Chiari surgery

Kiali surgery is used for surgical treatment of congenital dislocation of the hip. Chiari's Keali surgery is performed by humeral osteotomy above the acetabulum, and the distal pelvic block including the acetabulum is moved inward, while the osteotomy of the proximal end of the osteotomy is relatively outward, and the septum is covered. A cap is placed on the outer side of the femoral head. It is an arthroplasty in which the joint capsule is embedded. Its main function is to enlarge the area of the acetabulum, to make the femoral head more completely covered, increase the stability of the joint, and reduce the weight bearing capacity per unit area. The femoral head moves inward and increases the gluteal muscle lever torque to improve the hip gait. The new acetabulum made by the pelvic osteotomy can not maintain complete continuity with the true acetabulum, and there is no articular cartilage, but there are joint capsules separated. Over time, the acetabulum can be well shaped, such as The indications are properly selected and operated correctly, and most of them can be satisfactory. Treatment of diseases: congenital dislocation of the hip in adults with congenital dislocation of the hip Indication Kiali surgery is available for: 1. Untreated congenital dislocation or subluxation of children over 7 years of age with acetabular dysplasia. 2, the femoral head is large, the acetabulum is small, the head lice are not commensurate, it is not suitable for children under 7 years old who are Salter tibia osteotomy. 3, severe acetabular shallow, acetabular index > 50 °, or have osteoarthritis changes. 4. Patients with other surgical failures may be considered for this procedure. Contraindications 1. The general condition is poor and the skin in the surgical area has an infection. 2. The femoral head does not reach the relative level of the acetabulum. 3. The activity of the hip joint is obviously limited. Preoperative preparation 1. Traction Preoperative limb traction is necessary. Unless the femoral shortening is performed at the same time. Traction can: 1 contracture soft tissue relaxation, surgery easy to reset; 2 after the reduction of the femoral head stability, to prevent re-dislocation due to muscle contracture; 3 reduce the pressure between the femoral head and acetabulum after surgery, to prevent cartilage surface compression Necrosis and aseptic necrosis of the femoral head. In addition to the lower than 3 years of age and the upward displacement of the femoral head can be used for skin traction, generally using Kirschner wire for the treatment of lower bones of the tibia and fibula. For those with high dislocation, the Kirschner wire should be used for traction. Raise the bed 10 to 20 cm when pulling, as a counter traction. The direction of traction should be slightly buckling of the hip, consistent with the longitudinal axis of the trunk or a slight internal traction. If the affected limb is pulled in the outreach position, the femoral head is blocked on the tibia and cannot be pulled down. When the femoral head is brought to the acetabular plane, the affected hip can gradually abduct and straighten to pull the contracted soft tissue. The weight of the traction starts with 2 to 3 kg, and then gradually increases, generally not more than 7 to 8 kg. The traction time is 2 to 4 weeks. If the femoral head is not enough, the time can be extended appropriately. The age and pathology of the sick children are different, and the required traction weight and time are also different. During the traction process, the length of the two lower limbs should be measured. Check whether the groin can touch the femoral head. After 2 weeks of traction, take X-rays once a week to determine the position of the femoral head. Surgery can be performed after the femoral head has descended to the acetabular plane and is maintained for 1 to 2 weeks. If the procedure of simultaneous femoral shortening is used, traction therapy is not required before surgery. 2, do a good job in the general condition and skin preparation in the operating area. 3, preparation of blood: If it is estimated that the operation is difficult or need to add other operations at the same time, should be matched with blood 300 ~ 600ml. Surgical procedure 1, cutting, revealing The incision, the exposed joint, and the factors that relieve the internal and external joints from the joint are all the same as the open approach of the anterior approach. 2, osteotomy and pelvic internal movement Under the periosteum, the inner and outer plates of the hip bone and the large ischial notch were exposed. A curved bone sled was placed on the inner and outer sides of the humerus to make a large incision of the ischial bone, and the two were collided under the periosteum to protect the sciatic nerve and hip upper movement and vein. . The humeral osteotomy position is between the hip joint capsule and the rectus femoris oblique head, along the curve of the joint capsule attachment, the front from the anterior iliac spine, and then the sciatic notch for osteotomy. The osteotomy direction is inclined by 15° from the outside to the inside. In order to accurately grasp the position and direction of the osteotomy, the bone knife should be used for osteotomy, without the wire saw, and should be carried out under the perspective control of the C-arm X-ray machine. First cut all the outer cortical bones, slowly advance from the outside to the inside, and then cut the inner cortical bones. After the pelvic ring is completely cut off, the affected limb is abducted and pushed inwardly, so that the lower acetabular bone of the osteotomy line is moved inward and moved inward, so that the outer side of the femoral head is just flush with the lateral aspect of the proximal humerus. degree. If the internal movement is too small, the femoral head is not completely covered, and the internal movement is too much, the contact between the two sections of the humerus osteotomy is too little or the contact is lost. Generally, there is no need for internal fixation. If the humerus surface is found to be unstable, it can be fixed with a thick Kirschner wire to maintain the position. 3, joint capsule formation Thoroughly remove the joint capsule of the secondary acetabulum, remove the excess part of the joint capsule or suture the joint capsule, and trim tightly to eliminate the loose upper pocket-like joint capsule to prevent re-dislocation. When the joint capsule is sutured, an assistant will keep the hip flexed, abducting 30°, and mild internal rotation until the postoperative plaster is fixed. 5, stitching The rectus femoris muscle is sutured. If there is tension, the rectus femoris muscle can be sutured at the beginning of the straight head. The humerus humerus is sutured in situ, and the deep fascia, subcutaneous and skin are sutured layer by layer.

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