Name: posterior approach for debridement of the psoas abscess
Uploaded: 2020-03-02T13:30:00
Description: Watch this Scientific Journal Video about Posterior Approach for Debridement of the Psoas Abscess at JoVE.com

作者们要感谢所有那些为研究捐献身体，并在他死后继续影响他人的人。

为了开发这种方法，使用已故人类标本已获得 WellStar 研究所机构审查委员会的批准，并符合该机构道德委员会制定的道德准则。该方法中使用的标本全部为正式固定，在T12椎体上横切，并切除腹部器官和内脏。
1. 尸体标本和外科领域的准备
<ol><li>将先前解冻的尸体标本放在手术台上，用手术灯照亮场地。用毯子盖住试样，避免上腹部和下腹部。</li>
</ol>2. ?...

<ol>
	<li>Bartolo, D. C., Ebbs, S. R., Cooper, M. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Psoas+abscess+in+Bristol:+a+10-year+review.">Psoas abscess in Bristol: a 10-year review.</a> International Journal of Colorectal Disease. 2, 72-76 (1987).</li><li>Dietrich, A., Vaccarezza, H., Vaccaro, C. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Iliopsoas+abscess:+presentation,+management,+and+outcomes.">Iliopsoas abscess: presentation, management, and outcomes.</a> Surgical Laparoscopy Endoscopy &amp; Percutaneous Techniques. 23, 45-48 (2013).</li><li>Santaella, R. O., Fishman, E. K., Lipsett, P. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Primary+vs+secondary+iliopsoas+abscess.+Presentation,+microbiology,+and+treatment.">Primary vs secondary iliopsoas abscess. Presentation, microbiology, and treatment.</a> Archives of Surgery. 130, 1309-1313 (1995).</li><li>Yamagami, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+drainage+of+psoas+abscess+under+real-time+computed+tomography+fluoroscopic+guidance.">Percutaneous drainage of psoas abscess under real-time computed tomography fluoroscopic guidance.</a> Skeletal Radiology. 38, 275-280 (2009).</li><li>Tabrizian, P., Nguyen, S. Q., Greenstein, A., Rajhbeharrysingh, U., Divino, C. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+and+treatment+of+iliopsoas+abscess.">Management and treatment of iliopsoas abscess.</a> Archives of Surgery. 144, 946-949 (2009).</li><li>Labrechts, M. J., Wiegers, N. W., Ituarte, F., Shen, F. H., Nourbakhsh, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safe+zone+for+irrigation+and+debridement+of+psoas+abscess+through+a+dorsal+spinal+approach.">Safe zone for irrigation and debridement of psoas abscess through a dorsal spinal approach.</a> Surgical and Radiologic Anatomy. 40, 1217-1221 (2018).</li><li>Wilkinson, D. J., Piasecki, M., Atherton, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+age-related+loss+of+skeletal+muscle+mass+and+function:+Measurement+and+physiology+of+muscle+fibre+atrophy+and+muscle+fibre+loss+in+humans.">The age-related loss of skeletal muscle mass and function: Measurement and physiology of muscle fibre atrophy and muscle fibre loss in humans.</a> Ageing Research Reviews. 47, 123-132 (2018).</li><li>Aszmann, O. C., Dellon, E. S., Dellon, A. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anatomical+course+of+the+lateral+femoral+cutaneous+nerve+and+its+susceptibility+to+compression+and+injury.">Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury.</a> Plastic and Reconstructive Surgery. 100, 600-604 (1997).</li><li>Spivak, J. M., Paulino, C. B., Patel, A., Shanti, N., Pathare, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safe+zone+for+retractor+placement+to+the+lumbar+spine+via+the+transpsoas+approach.">Safe zone for retractor placement to the lumbar spine via the transpsoas approach.</a> Journal of Orthopedic Surgery. 21, 77-81 (2013).</li><li>Reid, J. G., Livingston, L. A., Pearsall, D. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+geometry+of+the+psoas+muscle+as+determined+by+magnetic+resonance+imaging.">The geometry of the psoas muscle as determined by magnetic resonance imaging.</a> Archives of Physical Medicine and Rehabilitation. 75, 703-708 (1994).</li><li>Hanson, P., Magnusson, S. P., Sorensen, H., Simonsen, E. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Differences+in+the+iliolumbar+ligament+and+the+transverse+process+of+the+L5+vertebra+in+young+white+and+black+people.">Differences in the iliolumbar ligament and the transverse process of the L5 vertebra in young white and black people.</a> Acta Anatomica. 163, 218-223 (1998).</li><li>Ilayperuma, I., Nanayakkara, B. G., Hasan, R., Uluwitiya, S. M., Palahepitiya, K. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Coracobrachialis+muscle:+morphology,+morphometry+and+gender+differences.">Coracobrachialis muscle: morphology, morphometry and gender differences.</a> Surgical and Radiologic Anatomy. 38, 335-340 (2016).</li></ol>

通过背风方法找到灌溉和切除脑肌肉脓肿的安全区最关键的步骤是：1） 在腹腔和背风处理过程中仔细钝化腰丛;2） 在隔离过程中保存横向过程，因为它们可能很脆弱，以便更好的可视化;3） 用手术尺校准 ImageJ 软件，并仔细测量以阐明 TP、LP 和 psoas 肌肉之间的关系。
用于解剖的手术器械可根据个人喜好进行更换;然而，对腰椎间盘进行仔细彻底的解剖，并确保对横向过程不?...

