Removal of tuberculosis lesions in cervical 3-7 vertebral bodies

Cervical 3-7 vertebral tuberculosis lesions are used for surgical treatment of spinal tuberculosis. Treatment of diseases: cervical tuberculosis Indication Cervical 3-7 vertebral tuberculosis lesion removal is applicable to: 1. Vertebral destruction with abscess, or the formation of dead bone. 2. Those who have difficulty swallowing and breathing. 3. Compression of the spinal cord causes early paraplegia. Contraindications 1. The vertebral body is lightly damaged, and it is easy to cure with non-surgical treatment. 2. Children's cervical tuberculosis, generally with anti-caries drugs plus neck pillow plaster support can be cured. 3. There are serious organic diseases, poor physical fitness can not tolerate surgery, such as coronary heart disease, open tuberculosis, liver and kidney dysfunction, and severe diabetes, etc., do not force the operation to avoid accidents during surgery. Preoperative preparation 1. Learn more about the presence or absence of active lesions. 2. Routine cervical 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. 7. Pay attention to oral hygiene and apply anti-infective drugs. Surgical procedure Anesthesia and position General anesthesia or intravenous anesthesia. The supine neck back cushion is slightly extended, so that the head is tilted to the opposite side, and the head is fixed on the head frame with a bandage, and the person with the skull can keep the traction, but does not add weight. Surgical procedure 1. The incision is centered on the lesion, and the skin and subcutaneous tissue are obliquely cut along the anterior border of the sternocleidomastoid muscle. The length is about 10 cm. The platysma is cut open, and the anterior border of the sternocleidomastoid muscle is removed. Do not damage the nerves. The lower margin of the parotid gland, the cervical sheath (including the total neck, internal and external carotid arteries, internal jugular vein and vagus nerve), and retracted toward the midline. The sternocleidomastoid muscle was transversely broken up and down with a thick thread, and the scapular scapula muscle was cut from the ankle to the sides. 2. Exposing the posterior pharyngeal wall abscess, can be cut longitudinally along the median line, suck out the pus, look directly at the bone destruction area, use the periosteal screwdriver to peel off the periosteum around the bone hole, carefully scrape the lesion, and use the osteotome to properly enlarge the bone hole. Remove necrotic tissue between the affected vertebrae, dead bones, etc. Before the end of the operation, put streptomycin 1g, isoniazid 200mg plus gelatin sponge to stop bleeding. 3. Cervical vertebrae 6, 7 lesions, along the side of the abscess, 2 cm above the collarbone, along the transverse incision. The inside of the incision was in front of the trachea and was about 10 cm long. The skin and platysma were cut open, and the external jugular vein and its branches were cut. The clavicular head and sternum of the free sternocleidomastoid muscle. Cut off from the two horizontal fingers of the clavicle. After the scapulae muscle is free, it is cut off by the ankle and pulled to the sides. Carefully dissipate the inner edge of the sheath, ligature and cut the inferior thyroid artery, and then pull the neck sheath to the outside. The thyroid gland, trachea, recurrent laryngeal nerve, esophagus, etc. are retracted to the midline, and the abscess can be seen. After the long needle is sucked, the abscess is cut longitudinally to remove the lesion. complication Pulmonary infection, airway obstruction; excessive removal of the vertebral body is likely to cause cervical dislocation, causing paralysis.