Application progress of pedicle screw fixation in spinal diseases Pan Lei review, Lu Guohua's review 1 Key words of bamboo column disease in the foot and foot device only the right document identification code. Although the pedicle screw internal fixation has experienced many difficulties from introduction to extensive promotion, it has greatly promoted the surgical treatment of spinal surgery diseases.
Application progress of pedicle screw fixation in spinal diseases Pan Lei review, Lu Guohua's review 1 Key words of bamboo column disease in the foot and foot device only the right document identification code.
Although the pedicle screw fixation has experienced many difficulties from introduction to extensive promotion, it has greatly promoted the surgical treatment of spinal surgery diseases. The historical biomechanical mechanism of transpedicular screw fixation is now available. Fixed principles and indications. Application advantages. Questions related to fusion of bone grafts. The application of postoperative complications in spinal diseases and a review of the expected problems.
1 History of transpedicular screw fixation In 1891, patients with cervical spine fractures and tuberculous spondylitis were internally fixed with wire for the first time. Lateral intervertebral facet joint screws were used in degenerative lumbar disease. In 1949, 616 and metre were used to describe the anatomy of the pedicle. And use the screw to enter the vertebral body from the posterior way through the pedicle. In 1959, 1 the screw was used to fix the lumbosacral fusion through the pedicle to the vertebral body, and good results were obtained. In 1969, 1 case, 1 and the factory used pedicle screw fixation to reset the 2 patients with high spondylolisthesis. In 1970, doctors in France and Switzerland began to use the pedicle screw for the clinical use of the technology in the 1985. A slidable channel steel plate was invented. The insertion point of the pedicle screw can be flexibly adjusted according to the anatomy of the patient's pedicle. In 1993 and 1996, the North American Spinal Society officially recognized the clinical use of pedicle screws.
2 Biomechanical mechanism of pedicle screw fixation; Heart 4 was first used in 1986 for the failure-free stability test, the first use of pedicle screws for the fixation of the spinal fracture model, showing the load through the vertebrae and placement The important significance of the device is the common transmission, which is the load sharing 5. The biomechanical mechanism of the pedicle screw model shows that the bone-density screw pull-out force of the instrument-bone contact surface plays an important role in the internal fixation. When the screw passes through the pedicle, it is recommended to use the largest diameter screw to give it maximum fatigue resistance because the tension of the screw is proportional to the square of its diameter. The torque is proportional to the cube of the diameter if possible. The angle screw can be angled with the sagittal diameter, and the stability of the internal fixation can be added. This is the oblique effect.
In the thoracolumbar spine, the length of the pedicle hole is 1525. The average diameter of the pedicle is 6.88. The ideal depth of the pedicle screw is to reach the anterior or ankle of the vertebral body, or to enter the iliac wing from the anterior. Found that the author briefs Pan Curtain. male. 29 years old. The Department of Spinal Surgery, Xiangya Hospital, Central South University, has an implantation angle of 8 at the anterior medial side, or an angle of the outside of the humeral wing. It has the most powerful pull-out force and is found to be the force of the root screw fixation. The weakest, if you want to increase the pull-out force of the screw should be screwed from the outer 45 angle into 18. PCT; The pedicle screw was used to pass through the anterior and posterior humerus bones to strengthen the fixation. It is judged that the 31 screws are easy to damage the internal iliac vein and ankle joint of the lumbosacral nerve. The 31 screws have two safe areas where the anterior medial side is the safest. 19. In the cervical vertebrae, 02 and horizontal use of pedicle screws is the current popular choice. 3,1 placement of the screw due to the limited volume of the cervical pedicle and a large change, easy to damage the vertebral artery and spinal cord. The insertion point of the 07 pedicle screw is located below the 06,7 small joint and the midpoint of the 1 side block. Inward is about 25 35 degrees. 1 found that the direct view of the pedicle and the medial side of the pedicle can increase the accuracy of the pedicle screw. 3 The principle of pedicle screw fixation and indications that the pedicle is the strongest part of the vertebral body. Considered to be the core of the vertebral body, correctly placed pedicle screws are dynamic against all loads on the plane and provide a fulcrum for correcting the rotation and sagittal orthotics of each vertebral body.
