Luque surgery

The luque procedure uses two l-shaped steel rods that are fixed to the laminae on both sides by wires under the lamina to fix and correct the deformity. It has the advantage of being fixed and firm, and correcting deformities; however, it is possible to damage the spinal cord by passing the steel wire under the lamina. The correction effect of simple luque surgery for severe scoliosis is not ideal; but the correction effect of mild scoliosis combined with kyphosis or lordosis is very good. At present, luque surgery is still applied to the reduction and internal fixation of spinal fractures, dislocation, and internal fixation of spinal tumors. Treatment of diseases: spinal tuberculosis, spinal fracture, spinal cord injury 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. 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. Before the incision is exposed, the soft tissue of each layer under the subvertebral plate is injected into the subcutaneous layer with 1:500000 hyporenal saline solution to make it evenly infiltrated, which can reduce the bleeding and save the operation time, but the blood vessel should still coagulate in time. 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. Laminar gap fenestration: All vertebral and interspinous ligaments are removed after the lamina that needs to be fixed is exposed and cleaned. The lumbar spine is wide and the spinous process needs to be removed. However, the thoracic spinous process is inclined and covers the next lamina. Therefore, the lower part of the spinous process should be cut off to reveal the laminar space and the ligamentum flavum. Use the spinous process to open the upper and lower spinous processes to enlarge the protrusion of the lamina. Before the lowest position of the laminar space in the middle of the lamina, the ligamentum ligament is used to remove the ligamentum flavum of 3 to 5 mm wide, and the epidural fat layer can be seen. The dura mater was used to close the upper and lower lamina, and the ligament of the lower part of the upper lamina was removed with a small laminar rongeur, and then covered with a brain cotton. All lamina gaps of the primary bend are then treated equally from bottom to top. 6. Cross the lamina under the wire: bend the double strands prepared before surgery into a small round wire with a small circle at the end of the curve (length 15cm, 0.8~1.2mm), according to the length of the lamina and the spine Correction: The length of the arc is equal to the length of the lamina. The arc of the lumbar vertebrae is similar to the semicircle, while the inner surface of the thoracic lamina is relatively straight, and the arc only needs 1/4 circle. Before the lowest position of the laminar space, the small wire protrudes into the wire along the inner surface of the lamina. After the gap of the last lamina is exposed, the hook wire is used to hook the inside of the circle at the exposed end of the wire, and the wire is tightened upwards to half the length of the wire. The anti-folding head of the double-strand steel wire is cut and divided into two single-strand steel wires, which are temporarily divided and placed on both sides for use. If it is from bottom to top, all the lamina is worn with steel wire, and it is divided into left and right. 7.luque rod preparation: according to the length of the original bend plus the length of the next lamina, the luque rod is used. When the length is too long, the steel rod can be cut and cut off. The luque rod is then bent with a bender as designed to correct the curvature of the scoliosis and kyphosis of the spine. In addition, a tunnel is made at the root of the spinous process furthest from the ends of the spine to be fixed so that the luque rod can pass through the right-angle end or through the interspinous ligament. 8. Bone graft fusion: the chisel is chiseled with an osteotome, the interarticular articular cartilage is removed, embedded in small bones, and then the bone graft taken from the rib or tibia is cut into thin strips and laid on the lamina (see Harrington surgery). ), first put a thin layer, after the luque rod corrects the deformity and fixes it inside, then fill the bone graft on both sides of the stick. 9. Fix the luque rod and correct the deformity: insert the short side of the concave side luque rod into the prepared base hole of the lower vertebrae, and place the rod between each of the lamina wires on the concave side, temporarily tighten the wire to fix the luque rod; Similarly, the convex side luque rod short head is inserted into the upper spinous process hole, and the rod is temporarily fixed by the convex side wire. Two steel bars form a rectangular clamp. At the junction of the two bars, the short head should be placed on the deep side of the long head and fixed with a wire to prevent the short head from rotating and sliding. Then, use the wire tightener to slowly tighten all the wires one by one. The scoliosis or kyphosis deformed gradually, and the deformity can be corrected to the preoperative limit. After awakening the test hand and the foot activity is good, the correction can be ended. It is safer if you have sep monitoring. Cut the end of the wire, leave a length of 1.5cm, and bend it against the bone graft. Finally, the bone graft is placed on both sides of the steel rod to strengthen the bone graft fusion. 10. Stitching: The bottom is hemostasis, soaked for 1:5 minutes with 1:1000 negerin solution, rinse off, place a negative pressure drainage tube, and poke a small incision from the side. The final layer is stitched.