Westand-toso-hall surgery

Dislocation of the humerus is divided into acute traumatic patellofemoral dislocation, recurrent patellofemoral dislocation and congenital dislocation of the tibia due to local causes of dislocation, degree of deformity and range. From the degree of displacement, it is divided into complete dislocation and incomplete dislocation (ie subluxation). Acute traumatic dislocation of the tibia, often in the joint capsule relaxation, weak femoral muscle weakness, femoral external dysplasia, shallow truncated concave part, flattened tibial articular surface, etc., suddenly suffered external forces, the humerus easily slipped out of the femoral block . In principle, the treatment is to use non-surgical treatment; sometimes a severe knee medial support band and joint capsule rupture require surgery. Recurrent patellofemoral dislocation can occur with a minor trauma or no history of trauma, and dislocation can occur repeatedly, often to the lateral dislocation of the knee. Dislocation often occurs on the basis of knee dysplasia; the soft tissue of the knee is weak, and the soft tissue of the lateral knee is contracted. Sometimes the individual muscle bundles of the lateral femoral muscle directly stop above the humerus; the humerus is small, the lateral part is flat, and the tibia is more High, the lower end of the femur, especially the lateral malleolus dysplasia, knee valgus, external rotation of the humerus, internal rotation of the lower end of the femur. When the knee joint is turned from the straight position to the flexion position, the tibia gradually slides to the outside of the knee. Once dislocated, the knee can not actively extend; if the tibia is controlled in the intercondylar fossa at the knee extension, the knee flexion is difficult or even impossible. Such dislocation non-surgical treatment is difficult to achieve and requires surgery. Congenital dislocation of the tibia is often bilateral, and non-surgical therapy cannot be automatically reset. Because there are many factors causing dislocation of the humerus, and they are different, the treatment should be based on the specific circumstances of the patient, using different surgical methods or several surgical methods to achieve the purpose of treatment. Pay attention to the following principles when choosing a procedure: 1. In order to relieve the traction of the tibia to the outside, all the soft tissues of the outside of the iliac crest, including the tendon bundle, the quadriceps expansion and the joint capsule, should be fully released. 2. Use the tendon shaping method to strengthen the contractile strength of the medial tibia muscle, and if necessary, transplant the semitendinosus to the tibia. 3. Adjust the pulling direction of the knee extension device. If the traction force is not resolved, the dislocation of the patella is still inevitable. 4. When the tibial resection is sutured, it is necessary to pay attention to whether the pulling direction of the knee extension device follows the femoral condyle. If the pulling direction is not correct, it must be adjusted. 5. The dislocation of the humerus caused by knee valgus deformity can be solved by osteotomy. The specific osteotomy site should be carefully designed after X-ray filming. 6. If the articular cartilage is extensively damaged, knee fusion or artificial knee replacement should be considered. 7. In children, if the femoral intercondylar fossa is found to be shallow, there is no need to deepen the operation. It is reported that as long as the humerus is reset, in the case of frequent movement of the knee joint, the intercondylar fossa can be gradually shaped and deepened in the future. Treatment of diseases: dislocation of the humerus Indication Westand-toso-hall surgery is suitable for patients with severe osteoarthritis of the knee, the lower end of the tibia and femur, especially the deformity of the external femoral condyle, knee joint dysfunction, or even complete loss of labor ability. Surgical procedure Incision The U-shaped incision of the knee is performed, starting from the femoral condyle, extending downward, crossing the midline in the plane of the tibial tuberosity, and then bending upward to the lateral femoral condyle, ending at the symmetry of the starting point of the incision. 2. Excision of the tibia and treatment of intra-articular lesions Retract the U-shaped incision flap to the proximal side, make the same U-shaped incision through the quadriceps dilatation part at the distal end of the humerus, use the periosteal stripper or knife to sharply remove the soft tissue around the humerus, remove the tibia, and explore and treat the knee. Intra-articular lesions, if there are free bodies, are removed, the ruptured meniscus needs to be removed, and the cartilage softening of the femoral condyle is flattened. 3. Repair suture defect The lateral joint capsule of the knee and the quadriceps were pulled to the medial side, and the ligamentum and medial joint capsule were sutured and fixed. 4. Fixed The medial femoral muscle is released and pulled to the outside of the knee to cover the gap left by the quadriceps tendon and the humerus, and the surrounding soft tissue is fixed and sutured. The lateral synovium was sutured, but the soft tissue defect was not sutured. 5. Suture incision The incision is sutured in layers.