Double Hastelrod fixation

Double Harrington rod fixation for the treatment of spinal fracture and dislocation. Curing disease: Indication 1, thoracolumbar vertebral burst fracture, vertebral compression more than 1/2 often occur chronic instability, it is appropriate to early open reduction and double Harrington rod internal fixation. Decompression is required for patients with incomplete paraplegia. 2, spinal flexion stretch injury, the posterior column instability in the spine, can be fixed with a double Hastelloy compression rod. Preoperative preparation Prepare a suitable Hastelloy fixture. Surgical procedure 1, cutting and revealing The posterior median incision was taken. The length of the incision was from 3 spinous processes on the injured vertebra to the next 3 spinous processes. The skin, subcutaneous and supraspinous ligaments were dissected, and the sacral spine muscles were removed under the periosteum, and three spinous processes, lamina and articular processes were observed above and below the injured vertebrae. Surgery should be revealed from the vertebral body to the injured vertebrae, and the lamina of the fracture or dislocation should be carefully removed to prevent the periosteal stripper and the laminar fracture piece from entering the spinal canal. Remove clots, clear fractures of the spine, small joint displacement or interlocking, and interspinous ligament, ligament ligament rupture. 2, positioning According to the injury of the posterior column of the spine and the surface markers, the vertebral body of the fracture and dislocation was judged by contrasting preoperative X-ray or CT. Important signs are: 1 lower scapula angle to the 7th intercostal space; 2 chest and lumbar segments can be judged according to the presence or absence of ribs, 12th rib and waist 1 transverse process spacing is about 1 horizontal finger; 3 waist 3 transverse process is the longest; 4The highest point is 3 to 4 spinous process gaps on the waist; 5 lumbosacral iliac crest can be located according to the intervertebral activity and the presence of the ligamentum flavum; if necessary, the film is positioned during the operation. 3. Reconstruction of fracture and dislocation The two groups are towed, one group is double-footed, one group is wound around the underarm, and the traction is from small to large. After a few minutes of traction, the surgeon clamped the upper and lower spinous processes with a rongeur and lifted it back to the back. When there is dislocation of the joint, the kidney bridge is temporarily raised to make the spine flex, and the spinous process or the sacral joint is corrected to rotate and shift. When the reset is difficult, the superior articular process of one or both lower spine can be removed. After resetting, the kidney bridge is flattened to restore the physiological curvature of the spine. 4, the placement of the hook The upper hook is generally placed at the two segments above the injured vertebrae. First, the joint capsule at the hook is scraped off, and the joint process is exposed. The lower joint and the lower edge of the lamina are trimmed by the osteotome to cut 3 to 4 mm, which is easy to recognize. Joint space and prevent the upper hook from slipping outward. 3mm outside the lower edge of the superior joint and the midline of the facet joint as a mark of the pedicle, ensuring that the hook hangs into the joint space and the hook blade reaches the pedicle. Then try to put a hook on the sharp end of the hook by inserting the hook end of the hook to the joint gap, and then hammering the hook to release the hook, so that the hook can be taken out and replaced with a blunt head or belt. Hook up. Finally, put a hook on it to avoid damage to the spinal cord. If a compression rod is required, it is necessary to expose the transverse process and hook the hook at the root of the transverse process. The hook edge is safe between the rib neck and the transverse process. 5, the placement of the hook The lower hook is generally hung on the 2 vertebral lamina below the injured vertebrae, the ligamentum flavum and the interspinous ligament are removed, and a distractor is placed in the interspinous space to facilitate the vertebral fenestration. The needle is clamped or chiseled with a needle-nosed pliers or a small bone knife. The edge, including the medial part of the facet joint, securely lays the hook when the epidural fat is seen. When using the compression hook, place it on the lower edge of the lamina, first remove the ligamentum flavum, bite the lower edge of the lamina and the inner edge of part of the lower articular process, and then place the appropriate lower hook. 6, put the Hastelloy stick Select the appropriate length of the Harrington rod, use a curved rod to fold into a curvature that conforms to the physiological curvature. In order to restore the height of the vertebral body, the thoracic vertebra should use a straight rod, while the lumbar vertebrae use a rod with a certain lord angle. Use a vise or a special holding pliers to hold the Harrington rod into the upper and lower hook holes. Keep the rod corresponding to the curvature of the spine. Open or compress the Harrington rod. Insert the Harvard rod into the washer or Tied the wire to prevent the hook from slipping. 7, bone graft fusion The cortical bones on the back of the lamina, articular processes and transverse processes are chiseled into rough surfaces, and the free bones of the posterior superior iliac spine are harvested and cut into thin strips for bone grafting. The fusion range may include 2 to 3 sections of the fracture and dislocation. The spine is also feasible for bone graft fusion of the entire fixed segment of the Hastelloy stick. 8, suture incision Fully stop bleeding, place a negative pressure drainage tube, and suture the incision layer by layer.