Transtrochanteric Rotational Osteotomy

Rotary osteotomy of the trochanteric head and neck for the treatment of avascular necrosis of the femoral head. The principle is to move the necrotic area of the anterior part of the femoral head to the non-weight-bearing area. To this end, the femoral head and the neck piece are rotated forward or backward along the longitudinal axis thereof, so that the joint surface of the original femoral head without necrosis becomes a new weight-bearing area. Treatment of diseases: femoral head necrosis Indication Rotational osteotomy through the femoral trochanter is applicable to: 1. Sugioka believes that the best effect is obtained in patients with early necrosis or extensive necrosis but no progressive collapse. For the necrosis stage II, the postoperative painless, no progressive collapse, the success rate was 89%. For stage III necrosis, the success rate was 73%. For stage IV necrosis, the success rate was 70%. 2. The relationship between the size of the intact region of the posterior femoral head and the progressive collapse: Sugioka emphasizes the size of the femoral head necrosis area from the lateral image of the hip. He believes that if the complete bone area of the posterior part of the femoral head is less than 1/3, 36% of the cases may continue to collapse, with a success rate of 64%. If the intact area is less than 1/3 of the total area of the femoral head, the success rate is 93%. Contraindications 1. Although Sugioka also has a statistical effect on the IV femoral head necrosis, the patient has a wide range of changes, including large femoral head collapse, large trochanter upshift and even hip subluxation. Therefore, stage IV cases are considered relative contraindications. 2. The general condition is poor, and those who are applying hormones should not be operated. Preoperative preparation 1. General X-ray film, radionuclide scanning, MRI examination should be completed before surgery to facilitate correct staging. 2. The lateral radiograph of the hip X-ray film should be placed in the supine position of the patient, the hip flexion is 90°, the abduction is 45°, and the internal and external rotation is 0°, so that the necrotic area is located in front of or behind the femoral head and the femoral head necrosis is measured. The proportion of the district. Surgical procedure Incision Surgery was performed with a modified Oiller incision, a lateral hip incision, and a modified Simth-Petersen incision. 2. Intertrochanteric osteotomy The large trochanter is revealed, and it is cut off at the base, and is turned proximally together with the gluteus medius, gluteus maximus, and piriformis attached thereto. In the intertrochanteric fossa, the external circumflex muscle attached to it is cut, the anterior and posterior joint capsules are widely exposed, and the posterior branch of the internal femoral artery is protected at the lower edge of the femoral muscle. The switch is cut around the edge of the acetabulum. Two guide pins are inserted from the outside to the trochanter under the X-ray guidance. The needle should be perpendicular to the femoral neck and live in the center of the femoral head neck on the positive lateral X-ray image. The intertrochanteric osteotomy was performed with a chainsaw, and the osteotomy line should be 10 mm distal to the trochanteric line and perpendicular to the central axis of the femoral head and neck. Then do the second osteotomy line, which should be located on the upper edge of the small trochanter, perpendicular to the first osteotomy line, and the distal part of the small trochanter should be retained after osteotomy. The retained small trochanter portion will help support the rotated head and neck portion in the future. If the patient has a wide area of necrosis, the plane of the osteotomy should be intentionally tilted to achieve rotation and varus of the femoral head and neck. After the completion of the second osteotomy line, the bony part of the femoral head and neck and the femur should be re-examined and cut so that the femoral head and neck can be in contact with the intertrochanteric line. 3. Femoral head rotation The insertion of the needle in the neck of the femoral head is used as the axis, and the neck and neck of the femur are rotated forward by 45° to 90°. The degree of rotation depends on the extent of the necrotic area. The principle is to rotate the necrotic area out of the weight-bearing area. After the rotation of the head and neck of the femur, it can be fixed by pressing the tassel nail on the outside of the large trochanter or by pressing the goose head under pressure. The proximal large trochanter is turned down along with the attached muscles to make the large trochanter close to each other at the distal end. For example, the intertrochanteric ridge of the femoral head hinders the close alignment of the large trochanter and should be trimmed. Then use a wire to fix the broken end. X-ray examination should be performed after the end of the operation to determine that the necrotic area of the femoral head is indeed in the non-weight bearing area. 4. Suture incision Rinse routinely and suture the wound layer by layer.

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