Three iliac osteotomies

Three humeral osteotomy for the surgical treatment of congenital dislocation of the hip. In 1973, Steel created three humeral osteotomy to cut the humerus, pubic symphysis and ischial branch above the acetabulum, so that the acetabular folds were free and could be rotated more fully. Place the femoral head to create a stable hip joint that conforms to the anatomical relationship. Treatment of diseases: tibia compact osteitis, compact osteitis Indication Three tibia osteotomy procedures are available for patients with 7 to 17 years of hip dislocation who have failed treatment in other ways. Due to the complexity of operation, extensive trauma, and the inability to change the size and depth of the acetabulum, it is generally not preferred. For older, semi-dislocated femoral head insufficiency or lateral osteoarthritis, it is easier to cover the acetabulum with this osteotomy. Contraindications 1. Poor general condition and infection of the skin in the surgical area. 2. The femoral head does not reach the position of the acetabulum relative to the plane. 3. The head is large and small, and the joint surface is inconsistent. 4. Hip joint mobility is significantly limited. 5. Being too old. Preoperative preparation 1. It is necessary to perform limb traction before traction. Unless the femoral shortening is performed at the same time. Traction can: 1 contracture soft tissue relaxation, surgery easy to reset; 2 after the reduction of the femoral head stability, to prevent re-dislocation due to muscle contracture; 3 reduce the pressure between the femoral head and acetabulum after surgery, to prevent cartilage surface compression Necrosis and aseptic necrosis of the femoral head. In addition to the lower than 3 years of age and the upward displacement of the femoral head can be used for skin traction, generally using Kirschner wire for the treatment of lower bones of the tibia and fibula. For those with high dislocation, the Kirschner wire should be used for traction. Raise the bed 10 to 20 cm when pulling, as a counter traction. The direction of traction should be slightly buckling of the hip, consistent with the longitudinal axis of the trunk or a slight internal traction. If the affected limb is pulled in the outreach position, the femoral head is blocked on the tibia and cannot be pulled down. When the femoral head is brought to the acetabular plane, the affected hip can gradually abduct and straighten to pull the contracted soft tissue. The weight of the traction starts with 2 to 3 kg, and then gradually increases, generally not more than 7 to 8 kg. The traction time is 2 to 4 weeks. If the femoral head is not enough, the time can be extended appropriately. The age and pathology of the sick children are different, and the required traction weight and time are also different. During the traction process, the length of the two lower limbs should be measured. Check whether the groin can touch the femoral head. After 2 weeks of traction, take X-rays once a week to determine the position of the femoral head. Surgery can be performed after the femoral head has descended to the acetabular plane and is maintained for 1 to 2 weeks. If the procedure of simultaneous femoral shortening is used, traction therapy is not required before surgery. 2. Do a good job in the general condition and skin preparation in the operating area. 3. Preparation of blood If it is estimated that the operation is difficult or needs to be added to other operations at the same time, it should be matched with blood 300-600ml. 4. The bladder must be emptied or indwelled before surgery. Surgical procedure Ischial osteotomy Make a mouth length of 7 to 8 cm at 1 cm on the hip line, and the incision is perpendicular to the long axis of the femur. The gluteus maximus was retracted to the lateral side, and the hamstring nodule was exposed at the sciatic nodule where the biceps muscle was sharply exfoliated to reveal a gap between the semimembranosus and the semitendinosus. The sciatic nerve is located on the outside, pay attention to protection, and generally will not be damaged. Insert a curved hemostat between the semimembranosus and the semitendinosus muscle, close to the ischial bone, enter the obturator, lift the obturator muscle and the obturator muscle, and make the hemostat end from the ischial bone The edge is exposed. Point the bone knife to the posterolateral side and form a 45° perpendicular to the vertical surface of the ischial bone to completely cut the ischial bone. The biceps muscles are returned to their original position. The gluteus maximus is sewn to the deep fascia and the skin is sutured. 2. Tibia and pubic osteotomy Replace the surgical gown, gloves and surgical instruments, re-sterilize the paving, pass the anterior hip approach, open the diaphragm and gluteal muscles from the iliac wing, and peel off the sartorius muscle. The anterior superior iliac spine was removed from the lateral attachment of the inguinal ligament and turned inward. The diaphragm and lumbar muscles are removed from the medial periosteum of the pelvis, thus protecting the nerve and vascular bundles of the thigh. Cut off the sacral part of the iliopsoas muscle and reveal the pubic tuberosity. The pubic symphysis was dissected under the periosteum. A curved hemostatic forceps was placed in the closed hole at 1 cm in the pubic tuberosity. The obturator was placed through the obturator fascia, and the tip of the hemostat was passed out from the lower edge of the pubis. If the pubic bone is particularly thick, the second hemostatic forceps can be inserted into the lower edge of the pubic bone to reach the first hemostat. The osteosynthesis was cut by aligning the osteotome with the posterior medial side and 15° from the vertical. The open reduction was performed according to the anterior approach and the patella osteotomy was performed according to the Salter method. 3. Rotation and fixation of the acetabular part After completion of the tibia, pubic and ischial osteotomy, the periosteum and fascia were separated from the inner wall of the pelvis, and the acetabular segment was freed. Use the towel clamp to hold the anterior inferior iliac spine and rotate forward and outward to the position that covers the femoral head. The triangular bone piece removed from the humerus was inserted into the gap opened by the tibial osteotomy and fixed with two Kirschner wires. The joint capsule was sutured and the wound was sutured in layers.