internal pelvic osteotomy

1. Older children (over 7 years old) congenital dislocation of the hip and dislocation of the adult. 2. Dislocation after surgery, or severe dysplasia of the acetabulum. 3. Anesthetic dislocation due to weak muscles or spasms. 4. Bilateral pelvic internal transfer osteotomy has an effect on the delivery of female patients, should be used with caution. Treatment of diseases: congenital dislocation of the hip in adults with congenital dislocation of the hip and dislocation of the hip Indication 1. Older children (over 7 years old) congenital dislocation of the hip and dislocation of the adult. 2. Dislocation after surgery, or severe dysplasia of the acetabulum. 3. Anesthetic dislocation due to weak muscles or spasms. 4. Bilateral pelvic internal transfer osteotomy has an effect on the delivery of female patients, should be used with caution. Preoperative preparation 1. Bone traction of the affected limb, so that the femoral head is pulled to the level of the acetabular y-shaped cartilage or below (confirmed by x-ray film). More than 3 years old, the method of traction and adductor muscle tension should be performed first. If the femoral head does not descend to the level of the y-shaped cartilage after traction, the lowering of the hip and the small muscles should be assisted. 2. Preoperative blood matching. 3. Prepare to pull the operating table and keep the operation under traction. Surgical procedure 1. Position, incision, and exposure to the anterior and posterior aspect of the hip joint (see the hip joint exposure pathway). However, the hip bone should not be exposed too much under the periosteum, otherwise it will affect the effect. Only a long strip of the inner and outer sides of the humerus between the acetabulum and the ischial incision can be seen, just insert a long and narrow hook before and after the sciatic notch. 2. Cutting the bone with a narrow osteotome to close the tibia close to the upper edge of the joint capsule between the rectus femoral head and the joint capsule. The direction of the osteotomy should be inclined from the outside to the inside and upward, and the inclination angle is 15° to 20°. The inner plate is cut from the outer plate of the hip bone. The anterior inferior iliac spine is self-twisted before the incision of the bone line, and the arc is backward to the ischial notch 3. After the bone is removed from the distal end of the bone, the lower extremity is abducted and pressurized upwards, so that the acetabulum and joint capsule are displaced to the medial side with the distal end of the tibia. The internal movement is about 1~1.5cm, which is equivalent to 50%-60% of the osteotomy surface, so that the proximal end osteotomy surface just becomes the top of the joint capsule, forming a new dome, and its outer edge just covers the outer edge of the femoral head. Use two Kirschner wires to fix the contact surface of the osteotomy. If the humerus is thin, after the internal movement, the proximal end of the osteotomy is not enough to form the dome. Then, the bone graft should be taken on the humerus and inserted into the two ends to form a new sac. The needle is fixed inside. 4. Trimming the joint capsule to thin the thickened joint capsule wall, and the excess joint capsule wall is partially excised and sutured, or overlapped and sutured. The sutured joint capsule should maintain a certain tension and should not be loosened to avoid local defects. 5. Suture the wound and rinse it, soak the incision with 1:1000 Xinjie and let liquid for 5 minutes, then rinse it with saline, place it in the incision with a 14-gauge catheter, and introduce a small skin incision to the skin. Negative pressure attraction. The incision was sutured layer by layer. Postoperatively fixed with hip herringbone plaster. The affected limb remains straight and abducted by 20° to 30°. The lower limb traction needle is fixed on the plaster.

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