medial approach open reduction

Medial approach open reduction is used for surgical treatment of congenital dislocation of the hip. The surgical approach of the medial incision approach was initiated by Ludloff in 1908. In 1973, Ferguson et al. considered that this procedure had the advantages of small tissue damage, simple operation, and less bleeding. However, due to inadequate surgical exposure, the loose joint capsule cannot be treated well and there is a risk of damage to the internal iliac artery. Therefore, about 40% of the sick children need reoperation, such as pelvic osteotomy and osteotomy of the upper femur. Surgery. The operation was very popular in the 1970s and has been replaced by other surgical methods in recent years. Treatment of diseases: congenital dislocation of the hip Indication Congenital dislocation of the hip within 1.1 years of age, the femoral head dislocation is not much, the acetabulum has no obvious secondary lesions. 2. Very unstable after closed reset. 3. Arthrography found that there are obvious blocking factors in the joint affecting the reset. Contraindications 1. Secondary lesions are severe, such as excessive relaxation of the joint capsule. The dislocation of the femoral head is higher, and the posterior wall of the joint capsule adheres to the outer plate of the tibia. 2. Teratogenic hip dislocation. Surgical procedure Incision Suffering from hip flexion 70°80° and abduction 30°45°, making a longitudinal or oblique incision along the posterior side of the adductor longus, extending 6~8cm from the adductor nodules. 2. Cut off the iliopsoas Incision of the skin to separate the subcutaneous tissue and deep fascia, cut off the end of the adductor longissimus and turn it down, and pull the pubis muscle downward, to avoid damage to the obstructed nerve branches and blood vessels, bluntly separate the adductor muscle gap, directly to the femur The trochanter and the iliopsoas are attached, and the iliopsoas muscle is picked up with a curved forceps, and the iliac crest muscle is cut at the sacral attachment point. 3. Exposing the joint capsule Separate the tissue around the joint capsule, pay attention to protect or ligature the inner branch of the circumflex femoral artery, touch the femoral head, and cut the switch capsule along the longitudinal axis of the femoral neck. Clearing the acetabulum to hinder the reduction of the tissue, such as the removal of the long round ligament, the transverse ligament of the lower acetabulum can also be cut. However, the inverted lip does not have to be removed. The hip joint was abducted by 30°, flexed by 15°, and internally rotated by 20° to reposition the femoral head, and then the joint capsule was sutured by overlapping the 7-gauge double-wire.