intertrochanteric osteotomy

Intertrochanteric osteotomy is mainly used for old femoral neck fractures, no necrosis of the femoral head, no degenerative changes in the hip joint, and no indication of artificial femoral head replacement. Adults usually use spinal anesthesia or epidural anesthesia, and children underwent basic anesthesia plus fistula anesthesia. Treatment of diseases: femoral neck fracture Indication 1. Old femoral neck fracture, no necrosis of the femoral head, no degenerative changes in the hip joint and no indication of artificial femoral head replacement. Intertrochanteric osteotomy can be used. 2. Due to trauma or inflammation, the hip joint is straightened to the non-functional position, the primary lesion has been static, and the general condition or local soft tissue is not suitable for arthroplasty. It is advisable to perform an intertrochanteric osteotomy. 3. Hip osteoarthritis with adductal malformation, or severe pain, affecting function, commonly used under the osteotomy. 4. Others such as hip varus, femoral head spasm, congenital or old traumatic hip dislocation, etc., can also be used to improve the function or reduce pain. Preoperative preparation 1. The indications should be carefully selected according to the patient's age, occupation, general condition and local conditions before surgery. For example, the most common old femoral neck fractures, such as osteotomy, angioplasty, fusion, artificial joint replacement and other surgical methods are available, each with its indications. The osteotomy is relatively simple, the patient's burden is relatively light, the equipment requirements are not complicated, and all osteosynthesis is ineffective, and other operations can still be considered. 2. Rotor section osteotomy can only correct deformities and change force lines to improve function; but it is impossible to fully restore function. Therefore, the purpose of the osteotomy and the expected effect can be explained to the patient before surgery. 3. For patients with muscle contracture, joint dislocation and fracture end displacement, bone traction or soft tissue contraction should be performed before surgery to overcome limb shortening and soft tissue contracture. Patients with severe skin scars in the operation area should be removed and repaired with a flap. 4. Take x-rays, understand the position of the femoral head, neck, force line changes and acetabular conditions, in order to carefully design the surgical plan to determine the location of the bone and correct the angle. Surgical procedure 1. Position: In addition to the severe deformity of the hip joint, it is necessary to take a special position, generally taking the supine position. It is best to perform surgery on a special orthopaedic operating table to prevent the patient from moving the bone when the cast is fixed. 2. Incision, exposure: With the lateral femoral incision, the skin and subcutaneous tissue were cut, the tensor fascia lata and the fascia lata were cut, and the lateral femoral muscle was cut longitudinally to reach the periosteum. Subperiosteal dissection of the anterior and posterior sides of the femur reveals the femoral rotor. It can also be separated from the posterior muscle of the lateral femoral muscle, and the lateral femoral muscle can be pulled forward to expose the rotor [see the lower extremity bone joint exposure pathway). 3. Incision: After the humerus plate is opened and the soft tissue is protected, a finger is inserted along the front of the femur, and the small rotor is touched on the posterior side of the femur, and a mark is engraved on the lateral side of the femur in the same plane as the small trochanter. From this point, a line obliquely to the upper edge of the small rotor is the osteotomy line. Along the bone cutting line, drill a row of holes with your hand to prevent the bones from splitting when you cut the bone. Then use this sharp bone knife (the width of the bone knife should be similar to the anterior and posterior diameter of the femur) to gently cut the femur, push the distal end to the inner side about 2cm (about 1/2 of the distal section), and abduct the limb About 15°. After hemostasis, suture layer by layer. After the operation is completed, the patient is not moved, and the hip herringbone is fixed to fix the affected limb in the functional position. 4. Internal fixation: If the patient is old, has heart, lung disease, and is unbearable for long-term external fixation of the plaster, after the bone is cut, it is fixed with a rotor steel plate or an angled pointed steel plate and a screw. Then rinse the suture. The affected limb is used for skin traction.