ilium lengthening

Temporomandibular extension is an improved operation of Salter pelvic osteotomy. It is characterized by not only stretching the anterior part of the humerus but also expanding the posterior part of the acetabulum. The trapezoidal gap is implanted into the corresponding trapezoidal bone in the prolonged intercondylar space. When the humeral osteotomy is extended, the contralateral ankle or pubic symphysis is used as the axis, and the acetabular rotation inward and downward will reduce the acetabular inclination and increase the CE angle, resulting in an increase in the femoral head coverage area and the femoral head. With the downward and internal movement, the therapeutic effect of stabilizing the hip joint and increasing the length of the lower limb is achieved. The humerus extension is a one-time extension, generally up to about 3cm. The improvement of postoperative gait is related to the increase of the length of the lower extremity, and also to the internal movement of the femoral head. The abduction of the affected limb and the elevation of the contralateral half of the pelvis are raised upwards, which increases the relative length of the affected limb. The extension of the tibia will increase the muscle strength of the hip abductor muscle, which is beneficial to the improvement of gait. Treatment of diseases: tibia compact osteitis Indication The humerus extension is suitable for: 1. Adolescents with a lower limb length of 3 to 5 cm are better with acetabular Y-shaped cartilage closed, but not more than 25 years old. 2. One side of the lower limb shortening accompanied by ipsilateral acetabular dysplasia or hip joint hemiplegia, this operation is the best choice. Contraindications 1. The lumbosacral muscle contracture, the hip joint has obvious flexion deformity or total dislocation. 2. The length of one side shortened more than 5cm without acetabular dysplasia. Preoperative preparation 1. In addition to the general routine examination of orthopedics, take a full pelvis orthotopic X-ray film for scribing and measurement to calculate its change. 2. Regular blood preparation 300 ~ 400ml. Surgical procedure Incision Make a 12-15 cm incision along the midpoint of the sac. 2. Reveal The fascia is cut between the sartorius muscle and the tensor fascia, and the lateral femoral cutaneous nerve is protected. Cut the sartorius muscle and the rectus femoris straight at the point of attachment and flip it down. The subperiosteal revealed the inner and outer slabs of the upper acetabulum and the large incision of the ischial bone. A curved retractor is placed from the inside and the outside of the humerus, and the two touch the large ischial notch. 3. Osteotomy Use a bending plier to bypass the large isch of the ischium and introduce the wire saw to cut the tibia between the upper and lower iliac spines. Generally, a 8 cm × 3 cm full thickness tibia block was cut behind the ipsilateral anterior superior iliac spine. The ipsilateral sacral dysplasia is taken from the healthy side. 4. Extend After the humerus is cut off, the distractor is inserted into the posterior part of the section. The surgeon gradually opens the osteotomy gap until the required length is reached. The assistant simultaneously pulls the lower limbs, so that the lower humerus section is displaced inward and downward, forming an inner narrow outer Wide trapezoidal extension gap. 5. Bone grafting and internal fixation Cut the bone into 1 piece of 3cm long and 1 piece of 5cm bone. The short bone is implanted inside and the long bone is planted in the lateral space. Note that the bone graft must be trimmed to fit the trapezoidal gap. After removing the spreader, fix it with four-hole steel plate screws. 6. Suture incision Rinse the incision, completely stop bleeding, place negative pressure drainage, suture layer by layer. complication 1. Local hematoma and wound infection The blood supply of the tibia is rich, and the hematoma is easy to form after the osteotomy is extended. Poor drainage can lead to infection. At the end of the operation, it is best to place negative pressure drainage and pressure dressing. 2. Ankle joint injury When the extension of the osteotomy is extended, the rotation of the ipsilateral upper humerus can cause the lower part of the ankle joint to separate, mainly due to excessive extension, but it is also easy to occur in people under 15 years old and over 25 years old. Therefore, care should be taken to strictly control the choice of length and age. 3. Nerve damage Excessive opening clearance is likely to cause nerve damage. Millis (1979) reported a case of prolongation of 3.5 cm, postoperative sciatic nerve palsy, and then reduced the degree of prolapse to 2.5 cm after reoperation to restore. The combination of iliac crest muscle contracture for the extension of the tibia can lead to femoral nerve injury. 4. Extension retraction Mainly due to the fixation of the bone graft is not strong and premature weight bearing. In order to prevent the postoperative bone graft from being compressed, in addition to the thicker bone block should be placed in the back of the trapezoidal bone space under pressure, the tibial bone graft must be firmly fixed and avoid premature weight bearing.