Peroneal tendon supporting ligament reconstruction and bony blocking

The iliac tendon supports ligament reconstruction and bony blockade for the treatment of patellofemoral spondylolisthesis. Skeletal muscle spasm slip is one of the common sites of tendon spondylolisthesis. In the normal state, the long and short tendons of the humerus are stabilized by the upper and lower support ligaments in a curved bone fiber groove on the posterior side of the lateral malleolus. In the case of acute injury, the patellofemoral tendon slippage may be caused by the fracture of the ligament or the fracture of the external malleolus, or may be caused by the shallow or absent lateral groove of the congenital lateral malleolus. After slipping, the long and short tendons of the humerus were displaced to the anterior and lateral 1/3 of the lower tibia. Due to the loss of the fulcrum and the inability to slide effectively, the mechanical effects of the tendon are affected. The acute injury period is mainly characterized by swelling of the soft tissue behind the lateral malleolus, subcutaneous congestion, local tenderness, and weakness of the ankle. However, due to insufficient understanding of the doctor, it is easily misdiagnosed as general soft tissue injury of the ankle and failed to be properly given. In the treatment of the ankle joint, when the ankle joint is stretched, the iliac crest tends to slide forward and form a habitual tendon slip. The treatment is generally based on surgical treatment. The principle is: deepen the posterior bone groove, reconstruct the support ligament or use the bone barrier to prevent the tendon from slipping again, but the early spondylolisthesis can be treated with non-surgical treatment. Placed in a mild flexion varus, so that the iliac crest tendon is returned to the posterior iliac crest, then the partial pad is compressed, and the short leg plaster boots are fixed for 4-6 weeks. Treatment of diseases: sacral muscular atrophy Indication 1. There is pain and spasticity of the iliac crest with obvious dysfunction. 2. Habitual patella tendon slippage. 3. Acute slippage is lost by manual resetting. Contraindications 1. Local skin has ulceration or infection. 2. Unsatisfied with severe bone and joint deformity in the ankle and foot, or difficult to correct at the same time. Preoperative preparation Preoperative routine ankle X-ray examination to rule out bone and joint disorders. Surgical procedure 1. Incision: longitudinally incision at the posterior side of the lower end of the humerus, extending forward along the lower end of the lateral malleolus near the humerus. 2. Repositioning: Retracting the flap, revealing the slippery tendon tendon, not cutting the tendon sheath, and resetting it together with the tendon sheath. Returned to the inside of the lateral sulcus. 3. Deepen the external sulcus and posterior sulcus: If the lateral sulcus is too shallow in the operation, the sulcus can be deepened with a bone knife or a circular chisel, and then the iliac crest tendon is included in the ditch. 4. Repair support ligaments: There are many repair methods, such as taking a fascia strip near the incision and suturing the residual support ligament or the lateral periosteum of the calcaneus; if the ligament defect is more, or the deep fascia is missing, the fascia required can not be made. When the flap is used, a 6cm×0.5cm wide fascia strip can be used to reconstruct the support ligament, and a bone tunnel is drilled in the outer iliac, and one end of the fascia strip is passed through the tunnel, and then folded back to suture itself. The other end crossed the iliac crest in the sulcus and was sutured on the posterolateral periosteum of the tibia. A 5 cm × 0.6 cm raft was also taken on the outside of the Achilles tendon, and the distal end was still attached to the calcaneus. Drill a bone tunnel before and after the lemma, pass the raft through the tunnel, and then fold back to suture itself. 5. Bone blockage: If the posterior sulcus deformity or defect is found during surgery, a 2cm wide wedge-shaped bone block can be taken from the lateral malleolus and moved back 0.5cm in the bone groove to block the patella tendon and prevent it from slipping. The bone block can be fixed with an autogenous bone plug or a screw. 6. Suture the incision: relax the tourniquet, completely stop the bleeding, flush the incision with isotonic saline, and suture the incision according to the layer.