knee compression fusion

The knee joint is large, so strong intra-articular fusion can be used to obtain strong bone healing. Sometimes the humerus is used as a bone graft for extra-articular fusion in order to make the appearance nearly normal. There are many methods for knee fusion, among which the advantages of compression fusion are many, the operation is simple, the healing rate is high, and the healing time is short, which is widely used in clinical practice. Patients who need knee fusion are often accompanied by different degrees of contracture deformity. For example, if the bone is to be resected by fusion alone to correct the deformity, the limb that has been shortened will be shorter, affecting limb function and body balance. Therefore, it is necessary to correct the contracture deformity before surgery to ensure the good effect of fusion. Treatment of diseases: knee joint injury knee joint meniscus injury 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. 2. Incision, exposure: Surgery under the inflatable tourniquet. Use the knee to close the median or anterior medial incision, cut the quadriceps tendon in a sacral shape, cut the switch sac along both sides of the humerus, and expose the front of the knee joint cavity together with the hip bone down. The patellofemoral ligament can also be severed, together with the humerus upturned to reveal the joint cavity. 3. Clear the lesion: first remove the anterior side of the joint capsule, synovial membrane, underarm fat pad and tibia, the healthy part of the tibia can be kept uncut, prepared for bone grafting. Then, flex the knee joint, pull the flaps on both sides to the posterior side, and sharply peel the inner and outer collateral ligaments tightly outside the bone, then cut the anterior and posterior cruciate ligaments, and remove the meniscus to completely dislocate the joint. Use gauze to lift around the lower end of the femur to completely remove the posterior lesion. Take care to prevent axillary vessels and nerves on the posterior side of the injury. 4. Excision of the bone end: According to the scope of the lesion and the design of the resection plane, the soft tissue around the bone end should be properly excised under the periosteum, especially the attachment of the posterior joint capsule should be separated, so that the ends of the femur and tibia are exposed at least. 2 to 3 cm. After pulling open and properly protecting the surrounding soft tissue, use a band saw or a wide bone knife to remove the bone ends. The femur is usually removed first, and then the tibia is removed. When resecting, the contralateral bone ends can be used for mutual protection to avoid damage to soft tissues and important blood vessels and nerves on the posterior side. In addition, you must also pay attention to the following three points: (1) The extent of bone resection should be reduced as much as possible to preserve the maximum length of the limb, but the bone must be completely removed. Therefore, for various bone damage, it should be designed individually. For the less damage, it can be cut off once; if the bone surface of the two ends is not uniformly damaged, it should be filled with the remaining; if there is a large cavity, it can be used for local resection, filling with the humerus or the iliac bone. (2) The functional position of the knee joint fusion is most suitable for micro-flexion of about 10°, but it cannot be laterally angled or twisted. The end of the bone should be in a horizontal position, do not tilt, so as to avoid displacement after pressurization. Therefore, in order to achieve this ideal angle, when sawing the bone, the femoral and humeral bones can be placed at 85° flexion, and then the two articular surfaces are cut at right angles to each other, so that the angle between the cutting plane and the longitudinal axis of the backbone becomes micro. 5 degrees. (3) The bone cutting surface should be flat, so that the contact surface is large, the healing is fast, and the healing is firm. It is relatively easy to operate with a saw, and it can also be removed with a wide flat chisel. 5. Pinning and compression fixation: The femoral and humeral sections are closely aligned, and the lower leg is placed in the neutral position without internal and external rotation and adduction and abduction, and the position is maintained by a special person. The nails of the femoral and tibia should be selected at a distance of 3 to 5 cm from the bone section. The line connecting the upper and lower nail points must be perpendicular to the bone section. Therefore, the nailing point does not have to be in the center of the front and back of the bone, and it can be adjusted to the cutting plane slightly before or after. Before the nail is put, the incision of the skin is firstly combined, and a small mouth is pierced with a knife tip on the skin of the corresponding bone nailing point, and the nail is inserted into the soft tissue of the subcutaneous layer (the femoral nail is from the inside to the outside, and the tibia is from the outside to the inside, so as to avoid Damage nerves, blood vessels). Place the nail tip at the predetermined bone piercing point, gently pry it in with a hammer, or slowly drill it by hand to make it pass through the small incision of the contralateral skin, and make the length of the exposed nails on both sides equal. When entering the nail, attention should be paid to the direction of the nail. The two nails must be parallel and perpendicular to the longitudinal axis of the backbone. Otherwise, the knee, the valgus or the rotation of the thigh and the tibia may occur. Then, put on the knee joint pressure cage, tighten the screws, and pressurize and fix. Generally, the pressure is slightly bent to the steel nail, and the bone cross section is relatively stable without being displaced when the calf is gently raised. Excessive compression can cause bone absorption. Before pressurization, care should be taken not to sandwich soft tissue between the two bones; after pressurization, the alignment of the bone surface should be checked again. If there is bone protrusion, it should be trimmed. If there is a gap, bone graft should be filled. Finally, the wound is rinsed, the tourniquet is released, and the hemostasis is completely sutured, and the plaster is externally fixed.

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