Thoracolumbar spine tuberculosis foci removal

Thoracolumbar spinal tuberculosis refers to the 11th thoracic vertebra to the 2nd lumbar vertebra tuberculosis. This segment is located at the junction of the lumbar and thoracic segments. After tuberculosis occurs, in addition to the abscess in the paravertebral column, it can still flow down into the axillary abscess under the great muscle of the lower back. Therefore, it is often necessary to remove the lesion through the combined incision of the back and abdomen. If the patient has bilateral lumbar muscle abscess, the operation needs to be performed in two phases: in the first phase, the lesion on the larger side of the abscess is removed first; if the patient is completely removed, the patient's condition is allowed to be changed immediately, and the supine position can be changed immediately. The oblique incision removes the abscess. If the lesion on the other side of the vertebral body is not completely removed, the contralateral lesion should be removed in the second phase after 4 to 6 weeks. For the 11th and 12th thoracic vertebrae structures without psoas abscess, a single rib and transverse process can be removed. Treatment of diseases: bone tuberculosis Indication It is suitable for patients with chest and lumbar tuberculosis and bilateral lumbar abscess. Surgical procedure 1. Position, incision, and exposure revealed the laparoscopic extraperitoneal exposure route. 2. Remove the lesion and pull the peritoneum and ureter, reveal the psoas abscess, puncture if there is no blood, no quadriceps contraction, only pus, you can poke a length of about 1cm after the saline gauze protects the surrounding wounds A small incision is inserted into the aspirator to drain the pus. Sometimes the lumbar muscle abscess is located in the deep or posterior side of the psoas muscle, and the nerve trunk is pushed to the front side. Therefore, it is necessary to extend the finger along the incision to touch the wall of the abscess, confirming the absence of blood vessels and nerves [Fig. 2 (2)], and the direction of the finger muscle fibers can be used. Bluntly separated. The anterior wall of the abscess is usually very thin and easy to separate. Then open the wall of the abscess, scrape the granulation on the wall, ooze the wall of the abscess, and block the hemostasis with a hot saline gauze pad. The deeper wall of the abscess can be seen as a cord, surrounded by granulation, which may be the nerve trunk that passes through. Do not accidentally injure. Then find the sinus in the inside of the abscess, you can use the curette, hemostat and other instruments to remove dead bone or necrotic tissue in the sinus. Such as sinus ostium, the lesion is easier to remove; such as the size of the sinus, can be slightly incision and subperiosteal peeling in the upper and lower sinus ostium, if necessary, can partially remove the bone, expand the exposure, control the x-ray film shows the removal of dead bone Lesion. If the sinusless or sinus ostium is too small to detect, it is difficult to remove the lesion by the upper method. The abdominal organs, the aortic abdomen and the inferior vena cava can be retracted to the opposite side to reveal the inner edge of the psoas muscle and the vertebral body. The anterior rim of the vertebral body is longitudinally incised to cut the iliac crest and the anterior longitudinal ligament. The ends are bent to the midline, and the transverse lumbar artery is ligated and cut. The vertebral body is removed from the vertebral body and the periosteal ligament flap is opened to the midline. , cut open and remove the lesion. If intervertebral bone grafting is required, it can be performed simultaneously. As described above, it is a step of clearing the lesions of the first and second lumbar vertebral tuberculosis complicated with psoas abscess. If there are 11th and 12th thoracic tuberculosis at the same time, the section of the 11th and 12th thoracic vertebrae can be removed by removing the tuberculosis from the ribs and the transverse process to remove the longissimus muscle from the outer edge of the spine muscle. Transverse process), ligating and cutting the intercostal nerves and blood vessels, revealing the 11th and 12th thoracic vertebral bodies outside the pleura. Along the lower edge of the 12th ribbed bed, the ribbed bed is completely cut back. Push the pleura from the diaphragm and chest wall upwards, cut the diaphragmatic foot on the anterior aspect of the vertebral body, and then cut the intercostal muscle between the 11th and 12th intercostals to make the chest and lumbar lesions communicate. The kidney and the abdominal aorta are pulled apart to the opposite side, and the lumbar muscles are pulled back, and the chest, lumbar vertebrae and psoas muscle abscess can be simultaneously revealed, and then the lesion is completely removed. 3. Stitching: After hot compressing the wound to stop bleeding, the wound was washed with physiological saline, and 1 g of streptomycin powder was placed, the anterior ligament of the vertebrae and the fascia of the lumbar muscle were sutured, and the muscles and skin were sutured layer by layer, and no flow strip was placed.