Adductor origin ischial transposition

Transposition of the adductor muscle isolium for the surgical treatment of hip deformity. The procedure for translocating the origin of the adductor to the ischial for the treatment of paralysis of the hip was first described by Nickel, Perry, Garrett, and Feiwell. It involves translating the starting point of the long rectus muscle and the gracilis muscle to the ischial bone and releasing the starting point of the short-receiving muscle and the anterior portion of the adductor muscle. Couch, DeRosa and Throop, Stephenson and Donovan, Griffin, Wheelhouse, and Shiavi used the procedure for cerebral palsy and thought it was better than other operations involving the adductor muscles to treat hip flexion, adduction, and internal rotation. The deformity is very effective. In addition to reducing hip deformity, the knee flexion deformity and the horseshoe malformation of the ankle are alleviated, and the stability of the pelvis is better, the hip instability is reduced, and the hip flexion contracture is reduced. It can replace the traditional adductor muscle cutting and obturator nerve resection to prevent hip subluxation. Treatment of diseases: dislocation of the hip Indication Adductor contracture, scissors gait or hip subluxation in early childhood. Preoperative preparation Regular preoperative examination. Surgical procedure 1.Couch, Derosa and Throop methods (1) Disinfect the perineum, buttocks, lower abdomen and proximal thighs, and lay a single. The surgeon sits between the legs of the patient. (2) Incision of the skin immediately above the long-necked tendon and extending straight to the ischial tuberosity, parallel to the edge of the subpubic and ischial bones. Cut the skin and subcutaneous tissue, reveal the long tendon and identify with the suture mark, cut off the starting point on the pubic branch with an electric knife, and then use the electric knife to loosen the starting point of the short-receiving muscle and the gracilis muscle. The anterior part of the muscle is dissected to the shiny obturator muscle fascia. Straighten and gently adduct the hip joint, so that the long tendon can reach the ischial tuberosity. (3) Do all the mouth in the bulge of the ischial tuberosity, push the short muscles, the adductor muscles and the gracilis muscles back to the ischial tuberosity, and then push them to the underside of the long tendon. The long rectus muscle is dissociated and straightened at the distal thigh, and sutured to the ischial tuberosity with non-absorbent suture. (4) Thoroughly rinse and suture the incision. 2.Root method (1) In the inner thigh, 1cm outside the inguinal wrinkles, the surface of the long adductor muscle paralleled the inguinal skin to make a surgical incision, the incision extended 6cm backward, and the fascia covering the long adductor muscle was cut to reveal the pubic bone. The branch of the long rectus muscle and the pubic muscle. Identify the gaps between these muscles and find and protect the branches of the obturator nerves. (2) Using an electric knife to cut the gracilis, long adductor and short-receiving muscles along the pubic branch, the subperiosteal peeling tendon is on the pubic branch, but retains the thick fibrous periosteal origin of these muscles. The remnant portion of the blunt exfoliation of the adductor attachment point. Use a vascular clamp to clamp the free periosteal attachment of the tendon, pull it toward the ischial tuberosity, and sew it to the ischial tuberosity with non-absorbent suture, and sew the most distal part of the muscle stop to the front of the ischial tuberosity below. (3) careful electrocoagulation to stop bleeding, routinely suture the incision.