Modified Stanisavljvic procedure

The modified Stanisavljvic procedure is used for the surgical treatment of congenital dislocation of the patella. Congenital dislocation of the patella is a rare congenital malformation that differs from recurrent or habitual dislocation of the patella. The disease often has a family history, often affected on both sides, and can be complicated by other malformations. At the time of birth, the tibia is dislocated, which is a fixed dislocation, and the technique cannot be reset. The structure of the quadriceps is abnormal and the force line is out of the way. The lateral femoral muscle may be absent or contracted, and the tibia is attached to the front of the iliac crest. The humerus is often small and deformed, and is located in the knee-extension structure of the quadriceps. Often fixed knee flexion deformity, can not fully extend the knee, bilateral dislocation of the tibia with severe knee flexion deformity, often walking. This disease is often accompanied by knee valgus and external rotation of the humerus. The medial joint capsule of the knee was pulled, and the lateral femoral condyle or the patellar tendon was out of position. Before 3 to 4 years old, the tibia was not ossified, and the tibia on the X-ray photograph was unclear. If you do not check carefully, it is not easy to diagnose. If you examine it carefully, you can touch the dislocated humerus above the humeral head of the lateral knee, which can be diagnosed. Treatment of diseases: dislocation of the humerus Indication Once a congenital dislocation of the patella is diagnosed, a surgical reduction should be performed as soon as possible. Contraindications 1. Because of the large incision in this operation, infants under 6 months are less tolerant to surgery and will not be operated temporarily. 2. Poor systemic conditions The skin is unhealthy and has infected lesions. Preoperative preparation 1. Check the whole body condition in detail, and prepare the skin 3 days before surgery. 2. Matching blood 150~300ml. Surgical procedure Incision Starting from 4cm below the greater trochanter of the femur, through the outer side of the thigh down to the front of the lateral femoral condyle, the arc crosses the plane of the knee joint and ends at 4 to 5 cm below the iliac crest. 2. Loosen the knee lateral contracture tissue The subcutaneous tissue was dissected and adhered to the deep fascia and revealed the quadriceps, tendon bundle, dislocated humerus, the medial and lateral aspect of the knee joint and the upper part of the tibia. The collapsed tendon bundle was extensively removed, and the cut bundle was stored in wet saline gauze. The lateral femoral muscle was bluntly separated from the lateral septum to the femur. In the case of a deep movement, a branch of the vein, it is ligated. Excision of the lateral muscle space of the contracture. The switch capsule, the lateral support band and all the fiber bundles connected to the outside of the tibia are cut along the lateral part of the dislocated humerus. 3. Subperiosteal shifting quadriceps 1cm in front of the lateral muscle interval, longitudinally incision of the periosteum, along the subperiosteal and inward and inward, the entire quadriceps stretch knee structure (including the humerus) rotated inward to the normal anatomy. If the internal rotation is difficult, the periosteum can be cut along the front of the knee at the proximal end of the distal femur. Subperiosteal dissection makes the quadriceps stretch knee structure with good internal rotation, less surgical bleeding, and less postoperative adhesion. 4. Patellar ligament formation The patellofemoral ligament was opened longitudinally, and the lateral half of the patellar ligament was cut at the tibial tuberosity. The lateral semitendinosus ligament was pulled out through the medial deep ligament of the patellar ligament, and it was sutured as far as possible to the iliac crest of the medial collateral ligament. 5. Strengthen the medial structure of the tibia Cut the switch capsule and synovial membrane along the medial side of the ankle to explore the knee joint. If there is a lesion, give the corresponding treatment and suture the synovial membrane. I cut the anterior periosteum and cut a shallow bone groove. The semitendinosus muscle was transferred to the upper part of the tibia and sutured with the periosteum to attach it to the bone groove. The loose medial femoral muscle is pushed downward and is sewn to the outer lower edge of the tibia. The tense femoral lateral muscles were cut from the upper part of the tibia and the iliac crest was detached 2 to 3 cm from the proximal side. The medial edge of the tibia is sutured to the medial joint capsule. The medial joint capsule is then covered outwardly to the lateral edge of the tibia. 10.6 6. Stitching Because of the inward rotation of the quadriceps and the lateral tissue defects of the knee after the reduction of the humerus, as long as the synovial membrane is intact and there is no defect, no suture is needed. If the synovial defect is too large to be sutured, it can be repaired with the removed tendon. Layered sutures under the skin and skin. The wound is stripped and the dressing is applied in a large amount. complication The main complication of the modified Stanisavljvic procedure is dislocation of the humerus. The causes were as follows: 1 the lateral release of the knee was not complete; the 2 quadriceps were not fully rotated inward; the abnormality of the 3 ligament direction was not corrected; 4 the loose medial structure of the ankle was insufficiently strengthened; 5 the combined bony deformity was not corrected. Observe the above surgical attention points and operating procedures, and recognize the pathological changes during surgery and give thorough correction to prevent this complication. Surgery should be performed as soon as possible, and the age is small and the surgery is easy to correct. The effect is better. The age is large, the secondary deformity is serious, the operation is difficult, and if necessary, the bone surgery should be corrected. After 14 years of age, the tibial tuberosity can be performed to correct the force line.

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