainly include: posterior fusion with or without orthopedic fixation, anterior and posterior fusion, anterior and posterior approach with convex semi-bone sacral block and semi-vertebral resection. Treating diseases: scoliosis Indication Winter anterior and posterior convex half-bone block fusion is applicable to: 1. The patient is <5 years old. 2. Scoliosis is progressive. 3. Side bend <60°. 4. Side bend <6 segments. 5. The concave side has growth potential. Even if the concave side stops growing, the anterior and posterior fusions achieve good results. 6. No pathological kyphosis or lordosis. Contraindications 1. For those with scoliosis involving T8 or above, because the thoracic vertebral body above T8 is small, screwing into the vertebral body screw can easily penetrate the vertebral body into the spinal canal and cause spinal cord injury. 2. Scoliosis with obvious pelvic tilt. 3. Scoliosis with obvious kyphosis. This procedure can make the kyphosis worse. 4. The patient's lung capacity and maximum respiration have been reduced by 40%. Due to the use of analgesics and post-thoracic and spinal orthopedics, lung volume and vital capacity will be reduced by 10% to 30%, which may cause acute lung failure. 5. Those aged <10 years old. Because the vertebral body is too small, it is not appropriate to wear nails on the vertebral body. This method should not be used by patients with osteoporosis. 6. There are spinal canal and spinal cord malformations, it is not appropriate to simply posterior fusion, but should discuss the treatment plan with neurosurgeon. 7. Poor systemic conditions and major organ diseases. 8. There are infected lesions in the skin near the surgical area. Preoperative preparation 1. Take the full-length positive X-ray of the spine and the full-spine full-shoulder slice to measure the degree of lateral curvature and vertebral rotation according to the X-ray film, and compare the suture position to measure the natural correction rate to understand the operation. Correct the maximum limit. For congenital malformations, especially those with suspected spinal cord longitudinal fissure should be performed first, and those with conditions can do CT scan or MRI. If it is confirmed that this disease is the first intraspinal bone septal resection. 2. Electrophysiological examination can be performed on the paraspinal muscle and lower extremity electromyography or spinal cord evoked potential examination. In order to understand whether there is spinal nerve damage, and as a control for intraoperative spinal cord monitoring. 3. Pulmonary function test to understand the extent of lung function, such as lung capacity below 60%, due to spinal surgery often reduce the original lung function by 15% to 20%, will lead to significant hypoxia. Therefore, lung function training must be performed before surgery, and the patient should perform deep exhalation training in the balloon. 4 to 5 times a day for 10 minutes each time, continuous 2 weeks will significantly improve lung capacity. 4. Blood biochemical examination blood CPK normal value is 2 ~ 130U / L, such as increased significantly, especially in the anesthesia above 1000U / L is prone to malignant hyperthermia, check blood potassium, sodium, chlorine and liver and kidney function, blood gas analysis, etc. Can fully understand the basic situation of the whole body. 5. Traction for 2 weeks before spinal traction surgery, the paravertebral muscles, ligaments and small joint capsules are relaxed, so that the intraoperative deformity can be corrected to the maximum allowable amount. In addition, for patients with congenital scoliosis or suspected intraspinal lesions, it can be understood whether there are neurological symptoms appearing or aggravating, and the correction rate in the operation is well known. 6. Bed and toilet training After admission, the patient is trained to bed and urinate in bed, which can prevent urinary retention and constipation due to unaccustomed postoperative operation, and at the same time enable the patient to learn the correct axial turning method after surgery. 7. Application of antibiotics 24 hours before surgery, intramuscular injection or intravenous administration of a sufficient amount of broad-spectrum antibiotics can maintain the effective antibiotic concentration in the blood during surgery, and play a positive role in preventing postoperative infection. 8. Skin preparation Because the patient's back is uneven, it is necessary to master the skin preparation method. Do not shave the skin. For those with folliculitis, 2.5% iodine is applied locally. In severe cases, it can be treated with reasonable treatment. All the folliculitis can be treated before it can be treated. 9. After preoperative localization of the disinfected skin, the injection needle was inserted into the side of the spinous process in the center of the predetermined incision, and the vertebral body was confirmed by X-ray film, and then 0.5 ml of 1% methylene blue solution was injected. When the surgery is to be performed on the next day, the extent of the lamina can be accurately revealed. If the methylene blue solution has been absorbed during surgery (no injection of methylene blue solution into the periosteal tissue), it is best to further locate the intraoperative film. 10. Prepare blood for 800 to 1000ml. 11. For younger children, the bone supply of the autogenous tibia is limited, and bone graft materials should be prepared. Surgical procedure 1. The way forward Can be determined according to the fusion segment. After the side bends are revealed, steel needles or other markers are inserted in the front and rear paths, respectively, and observed on the screen of the television X-ray machine. Once the appropriate site is identified, the anterior periosteum of the vertebral body is dissected and separated forward to the anterior longitudinal ligament margin, posterior to the pedicle base. The fibrous ring is cut at the upper and lower edges of the disc to remove the superficial part of the nucleus. Carefully remove the thick cartilage plate in children, remove at least 1/3 of the callus, but never more than half. After the cartilage plate is removed, the cortical bone plate is removed with a curette. Slot the side of the vertebral body and implant the autogenous rib block into the groove. Use cancellous bone to increase the volume of the autogenous ribs. If there is no autologous rib, the stock bone of the tibia or bone bank can be used. 2. The way of the road Includes standard unilateral subperiosteal exposure fusion zones. The intervertebral joints were cut, all the small articular cartilage was removed, and all the cortical bones were removed and bone grafted. 3. Fixed Immediately after the operation, it was fixed with Risser plaster. complication 1. Postoperative spinal deformity can be aggravated. 2. Causes of injury caused by spinal cord injury: 1 spinal cord ischemia caused by improper ligation of the lumbar transverse vessels; 2 accidental injury of the spinal cord when the intervertebral disc is removed; 3 misplacement of the spinal canal when the vertebral body screws are placed. 3. When the incision is closed, the free part of the transverse angle is not fixed. 4. Vertebral fragmentation is caused by improper position of the screw. 5. The steel wire at both ends of the metal rope is opened, and the sharp wire end can stab the important tissues and organs nearby. 6. Pseudo-articular formation occurs mostly in stiff paralytic lateral deformities. Dwyer reports that the incidence of this complication is as high as 50%, so it is emphasized that stiff paralytic lateral curvature should be added with posterior spinal fusion. 7. Acute lung failure surgical incision and correction of lateral curvature can affect the chest volume and vital capacity, prone to acute lung failure. Most scholars believe that the preoperative lung vitality and maximum respiration have been reduced by 40%, the risk of postoperative acute pulmonary failure is significantly increased, so preoperative lung function training is emphasized. 8. Others may also have pneumothorax, hemothorax, aspiration pneumonia and complications of intestinal paralysis. 9. The bone graft is not fused and the pseudo joint is formed. 10. The fusion site is bent and a "crankshaft" phenomenon may occur. 11. The effect is good in the first few years after surgery, but there may be a side bend in the fast growth period.