Joint retraction in Legg-Perthes disease

The external fixation can be used to treat femur, open humerus, closed fracture and nonunion of the fracture; bone extension technique can treat congenital sacral pseudoarticular, traumatic bone defect, fracture nonunion and joint contracture and complex stiffness horseshoe varus Just wait. The following only describes the application of joint distraction in the treatment of hip joint disease. 1. In the case of avascular necrosis of the femoral head, the cartilage has a high biological activity and tends to grow toward the non-weight bearing area of the hip. 2. After retracting the hip joint, the acetabulum is no longer weight-bearing, providing space for cartilage regeneration, allowing the femoral head to regenerate within the acetabulum, avoiding deformities. 3. While retracting the hip joint, the hip joint subluxation is also reset. 4. Since the hip joint is no longer loaded, the resorption process is guaranteed to continue, avoiding further collapse of the femoral head. 5. Retract the instrument: Select the one-arm outer holder with the "T" clip. Treatment of diseases: femoral head necrosis Indication The joint distraction of Legg-Perthes disease applies to: 1. Avascular necrosis of the femoral head in most older children, including the involvement of the entire femoral head. 2. Can be used in cases of hip joint stiffness. 3. Can be used in the resorption and ossification stage. 4. Can be used in cases where subluxation occurs. 5. The ideal timing of surgery is before the femoral condyle collapses. 6. Can also be used after the femoral condyle collapses. Surgical procedure 1. Advance adductor muscle and iliopsoas muscle release. 2. Insert the guide needle: Under fluoroscopic guidance, the guide needle is drilled through the femoral neck to the center of the acetabulum, and the guide needle is required to be perpendicular to the axis of the femoral shaft. If there is a subluxation, the center is usually located slightly below the center of the femoral head. 3. Install the matching template on the guide pin, and insert the joint shaft on the template into the guide pin during installation. Although the "T" clip is preferred, the "longitudinal" clip can also be selected. 4. Drill the radius needle into the tibia and femur according to the template. The humerus is drilled first, and the cortical bone radius needle is used. The ideal position is the humerus with a higher density at the top of the acetabulum, which is drilled through the inner plate of the humerus. Avoid penetrating the hip joint cavity during needle insertion. First make a small incision on the skin with a scalpel, then use scissors to bluntly separate to the outer plate of the humerus. Insert the radius needle cannula and the nail cone into the outer plate of the humerus through the hole and skin incision on the T clip template. Note that the pin cone has a tendency to slide backwards. After confirming the position, remove the nail cone and use a hammer. Knock the fixed teeth of the cannula into the outer plate of the humerus. 5. Insert the 4.8 mm drill sleeve into the radius needle casing and drill through the tibia outer and inner plates with a 4.8 mm drill bit. 6. Use a T wrench to screw the cortical bone radius needle into the tibia. When it feels like breaking through the inner plate, screw it in for 6 and a half turns. Next screw in the 2nd radius needle. It is usually sufficient to apply 2 radius needles to the tibia, but it can also be screwed into the 3rd to further increase stability. 7. Screw the radius needle into the femur according to the template. The template should be flexed forward by 15° (relative to the axis of the femur) when screwed into the femoral radius needle. For maximum stability, the first and fifth holes in the template should be used. After all the radius pins are screwed in, remove the template and the guide pins, fix the outer holder to the above-mentioned radius pin, tighten the fixing bolts, and finally tighten the cam of the cardan shaft with a torque wrench. 8. Install the compression-spreading assembly and open the hip joint until the hip joint has a 5mm gap, which is approximately 15mm away from the spreader. Lock the twisted hole of the extension rod, remove the compression-distraction assembly, flex the hip and knee joints to 90°, and loosen the skin at the needle eye if necessary. Carefully check the joint activity. If the flexion of the thigh is found, the joint axis on the external fixator does not move, indicating that the hip joint is not moving, but the spine is compensating. If the hip flexion is limited, one condition is an increase in soft tissue tension after distraction; the other is that the joint axis of the outer fixator is not positioned correctly.