hip fusion

The hip joint can be successfully fused by different surgical methods. This method is different in clinical practice. There are four main choices for doctors. The surgery should be selected according to the specific situation. Regardless of the surgical procedure chosen, the hip joint should be fused about 30° flex, 0° to 5° adducted, and 0° to 15° externally. Treatment of diseases: hip joint anterior dislocation hip joint tuberculosis Indication 1. Due to joint trauma, inflammation, degeneration, etc., the joint surface is disproportionate, causing severe joint dysfunction, or stubborn joint pain, affecting work and life, non-surgical treatment is invalid, and other surgery is not suitable. To maintain joint mobility, joint fusion should be performed. For example, severe arthritis caused by intra-articular fractures of the lower extremities, and there are a large number of scars in the surrounding soft tissue after septic arthritis, and it is not suitable for surgery such as arthroplasty. 2. Adult all-tubular tuberculosis, joint surface destruction, it is estimated that the joint function can not be preserved, joint fusion can be performed at the same time as the lesion is removed; and there are deformities, which can correct the deformity at the same time. 3. Muscle spasm caused by neuropathy or injury, causing severe instability of the joint, affecting the whole limb function, and simple tendon metastasis is not enough to maintain joint stability and restore sufficient effective function. Fixing local joint can improve limb function. Perform joint fusion. For example, after the anterior horn polio of the spinal cord, the upper limbs can not be lifted. If the shoulder joint is fixed in the functional position, the function of the upper limb can be improved by sliding the shoulder between the shoulders. 4. Congenital or acquired spinal deformity (such as hemivertebra, scoliosis, lumbar spondylolisthesis, etc.), in order to prevent the development of deformity, early laminectomy can be performed, or after deformity correction. Contraindications In addition to the general contraindications for elective surgery, the following conditions should also be contraindicated: 1. Patients with osteoarthritis adjacent to the joint should not be used for arthrodesis. If the hip joint is fused, its activity can be compensated by the normal lumbar spine and knee joint to meet the needs of work and life activities. If the lower lumbar or knee joint is already stiff, hip fusion will cause great difficulty to the patient. 2. Among the same joints of the limbs, one side has a strong straight, and the contralateral side should not be subjected to arthrodesis. If the hip joints are fused on both sides, it will be very difficult to get up, lie, walk and sit. 3. Children's articular cartilage is rich, joint fusion is not easy to cause bone fusion, but also easy to damage the epiphysis, affecting growth and development; at the same time, children in the limb development stage and muscle sustained action, the fusion joint can be deformed again. Therefore, children under the age of 12 should not undergo arthrodesis. Preoperative preparation 1. Arthrodesis may actually include a series of operations such as lesion removal, joint fusion, bone transplantation, and correction of deformity, so it is a complicated operation. Therefore, the surgical plan should be determined according to these surgical requirements, comprehensive consideration, try to get a surgery, a cut to solve the problem, in order to achieve the best results at the least cost. 2. Loss of activity after joint fusion can cause the patient's ideological concerns, and should be dispelled before surgery: the fusion of a joint that affects the function of the limb will improve the function of the entire limb. 3. The joints of the shoulders, hips and other large joints have more bleeding during the operation, and there is a possibility of shock. A certain amount of blood should be reserved before surgery. When the elbow and knee joints are operated, the inflatable tourniquet is used to keep the field clear for the operation. 4. Inflammatory joint disease (such as tuberculosis, suppurative) should be applied preoperative antibiotics or anti-tuberculosis drugs to control the infection or prevent the recurrence of the resting lesion. 5. If the joint has soft tissue contracture, the deformity will not be easily corrected during the operation, and the joint will be difficult to reset. It is difficult to maintain stability even if it is barely repositioned; if it is strongly corrected during surgery, it will cause damage to nerves, blood vessels, etc. Postoperative muscle spasm, and even cause complications such as dislocation. Therefore, traction should be performed before surgery to overcome contracture as much as possible; and design the steps to relieve contracture during surgery. Surgical procedure 1. Position: supine position, sick side buttocks and torso with a sandbag pad 45 °. 2. Incision and exposure: The clinical use of the lateral incision of the hip joint is widely revealed and easy to operate. The incision was started from the 1/3 of the iliac crest, and was descended to the greater trochanter of the femur by the anterior superior iliac spine, and then bent to the posterior side of the femur. Cut the skin, fascia, separate the sartorius muscle and tensor fascia interosseous space, remove the fascia lata and gluteus medius from the outer periosteum of the iliac wing, cut the fascia with the lower edge of the incision, together with the flap Open backwards. Then, the stop point of the gluteus medius muscle is cut off from the greater trochanter and pulled back, and then the rectus femoris reclining bone is peeled forward on the upper edge of the acetabulum, and the rectus femoris and the iliopsoas muscle are pulled forward. The 1/3 of the tibia, the hip capsule and the greater trochanter of the femur can all be revealed. 3. Dislocation and removal of cartilage surface: After removal of the joint capsule and lesions, fully flush with saline, and then use the acetabular chisel to separate the femoral head and acetabulum, cut the round ligament, while adduction and external rotation of the lower extremities, dislocation of the hip (dislocation) When using violence, avoid using a decalcified femur to fracture. The gauze was pulled over the posterior aspect of the femoral neck, and after maintaining the external rotation position, the cartilage surface corresponding to the acetabular head of the femoral head was removed with a bone chisel. Then use the yin and impotence to trim, so that the two can closely match to facilitate healing. Rinse the wound with plenty of saline. 4. Extra-articular fusion: After the cartilage surface is completely removed, the internal rotation and abduction of the lower limbs can be used to reset the femoral head to the acetabulum, and the person is kept in the functional position. The greater trochanter is split into the sagittal plane, but the base must remain attached to the femur. Then, a shallow groove equal in width to the greater trochanter is drilled on the upper edge of the acetabulum to roughen the upper surface of the femoral neck. The bone graft is removed from the outside of the tibia and has a length equal to the length of the apex of the acetabular groove to the bottom of the large rotor, and the width is equivalent to the width of the greater trochanter. When bone grafting, first lower the lower limbs to increase the acetabular and rotor spacing. After the bone is inserted into the groove, the lower limbs can be abducted to fit the bone piece tightly into the groove. The joint space and the bone graft gap were tightly filled with small bone pieces taken from the tibia, and a negative pressure drainage tube was placed, and then sutured by layer. Hippocampus plaster fixation was performed after surgery. complication Joint pain.

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