Acetabular volume expansion

Acetabular volume expansion is used for the surgical treatment of avascular necrosis of the femoral head. Childhood femoral condyle ischemic necrosis is also known as Legg-Calve-Perthes disease. Although the disease is self-limiting, that is, after the ischemic necrosis of the epiphysis, after pathological processes such as fragmentation, absorption, revascularization and ossification, the femoral condyle is repaired and still. Its natural course takes about 18 to 36 months. Early detection of early treatment of femoral condyle can return to normal, but in most cases, it is found that although the treatment is left with different degrees of deformity, affecting hip function. In severe cases, flat hip deformity can occur and can cause early onset osteoarthritis. Curing disease: Indication 1. Avascular necrosis of the femoral head Catterall III, type IV. 2. The femoral head is enlarged and partially exposed, and the acetabulum is poorly covered by the femoral head. 3. Flat hips. 4. Age 6 years or older. Contraindications 1.Catterall I, Type II 2. Age is small and the tibia does not provide enough bone graft. Preoperative preparation 1. Perform detailed physical examination, blood matching and various laboratory tests before surgery. 2. X-ray films of bilateral anteroposterior and bilateral abduction internal rotation. Surgical procedure Incision The hip joint is revealed using a anterior lateral approach or a Bikini incision. 2. Reveal the rim of the acetabulum and prefabricate the bone groove When the proximal rectus femoris is exposed, the straight head and the retracted head are bluntly separated. Note that the latter is cut at the anterior and muscle junction, the acetabular trailing edge is retained, and placed behind the acetabulum. Side, later used to fix the bone graft, or to thin the thickened joint capsule, use the joint capsule to form a rectangular strip, and keep the posterior side connected to the joint edge as a material for fixing the bone graft. Subsequently, the anterior lateral edge of the acetabulum is determined by a probe, and the upper edge of the acetabular articular cartilage is closely attached, and the site where the bone groove is formed is designed and defined from the front to the back. First drill a hole with a diameter of 4.5mm in the pre-formed bone groove, the depth is about 1cm, then along the bone hole in the upper edge of the acetabulum, bite the cortical bone and cancellous bone with a sharp-nose bite. A bone groove 1 cm deep and 0.5 cm wide. 3. Cut the bone graft and bone graft Along the proximal end of the humerus and the proximal end of the prefabricated bone groove of the acetabulum, a rectangular or rectangular bone strip with a length of 2.5 cm and a width of 1 cm was cut with an arc-shaped osteotome. The bone strip consisted of cortical bone and cancellous bone, and the retention was noted. The inner plate of the humerus. 4. Bone graft A bone strip having a thickness of 0.1 cm, a width of 1 cm and an appropriate length is selected from the cut bone strips, a concave surface is placed downward, placed on the surface of the joint capsule, and one end of the bone graft strip is inserted into the bone groove. Then, the thicker bone graft is placed along the acetabulum direction, that is, at the right angle to the first layer on the surface of the first layer of the bone graft, and then the back of the rectus femoris or the joint capsule cord The posterior aspect is covered on the surface of the second layer of the bone graft, and is tensioned and sutured to the proximal end of the rectus femoris or the joint capsule of the front edge of the graft strip to play a fixed role. Finally, the broken bone pieces are stacked on the surface of the bone graft to promote the fusion of the bone graft and the upper edge of the acetabulum.