External fixation technique compression fixation, proximal tibial osteotomy and lengthening

External fixation technique with compression fixation and proximal humerus osteotomy for the surgical treatment of congenital sacral pseudoarthrosis. The main reason for the lower cure rate of congenital sacral pseudoarthrosis is that it can not solve the contradiction between thorough removal of the lesion and residual large bone defect and limb shortening. In 1988, Ilizarov reported the use of extra-articular fixation for the treatment of congenital patellofemoral joints, and the use of bone extension to correct the deformity of the affected limb. Paley reported 14 cases of Ilizarov technique and 13 cases of pseudoarticular bone healing. In 1996, Li Qihong reported that the external fixation was used to perform the interphalangeal compression fixation. At the same time, 11 cases of proximal metaphyseal and metaphyseal osteotomy of the humerus were performed. 9 cases of bone healing, 1 case was not healed, 1 case 3 years and 8 months after the trauma and then fracture. This method is relatively simple, less invasive and easy to implement. At the same time as the lesion is completely removed, the extension of the upper end of the humerus can fully correct the deformity of the limb. The use of a half-ring groove external fixator for three-dimensional external fixation with Kirschner wire, fixed dynamic and dynamic axial stress stimulation caused by weight-bearing activity, is conducive to promoting the healing of congenital sacral pseudoarthrosis. Curing disease: Indication 1. The cyst type and the anterior arch type have not yet formed a pseudo joint. 2, poor general condition or have important organ diseases. 3. There are infected lesions in the skin near the surgical area. Preoperative preparation 1. It is found that there is a pseudo-articular formation of the humerus, that is, it should be protected by a bracket to prevent the deformity from increasing and increasing the difficulty of surgery. 2, before the operation should be clear to the parents of the sick children, such malformation treatment is very difficult, the surgery is likely to fail, there may be multiple operations, and even the possibility of amputation. 3, the whole body to do the system, comprehensive inspection. 4. Prepare the skin 3 days before surgery. Surgical procedure 1, incision and resection of diseased tissue The same as "double-sided attachment and bone grafting". 2, bone end treatment and external fixation After completely removing the diseased tissue between the fractured end of the bone, the periosteum and its surrounding area, the lesion of the zygomatic pseudoarticular bone and the hardened bone were removed, and the distal and proximal medullary cavity was drilled. For example, the humerus also has pseudo-articular formation, the same method for the removal of the humeral lesion tissue and the treatment of the humeral bone fracture. If the humerus is completely separated from the two ends of the humerus, another incision should be made to remove a segment of the humerus in order to make the two ends of the humerus meet. In order to make the distal and proximal bone ends close together and increase the bone end contact surface, the bone end can be trimmed into a shape. Then, two diameters of 1, 5 to 2, and 5 mm Kirschner wires were placed at 3 to 5 cm above and below the fracture ends, and each group of K-wires was crossed at 25 to 45 degrees in the same plane. One of the two Kirschner wires in the lower part of the fracture end should have one through the lower ankle joint to prevent the lateral malleolus from moving up. The fracture end is repositioned or inserted into one end of the other end of the medullary cavity to correct the deformity. In order to accelerate the healing of the fracture end, autologous humerus or allogeneic bone can also be implanted around it. The crossed Kirschner wire is fixed by a semi-ring groove external fixer, and the axial end is pressed to make the bone end tightly contact and fixed. 3, the upper end of the humerus osteotomy A 4 cm skin incision was made in the upper third of the humerus to expose the humerus, and the humerus was obliquely cut under the periosteum, and the wound was sutured in layers. Take a slight outward arc incision in front of the upper end of the humerus, 4 to 6 cm long, or extend the incision of the diseased tissue appropriately. The third group of steel needles are crossed and crossed at the proximal metaphysis or the metaphysis-bone of the humerus. The cross angle of the two Kirschner wires is still 25°45°, and one of them should penetrate the humeral head or the upper end of the humerus at the same time. In order to prevent the humeral head from moving down. The osteotomy plane is located 1 cm below the steel needle. Peel the periosteum and cut the humerus under the periosteum. Keep the periosteum in the operation and do not tear the periosteum. After osteotomy, the periosteum is tightly sutured. The third group of K-wires is mounted and fixed to the semi-ring type external fixator. 4, stitching Thoroughly flush the hemostasis. After installing and adjusting the external fixator, check the contact between the pseudo-joint and the upper end of the humerus at the osteotomy and the joint is good. The deformity is satisfactory, no lateral and angular deformity. The upper end of the humerus is not extended during surgery. The postoperative correction of the limb shortening deformity is gradually extended according to the procedure. Tightly suture the skin and skin. Sterile dressings and pinholes. The upper end of the humerus is not extended during surgery. complication 1, needle infection Follow the aseptic operation and related technical requirements when wearing the needle, and strengthen the postoperative pinhole care, which can generally be avoided. For mild needle infections, use ethanol to wipe, and more self-healing; for severe needle infections, the steel needle should be removed in time, routine surgical debridement should be performed, and the circulation and systemic antibiotic treatment should be maintained. After the steel needle is removed, depending on the degree of influence on the stability of the fracture, it is decided whether or not to wear a needle separately. When the needle is required, it should be 3 cm away from the infection. 2, nerve, vascular injury When the upper end of the humerus and the humerus are osteotomy and needle insertion, the common peroneal nerve and the posterior tibial blood vessel may be damaged. In addition, the bone may be stretched too fast and the nerve and blood vessel may be damaged. In this regard, as long as the surgeon is familiar with the anatomical position and carefully regulate the operation, it can generally be effectively prevented. According to different situations, effective treatment measures can be taken for treatment, which can better restore it. 3. Prolong the slow healing of the bone and the nonunion After stopping for a period of six months, the area of the bone has an irregular defect gap, and the cortical bone shadow is not obvious, in order to prolong the slow healing of the bone. If not treated in time, the prolonged area will absorb, shrink, harden, and pseudo joints, forming nonunion. As long as a reasonable extension rate is established according to the specific situation, and through the limb extender and effective functional exercise, providing an excellent mechanical environment for bone regeneration, such complications can be prevented. Once it occurs, autologous cancellous bone grafting should be adopted, and the method of stepwise compression shortening should be used. In the early stage, it can also be combined with trace DC stimulation or pulsed electromagnetic field treatment to promote bone healing. 4, knee and ankle dysfunction The proximal humerus osteotomy is prolonged, and there are often varying degrees of knee joint movement limitation; >15% of the tibia is prolonged, which is prone to ankle dysfunction. The prevention methods include: the osteotomy position is as close as possible to the backbone, determining a reasonable extension ratio, and effective functional exercise. In case of occurrence, surgical treatment should be performed in time.

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