2. Located in the midline between the long neck muscles on both sides, the anterior fascia of the vertebral body was cut longitudinally, and the fascia was pushed aside with a periosteal stripper to expose the vertebral body and intervertebral disc. The intervertebral disc is white, slightly higher than the plane of the anterior edge of the vertebral body. The vertebral body is grayish white with slight depression in the intervertebral disc. Take a meaningless needle, cut it into 1cm length, insert it into the exposed intervertebral disc, and take a lateral radiograph of the cervical vertebra to locate it. If there is lip hyperplasia with a specific shape at the edge of the diseased vertebral body, it can also help to identify and locate. The patient's upper limb should be pulled to the distal end during radiography, which is beneficial to the development of the lower cervical spine on X-ray film. Necks 6 and 7 can't be clearly developed on the lateral radiograph, so the positioning needle can be inserted into the normal intervertebral disc higher than the diseased vertebral body to take pictures, which is beneficial to the positioning needle development. If you have a TV X-ray machine, you can simply locate it in perspective.
Remove damage
⑴ Circular sawing method: After the positioning is determined, please ask the anesthesiologist to keep the patient's neck neutral. The drill core indicated by the trephine is nailed into the diseased intervertebral disc longitudinally, vertically and in the middle, and the drill core is related to the vertebrae of the adjacent vertebrae up and down. Take the corresponding circular saw, cover it outside the drill core handle, and rotate it left and right, so that the circular sawtooth can be screwed into the spine and intervertebral disc, and then gently press it clockwise to safely screw it in (3). When rotating, prevent the saw handle from shaking left and right, because shaking will lead to fracture and make the operation difficult. With the deepening of drilling, when the trephine enters the posterior edge of the vertebral body, the operator can feel a sense of roughness. At this time, the drill should be drilled slowly and steadily, and pay attention to the exposed scale of the drill core handle. If the mandrel rotates with the circular saw, it means that the bone block in the circular saw has moved and the circular saw has drilled through the vertebral body. At this time, there is no pressure when rotating the ring saw, and the ring can rotate slightly clockwise or counterclockwise. If there is adhesion outside the dural sac, there may be tearing feeling, and the movement must be slow and light. When the rotary motion of the core handle with circular saw reaches180, the circular saw and the core handle can be lifted and pulled out. Check whether the bone block is complete and whether the dura surface of the intervertebral disc is broken. Vertebral drilling was washed with frozen normal saline at 6℃ ~ 8℃. When there is blood oozing from the hole, use bone wax to temporarily stop bleeding and keep the hole clean. After hemostasis with dry gauze, combined with CT display, all osteophytes at the posterior edge of vertebral body were scraped off with a small curette or bitten off with a gun-biting osteotome. Gently block the wound with gelatin sponge to stop bleeding, which is used for bone grafting.
⑵ Osteotomy and discectomy: After the positioning is determined, use a thin bone knife with a width of about 1cm to drill into the upper and lower vertebral bodies at 3 ~ 5 mm in the intervertebral space of the lesion, keep vertical, and the drilling force is gentle and stable, and then slowly drill into it to a depth of about1~1.2 cm; Then cut into the intervertebral disc at the inner edge of the long neck muscles on both sides. Connect the upper and lower transverse blades, and take out the rectangular vertebral body and intervertebral disc block. Remove the residual intervertebral disc tissue and osteophyte at the posterior edge of vertebral body with curette or gun rongeur. Rinse and suck out with frozen normal saline at 6℃ ~ 8℃, and temporarily fill with gelatin sponge to stop bleeding and bone grafting.
4. Ilium is usually taken out through the incision at the outer edge of the anterior and middle iliac crest to expose the ilium, and the ilium block is cut according to the size and shape of the opening at the cervical vertebra. If a circular saw is used to drill a hole in the cervical vertebra, one or more bone pieces are drilled on the ilium with a circular saw one size larger than it according to the operation requirements. Bone should be taken from the back of iliac crest where thicker bone pieces are needed. The residual iliac bone wound was coated with bone wax to stop bleeding, and the iliac bone wound was stitched layer by layer. Remove the soft tissue attached to the bone block, trim it according to the opening size of the cervical vertebra, and then cover it with normal saline gauze for later use.
5. When bone grafting and cervical bone grafting, the anesthesiologist should be required to properly pull the patient's head to enlarge the cervical intervertebral space. Put the bone graft into the bone hole of the diseased area, put the bone graft device evenly on the bone graft, and gently tap it with a hammer to make the bone graft go deep and slightly lower than the front edge of the cervical spine or even the same. Relax the neck, bend and rotate the neck, and check whether the bone graft is firmly embedded. If the bone graft is firmly implanted, the wound can be sutured.
6. After the wound is closed and washed, check that there is no bleeding and no foreign body residue. After draining the vertebral body with rubber sheet, suture the incision layer by layer.