脓肿 （PA） 是一种罕见的诊断报告在 0.4–1 每 10，000 入院到医院1，2。PA可以由血性扩散、淋巴从遥远的传染部位传播或从邻近器官连续传播3引起。目前，在实时计算机断层扫描下，皮下排水是PA4的安全一线处理。迪特里希等人发现，与开放式手术相比，其成功率更高，死亡率更低，住院时间更短。然而，大不列里亚等人发现，44%接受皮下排水治疗的患者接受了开放式手术，以根除感染。
鉴于为治疗脓肿而进行的开放式手术的发生率，本研究开发的方法的目的是通过背毛方法找到一个"安全区"，用于灌溉和除化脓肿的"安全区"。采用初始腹腔方法识别和分离关键解剖结构，包括横向过程 （TP）、psoas 肌肉和腰丛 （LP）。然后采取背对子方法，进一步将 TP 和 LP 与周围的结构隔离开来。在整个解剖步骤中，可以获取照片。一旦解剖完成，图像将上传到ImageJ（1.48v，国家卫生研究所），并采取若干测量，以确定TP，LP和psoas肌肉之间的关系。最后，利用获得的测量值，计算了进入psoas物质和最小化腰丛损伤风险的"安全区"。据我们所知，这是第一次使用横向过程作为参考点的工作，目的是为脓肿的I&D找到一个安全区。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Blunt ended dissecting scissors</td>
			<td></td>
			<td></td>
			<td>To cover the specimens</td>
		</tr>
		<tr>
			<td>Camera</td>
			<td>Sony a7 III</td>
			<td>ILCE-7</td>
			<td></td>
		</tr>
		<tr>
			<td>Cobb elevator</td>
			<td>Sklar</td>
			<td>40-6950</td>
			<td>For isolation of TP and general dissection</td>
		</tr>
		<tr>
			<td>Dissection table</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Formalin fixed cadavers</td>
			<td>Restore Life USA</td>
			<td>N/A</td>
			<td>Transected at T12 with abdominal organs removed</td>
		</tr>
		<tr>
			<td>Hemostats</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Retractors</td>
			<td></td>
			<td></td>
			<td>For blunt dissection</td>
		</tr>
		<tr>
			<td>Rongeur</td>
			<td>Sklar</td>
			<td>40-4085</td>
			<td></td>
		</tr>
		<tr>
			<td>Scissors</td>
			<td>Sklar</td>
			<td>15-2555</td>
			<td></td>
		</tr>
		<tr>
			<td>Surgical absorbent pads</td>
			<td></td>
			<td></td>
			<td>Placed under the cadaver to absorb fluids</td>
		</tr>
		<tr>
			<td>Surgical blades/scalpels</td>
			<td>Dynarex</td>
			<td>4110</td>
			<td></td>
		</tr>
		<tr>
			<td>Surgical drape/blanket</td>
			<td></td>
			<td></td>
			<td>For blunt dissection</td>
		</tr>
		<tr>
			<td>Surgical gauze sponges</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Surgical lights</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Surgical Ruler</td>
			<td>Aspen Surgical Products</td>
			<td>42182702</td>
			<td></td>
		</tr>
		<tr>
			<td>Tissue forceps</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Tool tray</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

posterior approach for debridement of the psoas abscess

该方法侧重于概述一个安全区，通过后处理方法灌溉和消除脓肿。最初，对脊柱进行前处理，以确保前纵向韧带和脊柱肌肉可以可视化。所有的腹部器官都被切除了。随后，进行了后脑方法，从L1+L5中去除脑脊髓肌肉。确定了L1-L5的横向过程、关节间和层压。退出的神经根在横向过程之间被识别，然后进入psoas肌肉的物质。使用前部和后部方法，腰丛与psoas肌肉的物质分离。在各种解剖步骤之前和之后，获得了数码照片。这些图像被上传到 ImageJ 和多个测量中，包括每个 TP 的横向上部和下部尖端与丛中最横向区域之间的距离，TP 的横向上部和下等尖端之间的距离。记录了腰椎的侧边和腰丛的宽度。进入psoas肌肉物质的安全区域在psoas肌肉的侧边和腰丛的侧边之间定义。测量并报告此间隔与每个级别横向过程尖端的关系。

包括11名正式固定尸体，平均年龄80.5岁6岁。两名尸体损坏了右侧的腰椎，被切除。因此，共进行了20次测量，其中13项为女性，7为男性。在L1+L3处，安全区的内侧边界由腰丛最横向的一侧定义，在L1+L3处，其内向TP尖端大约1厘米，但在L4和L5处分别缩小到约6和1毫米。然后，通过每个 TP 的颅尖和胆尖到每个级别 psoas 肌肉的侧边的距离减去安全区的中边。这?...

