Harrington surgery

Harrington surgery is a surgical method for the treatment of spinal and thoracic diseases. It is suitable for: 1. During skeletal development, the Cobb angle of scoliosis is greater than 40°, and those who continue to develop should be surgically corrected; those who are younger than 12 years old only undergo instrumental correction surgery. , do not make fusion, surgery correction every 6 to 12 months, straight can be merged. 2. After the development of the spine is stopped, the scoliosis continues to develop, or the pain is severe, or the heart and lung function are affected, and the surgery should be corrected. 3, severe thoracic deformity, affecting life and shape, patients require surgical orthopedics. Treatment of diseases: thoracic deformity scoliosis Indication 1. During skeletal development, the cob angle of scoliosis is greater than 40°, and those who continue to develop should be surgically corrected. Those who are younger than 12 years old are only undergoing instrumental correction surgery, and no fusion is performed. The surgery is corrected once every 6 to 12 months. Until the time of integration. 2. After the development of the spine is stopped, the scoliosis continues to develop, or the pain is severe, or the heart and lung function are affected, and the surgery should be corrected. 3. Severe thoracic deformity affects life and shape, and patients require surgical orthopedics. Contraindications 1, patients with bleeding tendency should first treat coagulation function, and then surgery. 2, allergic to local anesthetics, or anti-anaesthetic should pay attention. Preoperative preparation 1. The normal and lateral x-ray films of the conventional standing position and the traction position, and the cobb angle, rotation degree and stiffness are determined as the basis for selecting the surgical method. The range of internal fixation and fusion is designed according to the convexity range. Those with severe spinal rotation deformities should take a rotating x-ray to clearly show the true image of the vertebral body. 2. Routine measurement of vital capacity, electrocardiogram, understanding of heart and lung function. Patients with a significant reduction in lung capacity should be trained before surgery and subjected to oximetry until the surgical safety requirements are met. 3. Comprehensive and detailed physical examination, including skin pigmentation, nervous system signs, liver and kidney function. Patients with congenital scoliosis should be examined by myelography, except for spinal deformities. 4. For more severe scoliosis, the soft tissue contracture should be loosened as much as possible before surgery. It can be pulled with the occipital band (or sliding bed) 2 to 3 weeks in advance, or pulled with the cranial ring support frame to improve Surgical correction effect. 5. Train the patient 1 to 2 weeks in advance to actively move the fingers and toes during the anesthesia awakening. 6. Skin preparation for 3 days, the scope should be sufficient. Antibiotics were applied 3 days before surgery. Prepare blood 1000~2000ml. Indwelling catheterization on the day of surgery. And contact the intraoperative x-ray film. 7. Preoperative routine examination of the back, side and waist of the body, height measurement, thoracic height, etc., records for postoperative comparison. 8. Select the appropriate internal fixation before surgery, including harrington rods, luque rods and wire or other. Surgical procedure 1. Position: In the prone position, the spine is required to be horizontal, the breathing is not restricted, and the hand and foot activities are unobstructed to facilitate the observation during surgery. Applying the prone position, the position is more appropriate, but care should be taken not to press the abdomen and femoral artery, and the upper extremity abduction should not exceed 90°. 2. Incision: The midline incision of the back should be longer than the two spinous processes of the upper and lower polar vertebrae. The bone graft is generally taken from the rib of the convex thoracic deformity area or from the posterior aspect of the humerus, and a corresponding incision is made in this area as needed. 3. Exposure: Before the incision, the soft tissue of each layer under the subvertebral plate is injected into the skin with 1:500000 hyporenal saline solution to make it evenly infiltrated, which can reduce bleeding and save operation time, but the bleeding of blood vessels should still be timely. Stop bleeding. The subcutaneous tissue was incised until the supraspinous ligament, the lamina was extensively excised under the periosteum, the thoracic vertebra was crossed to the bilateral apex, and the lumbar vertebrae reached the bilateral articular processes. The retractor was retracted with an automatic retractor to completely remove the soft tissue remaining on the lamina. 4. Positioning: Firstly, on the proposed t12 spinous process, use the towel clamp or thick needle clamp or puncture the spinous process as a marker, and take the lateral x-ray film as the center to determine the true ordinal number of the spinous process. . This counts up and down to clarify the upper and lower polar vertebrae of the original bend. It is easier to judge under the perspective of the TV x-ray machine. 