Cervical vertebral tuberculosis debridement

Treatment of diseases: cervical tuberculosis Indication Cervical tuberculosis lesion removal is applicable to: 1. Cervical tuberculosis has abscess formation or spinal cord compression, and there is no significant improvement after systemic anti-tuberculosis treatment for 2 months. 2. Cervical tuberculosis abscess after ulceration, the sinus is unhealed for a long time. Contraindications 1. Active tuberculosis lesions in other parts of the body, such as invasive tuberculosis, tuberculous meningitis, etc., should be considered as surgical contraindications. However, surgical treatment can still be considered if the treatment is cured or stabilized. 2. After treatment with anti-tuberculosis drugs such as streptomycin, there is no improvement in symptoms of systemic poisoning. 3. Poor overall condition or infants, the elderly, and those who are difficult to tolerate surgery should suspend surgery and switch to other methods. Preoperative preparation 1. Preoperative system for anti-tuberculosis drugs for 2 to 3 weeks to reduce or prevent the spread of intraoperative tuberculosis. 2. Skull traction should be performed when the cervical vertebrae are severely damaged to reduce spinal cord injury. Surgical procedure Incision S1 ~ 2 vertebral tuberculosis with paraspinal abscess can be through the oropharynx approach. First, the tracheotomy and intubation were performed under local anesthesia. Use the opener to keep the mouth open. The mucosa of the oral cavity and the posterior pharyngeal wall is disinfected with thimerosal. The tongue is pressed down with a tongue depressor, and the uvula is sutured on the soft palate. The esophagus and tracheal inlet are temporarily closed with a spun yarn to prevent pus or blood from flowing in. In addition, a longitudinal incision is made in the mid-abdominal abscess of the posterior pharyngeal wall, which is about 3 to 4 cm long. S3 ~ 7 vertebral tuberculosis with paraspinal abscess, can be obliquely incision through the anterior border of the sternocleidomastoid, the incision is about 7 ~ 10cm long. 2. revealing the lesion When the oral cavity is opened, the mucosa of the posterior pharyngeal wall is cut and the lesion can be accessed. Take the cervical anterior oblique incision, open the skin, the cervical superficial fascia and the platysma, separate the medial edge of the sternocleidomastoid muscle and the visceral viscera, can reveal the pre-neck abscess area. 3. Aspirate pus and clear the lesion When the pre-neck abscess is fully revealed, first puncture with the 18th needle and protect the surrounding tissue with a saline gauze pad. If the abscess tension is large, a small incision should be taken longitudinally to connect the aspirator. After the pus is aspirated, the incision is extended, and the granulation tissue and fibrous tissue of the swollen wall are removed with a curette, followed by swelling. The abscess enters the intervertebral space of the lesion, clears the dead bone, necrotic intervertebral disc and caseous necrotic tissue, paying attention to the gentle movement, and the curette should not enter too deep to prevent damage to the spinal cord. 4. Close the incision After the lesions were completely removed, the rats were repeatedly washed with saline, and anti-tuberculosis drugs and antibiotics were sutured layer by layer to close the incision.