anterolateral approach open reduction

Anterior lateral approach for open reduction is used for surgical treatment of congenital dislocation of the hip. Congenital dislocation of the hip is a common hip deformity. The characteristic is that in the first birth, most of the sick children have part of the femoral head out of the acetabulum, and a few are completely detached from the acetabulum. The lesions involve the acetabulum, the femoral head, the joint capsule, and the ligaments and muscles around the hip joint. There are two types of this disease, typical congenital hip dislocation and teratogenic hip dislocation. The latter is rare, and it is a deformity disease in the growth of embryonic organs, often combined with other parts of the deformity such as congenital multiple joint contracture, congenital vertebral vertebral deformity. Typical congenital dislocation of the hip can have different degrees of pathological changes. The lighter one is only the hip joint is loose and unstable, and the severe one has subluxation or complete dislocation. Treatment of diseases: congenital dislocation of the hip and acetabular fracture Indication 1. A sick child who is under 3 years of age. With the extension of walking time, the hip ligament and soft tissue contracture were obvious, and the femoral head moved up. 2. Acetabular dysplasia, acetabular index of 40 ° or more. 3. Close the reset failure. 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 A curved incision was made along the anterior 1/3 of the humerus and the anterior superior iliac spine to 8 cm below the large trochanter, an improved Smith-Peterson curved incision, 15 cm long, and the skin and subcutaneous tissue were cut. 2. Peeling adhesion tissue around the joint capsule Passive separation between the tensor fascia lata and the sartorius muscle. The lateral femoral cutaneous nerve is first exposed on the lateral edge of the sartorius muscle and retracted to the medial side. Longitudinal incision of the humerus and humerus, subperiosteal dissection of the temporomandibular fascia of the external humerus, part of the gluteus medius and gluteal muscles, revealing the upper rim of the acetabulum and the anterior joint capsule. When peeling off the humerus outer plate, the vascular barrier should be ligated or electrocautery to stop bleeding, and the nutrient hole bleeding should be filled with bone wax to stop bleeding. Keep the external motion and vein branches of the cyclone. 3. Cut the rectus femoris tendon and the iliopsoas tendon The proximal end of the rectus femoris was separated, cut at the point close to the straight and oblique head, and a fixed line was sutured to prepare for re-surging the tendon. The iliopsoas muscle sometimes adheres tightly to the anterior side of the joint capsule, and can be bluntly separated. Be careful not to damage the femoral, venous, and femoral nerves. Cut the iliopsoas muscle in the small trochanter. 4. Reveal the hip joint The switch capsule is cut obliquely inward and downward along the outer upper part of the joint capsule to remove the hypertrophic round ligament and the axillary fat tissue in the acetabulum which hinder the reduction of the femoral head. The transverse ligament of the acetabulum has certain limitations on the reduction of the femoral head. It is often necessary to cut or resect and remove the humeral cartilage of the acetabular rim. However, for younger patients, care should be taken to avoid damage to the acetabulum when reversing the inverted lip. The upper margin of the cartilage affects the development of the acetabulum. 5. Trial of femoral head reduction Firstly, the affected limb was placed in the abduction internal rotation position, and the femoral head was restored under direct vision. For example, after the reduction, the pressure between the femoral head and the acetabulum was large, and it was unstable, and the upper end of the femur was shortened and osteotomy. At the same time correct the excessive femoral anteversion. 6. Joint capsule tightening and overlapping suture The excess joint capsule at the top of the acetabulum was trimmed into a triangular flap, and the joint capsule was sutured with a 7-wire suture. Finally, the top of the acetabulum was sutured with a triangular flap, and the unilateral hip or bilateral hip herringbone was fixed after operation.