Hip Rotation Osteotomy

Indication Hip-incision reduction can be performed in patients with sickness within 1.4 to 5 years of age who have failed to undergo manual reduction, or 5 to 9 years old who are not suitable for non-surgical treatment. Older patients with severe pathological changes need to be supplemented with other operations. 2. The acetabulum and femoral head are symmetrical, but the sputum is shallow, and the acetabular angle is less than 45°. The hip bone placement can be performed at the same time as the reduction and reduction; if the acetabular angle is greater than 45°, it should be performed. Acetabuloplasty. 3. The acetabulum is small and shallow, and can not accommodate the femoral head. The acetabular capping should be performed at the same time as the reduction and reduction. At the age of the femoral head dislocation, it is impossible to cut open, the false sputum is shallow, and the joint is not very For stabilizers, consider the in situ false-twisting technique to improve function. 4. If the femoral neck anteversion angle exceeds 45° or the neck dry angle is above 140° (normal anteversion angle is 15°, neck dry angle is 120°130°), it should be performed at the time of hip open reduction or second stage operation. Femoral osteotomy or adduction osteotomy. 5. Adult congenital subluxation of the hip; male children and adolescents with congenital dislocation of the hip is not suitable for pelvic rotary osteotomy, acetabular formation or occlusion, travel pelvic internal osteotomy (chiari surgery). 6. Patients over the age of 15 should not be subjected to the above various operations. For patients with severe deformity, joint instability, and poor weight-bearing line, which may cause hip or low back pain, consider improving the weight-bearing line and stability surgery (such as femoral trochanter). Lower osteotomy or hip fusion, etc.). Contraindications Older, combined with severe heart, liver, kidney and other diseases and difficult to tolerate surgery. Preoperative preparation 1. It is very important to routinely perform limb traction before surgery to return the femoral head from the posterior superior aspect of the acetabulum to the acetabular level. Traction can relax the contracted muscles, on the one hand, it can make the operation reset easily and prevent postoperative dislocation; on the other hand, it can reduce the cartilage surface necrosis and avascular necrosis of the femoral head after compression of the femoral head. opportunity. Older, dislocated children can be used for traction; older age should be treated with humeral traction. Generally, the femoral head can be lowered to the acetabular plane after 2 to 3 weeks of traction. After the X-ray film is confirmed, the weight can be appropriately reduced, and the femoral head can be maintained in the plane for 1 to 2 weeks. 2. If the traction of the femoral head is not obvious, it should be checked whether it is caused by the contraction of the femoral or gluteal muscles. In this case, the adductor muscle starting point should be cut or released, and then the limbs should be pulled to meet the traction requirements. Generally speaking, those who are more than 2 to 3 years old need to be cut off and can be released. 3. Preoperative cases were prepared for skin around the hip joint and lower limbs for 3 days. 4. Preoperatively, the anteversion angle, the hip valgus angle, the selected capping site, the hip osteotomy site, and then the surgical design of the femoral or hip bone osteotomy angle and the size of the bone graft should be determined. 5. Prepare blood 200 ~ 600ml. Surgical procedure 1. Position: supine position, the side of the sick side is high, so that the buttocks and the operating table at 30 ° angle. 2. Incision, exposure: the anterior and posterior incision of the hip joint (see the way the hip joint is exposed). However, most of these patients are children, and the humerus should be preserved to avoid pelvic developmental disorders. After the cartilage is revealed, the cartilage is cut longitudinally along the midline. Then cut to the periosteum in the plane of the epiphysis line, and use the periosteal stripper to push the semitendinosus of the diaphragm in the periosteum from the inner side of the iliac wing, and quickly block the hemostasis with the dry gauze under the periosteum; The tensor fascia lata, gluteus medius, gluteus medius and external semitend cartilage are pushed under the periosteum from the lateral aspect of the humeral wing, and the hemorrhage is quickly blocked by dry gauze. Use a small hook to pull the sartorius muscle to the inside, and cut the rectus femoris in front of the iliac spine and turn it downward. At this time, the inner and outer sides of the humerus wing and the hip joint can be fully exposed. A dislocated femoral head and a posteriorly extending, thickened hip joint capsule can be found on the posterior superior to the acetabulum. 3. Cut the hip bone: in the anterior and posterior iliac spine, use the periosteal stripper to remove the medial and lateral sides of the humerus under the periosteum, and reach the front and rear edges of the large incision of the ischial bone. Pull apart the muscles on both sides, under the protection of the periosteal stripper, from the large isch of the ischial bone to the hip bone through the wire saw (should be careful to avoid damage to the sciatic nerve and gluteal nerve), and then try to level the bite in front of the iliac spine Broken hip bone. 4. Correct the direction of the acetabulum: use two towel clamps to clamp the bone segments on both sides of the osteotomy, the proximal towel clamp to fix the proximal hip bone, the distal hip clamp with the distal towel clamp, and insert the saw with the periosteal stripper. In the fracture line of the fracture line, with the help of the squatting and lowering, the pubic symphysis is used as the axis, so that the distal hip and acetabulum rotate downward, forward and outward, and the acetabulum can completely cover the femoral head. Straightening, adduction, and external rotation of the lower extremity when the femoral head is not easy to escape.] 5. Take the iliac bone graft: a wedge-shaped bone is drilled on the anterior aspect of the humerus, the length of which corresponds to the anterior and posterior diameter of the humerus at the upper edge of the acetabulum. The thickness of the base is determined by the size of the fissure after the rotation of the osteotomy. After trimming, it is transplanted into the fibular fissure. The Kirschner wire is used to fix the bone graft to the proximal and distal segments of the hip. The end of the Kirschner wire should be placed at a right angle outside the humerus to avoid slipping into the pelvis. Easy to remove later. Then, the special person maintains the lower extremity in a slight internal rotation and outreach position to prevent dislocation of the femoral head, and adjusts according to the correction of the x-ray film. 6. Stitching: suture the excess joint capsule and suture, suture the iliopsoas and rectus femoris, and suture the split iliac crest with soft tissue. Finally stitched by layer. 7. External fixation: After the operation, the bilateral hip joint was used to fix the diseased side hip joint in abduction 20°, mild internal rotation, flexion position, and slightly flexed knee joint. complication Joint pain.

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