Transcervical tuberculosis debridement

Applicable to cervical vertebra 3 to 7 tuberculosis. Treatment of diseases: cervical tuberculosis Indication Applicable to cervical vertebra 3 to 7 tuberculosis. Contraindications Older, combined with severe heart, liver, kidney and other diseases and difficult to tolerate surgery. Preoperative preparation Except for the general preoperative preparation of bone and joint tuberculosis, there are many vertebral body defects and obvious kyphosis. The skull should be used as much as possible before surgery to make the neck overextended and correct the deformity to facilitate the exposure and intervertebral space. Bone grafting. Can also be corrected by the skull ring plus gypsum traction. Surgical procedure 1. Position: The patient is lying on his back, with a thin pillow under his shoulders, so that the neck is slightly stretched. The face turns to the opposite side when the oblique cut is made. The anterior side reveals the route (see the anterior side of the cervical spine). 2. Incision, exposure: a cervical oblique or transverse incision is used. 3. Clear the lesion: After the anterior vertebral abscess is revealed, the puncture is confirmed. The anterior fascia and abscess wall were then cut longitudinally in the anterior median line. On the lateral side of the longissimus dorsi, there are paravertebral sympathetic ganglia and chain at the junction of the vertebral body and the transverse process. The anterior oblique angle muscle has a sacral nerve obliquely crossed, and the vertebral artery and brachial plexus are behind the muscle. The median incision can avoid injury. . After the abscess is opened, the pus is drained, and the line is pulled apart at the margin of the abscess wall. The periosteum is peeled off to both sides, but the inner edge of the transverse process should not be exceeded to avoid damage to the vertebral artery. If necessary, the inner cervical long muscle fibers can be cut transversely to fully reveal the lesion. Then, use a curette or hemostat to remove tuberculous granulation tissue, dead bone and necrotic tissue. Care should be taken when removing the posterior margin of the vertebral body to avoid damage to the spinal cord. Generally, the cervical vertebrae are narrow, and the vertebral lesions are satisfactory and clear. However, the soft tissue abscess of the contralateral neck can not be revealed. The contralateral neck should be pressurized to check whether there is pus inflow. If there is pus out, use a curette to gently squirt from the sinus into the contralateral abscess, and extend into a curved metal tube or catheter, and rinse with saline. If the pus is thick and can not flow out, it should be removed from the contralateral incision. If the condition is not allowed, it can be left for treatment in the second phase. 4. Interbody fusion: After thoroughly washing the ward and stopping bleeding, it is advisable to perform interbody fusion at the same time to completely remove the lesion and have vertebral defects to promote healing, correction or prevention of deformity. Firstly, the upper and lower vertebral bone surfaces of the defect area are repaired into fresh bone surface, and then a shallow groove is cut in the front. According to the size of the defect and the length of the groove, a corresponding t-shaped tibia is taken, and the head is gently pulled to make the neck Over-extension, after opening the cervical intervertebral space, embedded in the cervical spondylosis area. Then, slowly relax the traction, place the neck in the neutral position, and the graft bone is tightly embedded between the upper and lower bones. The two arms of the t-shaped bone block are placed in the shallow groove in front of the vertebral body, so that the bone graft does not protrude into the spinal canal and compresses the spinal cord. However, the bones should not be too much higher than the front edge of the vertebral body to avoid obstructing swallowing. If the bone graft is unstable, it can be fixed with steel wire or screw. 5. Stitching: The lesion is filled with streptomycin powder 1g, the anterior fascia is sutured, and the bone graft is tightly fixed. In order to avoid the blood pressure in the wound and force the trachea, causing difficulty in breathing, a rubber sheet can be externally drained from the lesion and taken out from the lower end of the incision. Then, suture the scapula and the incision layers. complication Breathing should be closely observed after surgery. If you have difficulty breathing, you should immediately remove the suture to check the wound and remove the hematoma, stop bleeding, and if necessary, tracheotomy. If there were no special circumstances, the rubber sheet was taken out 24 hours after operation, and the suture was removed on the 5th to 7th postoperative day. The rest were referred to oral cavity removal.