Hip joint tuberculosis debridement

The incidence of tuberculosis in the hip is second only to spinal tuberculosis. This disease is more common in children. The joints of the extremities are easier and clearer than the spine, and the lesions are more thorough. Therefore, the cure rate of joint tuberculosis of the extremities is higher than that of the spinal tuberculosis. Early ankle joint tuberculosis, including simple bone tuberculosis or synovial tuberculosis, can not only cure tuberculosis lesions, but also retain most or all of the joint function. In the late ankle joint tuberculosis (including total joint tuberculosis and secondary infection), although the lesion can be cured, the joint function will be lost. Therefore, early diagnosis of ankle joint tuberculosis should be done to reduce disability. Treating diseases: hip tuberculosis Indication Any type of ankle joint tuberculosis (including simple bone tuberculosis, simple synovial tuberculosis, total joint tuberculosis and its secondary infection), except for poor general condition or too young age, is suitable for lesion removal. Contraindications Older, combined with severe heart, liver, kidney and other diseases and difficult to tolerate surgery. Preoperative preparation The ankle joint is often caused by protective muscle spasm, resulting in hip flexion, adduction deformity, and even pathological dislocation. Therefore, skin traction should be done before surgery to relieve pain and correct deformity. For those with pathological dislocation, the femoral head should be gradually pulled to the acetabular plane for surgery. Surgical procedure 1. Position: The patient is supine, with the soft buttocks on the hip and waist pads on the side of the surgery, so that the back and the operating table are at an angle of 15° to 20°. 2. Incision, exposure: the anterior and lateral exposure of the hip joint is used. Cut the skin, separate and protect the lateral femoral cutaneous nerve. Cut the periosteum to reveal the inside and outside of the humerus. The outside should be peeled off to the upper edge of the acetabulum. The medial side should be stripped to the anterior iliac spine and the superior pubis. Then, the sartorius muscle and the fascia lata muscle are separated, the upper part of the lower rectus muscle is cut, and the iliopsoas muscle is pulled to the inner side, and the anterior side and the inner side and the outer side of the joint capsule are fully exposed. 3. Clear the lesion: Cut the anterior wall of the sac of the switch, drain the pus, and then remove the exposed joint capsule including the synovial membrane. At this time, the flexion, adduction and external rotation of the hip joint were performed, and the femoral head was dislocated from the acetabulum without violence. Usually dislocation is not difficult, the more severe the joint damage, the easier it is to dislocate. However, in the case of simple bone tuberculosis or joint fiber rigidity, dislocation is more difficult. When the round ligament of simple bone tuberculosis is intact and hinders dislocation, the lower extremity should be gently rotated to separate the femoral head from the ankle. When the scalpel is inserted into the acetabulum and the round ligament is cut, the dislocation can be dislocated. When the joint fibers are stiff, the joint capsules that have already been exposed should be removed as much as possible. In patients with complicated flexion and deformity, the lumbosacral muscles must be cut off to relieve contracture. Then, gently rotate the lower extremity, insert the periosteal stripper or acetabular chisel between the femoral head and the ankle, separate the adhesion or chisel the fiber to the straight part, until the back side of the femoral head, then gently use the technique. One side of the femoral head was picked up with a periosteal stripper to dislocate it. Dislocation, first remove the femoral head and femoral neck lesions, then place the lower extremity in the straight, adducted and external rotation position, so that the acetabulum is fully exposed, in order to remove the lesions in the acetabular and posterior joint capsules [Figure 1 (2)] . When the lesion of the posterior joint capsule is removed, due to the deeper position, the exposure is small, and should be carefully operated, and the deep sciatic nerve should not be damaged. If it is difficult to remove, use a curette to scrape off the granulation or remove some of the synovial membrane. After the lesion is completely removed, if it is necessary to make joint fusion, the wound can be washed with physiological saline, the cartilage surface of the acetabulum and femoral head can be removed, the rough surface of the two can be closely contacted, and the autogenous bone is taken from the tibia for intra-articular fusion. 4. Stitching and external fixation: The wound was repeatedly washed with sterile saline, and after complete hemostasis, 1 g of streptomycin powder was added to the acetabulum to restore the femoral head, which was maintained at a functional position by a special person and sutured layer by layer. The rectus femoris muscle contracture should be prolonged [Fig. 1 (4)], and the wound is not placed in the drainage strip. After the operation, the hip-shaped gypsum was externally fixed to the functional position. complication joint pain.

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