open spinal cord injury debridement

Open spinal cord injury is mainly seen in wartime firearm injuries, and in peacetime, it is mostly sharp injury, which is relatively rare. In general, injuries to open spinal cord injury are severe. Easy to have shock and infection, and often coexist with chest and abdomen organ injury, handling trouble, the mortality rate is about 10% to 15%. Treatment of diseases: spinal cord injury Indication Open spinal cord injury within 1.12 hours without infection. 2. Those who develop cerebrospinal fluid. Contraindications The age of the body is weak, the vital organs such as the heart and lungs are poor, and the surgery does not restore hope. Preoperative preparation 1. Make a detailed systemic examination to find possible co-existing craniocerebral injury, chest and abdomen organ damage, limb fracture and dislocation. 2. The injured part should be examined by x-ray and ct or mri to determine the damage of the spine and spinal cord. 3. Actively rescue shock and protect the wound. 4. Tetanus antitoxin 1500u, intramuscular injection after negative skin test. 5. Preventive application of antibiotics, intravenous drip, should begin after admission. Surgical procedure 1. Shallow debridement: according to the requirements of debridement, clean the skin around the wound, and remove the shallow contaminated tissue, inactivated tissue and foreign bodies. 2. Incision, exposure: Select the appropriate approach based on the location of the injury and the entrance and exit of the ballistics. Generally, the wound is centered, and the incision is extended upward and downward according to the posterior or posterolateral approach to reveal the two laminae of the upper and lower sides of the injured road. If the wound is away from the spine, an additional incision can be made from the posterior side to reveal the lamina. Excision of the lamina can reveal the damaged dura mater, spinal cord, nerve roots and foreign bodies. At this time, the lamina, articular processes, or pedicles should be further removed to completely reveal the defect of the dura mater. 3. Deep debridement: After the spinal cord is exposed, remove blood clots, foreign bodies, broken bones, necrotic tissue, contaminated tissue and spinal cord in the spinal cord and nearby, and reset the displaced fracture piece, trim the dura mater and prepare for repair. 4. Repair the dura mater: If possible, the broken nerve root should be trimmed and anastomosed. Dural defect. Do not force the suture under tension. A fascia should be taken near the incision to repair the dural defect. When the ventral dura mater is not easy to suture, it can be covered with fascia and fixed several needles. 5. Stitching and drainage: The trajectory of the spinal canal connected to the chest and abdominal cavity should be closed. If the trajectory is large, it can be blocked by muscle flap transfer. The incision can be sutured layer by layer, but the ballistic exit and inlet should be drained.