超聲偽影識別及應(yīng)用等多個腹側(cè)開槽術(shù)

forcervicalintervertebraldiscforcervicalintervertebraldiscThomasDACVIM(Neurology),Marie-KerstinUNIVERSITYofLEIPZIG,DepartmentofSmallAnimalRequiredlevelofexpertiseAtlantoaxialSpinalfracture/luxationrepairCervicaldistraction/fusionRequiredlevelofexpertiseAtlantoaxialSpinalfracture/luxationrepairCervicaldistraction/fusionLumbosacralPartiallateralcorpectomyVentralslotDorsalWhentoperformventralWhentoperformventralWhentoperformventralWhentoperformventralWetreatclinicalsymptoms-wedon‘ttreatcryingoutinpainonheadnotshakingmuscletensiononcervicalpainonflexionorextensionoftheunilateraldelayedpawpositioning(consciouscervicalintervertebraldiscdiseasedoespoorlyrespondtoconservativetreatmentCervicaldiscdisease:conservative?SuccessfulconservativeRecurrencerate:Cervicaldiscdisease:conservative?SuccessfulconservativeRecurrencerate:??OutcomeafterventralclinicalOutcomeafterventralclinicalsymptomsresolvewithinafewdaysinmostrewardingGeneralrisksofventralGeneralrisksofventralGeneralrisksofventralGeneralrisksofventralGeneralrisksofventralMajoradverseGeneralrisksofventralMajoradverseevents(SAVESgrades3-6/6):3:requirescomplexmedicalorsurgicaltx,affectsoutcome4:requirescomplexmedicalorsurgicaltx,prolongedadverse5:significantlyneurological6:neurologicalpersistent～50%requiresurgicalSurgery:positioningontheSurgery:positioningonthedorsalsupportsupportneckwithtapenosetotheSurgery:positioningontheextensionsignificantlyreduceshowdeepyourapproachtothespinewillbeSurgery:positioningontheextensionsignificantlyreduceshowdeepyourapproachtothespinewillbeneutralextendedSurgery:positioningonthedorsalsupportsupportneckwithSurgery:positioningonthedorsalsupportsupportneckwithtapenosetothe喉manubriumsterniSurgery:checkcorrectSurgery:checkcorrectSurgery:preparationofthesurgicalBackkaustowelclampsadhesiveSurgery:preparationofthesurgicalBackkaustowelclampsadhesiveincisionIlargesternomastoidsternomastoidSurgery:importantnecklonguscollimusclecarotidsheathcarotidarteryvagalSurgery:importantnecklonguscollimusclecarotidsheathcarotidarteryvagalnervesympatheticnervetrachea(recurrentlaryngealsternohyoidmuscleSurgery:muscleCsternohyoidCSurgery:muscleCsternohyoidCSurgery:?important?neckCcaudalthyroidSurgery:?important?neckCcaudalthyroidSurgery:furthermoveallSurgery:furthermoveallneckstructures(esophagus,trachea,vagosympathetictrunc,recurrentlaryngealnerve)totheleftsideofthepatienttherefore:cauteriseallright-sidedmusclebranchesofthecaudalthyroidseparatetracheaandsternohyoidmuscleontherightsideofthetracheausingMetzenbaumsissors用梅氏剪分離氣管右側(cè)的氣管肌和胸骨舌骨肌CCSurgery:furtherretractionofneckCseperatebluntlytissueusing2fingersontherightsideofthetrachea,sothatallstructurescanSurgery:furtherretractionofneckCseperatebluntlytissueusing2fingersontherightsideofthetrachea,sothatallstructurescanberetractedtotheleftlaryngealnerveSurgery:vagosympathetictrunc(caroticSurgery:vagosympathetictrunc(caroticvagalnervecommoncaroticandretracttotheSurgery:deepmuscledissectbluntlyalltissue(!)Surgery:deepmuscledissectbluntlyalltissue(!)andretractittotheleftuntillonguscollimuscle(directelyventraltothespinalcolumns)isclearlySurgery:howtoidentifycorrectSurgery:howtoidentifycorrectdisc(2ventralspinousprocesscranialcaudalSurgery:howtoidentifycorrectdisc(2Surgery:howtoidentifycorrectdisc(2ventralspinouslargeventrallydirectedtransverseSurgery:checkcorrectidentifyoneSurgery:checkcorrectidentifyoneofthose2countventralspinalprocessus(bulging)fromthereuntilyouidentifythedesireddiscventralspinouslargeventrallydirectedtransverseSurgery:checkcorrectcheckSurgery:checkcorrectcheckcorrectdiscidentificationusing