3.3 There is still controversy about the spinal canal decompression. Zou Dewei and others believe that relying on people to fully extend the posterior longitudinal ligament, so that the fracture block is well returned, restore or nearly restore the volume of the spinal canal 14. Other scholars 5 believe that the indirect decompression effect of the posterior instrument is limited, not complete The 〃 è‡ è‡ èƒ¸ 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸 胸Patients who have a spinal cord transection and complete paraplegia in the river are not decompressed but only fixed internally. However, the following conditions have improved lumbar decompression indications 1 thoracolumbar burst fracture with severe neurological symptoms. The delayed operation of thoracolumbar burst fractures after 1 degree or more due to hematoma mechanization and scar formation, affecting the indirect reduction effect. Ding tablets showed large free bone masses protruding into the spinal canal. The prognosis of the longitudinal ligament was severe, and it was difficult to obtain a satisfactory indirect reduction.
4 References I1 Zou Cheng. Hairu. Horse material 1 dimensional; research and development of the arch screw system! 1. Clinical application 4. Chinese Journal of Surgery, 1995, 33219221.
Li Heng, Peng Aqin, Li Changping, et al. Treatment of thoracolumbar fracture and dislocation with nail reduction and internal fixation. Chinese Journal of Spine and Spinal Cord, 1999, 929192.
Clinical data This group of 14 males and 3 females, aged 2046 years. The average is 27.8 years old. There were 9 cases of thoracic vertebrae in the lesions, including 2 cases of 6 cases and 7 vertebral bodies. Ding 718 vertebral body destruction in 3 cases. 1 case of 9 vertebral body destruction; 8 cases of lumbar vertebrae, 3 cases of 3 vertebral body destruction, 5 cases of 5 vertebral body destruction.
After anesthesia. Conventional lesions clear the way. Reveal the diseased vertebra. Enter the paravertebral abscess and find the lesion. Use a curette to completely remove the porcine-like necrotic material granulation tissue dead bone pus. A spinal cord oppressor is decompressed laterally or anteriorly to remove necrotic material from the spinal canal. After repeated washing of the wound, the thoracic vertebrae were stretched out. Patients with lumbar spine lesions need to lift 13 waist bridges to open the gap between the lesions. Re-examine the lesion and remove the remaining necrotic material and dead bone. After washing thoroughly. According to the size of the bone defect. Take the body tibia. According to the shape of the lesion, the corresponding shape of the bone is made. Push open the diseased vertebral body or the intervertebral periosteum to the positive 45 hole, tap with a tap, use a special screwdriver to insert the appropriate length of the absorbable screw 2 pieces. After the bone graft was stabilized, 1.0 g of streptomycin was placed. Muscle flap coverage. Place the drain tube. 2448 was removed after surgery. Patients with thoracic tuberculosis were bedridden for 46 weeks and lumbar patients were bedridden for 810 weeks. Postoperative anti-tuberculosis drug treatment for 1215 months.
Results were followed up. 15 cases of 5 bone grafts all healed. The lesion is cured. No recurrence cases. Incomplete sputum all recovered. Discussion of traditional lesion removal surgery sometimes encountered the scope of dead vertebral bone damage mostly accounted for the push body, 2 incomplete sputum, and 4 cases of tuberculosis.
1 Department of Orthopaedics, 253 Hospital of PLA, 010051, Inner Mongolia, Hohhot, the side of the regular vertebral body. The bone knife and the narrow-mouth rongeur were grooved on the lateral side of the normal vertebral body. The convex bone block is fully implanted. Close contact with the vertebral body. For use, the drill bit is obliquely inserted into the bone of the bone graft of the bone graft. Clearing is more difficult. The internal fixation with the Hastelloy rod not only enlarges the intervertebral space but also stabilizes the spine. It is very convenient to completely remove such dead bones. After the lesion was removed, the internal fixation was performed at the same time. The stability of the spine was reconstructed and the proliferation was reduced on page 167. On the basis of the hypertrophy of the ligamentum flavum, extensive calcification and ossification occurred in the yellow initial zone. The inside of the push is formed into a nodular protrusion.
Cause spinal stenosis, can compress the spinal cord to cause the corresponding symptoms. It is a relatively advanced and relatively serious lesion. The types of lesions can exist in different parts of the same case at the same time, reflecting that the lesions develop evenly. The peripheral type and diffuse ossification can be seen in the naked eye without obvious difference, and it is necessary to distinguish them by imaging.