5. Place the upper support hook: the upper support hook should be placed on the concave side of the lower articular process on the lamina of the upper polar vertebra. First use a small bone knife to remove the tip of the lower articular process about 0.5cm. Be careful not to cut into the inner edge of the facet and enter the spinal canal. Then use the periosteal stripper to insert the posterior joint to loosen and separate it. Hold the hook with the hook clamp. Into the joint space, and then inserted into the upper hook hole with a hook feeder to hammer into the joint until it is firmly fixed in the joint joint [Figure 2]. 6. Place the lower support hook: the lower support hook is placed on the concave side of the upper edge of the lower lamina of the lower pole. Firstly, the ligamentum flavum on the concave side of the gap is removed, and the laminae at both ends and the outer part are bitten, the gap is expanded to 0.5 cm, and the lower hook is placed in the same position as the upper hook to make it straddle the next lamina. Take care to avoid inserting the lamina [Figure 3]. 7. Device side convex opener: After the test upper and lower position open hooks are fixed firmly, the hooks can be clamped by the hooks. If the partial spinous process obstructs, the part can be bitten, and then the spine expander is used to fix the clip. On the hook, turn the diverter clockwise to extend the distance between the hooks and correct the scoliosis [Figure 4]. 8. Place the compression rod and hook: Generally, the full-thread compression rod is used to carry the compression hooks of the upper and lower edges of each of the three blades. Before placing, the selected spine is selected. The upper hook is placed on the transverse process of the three spines below the upper polar vertebra. The t 10 or more transverse warp is long and upturned, and the upper hook can be hung downward. Three lower blade hooks are placed on the lower edge of the three lamina above the lower polar vertebra. The upper hook is inserted into the transverse rib joint of the rib from the transverse process, and the lower hook is inserted into the epidural space under the lamina, and the lower edge of the lamina has to be cut into a plane for hooking. Prepare the hook before placing the compression rod, then bend the hooked compression rod into a similar curvature according to the convex shape, adjust the relative position of each hook and the part of the nut, put it on the hook, and use the compression hook installer The hook blade hits the transverse rib joint along the upper edge of the transverse process, and the nut is temporarily fixed and placed from top to bottom. Finally, the lower hook is inserted into the predetermined position, and the nut is temporarily tightened to fix the lower hook. The modified compression hook is open at the top, and the compression hook can be first placed, then the compression rod is placed, the fixing bolt is inserted into the hook hole, and then fixed by the nut. However, according to the author's experience, such as the compression hook mounter, the traditional compression rods and hooks are not difficult to install, and the price is cheap. 9. Correcting the convex deformity: While gradually extending the lateral convex opener, tighten the compression hook and correct the scoliosis with the technique. If the concave soft tissue, especially the intertransverse ligament, is contracted, the interspinous ligament is found. When the effect is corrected, it can be cut off; for example, muscle tension can give muscle relaxant. The above distraction must be interrupted and slowly completed, and if it is too urgent, the spinal cord will be damaged. During the traction, the chiseling plate can be prepared for bone grafting. It is better to have a somatosensory evoked potential (sep) monitoring during the correction process. If not, the patient should be awakened at an appropriate time, and the respiratory patient should manually determine the opening limit. If there is an activity disorder, relax and open until the foot and toe are normal, but try to avoid it. 10. Laminar fusion: The lamina fusion range must include a lamina other than the superior and inferior vertebrae. The fusion step is seen in the ankle joint exposure pathway, but the focus of the scoliosis fusion should be the removal of the cartilage surface of the intervertebral joint and bone graft fusion. There are many methods to choose from. The vertebral plates within the fusion range are then chiseled. In order to save time, the two groups can be divided into laminar preparation and cutting the humerus, and the tibia is cut into thin strips on the lamina. 11. Place the open stick: Select the appropriate length of the open stick, and the ratchets left inside the upper hook should be minimized to avoid breaking easily in the future. Bend the rod into a suitable curvature according to the kyphosis condition, first through the upper hook hole, and then into the lower hook hole; use the expansion clamp to use the ratchet as the fulcrum, slowly expand the upper hook to correct the lateral convex to the limit, and then put the spine The toothed washer is clamped to prevent retraction. At the same time, tighten the compression rod hook, and finally remove the side protrusion spreader and the hook holder. If you wake up and wake up again, you must wake up again to observe the activity of the foot. 12. Drainage and suture: The wound and the internal fixation were soaked with 1:2000 chlorpyrifos solution for 5 minutes, then thoroughly rinsed with physiological saline, and placed in a drainage tube and poked out from the incision for negative pressure drainage, and sutured layer by layer. complication Incision infection: timely use of effective antibiotics, a small amount of hormones and hemostatic drugs, intravenous medication for 7 days, to prevent wound infection.