Transabdominal debridement of lumbosacral tuberculosis

Transabdominal lumbosacral lesions were used for the removal of lumbar 5, 1 vertebral tuberculosis lesions. Removal of tuberculosis through the abdominal cavity is easy to cause intra-abdominal infection and intestinal adhesion, so do not use it as a routine incision. However, if the patient has had multiple operations or mixed infections, it is estimated that the local adhesion is severe, and it is not easy to reach the front of the waist 51 from the peritoneum. Treatment of diseases: lumbar tuberculosis Incision The left lower abdomen midline incision, from the umbilicus to the pubic bone, cut the peritoneum in the direction of the incision. 2. revealing the lesion After entering the abdominal cavity, push the small intestine up with 4 saline gauze pads, push the sigmoid colon to the left, push the ileocecal to the right, push the bladder (and uterus) downwards, and put the hook. Touch the position of the humerus and the left and right iliac arteriovenous veins with your fingers to recognize the triangle in the lower part of the large vessel bifurcation and properly protect the common arteriovenous vein. The peritoneum, anterior longitudinal ligament and periosteum were dissected for subperiosteal separation. 3. Clear the lesion When the abscess is cut, the pus is prevented from contaminating the abdominal cavity. After the pus is absorbed, the cheese-like substance, granulation tissue, dead bone and intervertebral disc tissue are scraped off with a curette. The lesions present in the vertebral body cavity are scraped off. After the lesion is cleared, a bone groove is cut with a bone knife, and a tibia is inserted between the lumbar vertebra and the tibia to fuse it. 4. Stitching After the wound is washed and the gauze is pressed to stop bleeding, 200 mg of isoniazid is placed in the bone cavity, the gauze pad is taken out, the abdominal organs are returned to the original position, and the incision is layered and sutured. complication Macrovascular injury Commonly, the large veins are as follows: the vena cava, the common iliac vein, and the branches. Its blood vessel wall is thin, lacks elasticity, and has no pulsation, so it is easily damaged. Because the wall of the aorta is thick and pulsating, it is not easy to be injured. The cause of the damage is mostly caused by excessive pulling and mistaken peeling. Once damaged, it can cause massive bleeding and must be actively treated. The treatment method is the same as described above. 2. Lumbar nerve injury When the anterior vertebral body is approached, it is susceptible to injury when the abscess is scraped off. If it is cut, it should be sutured immediately.