Surgery:preparationofdiscandareatoSurgery:preparationofdiscandareatoremovelonguscollimuscleoftheidentifieddiscaswellasof1/3oftheadjacentcranialandcaudalventralvertebralbodyusingperiostalelevator,scissorsandcauterySurgery:preparationofdiscandSurgery:preparationofdiscandareatoinsert2Gelpiretractortoseperatelonguscollimuscleidentifymidlineofthecranialandcaudalvertebralbody(canbefeltasventralrim)l::sandcorrectwrongdiscsareangledtherefore:startdrillingmoreinthevertebralbodycranialoftheSurgery:discfenestratediscSurgery:discfenestratediscusingano.15scalpel?bite“aguidegroovefortheburrintothecranialandcaudalvertebralbody(midline!)Slotmaximalslotwidth:Maximum50%ofthevertebralbodywidth(better30%only)Slotmaximalslotwidth:Maximum50%ofthevertebralbodywidth(better30%only)maximalslotlength30%ofthevertebrallengthineachriskoftolargevertebralvertebrallacerationofvertebralvenoussinusSurgery:startingtoselectappropriateroseheadSurgery:startingtoselectappropriateroseheadburrperpendiculartothelongaxisofthepatientstayinthemidline!checkfrequentlyusecontinuesflushingand::ll3layers三outerlayerofcorticalbone:外層皮質(zhì)骨：白松質(zhì)紅innerlayerofcorticalbone:內(nèi)層皮質(zhì)骨：gey:3layerstodrill(white-red-bone(red)gey:3layerstodrill(white-red-bone(red)椎間bone(red)Ventralslot:dimensionandVentralslot:dimensionandwithsignificantriskofseverestayinthekeeptheslotasnarrowasdon‘textendtheslottofarcraniallyorinternalvertebralvenousSurgery:finallig.long.switchtosmallerburrbitsthecloseryougetSurgery:finallig.long.switchtosmallerburrbitsthecloseryougettothevertebralusediamondburrinsteadofaroseheadburrbitforfinalltestfrequentlyiftheremainingtissueisgettingsoft:stopSurgery:finallig.long.Rose-headswitchtosmallerburrSurgery:finallig.long.Rose-headswitchtosmallerburrbitsthecloseryougettothevertebralusediamondburrinsteadofaroseheadburrbitforfinalltestfrequentlyiftheremainingtissueisgettingsoft:stop:ll:ll松質(zhì)innerlayerofcorticalboneintervetebral椎間椎間innerlayerofcorticalbone松質(zhì):l:llinnerlayerofcorticalbone椎間innerlayerofcorticalbone::llSurgery:resectionofdorsallongitudinalprobeSurgery:resectionofdorsallongitudinalprobewithabluntinstrument(i.e.hook)iftheremaininglayerissoft:noboneanymoremakeanincisionalongthebordersofyourslotintotheremainingsoftlayerusingano.11scalpelblade層Surgery:removalofdiscSurgery:removalofdiscmakeanincisionalongthebordersofyourslotintotheremainingsoftlayerusingano.11bladeremovetheincisedligamentandanddorsalannulususingmosquitoclampremoveextrudeddiscmaterialbyprobinglaterallyusingablunthookspinalcordisdecompressedifitcanbeseenintheslotSurgery:removalofdiscmakeanincisionalongthebordersofyourslotintotheremainingsoftlayerusingaSurgery:removalofdiscmakeanincisionalongthebordersofyourslotintotheremainingsoftlayerusingano.11removetheincisedligamentanddorsalannulususingmosquitoclampremoveextrudeddiscmaterialprobinglaterallyusingabluntspinalcordisdecompressedifitcanbeseenintheslotHowimportantiscompleteprettycouldbeHowimportantiscompleteprettycouldbeperfectprepostHowimportantiscompleteB?ttcherHowimportantiscompleteB?ttcheretal.,VetSurg.nocorrelationbetweendegreeofdecompressionandneurologicalscoreatdischargeHowimportantiscompleteB?ttcherHowimportantiscompleteB?ttcheretal.,VetSurg.nocorrelationbetweendegreeofdecompressionandneurologicalscoreatdischargeSurgery:longuscolliremoveSurgery:longuscolliremoveassistantretractsneckstructuresusingfingersSultansutureabsorbable3-0Surgery:sternohyoideussimplecontinousSurgery:sternohyoideussimplecontinouspreservecaudalthyroidvenewhichisontheinnersurfaceofthesternohyoidSurgery:sternomastoideussimpleSurgery:sternomastoideussimplecontinousabsorbable3-0about50%ofthelengthofthemuscleSurgery:simplecontinousSu