COSTOTRANSVERSECTOMY (costotransversectomia; lat. costa an edge + transversus cross + grech, ektome cutting, excision) — a resection of the tail of an edge and a cross shoot of the corresponding vertebra for access to side and front departments of a body of a vertebra for the purpose of removal of the center of defeat from it or surrounding fabrics (congestive abscess, curdled masses and so forth). In literature To. the author who brought a number of improvements in this operation and described it under the name K is called Menar's access by name.
To. is considered as one of the extra pleural quick accesses made by hl. obr. to averages and the lower chest vertebrae at their tubercular defeat.
For the first time similar operation was executed by J. Izrael (1882). Deleting a carious edge and scraping out patol. the center from a body of the corresponding vertebra, it got into the spinal canal. Bekkel (E. Boeckel, 1882), the tuberculous focus which ekstraplevralno removed from a body of a vertebra, anatomically proved this access.
Indications and Contraindications
Indications. It is recommended to make To. at small forms of tubercular damage of bodies of vertebrae with perifocal abscesses.
Contraindications — common forms of tubercular damage of a backbone.
To. on the Menorah consists in cross section 5 — 7 cm long over an edge according to top of a kyphosis. Bare an outer surface of an edge subperiostalno, at distance of 4 cm from the end of a cross shoot cross an edge and this site delete (fig.). Delete also cross shoot. Operation comes to an end with removal of surrounding impractical fabrics, contents of the center of defeat, washing of the formed cavity and it drainage (see).
Described by Menar (V. Menard, 1894) access is convenient for drainage of juxtaspinal abscess. However on it this access is insufficient for a research of front department of the affected vertebra and manipulations.
Due to various localization patol, the centers in a backbone Debeyr (J. Debeyre, 1961) offered a number of modifications of the main method. Make an extensive resection of edges throughout 8 cm for the best access and delete or two edges at the isolated center in one vertebra, or four at damage of two vertebras. Kastert (J. Kastert, 1956) resects 2 — 4 edges together with cross shoots throughout 3 — 5 cm, further under radiographic control makes at first a trial puncture of a body of a vertebra in the direction of the center, and if necessary gets into the last by means of a narrow chisel or an acute spoon. After removal of contents of the center the wound is sewn up with leaving in his cavity of a catheter through which make repeated instillations of solutions of antiseptic agents.
According to P. G. Kornev (1964, 1971) To. it is carried out as follows. Paraspinalno, on the outer edge of long muscles, otstupya on 3 — 4 cm from the line of acanthas, make a slit 12 — 15 cm long. At places of an attachment cut trapezoid, rhomboid, and in the bottom of a wound — the broadest muscle of a back; stupidly allocate and remove longitudinal muscles in the lateral party thanks to what cross shoots of vertebrae are bared. Back departments of edges bare by moving away in the lateral direction of the cut trapezoid, rhomboid and widest muscles. It is more reasonable to open four edges that two averages from them could be resected. After a longitudinal section of a periosteum and its amotio from a front and back surface of an edge the last have a bite at distance 4—6 cm from a cross shoot. Then by means of a disk spoon or the narrow raspatory allocate medial department of an edge from a kostotransverzalny joint and from an union with a cross shoot which is at the same time resected, and then allocate a head of an edge from the kostovertebralny joint captured by a radiant sheaf.
Further for the purpose of drainage of congestive abscess cut intercostal muscles, tie up the crossed intercostal vessels and vessels on a side surface of a body of a vertebra and, stupidly removing an intrathoracic fascia together with a parietal pleura, get deep into.
The found congestive abscess is punktirut in the beginning, then opened, cleared of contents and through his cavity get into the bone center. The cleared cavities on site of the opened abscesses and the bone centers fill up with streptomycin, and sew up a wound tightly. In cases when there are big cavities, they for 2 — 3 days are drained. In the postoperative period appoint therapy antibiotics according to sensitivity of microflora.
Despite a significant amount of the offered modifications To., their common fault is limitation of access to the affected vertebras, and also the subsequent disturbance of a statics of a backbone owing to removal of cross shoots and edges, especially at bilateral access.
Complications at To. are connected with features most patol, process or insufficient radicalism of surgical intervention. In the presence in congestive abscess of liquid pus and disturbance of its evacuation infection of the neighboring sites of healthy fabrics with the subsequent progressing of an inflammation is possible. Besides, not recognizable small tuberculous focuses in a body of a vertebra near the main focus after its curettage can be the reason of an aggravation of specific process. The main action in fight against these complications are strict indications for use To. only at small, limited damages of bodies of vertebrae with perifocal abscesses.
Bibliography: Kovalenko D. G. Radical surgical treatment of tuberculosis of chest department of a backbone and its complications, Vestn, hir., t. 84, No. 2, page 69, 1960; Kornev P. G. Surgery of kostnosustavny tuberculosis, page 133, L., 1971; Sivtsev S.A. Radical recovery spinal tuberculosis operations, page 48, Grozny, 1:974; C and in ý-I Ya. L. Hirurgiya's N of a backbone, page 115, M., 1966, bibliogr.; Boeckel E. De I’evidement du corps des vertebres, Gaz. hebd. Sci. med. Bordeaux, t. 19, p. 171, 1882; Israel J. Operative Eroffnung eines Abscesses im Ruckgratscanal mit. Resection eines halben Wirbelkorpers, Berl. klin. Wschr., S. 146, 1882; M e-n a r d V. Traitement de la paraplegie du mal de Pott dorsal par le drainage lateral costo-transversectomie, in book: HuitiSme Cong, de Chir. Lyon 1894, p. 645, P., 1895; it, Etude pratique sur le mal de Pott, P., 1900.
D. K. Khokhlov.