A manual of operative surgery . eningitis, should bementioned here. Instruments Required.—Stout and fine scalpels ; trephine;bone-cutting forceps of several shapes ; rugine ; elevator;necrosis forceps ; chisel and mallet ; retractors ; blunt hooks ;probe ; Volkmanns spoons ; fine tenaculum-pointed forceps ;fine scissors ; small curved needles and needle-holder; straightneedles ; ligatures ; sutures, etc. Sir V. Horsley has devised a CHAP. XVll LAMINECTOMY 299 special form of angular cutting forceps for dividing the guarded saw is recommended by some. The Operation.—One of the mo
A manual of operative surgery . eningitis, should bementioned here. Instruments Required.—Stout and fine scalpels ; trephine;bone-cutting forceps of several shapes ; rugine ; elevator;necrosis forceps ; chisel and mallet ; retractors ; blunt hooks ;probe ; Volkmanns spoons ; fine tenaculum-pointed forceps ;fine scissors ; small curved needles and needle-holder; straightneedles ; ligatures ; sutures, etc. Sir V. Horsley has devised a CHAP. XVll LAMINECTOMY 299 special form of angular cutting forceps for dividing the guarded saw is recommended by some. The Operation.—One of the most lucid accounts of the opera-tion is that given by Dr. William White, and it has been, to agreat extent, followed in the appended description :—? The patient lies in a prone or semi-prone position, and agentle curve is given to the spine by means of a small hard pillowplaced under the lower ribs. A long incision is made in the median line, exactly over thespines of the vertebrae, in the region it is desired to : FIG. 305. —SECTION THROUGH THE SIXTH DORSAL VERTEBRA. C vi., Sixth rib ; iv., Spine of fourth dorsal vertebra ; L, lung ; , as in Fig. 304. The incision is carried deep down, and the muscles are freelyseparated from the sides of the spinous processes and the pos-terior surfaces of the laminae by the knife, aided by the side is cleared, and all the bleeding arrested, before theother side is exposed in like manner. A considerable portion of the spine being now exposed, theperiosteum is divided along the angle between the spinous pro-cesses and the laminae, and is then reflected from the surfacesof the vertebral arches by means of a curved rugine. Firm 300 OPERATIONS ON THE SPINE [part hi rectangular metal retractors are needed at this stage of theoperation. Sir V. Horsley divided the deep fascia at right anglesto the line of the incision in one or more places. Gordon severedthe muscular bundles attached to the articular process
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