Hip fork osteotomy

Hip fork osteotomy for surgical treatment of hip joint injuries. Hip joint osteotomy is based on the head and neck resection, and then the femoral trochanteric wedge-shaped abduction osteotomy, the treatment of degenerative hip arthritis can get better results, but there are still more postoperative limb shortening and Often there is an external rotation deformity, the shortcomings of the "eight-foot". Treating diseases: hip tuberculosis Indication 1. Hip ankylosis, especially non-functional rigidity, through surgery to obtain a painless and active hip joint, enabling the patient to sit or kneel down and improve walking function. 2. Hip dysfunction after injury, such as old femoral neck fracture, old hip dislocation, and hip deformity after trauma. 3. Osteoarthritis secondary to congenital dislocation of the hip, flat hip and femoral epiphysis, with severe pain. 4. Failure after artificial total hip arthroplasty or artificial femoral head replacement. 5. After tuberculosis, suppurative inflammation, hip deformity or pain, if the clinical comprehensive treatment has no recurrence for several years, and the skin around the joint is healthy and the muscle condition is good, under the antibiotic or anti-tuberculosis treatment, this operation can still be done to improve Joint function. Contraindications 1. Children are not suitable for this operation, because after the removal of the femoral head and neck, in addition to the shortening of the lower limbs, it will affect the development of the femur and spine. As the age increases, the length difference between the two lower limbs is greater. Serious, long-term will cause low back pain. 2. Muscle atrophy of the affected limb, after a physical therapy or physical therapy, the muscle contraction force can not be improved. 3. Too obese patients should not be operated on. 4. Hip joint tuberculosis or septic hip arthritis, clinically unhealed. Preoperative preparation 1. Sterile preparation of the patient: During the period of time before the operation, the patient has no distant infectious lesions, and even a small infection is not suitable for surgery. For patients with hip joint infection or surgery, or rheumatoid hip arthritis, antibiotics should be strengthened before surgery to prevent postoperative infection. In patients with rheumatoid hip ankylosis, if surgery is required, the infection rate is three times higher than that of hip osteoarthritis patients, which may be related to long-term application of glucocorticoids. In addition to early use of antibiotics in such patients, it is more important to apply it again 1 to 3 hours before surgery to obtain the peak concentration of antibiotics during surgery. In addition, the patient's hospitalization date should be shortened as much as possible before surgery. It is reported that the infection rate is 6% after 2 days of hospitalization. If the patient is hospitalized for more than 3 weeks, the infection rate can be as high as 14.7%. The longer the hospital stay, the patient and the environment. The more contact with medical staff, the greater the chance of carrying bacteria, and the infection is easy after surgery. 2. Preparation for skin and muscles around the hip: The skin around the hip should be soft, stretchable, and blood supply should be good. For this purpose, appropriate physical therapy, physical therapy, and massage should be performed before surgery to improve the skin and muscles around the joints. condition. It is not advisable to perform this operation on the bones around the joints, or the skin should be repaired before surgery. 3. When the hip joint is stiff or has contracture deformity, the affected limb should be treated for a period of time before surgery, or the soft tissue around the hip joint should be released before being pulled. Surgical procedure Skin incision Starting from the outer 2/3 of the upper iliac spine and the trochanter of the femur, after the big trochanter, cross the outer side, and then along the outer midline of the femoral shaft until 10 cm below the large trochanter. 2. Exposing the joint After cutting the skin and subcutaneous tissue, the gluteus maximus membrane was cut along the direction of the muscle fibers in the upper part of the incision. In the direction of the incision in the large trochanter, between the anterior gluteal muscle front and the posterior margin of the tensor fascia, longitudinally Open the fascia. Thereby, the gluteus maximus is bluntly separated, and the loose connective tissue of the gluteus maximus and the deep fascia is separated, and then the gluteus maximus and the sciatic nerve in the fat are pulled inward, and the affected limb is rotated internally. The external rotation muscle group on the posterior side of the hip joint can be fully revealed, and the external rotation muscle group is cut at the stop point, that is, the intertrochanteric spasm. Peel it off with a bone knife to see the posterior capsule. The joint capsule is T-shaped and the joint capsule is removed into the hip joint to reveal the femoral head and neck and the acetabular edge. 3. Head and neck resection If the femoral head and the acetabulum are not boneless, the head and neck resection is more convenient, that is, the femoral head is dislocated first, and then the femoral neck is cut off along the midpoint of the lower edge of the femoral neck, so that the small trochanter can be retained. 2cm high femur distance. The section is dug into a curved concave surface such that the base of the femur is about 1/5 of the length around the neck, and the tip is about 0.5 cm wide. The tip and the base are isosceles triangles and the height is about 2 cm. Then remove the joint lip, first use the acetabular chisel to remove the acetabular inner ligament and adipose tissue, and then use the acetabulum to remove the articular cartilage and its lesions until the subchondral bone. If the hip joint has healed, you need to use a bone knife or bone saw to cut it along the edge of the acetabulum or under the femoral head to make the femoral neck out of the acetabulum. Then, according to the above method and requirement, the femoral neck can be used to trim the osteotomy. The acetabular side should be chiseled into a concave surface similar to the original acetabulum. After washing the wound and acetabulum with a pulse irrigator, the gauze is stuffed to stop bleeding. 4. Subtrochanteric osteotomy Peel the outer trochanter of the large trochanter, and reveal the posterior and lateral sides of the large trochanter, determine the position of the small trochanter, and obliquely cut the osteotomy 1 to 1.5 cm below the small trochanter to make the osteotomy line and the femur It is about 45°. In order to prevent bone fissure, before the osteotomy, according to the direction of the intertrochanteric line, a bone drill is drilled along the osteotomy line to penetrate the bone hole of the anterior and posterior cortical bones, and then the osteotomy is used to cut the bone. If you use a chainsaw to cut bones, you don't have to drill holes. After the osteotomy of the trochanter, a small groove is made with the osteotome obliquely facing the osteotomy surface of the trochanter, and the bottom of the groove should be at the upper edge of the small trochanter. The size of the groove is suitable for accommodating the distal tip of the femur. The lower extremity is then rotated about 25°, abducted by 30°, and inserted into the groove. If the bone end is still not easy to insert, cut a small portion of the edge of the upper end of the femoral shaft until the tip is fully inserted into the groove. After the bone end is fully inserted, the upper end of the femur is fixed with the small trochanter with 2 to 3 screws, and the direction is obliquely inward and upward from the outer lower side, and the screw passes through the cortical bone of the small trochanter. The purpose of the distal femoral abduction insertion is to support the body weight when the patient is standing and walking after the osteotomy is healed, so that the femur above the small trochanter is placed against the acetabulum. 5. Suture incision After completely stopping bleeding and rinsing the wound, the lateral femoral muscle was sutured with a medium-sized silk thread, and then layered and sutured. After the incision was applied as a sterile dressing, the patient was changed to the supine position, and the tibial tuberosity was performed on the affected side.

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