transthoracic debridement

Transthoracic lesion removal is used for surgical treatment of spinal tuberculosis. There are two ways to clear the thoracic tuberculosis, through extrapleural and transthoracic surgery. Transthoracic surgery has a great influence on cardiopulmonary function, and surgical indications should be strictly controlled. Transthoracic surgery is the removal of one side of the rib and the transverse process into the lesion, which is less common in cardiopulmonary function and is therefore more commonly used. Treating diseases: tuberculosis Indication Transthoracic lesion removal is applicable to: 1. Chest 4 ~ 11 tuberculosis, especially vertebral body destruction segment, paravertebral abscess longer or jumping lesions. 2. Paravertebral abscess is broken into the chest or lungs. Contraindications 1. Patients with active lesions in the lungs that have not yet been controlled should be treated with anti-tuberculosis treatment. 2. Those with poor heart function or poor general condition. Preoperative preparation 1. Learn more about the presence or absence of active lesions. 2. Regular chest X-ray films, chest radiographs, if necessary, CT examination. 3. Regular examination of erythrocyte sedimentation rate, liver and kidney function. 4. Apply anti-tuberculosis drugs, systemic support therapy. 5. Prepare blood 300~600ml. 6. Do a good job of neck pillow plaster before surgery. Surgical procedure 1. Incision: Walk along the rib that is scheduled to be removed. From the front to the front of the sacral line, and then to the outer edge of the sacral spine muscle, the adult incision is about 25cm long. 2. Cut the latissimus dorsi, trapezius, rhomboid and anterior serratus in the direction of the incision and retract them to the sides. The electric knife cuts the periosteum of the rib, and after the subperiosteal peeling, the rib is cut and the bone to be implanted is removed. The pleura was cut through the rib bed into the chest. Use the chest automatic retractor to open the chest. If there is adhesion, use a finger to place the gauze along the pleural wall layer for separation. The atrophy of the lung tissue can be revealed by atrophy of the lung tissue and retracting toward the front midline. 3. Exposure of the lesion: The paravertebral abscess of the bulge is indented by the compression of the intercostal arteries and veins. Cut the wall of the abscess and cut off the pus. Each of the intercostal muscles and veins was clamped by two vascular clamps, and cut between them, and sutured and ligated. After treating the three intercostal vessels with this method, the paraspinal abscess is opened to form a wall of the abscess and turned outward. 4. Clear the lesion: firstly scrape and destroy the diseased cheese-like tissue and granulation, then scrape off the dead bone and necrotic intervertebral disc, completely remove the lesion, so that the compressed spinal cord is released. 5. Bone graft fusion: See "Ribral Transverse Resection". 6. Thoracic drainage and suture: After washing the lesion and the abscess, put streptomycin 2g, isoniazid 200mg, suture the abscess wall with absorbable wire. Rinse the chest cavity, inflate the lungs, and observe the presence or absence of air leaks before closing the chest. Closed drainage. The incision was layered with a thin stainless steel wire using a rib cage. complication 1. Secondary chest infection. 2. Spinal cord injury increases paraplegia. 3. Generally open the chest by the left side, such as the right side of the chest, the right inferior vena cava wall can not only adhere to the abscess wall, may be surrounded by abscess, difficult to identify and separate, accidentally easy to damage the inferior vena cava, resulting in Major bleeding, even life-threatening.