Watch this Scientific Journal Video about Posterior Approach for Debridement of the Psoas Abscess at JoVE.com

Posterior Approach for Debridement of the Psoas Abscess

这是一个尸体研究，调查了后人灌溉和脱毛脓肿的地标。横向过程 （TP） 之间的间隔用于访问 psoas 肌肉的物质。

切除普索阿脓肿的后向方法

This method focuses on outlining a safe zone for irrigation and debridement of a psoas abscess through a posterior approach. Initially, an anterior ...

此方法使用横向过程、psoas 肌肉和腰椎丛来计算通过背部脊柱方法进入 psoas 肌肉的安全区。该技术的主要优点是，它通过提供测量来计算一个安全区域的灌溉和脱毛的psoas abces，从而提高了患者的安全。在开始手术之前，将先前解冻的尸体标本放在手术台上，用手术灯照亮场地，然后用毯子盖住标本，避免上腹部和下腹部。对于使用心室方法隔离和识别关键的解剖结构，使用刀片将中线颅切到下胃区，并直接垂直于前上侧腹椎骨。在前部优越的腹椎之间进行横向切割，并使用手术刀片和剪刀反射和去除腹部肌肉和筋膜，以提高可视化效果，并有助于提高测量精度。确定横向过程，腰椎的跛脚，关节间，psoas肌肉，和腰椎丛的神经根离开神经福拉米纳。一旦所有关键的解剖结构被识别为未损坏和完好无损，小心地翻过标本，开始后向。当标本处于易发位置时，使用手术刀片、剪刀、Cobb 电梯和其他手术工具重新切除拉西穆斯多西和准脊髓肌肉，从后旋过程依次开始到横向过程。酌情使用 Cobb 电梯和其他手术工具，将横向过程与任何剩余的软组织附件隔离，以帮助实现可视化和精确测量。现在，随着半边肌的去除，放置一个手术尺平行于手术场，以获得完整的psoas肌肉的数字照片，以证明其与每个椎骨水平的横向过程的关系。获得足够数量的高质量图像后，将标本转回超生位置，使用手术刀片将 psoas 肌肉从每个腰身的中侧附件中剥离，并使用钝刃剪刀小心地露出整个腰椎丛，并横向反射 psoas 肌肉。与手术场平行放置手术尺，拍摄额外的照片，以捕捉腰椎与每个级别的横向过程的关系。最后，将试样侧翻一边并获取其他照片，以演示横向过程与下垂平面中腰椎丛的关系。要校准组织测量，请打开要在 ImageJ 中分析的图像，并使用放大镜工具放大照片中的手术标尺。使用线条绘制工具在标尺上一毫米段的边距之间仔细绘制一条直线，在"分析"下，选择"设置比例"将已知距离设置为 1，将长度单位设置为 1 毫米，然后在"全局"旁边的框中放置一个复选框，然后单击"确定"。测量值将根据标尺上每毫米的像素数进行校准。要计算最大灌溉、脱毛和安全区，请使用划线工具在每个横向工艺的横向上端之间绘制一条直线，以绘制到同一水平的 psoas 的横向边缘。绘制所有线条后，从"分析"菜单中选择"测量"。将打开一个新的"结果"窗口，测量值将在"长度"列中的新窗口中以毫米为单位显示，按获取顺序显示，然后重复对表中指示的每个测量值的计算。通过测量从横向过程的上部和下部到相应椎骨水平的 psoas 肌肉的横向边缘的距离，确定日冕平面中到横向灌溉和脱毛的最大中向和脱毛的区域。平均而言，横向脱毛的最大范围可以执行 5.5 和 5.7 毫米中位到 L1 的横向工艺的劣质和高级尖端， 4.7 和 5.1 毫米中位，L2、1.8 和 2.5 毫米中位，L4 中位为 4 毫米，在 L5 时为 3.8 毫米和 3.7 毫米。在下垂平面中，腰椎丛通常比横向过程前大约 15 到 20 毫米。在横向过程中，请小心谨慎，因为它们可能很脆弱，任何损坏都会使获得与这些地标相关的任何测量结果失去资格。

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