Pemberton pericapsular iliac osteotomy

Percutaneous osteotomy of the Pemberton joint capsule for the treatment of congenital dislocation of the hip. This procedure was first reported by Pemberton in 1965. He believes that the factors affecting the instability of congenital hip dislocation are abnormal acetabular orientation and asymmetry of head lice. He proposed that the structure of the Y-shaped cartilage is soft, with it as the axis, the iliac osteotomy outside the joint capsule, rotating the acetabulum forward and downward, changing the orientation and depth of the acetabulum, so that the size and shape of the acetabulum are obtained. Remodeling. The ability of this procedure to remodel the acetabulum is greater than that of the Salter procedure, but its operation is more difficult. Treatment of diseases: congenital dislocation of the hip Indication Peribular osteotomy around the Pemberton joint capsule is suitable for hip dislocation and subluxation of 1 to 14 years old (ie, Y-shaped cartilage closure age) for the first treatment or previous treatment failure and acetabular dysplasia The bone and the acetabulum are obviously asymmetrical. Contraindications 1. Poor general condition and infection in the skin of the surgical area. 2. The femoral head does not reach the relative horizontal position of the acetabulum. 3. Hip joint mobility is significantly limited. Preoperative preparation 1. Traction: It is necessary to perform limb traction before surgery. 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. 2. Do a good job in the general condition and skin preparation in the operating area. 3. Preparing blood: If it is estimated that the operation is difficult or needs to be done at the same time, it should be matched with blood 300-600ml. Surgical procedure General anesthesia or basic anesthesia plus epidural anesthesia or basic anesthesia plus fistula anesthesia. In the supine position, the affected side of the buttocks and the back are raised so that the body is tilted 30° to the healthy side. Incision Starting from the middle of the sacral section, an arc-shaped incision was made, and the anterior superior iliac spine was extended 6 to 8 cm downward in the gap between the sartorius muscle and the tensor fascia. 2. Expose the joints and clear the pathological factors that hinder the reduction Same as "Salter tibia osteotomy". 3. Osteotomy Two periosteal strippers were extended along the periosteum in the medial and lateral humerus to the large ischial notch to reveal the medial and lateral humerus of the tibia. Fully exfoliate to confirm the joint capsule at the acne of the true acetabular rim. Osteotomy with a curved bone knife. Starting from the top of the anterior iliac spine, 1 cm above the hip joint capsule is parallel to the joint capsule, and the posterior cortical bone of the humerus is cut obliquely, until the stripper at the large notch of the ischial bone, and then The edge of the osteotomy knife is turned down, parallel to the long axis of the body, and then cut down 1.5cm deep, reaching the center of the humerus branch of the Y-shaped cartilage, that is, the cortical bone of the lateral hip bone is cut. Next, the medial cortical bone of the humerus was opened on the anterior iliac spine, and the osteotomy line was parallel to the osteotomy line of the lateral cortical bone, and the Y-shaped cartilage was directly posterior. Correction of the acetabular direction after osteotomy is controlled by the different osteotomy depths of the medial cortical bone of the posterior tibial osteotomy. For example, if the osteotomy of the medial cortical bone is more in front, the acetabular apex will rotate less forward; on the contrary, if the osteotomy is later, the acetabular apex will rotate more forward. When the medial and lateral cortical bones are completely dissected, insert a wide curved bone knife between the upper and lower osteotomy, and slide the distal bone block downward until the leading edge of the two humerus is at least 2.5 to 3 cm. the distance. Then, a narrow groove in the front-rear direction is cut into each of the rough surfaces of the split tibia. A wedge-shaped bone piece is taken from the upper anterior superior iliac spine, and the bone piece is embedded in the groove on both rough surfaces of the humerus, so that it is firmly embedded, the acetabulum is kept in a corrected position, and the femoral head is restored. 4. Stitching The rectus femoris muscle is sutured. If there is tension, the rectus femoris muscle can be sutured at the beginning of the straight head. The humerus humerus is sutured in situ, and the deep fascia, subcutaneous and skin are sutured layer by layer.