open reduction

Except for a small number of congenital hip dislocations that have not been treated in the past, it is impossible to reset after adulthood. The basic surgery for patients with congenital hip dislocation is open reduction. The age of surgery can reach adolescent puberty, such as subluxation can be extended to adulthood or later. For children with less than pathological changes, most children under 4 years old can be completely cured by open reduction and reduction, but the pathological changes are heavy, especially those with large acetabular changes. The open reduction must be supplemented by the corresponding orthopedic surgery. Get cured. The purpose of open reduction is to create a concentric circle within the acetabulum, which is to restore the anatomical position of the hip, thus creating conditions for the patient to return to normal function. To achieve this goal, all factors that impede the reduction of the femoral head need to be eliminated, including intra-articular and extra-articular factors, as well as bony and soft tissue factors. Treatment of diseases: congenital dislocation of the hip and intertrochanteric fracture 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 the femoral head are symmetrical, but the sputum is shallow, and the acetabular angle is less than 45°. The hip bone placement and osteotomy 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 open reduction. The age is large. It is impossible to cut open the femoral head dislocation. The false sputum is shallow and the joints are 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 hip subluxation patients, congenital hip dislocation in male children and adolescents is not suitable for pelvic rotary osteotomy, acetabular formation or occlusion surgery, 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.). 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 is easy to successfully reset the operation, and can prevent dislocation after surgery. On the other hand, it is possible to reduce the chance of cartilage surface necrosis and avascular necrosis of the femoral head due to compression after reduction of the femoral head. Older, dislocated children can be used for traction, and older patients 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 with the periosteum from the inner side of the humeral wing, and quickly block the hemostasis with the dry gauze under the periosteum, and then the outer side. 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. Clean the joints and eliminate the reduction obstacles: firstly cut the thickened joint capsules along the edge of the acetabulum 1.5 to 2 cm, and check the joint capsule for stenosis. Dislocation of the femoral head to the posterior acetabulum often causes the iliopsoas muscle to contract and become a cord, compressing the joint capsule into a gourd shape and obstructing the reduction of the femoral head. In this case, the iliopsoas muscle should be cut at the end point or z-shaped, and then the stenosis of the sac of the sac. Then, the hip joint is flexed and externally rotated, and the acetabulum and the posterior superior femoral head are exposed from the joint capsule. The femoral head is often poorly deformed and deformed. The cartilage surface is dark, dull, and has irregular embossing. The round ligament is elongated and thickened. The acetabulum is shallow, and the sputum is filled with fat, fibrous tissue and hyperplastic soft tissue. Sometimes there is a labial cartilage that is turned into the iliac crest above the iliac crest; a transverse ligament at the lower edge of the acetabulum obstructs the reduction. All acetabular fillings that affect the reduction of the femoral head should be removed to prepare conditions for femoral head reduction. 4. Deepen and enlarge the acetabulum: The acetabular surface is removed with a curette or round acetabulum to remove a layer of cartilage tissue, deepening and expanding the acetabulum, but not to expose the bone surface. For the uneven femoral head cartilage surface, it should be rounded. If the femoral head is large and can not adapt to the acetabulum, the concave acetabular surface of the ball can be used to reduce the cartilage surface to make it smaller. Then measure the diameter and depth of the acetabulum and femoral head. When the two are proportional, the reduction is performed, so that the femoral head can be stably stored in the armpit. When the head is large and the hour is reset, the head must not fall into the bottom of the sputum. The femoral head will not be stable. It may recur and dislocate in the future. It should be noted. 5. Reset: internal rotation, straightening of the diseased limb, downward traction, so that the femoral head is also included in the acetabulum. The stability of the femoral head in the acetabulum and the tension of the soft tissue, such as moderate hip flexion and adductor femoral head without dislocation tendency, the stretching of the femoral head with only a slight degree of relaxation, can be considered stable. That is, the person should keep the lower extremity in a moderate abduction and internal rotation until the plaster is fixed to prevent dislocation. Additional assisted surgery can be performed after resetting. 6. Stitching and external fixation: the excess part of the upper joint capsule should be sutured or sutured to enhance the stability of the posterior wall and joints of the joint and eliminate the chance of recurrence. Then, the suture sacral tendon is extended, the wound is washed, and the hose is placed under negative pressure drainage and sutured according to the layer. At the end of the operation, the bilateral hip joints of the diseased side hip abduction and internal rotation were fixed. Gypsum fixation should be elastic to prevent dislocation of the joint after surgery. complication Phantom limb pain.

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