Replacement Quadriceps Surgery
For quadriceps tendon caused by various reasons, quadriceps surgery can be used to strengthen the quadriceps muscle strength and correct knee flexion deformity. Hip and knee joint activities are organically combined. Before performing quadriceps surgery, the muscle strength of each group of lower limbs should be examined in detail, and the balance of muscle strength of each group after surgery should be predicted. For example, when the gluteus maximus is completely paralyzed and the hip joint cannot be stabilized, the quadruplex surgery alone cannot be effective; the patient with quadriceps tendon often controls the extension of the knee joint with the contraction of the gastrocnemius muscle to maintain a certain degree. Stable, such as gastrocnemius tendon at the same time, will cause severe overextension of the knee after surgery on the quadriceps. Therefore, when the gluteus maximus and gastrocnemius muscle have spasm, it is not appropriate to use this surgery alone. At the same time, if there are severe hip, ankle, and foot deformities, surgery should be performed after correction. Usually two sets of muscle metastases are used to create quadriceps, biceps and semitendinosus, sartorius muscle and tensor fascia. The former is more commonly used. Treatment of diseases: quadriceps tendon rupture Indication For quadriceps tendon caused by various reasons, quadriceps surgery can be used to strengthen the quadriceps muscle strength and correct knee flexion deformity. Hip and knee joint activities are organically combined. Before performing quadriceps surgery, the muscle strength of each group of lower limbs should be examined in detail, and the balance of muscle strength of each group after surgery should be predicted. For example, when the gluteus maximus is completely paralyzed and the hip joint cannot be stabilized, the quadruplex surgery alone cannot be effective; the patient with quadriceps tendon often controls the extension of the knee joint with the contraction of the gastrocnemius muscle to maintain a certain degree. Stable, such as gastrocnemius tendon at the same time, will cause severe overextension of the knee after surgery on the quadriceps. Therefore, when the gluteus maximus and gastrocnemius muscle have spasm, it is not appropriate to use this surgery alone. At the same time, if there are severe hip, ankle, and foot deformities, surgery should be performed after correction. Usually two sets of muscle metastases are used to create quadriceps, biceps and semitendinosus, sartorius muscle and tensor fascia. The former is more commonly used. Preoperative preparation 1. If there are severe hip, ankle, and foot deformities, they should be corrected before surgery or corrected at the same time. Patients with quadriceps tendon need more contraction of the gastrocnemius muscle to maintain knee stability, long-term achilles tendon shortening and secondary tendon deformity, and should be corrected by Achilles tendon extension. 2. Mild flexion or other contracture deformity of the knee joint must be corrected before surgery. Surgical procedure 1. Position: supine position. 2. Incision: A total of 3 incisions are required: Incision 1: longitudinally on the lateral side of the lower part of the femoral, biceps tendon, 6 to 8 cm long; Incision 2: longitudinally cut at the inner side of the lower part of the femoral and semitendinosus, length 6-8 cm; Incision 3: longitudinally in the middle of the knee and in front of the tibia, about 3 cm long. 3. Isolation and transfer of the biceps tendon: The incision 1 was pulled open with a four-claw hook to reveal the lateral femoral muscle and the deep fascia. Cut the deep fascia, which reveals the biceps femoris. Separate the biceps tendon and use a gauze band to lift it up. The common peroneal nerve can be seen on the posterior and medial side of the biceps tendon, taking care to avoid injury. Try to separate the biceps femoris to the humeral head. Here, the biceps tendon is fixed in a fan shape, that is, it is cut at the stop point with a sharp-edged knife, but be careful not to damage the lateral collateral ligament of the knee. Flip up the muscle flap and try to separate the biceps femoris as far as possible until the blood vessels and nerves of the biceps muscles are supplied, and pay attention to protection to avoid damage. A straight subcutaneous tunnel is made from the incision 1 to the incision 3, and the tendon is pulled out from the incision 3 by the incision 1 through the subcutaneous tunnel. 4. Isolation and transfer of the semitendinosus tendon: retract the incision of the incision 2, taking care not to damage the great saphenous vein. After cutting the deep fascia, you can see the three muscles from the front to the back as the sartorius muscle, the thin femoral and the semitendinosus, and the semitendinosus tendon is the thinnest and longest. Pull the gracilis and sartorius muscles forward, separate the semitendinosus muscles to the point where it is inside the humeral trochanter, cut with a sharp-edged knife, and separate the semitendinosus abdomen as far as possible. A straight subcutaneous tunnel is made from the incision 2 to the incision 3, whereby the semitendinosus tendon is pulled out of the incision 3 from the incision 2. 5. Fixing the tendon: Cut the periosteum of the tibia with a work shape, and use the periosteal stripper to peel the periosteum to the left and right to reveal the tibia bone. Drilling from the medial edge of the upper half of the humerus to the lateral edge to make the tunnel of the humerus, it is important to note that the callus between the two holes cannot be broken. The suture is cut at the end of the semitendinosus tendon, and the suture and tendon are guided from the inside to the outside through the tunnel to form a u-shaped sputum. The broken end is overlapped with the biceps tendon and then sutured. Tighten to a certain tension), then suture intermittently between the proximal ankles, and sew into the dilated part of the quadriceps to strengthen the fixation. Finally, the incisions are sutured separately.
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