Histological examination can be a fusion of collagen fibers in the ligamentum flavum, mucus ejection 1 reticular fibers and elastic fibers are reduced, irregularly arranged, and varying degrees of cartilage metaplasia can be flaky or single chondrocyte shaped salt deposition and small bone Beam formation. Peripheral ossification occurs mainly in areas that are connected to the vertebral body. From the nature of pathological changes, there is no obvious difference in species types, and the characteristics of the general types are different stages of disease and different underlying diseases. Most of the lesions with hypertrophy in the early stage of the spleen are nodular, and those who are secondary to fluorosis have formed a type.
3.2 The mechanism of ossification of the ligamentum flavum causes the exact cause of ossification of the ligamentum flavum. Although it is not clear, long-term chronic injury may be the basic cause of the disease. 3. Due to chronic damage, the local environment changes of the ligamentum flavum, collagen fiber degeneration Nowadays, cartilage metaplasia, as well as aging and ossification, form a nodular shape when ossification or cartilage and bone formation are formed on the basis of hypertrophy. The soft bamboo and soft bamboo formed in the ligamentum flavum are actually the result of the disease, which is the stage of the development of the lesion, not the initial stage of ossification.
From the data of this group, the elastic fibers and reticular fibers in the normal ligamentum flavum are richer and evenly distributed, and the collagen fibers are also distributed in the longitudinal direction, which is arranged in the longitudinal direction. This structure is beneficial to its function.
The collagen fibers in the lesion's jaundice are swollen and mucoid-like, which is the basis of cartilage formation. The underlying cause of this change may not be due to a full or partial disease, and may simply be a form of adaptive change in the body. Due to the long-term stress caused by the yellow belt, the collagen fiber elastic fibers and reticular fibers are denatured, and the mucus-like degeneration occurs in the affected part, followed by cartilage metaplasia, and the ossification of the yellow capillaries through the cartilage. 54 References Wen, Wang Quanping, Wang Zhe, et al. Pathological observation of ossification of the ligament of the thoracic ligament of the corpse Wang Pei, Guo Shizhen, Zhang Xiuyi, et al. Thoracic spinal canal stenosis combined with myelopathy. Chinese bone Zhang Yongxing, Wang Quanping, Lu Rong, and so on. Histopathological study and clinical significance of the initial spine of ossification of the ligamentum flavum in patients with ligamentum flavum. Chinese Journal of Spinal Cord and Spinal Cord, 199816 Wang Zhe, Wang Quanping, Li Xinkui. Ultrastructural observation of ossification of the thoracic vertebrae. The editing of Lu Qingxia on the 158th page of this article is conducive to bone graft fusion. It also allows the patient to start functional exercise earlier. Early activities can promote heart and lung function, promote gastrointestinal motility, and absorb nutrients. In order to improve the body's disease resistance, this group of patients began to protect under 6 weeks after surgery. worth emphasizing is. The success of surgical treatment is closely related to the timing of surgery and the drug treatment before and after surgery, which is the necessary guarantee to prevent the recurrence and spread of the lesion. This group are patients with thoracolumbar tuberculosis, regular medication for 46 weeks, good systemic conditions. Without fever and erythrocyte sedimentation, the lesion vertebral body is limited to 1 or 2 vertebral bodies. When implanting bone, attention should be paid to the following questions: 1 The lesion should be fully exposed, especially to reveal the healthy side of the upper and lower vertebral bodies. 2 soft tissues such as intervertebral discs should be completely removed. To facilitate healing. 3 The shape and size of the side of the vertebral body are caused by the convex bone. 4 Determine the depth and direction before drilling. To prevent the occurrence of secondary damage. 5 The length of the bone graft is about 1.5 longer than the bone graft bed so that the bone block is tight. 6 The direction of the hole and the longitudinal axis of the vertebral body are 4 爻 oblique side or side down, and it is not required to drill through the cortex. 7 Use full threaded screws. It is important to determine the extent and extent of vertebral destruction before the screw is tightened to determine whether it is suitable for this operation and how to implant the bone. If there are many vertebral bodies, the damage is wide and the abscess is too large. The operation is difficult and the trauma is increased. It is not appropriate to use this surgical method. It is instructive to use the examination to determine whether the size of the vertebral body is abscess or not. The bilateral abscess is larger. However, if the lesion is limited, two surgical lesions should be used for removal, and internal fixation bone graft should be applied during the operation to ensure good surgical results. In this group of patients, 5 patients underwent bilateral surgery. The use of internal fixation with anterior and posterior bone grafting can enhance spinal stability.
The operation is simple. It is lower than other internal fixation costs and does not require surgery to remove the internal fixation. The bone graft is stable. The healing rate is high.
1 Zhang Weijiang, Wu Qiqiu. Lin Yu. Wait. Treatment of 109 cases of spinal tuberculosis due to debridement. The Chinese knot is called 5th. 19, 21 illusion.
2I Yang Keqin, editor of the state. Bridge-shaped surgery Shanghai Shanghai science and technology
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