Anterior hip incision and lavage

Anterior incision lavage of the hip for surgical treatment of hip septic arthritis. There are four ways of hip incision lavage, namely the anterior side, the lateral side, the posterior side and the medial side. The anterior approach of the hip, because the opening is in front of the hip, does not conform to the principle of low-level drainage, so it is generally not used for the drainage of the open switch. The most common route for low-level drainage is the posterior hip (Ober) incision. If the abscess is on the outside of the hip, it is feasible to open the drainage outside the hip. If the pus is worn from the medial side of the joint capsule to the adductor muscle, drainage should be performed on the medial route. In addition to the medial pathway, the lateral and posterior approaches of the hip can be used to cut the perfusion drainage, and the catheter is used to flush the incision. Curing disease: Indication 1. Early septic arthritis: Incision and drainage of the early suppurative joints, actually cutting the switch joints for cleaning. The operation of placing the drainage tube to suture the joint is different from that of the late stage. 2. In patients with advanced septic arthritis closed drainage can not be controlled, it is to open the drainage, and the open switch section is not sutured. Preoperative preparation For blood-borne septic arthritis, antibiotics are used before surgery to improve the general condition and local fixation. Once the exudate or pus is extracted by the joint puncture, the smear Gram stain is immediately applied to find the bacteria. If it is positive, there is no need to wait. Instead, surgery should be done as soon as possible. For infants and children, those who can not be diagnosed under local anesthesia can be operated according to other signs, joint puncture under anesthesia, and exudate or pus. Surgical procedure 1. Incision and exposure The anterolateral anterior incision was made from the first 1/3 of the iliac crest, and the anterior iliac crest was 10 cm downward. The periosteum was dissected, and the periosteum was pushed open to reveal the outer plate. From the tensor fascia and the sartorius muscle. Deep separation, after incision of the fascia, first find the femoral cutaneous nerve to the medial side, the rectus femoris straight and return to the head from the anterior inferior iliac spine and turn to the far side, to the outside to reveal the joint capsule. 2. Clean up the lesion After exposing the joint capsule, do a "T" shape incision or "Ten" incision, aspirate the joint exudate, check the synovial congestion, and have fibrin strips attached to the cartilage or synovial membrane, no fibrin strips For the early period of pulp exudation, some are stage II. Rotate and adduct the abducted hips to observe the luster and color of the cartilage surface of the femoral head. Remove tissue fragments and exfoliative necrotic cartilage, and wash the joint cavity with saline. 3. Suture joint capsule Place the silicone tube into the upper part of the joint cavity. The tube end should be deep into the posterior part of the joint cavity. Place the tube in the lower part of the joint cavity. 4. Suture incision The incision is sutured layer by layer, and the drainage tube is taken out from the other side of the wound, and the outlet tube should be lower than the irrigation tube. It is fixed with sutures to prevent the tube from coming off. complication Acute septic arthritis is treated with incision and drainage, and the drainage tube is sutured for irrigation. If the inflammation cannot be controlled, the drainage tube is only used, and the joint secretion is not enough, and when the pus is completely, the lumen is easily blocked. If there are joint pains, systemic fever and other inflammatory symptoms, open drainage should be opened.