derotation varus osteotomy

Rotating varus osteotomy for surgical treatment of hip dislocation. Hip dislocation or subluxation can cause pain in many children. Children over 8 years of age need to undergo sacral surgery to correct or reduce medullary dysplasia and prevent recurrence of dislocation. Conventional Chiari osteotomy or modified Steel pelvis three plane osteotomy, while femoral varus reverse rotation osteotomy and adduction or flexor lysis. Pemberton and Salter pelvic osteotomy are not effective. Cover surgery can be used to increase the coverage of stunted residual acetabulum. It is reasonable to use a wide range of surgical procedures for open reduction, pelvic osteotomy, femoral shortening, and varus reverse rotation osteotomy for the treatment of severe hip injuries. Treatment of diseases: dislocation of the hip before anterior dislocation of the hip Indication Derotation varus osteotomy is suitable for patients over 3 years old, excessive femoral valgus and valgus deformity and hip subluxation or dislocation. Preoperative preparation Regular preoperative examination. Surgical procedure Root and Siegal method: 1. Make a 15 cm long incision on the surface of the greater trochanter. The proximal end of the incision and the gluteus maximus muscle are in the same direction, extending from the greater trochanter along the posterior lateral edge of the femur to the distal end. 2. Separate the deep fascia from the gluteus maximus to reveal the posterior and posterior lateral sides of the upper femur, including the greater trochanter. The starting point of the lateral femoral muscle was removed from the proximal femur with an electric knife, cut transversely at the base of the greater trochanter, and then cut along the thick line of the femur. The subperiosteal shows the proximal side of the proximal femur. 3. In the upper edge plane of the small trochanter, the sacral and muscular attachment parts of the proximal end of the quadriceps muscle were cut with an electric knife and turned from the posterior and posterior sides of the femur. At this point, the underside of the femoral neck can be reached, and the small rotor is determined, and the iliopsoas tendon is released from the small rotor. At this point, the osteotomy area has been fully revealed. Osteotomy is performed at the level of the small trochanter. The size of the wedge-shaped bone block is calculated according to the pre-operative measurement for osteotomy. The neck dry angle of children under 8 years old should be placed at 100 ° ~ 110 °, while the older neck dry angle should be placed between 115 ° ~ 120 °. 4. The appropriate plane of the osteotomy can be determined by the guide needle of the femoral neck. The guide needle should be driven from the rotor into the upper part of the femoral neck, parallel to the proximal osteotomy line. After the guide needle is driven into position, the bone knife is driven into the lower region of the femoral trochanter in parallel with the guide needle at the intended position of the sputum plate. Intraoperative fluoroscopy or filming to confirm the location of the osteotomy. At the back of the femur, use an electric knife to draw a (vertical) line parallel to the long axis of the femur as a reference for rotational osteotomy. 1.5 to 2 cm below the plane of the femoral neck bone knife, and the first osteotomy surface parallel to the bone knife, the osteotomy does not enter the femoral neck. At the distal end, the second osteotomy surface and the femoral shaft are at right angles, and a wedge-shaped bone piece having a width in the front of the base and having a width determined before surgery is cut off, so that the femoral neck is properly inverted. The wedge-shaped bone block should include some or all of the small rotors. The distal osteotomy should be cut but not cut off the cortical bone on the lateral side of the femur; the distal femur is fixed to the longitudinal plate of the horn plate ( plate) with a rongeur, so that the triangle after the wedge is removed gap. Intraoperative fluoroscopy or filming checks the position of the angle plate and the condition of the osteotomy. Relax the rongeur and reverse the rotation of the femur with the longitudinal scribe line that has been prepared behind the femur to correct the forward tilt. After reaching the correct angle of rotation, the distal end of the femur is clamped and fixed to the steel plate to facilitate stability. Flex the knee joint and rotate the hip joint to check if the forward tilt has been corrected. The hip joint should maintain an internal rotation of about 15° to 20°. After the distal femur reaches a suitable angle of rotation, the screws are fixed and the incision is routinely sutured.

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