Clark two-dimensional trochanteric osteotomy

Clark two-dimensional trochanter osteotomy for the surgical treatment of femoral condyle spondylolisthesis. For moderate and severe chronic femoral epiphyseal spondylolisthesis, due to the abnormal position of the head and neck, the mechanical mechanism of the hip joint is changed, and the occurrence of degenerative osteoarthritis is inevitable. Through osteotomy, the mechanical relationship of the hip joint is restored as much as possible to delay or delay the occurrence of osteoarthritis. Osteotomy is suitable for the treatment of chronic spondylolisthesis with poor positioning. The difference between chronically dislocated osteophytes and chronic spondylolisthesis is that the former's tarsal plate has merged and no further slippage occurs. However, long-term follow-up results such as Carney and Weinstein showed that the hip function after osteotomy was not as good as that without osteotomy. Therefore, it is recommended that in situ fixation should be used regardless of the degree of spondylolisthesis. The location of osteotomy can be divided into cervical osteotomy at the proximal epiphysis, osteotomy at the base of the femoral neck, and osteotomy at the trochanter. Although the osteotomy of the femoral neck can maximally restore the deformity of the femoral head and neck, the ratio of avascular necrosis of the femoral head is 2% to 100%, and the rate of cartilage dissolution is 3% to 37%. Osteotomy through the femoral neck is now almost no longer used. Treatment of diseases: femoral head necrosis Indication Clark two-dimensional trochanter osteotomy is available for: 1. The femoral skull is a chronic slipper. 2. The femoral skull is slippery and deformed. Surgical procedure 1. Incision and exposure From the anterior superior iliac spine to the outside of the femoral shaft, a 15-20 cm long lateral arc-shaped incision was made to make the tip of the arc bypass the trailing edge of the large trochanter. The fascia lata and lateral femoral muscle were cut along the skin incision to the lateral side of the femoral shaft, and the femoral shaft and small trochanter were removed under the periosteum. Use a sharp periosteal stripper to close the point of the free iliac crest muscle of the bone surface, taking care to avoid damage to the surrounding blood vessels and the sciatic nerve. The outer side of the femoral shaft is exposed on the small trochanter level. The femur here is similar to a rectangle. 2. Wedge osteotomy The front side and the outer side of the femur were judged in the direction of the knee joint, and a trace was drilled at the junction of the two sides as a positioning mark. In the middle level of the small trochanter, a mark is made transversely on the anterior and lateral sides of the femur. From the horizontal line (X"T), make a mark X (XT line) 1.5 cm upward along the positioning mark, and cut a beveled mark (X"X) on the anterior side of the femur as the front upper edge of the wedge-shaped osteotomy block. On the side of the femoral shaft, a mark X' is made 1.3 cm backwards along the horizontal line, and a line is made from X to X', which is the outer upper edge of the wedge-shaped osteotomy block. Includes all of the anterior side of the femur, 1/2 to 2/3 of the lateral side (along the horizontal line). Using a bone saw or sharp bone knife, cut the lateral and anterior bone of the femur along the XX' and XX" lines, intersecting them on the X'-X" line of the transverse, then cutting the bone along the horizontal plane to complete the wedge-shaped bone The interception. A steel needle is drilled into the femoral head in the direction of the small trochanter with the oblique side of the parallel wedge-shaped osteotomy block to control the proximal end of the osteotomy when the lateral plate is fixed. Cut the femur along the horizontal marker and open the small trochanter. 3. Fixed A special pressurizing device is placed over the steel needle at the large trochanter. After the osteotomy surface is pressurized, a special steel plate is bent and placed on the posterolateral side of the large trochanter. Use two 5 cm long cortical screws to screw into the proximal end of the osteotomy. At least one screw should be inserted into the femoral distance, and the other screw can be inserted into the musculoskeletal neck. Screw the other 3 screws through the plate into the distal end of the osteotomy surface. Take out the pressurizing device and fix the steel needle. If the femoral head tarsal plate is not closed, it is necessary to further fix the femoral condyle of the femoral head. Take X-ray films and check the position of the osteotomy and the fixation of the plate screws. 4. Close the incision layer by layer.