Patients with sexual compression fractures are not suitable for internal fixation with transpedicular screws. When the bone density is below 0.45, 2, the screw can withstand the periodic load to increase the probability of looseness. 1 The integrity of the anterior column of the spine is found. 1 when it is destroyed. Option 1 talked about the increased rate of loss of internal fixation of the screw. When the longitudinal connector of the pedicle screw is a steel plate, the complete fit of the screw steel plate interface cannot be obtained, which may lead to excessive contact of the screw bone or the screw steel plate. Causes structural or pedicle early fatigue failure. After placement of the pedicle screw, the patient developed pain symptoms. Whether it is necessary to pull out the internal fixation, there is no consensus on the advantages and disadvantages. Although pedicle screw internal fixation is stable, it can significantly improve the fusion rate, but the clinical efficacy is related to many factors. Especially related to preoperative diagnosis, long-term follow-up study is needed to better determine the status of transpedicular screw fixation in the treatment of spinal diseases. With basic research, such as neurophysiological radiology epidemiology. The impact of tissue engineering on clinical applications. The complication of transpedicular snail 6 through pedicle screw fixation showed an increase in the activity of the spinal segment adjacent to the instrument after pedicle screw fixation, and the spine segment adjacent to the instrument was prone to fracture. And the pressure in the intervertebral disc changes. 3. In the case of scoliosis surgery, the incidence of improper placement of the screw is 02. The incidence of degenerative disease in handcuffs is 4.2, 41. However, there is no nerve in the case of improper screw position. Symptoms of root damage. Placement of spinal canal misplacement rate, but routine application has greatly increased the cost and potential risk of patients. The pedicle screw used in the surgery of degenerative spinal disease reported 2 cases of dura to 6017. Among them, 2 cases The high nail rate is reported as a posterior short-segment pedicle screw fixation after severely comminuted spinal fractures. 8. Therefore, when the posterior approach is short-segment fixation, it is recommended to remove the comminuted vertebral body in the anterior approach. The anterior fixation, 7 internal fixation of the pedicle screw in the spinal cord disease will be gradually improved. Making it easier to use for a wider range of operations. Less expensive and less complication.
8 pedicle screw fixation is expected to solve the problem of suture method for the treatment of low anal fistula 68 cases report Qian Xuecheng keyword anal fistula; suture technology in the classification number 657.16 document identification code!
There are many ways to treat anal fistula. There are only a dozen surgical procedures. From 1997 to 2001, the author used a suture method to treat 68 cases of low anal fistula. The healing process was short and painless, and the scar was small. Summarized as follows, the clinical data 1.1 is expected to be 68 patients in this group, 46 males and 22 females; aged 776 years. The average duration of the disease was 5.6 years and 32 years. All are low anal fistula.
1.2 treatment method preoperative enema, surgery to take the lateral position or lithotomy position. After anesthesia, inject methylene blue from the outer mouth for marking. After probed the inner mouth, the outer mouth was circularly resected, and then the subcutaneous tissue of the skin was cut along the direction of the fistula, but the wall of the fistula was not cut, and the wall of the fistula and the surrounding scar tissue were completely removed, especially the anal gland tissue at the inner mouth. Hypertrophic anal nipples. Strict 1.1 wounds. 125 fire drops liquid 10,1 rinse. In the month, the sacral line starts from the outer mouth, and the suture is sutured. The suture is sutured when the anal canal is sutured. After the suturing is completed, the iodophor yarn is externally applied to the incision. Aseptic dressing is applied. Broad-spectrum antibiotics were applied after surgery. Control bowel movements. The first time is cheaper after 72 days after surgery, after the dressing change, no need to take a bath.
2 Results Of the 68 patients in this group, 67 patients healed. 1 case was opened for dressing due to infection. Received date 120214 Revised date 20021203 Author brief introduction Qian Xuecheng, male. At the age of 42, he is the attending physician of the Dean of Tianzhu Hospital, Qidong City, Jiangsu Province, and is engaged in anorectal surgery. Qidong 226244 was delayed in healing and had no recurrence after 24 years of follow-up.
3 Discussion Anal fistula resection suture is not widely accepted by anorectal surgeon because its efficacy is difficult to grasp. Recently, domestic 3 reported that its effect on low-level straight non-acute anal fistula is significantly better than 1 therapy.
In this group of 68 cases of low anal fistula suture, the advantages are as follows, the lesions are completely removed, including internal and external mouth and infected anal gland tissue, the incision heals quickly after the direct suture, shortening the course of treatment; feces are not directly in contact with the wound during defecation. The mechanical stimulation of the wound surface is eliminated, the incision is well healed, and the sequelae of anal skin defect and deformity are reduced.
However, we should pay attention to the following matters and strictly control the indications. This is the first step in the treatment of this therapy. It is better to use low-grade sputum in local inflammation. Avoid cutting the wall of the fistula or leaving the wall of the fistula when you are in the 1st, and leave no dead space when suturing. Appropriate use of antibiotics after surgery. , regular dressing change. If the case is properly selected, the anal fistula is resected, and the suture has a good therapeutic effect. 1 Reference 1 Liu, Wen. A total of 87 cases of high-level infectious anal fistula were treated with type 1 segmental resection and suture. 5. Chinese anorectal smear. 1 out of 9.512.
2 Hong. Clinical summary of 5 cases of anal fistula treated with alum combined with surgery. Chinese anal vein 3 Zhuang is in the letter. A controlled observation of the effect of anal fistula resection and suture and incision dressing change. Chinese anal
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