手术记录-腰椎滑脱讲课稿.doc

全麻醉生效后，病人取俯卧位。以腰4、5和骶1棘突为中心常规术区消毒，铺无菌手术巾、单。 取腰部后正中切口，以腰4、5和骶1棘突为中心，切口为7厘米。切开皮肤、皮下组织和深筋膜，暴露腰4、5和骶1棘突，切开椎旁韧带和肌腱，骨膜下剥离双侧棘突和椎板，直至关节突外侧。可见骶1的上关节突明显的增生，肥大。腰5的椎板不稳，双侧椎弓根处断裂。将腰5的椎板完全咬除后，显露骶一的上关节突，和腰5的椎弓根。 按照术前方案，在骶1 、腰5的椎弓根部分别打入一枚椎弓根钉，进针点的位置是横突中点和上关节突外缘的焦点。用尖锥在椎弓根上钻孔后，分别放入一枚铁棒，C-臂X光机透视后，确定位置正确，铁棒的位置良好，分别拔出铁棒，拧入一枚椎弓根钉（椎弓根钉的大小为6.5X500mm）。透视后确定位置正确。 用髓核钳将骶1和腰5 椎间隙中增生的瘢痕组织咬除后，松解骶1 的神经根，直至关节突下切迹，可见双侧的神经根水肿，增粗。完全 松解神经根后，安放连接杆，撑开器撑开后锁紧螺丝，复位，可见前脱位的腰5 椎体已经基本复位，缩紧螺丝后，固定牢固。将神经根拉向内侧后显露椎间隙，用骨刀和圆凿将骶1的上缘和腰5椎体的下缘凿除，直至松质骨。 取同侧髂后上棘出的骨块，修成1X3cm的骨块后，植入两侧的椎间隙。 彻底止血，冲洗创口，放置负压引流，清点纱布器械无误后，逐层闭合创口，术后安返病房。 2016中考复习错题整理 一．单选题 1. We’re here to have fun, to learn, to work together and to make difference. A. a; a B. a; / C. /; a D. /; / 2. We can have bluer sky if we create less polluted world. A. a; a B. a; the C. the; a D. the; the 3. —I always get nervous when I start a(n) with others. —Take it easy. Believe in yourself. A. expression B. introduction C. communication D. celebration 4. — fathers didnt come to the meeting. Why? —Because they have gone to Beijing. A. Jeffs and Amys B. Jeff and Amy C. Jeffs and Amy D. Jeff and Amys 5. mother cant go to the parents meeting because she is too busy . A. Jack s and Paul B. Jack s and Paul s C. Jack and Paul s D. Jack and Paul 6. Nowadays schools should care for the full of a student’s talents. A. satisfaction B. development C. communication D. preparation 7. —Have you ever played football? —Yes, I did when I was little, but I haven’t played for while now. A. the, the B. the, a C. /; a D. /; the 8. —Do you know man in blue? —Yes, he’s a professor of university. A. the, a B. a, an C. the, an D./, the 9. I still remember there used to be underground cave. My friends and I often had fun in