spinal sinus clearance

Spinal sinus removal can be divided into two types, transperitoneal and transperitoneal. Transabdominal lesion removal is a midline abdominal incision, incision of the peritoneum, push open the intestine, and then open the peritoneum to reveal and clear the lesion. Because the incision is centered, although it is relatively straightforward, it is inconvenient to treat the psoas abscess on both sides, or it can be removed by another posterior peritoneal incision. Because of the abdominal cavity operation, the abdominal cavity is disturbed more, the pelvic stimulation is also heavier, and it is prone to abdominal distension, urinary retention, etc. after surgery, and may even cause intestinal adhesion or intra-abdominal tuberculosis infection. Treatment of diseases: spinal tuberculosis complicated by sinus spinal tuberculosis Indication Surgery may be considered if the following conditions are met: 1. The vertebral body is obviously destroyed, with dead bone, cheese substance, or flow abscess; 2. The sinus secondary infection is controlled, the whole body does not have fever, the local pus is less, and the bacteria culture is negative for 2 to 3 times; 3. The sinus is circulated smoothly. Contraindications 1. Patients with vertebral joints have lesions: for example, vertebral infection, vertebral endplate sclerosis and tumor. 2. Others: refers to those who are old and weak, unable to withstand surgery and poor mental state, and difficult to cooperate after surgery. Preoperative preparation 1. Anti-tuberculosis drugs: Choose drugs that are effective against both tuberculosis and mixed infections, and formulate plans for rifampicin, orfusin, and ciprofloxacin. Combined medication for 2 to 3 months. 2. Sinus angiography: Defining the orientation of the sinus, the size of the sinus dead space and its relationship with bone lesions and internal organs provide a reference for surgical design. 3. Ensure that the sinus circulation is smooth, and control the secondary infection: Expanding the sinus before surgery, or shortening the sinus to ensure the smooth flow of the sinus is an important part of the perioperative management. Do not rinse with drugs to prevent superficial pyogenic bacteria from entering the depth of the lesion. 4. Systemic support therapy to improve the general condition of the patient and enhance resistance. Surgical procedure Position: According to the location of the bone lesion and sinus. Anesthesia: general anesthesia. Steps (1) Incision: Depending on the location of the bone lesion, refer to the relevant section. It is best to use the sinus as a separate mouth, remove the skin of the sinus as much as possible, subcutaneously, and scrape the sinus wall. These soft tissue pathological sections prove that there are tuberculosis lesions in 80% of cases, and should be removed during surgery. (2) Exposure to the lesions: tissues or organs adjacent to the sinus wall, such as the peritoneum, intestine, and nerves and blood vessels, should be carefully peeled off to avoid damage, completely remove the dead bones, cheese, and granules in the bone lesions and sinus. And scar tissue. Hemostasis should be improved and rinsed with a large amount of saline or antibiotic solution. Use the absorbable thread to suture the wound as far as possible without leaving a dead space, if necessary, fill it with a pedicled muscle flap. Negative pressure drainage of the silicone tube is placed on the lesion, and the drainage of the rubber under the skin is the key to prevent infection to ensure the success of the operation. complication Hematuria: suggesting that there may be ureteral injury