subtrochanteric rotational osteotomy

Rotary osteotomy of the femoral trochanter is a surgical procedure for the treatment of femoral head disease. Patients over the age of 15 should not be subjected to the above operations. For patients with severe deformity, joint instability, and poor weight-bearing lines that cause hip or low back pain, consider improving the weight-bearing line and stability (such as the femoral trochanter). Lower osteotomy or hip fusion, etc.). Treatment of diseases: subtrochanteric fractures of the femur Indication Hip-incision reduction can be performed in patients with sickness within 1.4 to 5 years of age who have failed to undergo manual reduction, or 5 to 9 years old who are not suitable for non-surgical treatment. Older patients with severe pathological changes need to be supplemented with other operations. 2. The acetabulum and femoral head are symmetrical, but the sputum is shallow, and the acetabular angle is less than 45°. The hip bone placement can be performed at the same time as the reduction and reduction; if the acetabular angle is greater than 45°, it should be performed. Acetabuloplasty. 3. The acetabulum is small and shallow, and can not accommodate the femoral head. The acetabular capping should be performed at the same time as the reduction and reduction. At the age of the femoral head dislocation, it is impossible to cut open, the false sputum is shallow, and the joint is not very For stabilizers, consider the in situ false-twisting technique to improve function. 4. If the femoral neck anteversion angle exceeds 45° or the neck dry angle is above 140° (normal anteversion angle is 15°, neck dry angle is 120°130°), it should be performed at the time of hip open reduction or second stage operation. Femoral osteotomy or adduction osteotomy. 5. Adult congenital subluxation of the hip; male children and adolescents with congenital dislocation of the hip is not suitable for pelvic rotary osteotomy, acetabular formation or occlusion, travel pelvic internal osteotomy (chiari surgery). 6. Patients over the age of 15 should not be subjected to the above various operations. For patients with severe deformity, joint instability, and poor weight-bearing line, which may cause hip or low back pain, consider improving the weight-bearing line and stability surgery (such as femoral trochanter). Lower osteotomy or hip fusion, etc.). Preoperative preparation 1. It is very important to routinely perform limb traction before surgery to return the femoral head from the posterior superior aspect of the acetabulum to the acetabular level. Traction can relax the contracted muscles, on the one hand, it can make the operation reset easily and prevent postoperative dislocation; on the other hand, it can reduce the cartilage surface necrosis and avascular necrosis of the femoral head after compression of the femoral head. opportunity. Older, dislocated children can be used for traction; older age should be treated with humeral traction. Generally, the femoral head can be lowered to the acetabular plane after 2 to 3 weeks of traction. After the X-ray film is confirmed, the weight can be appropriately reduced, and the femoral head can be maintained in the plane for 1 to 2 weeks. 2. If the traction of the femoral head is not obvious, it should be checked whether it is caused by the contraction of the femoral or gluteal muscles. In this case, the adductor muscle starting point should be cut or released, and then the limbs should be pulled to meet the traction requirements. Generally speaking, those who are more than 2 to 3 years old need to be cut off and can be released. 3. Preoperative cases were prepared for skin around the hip joint and lower limbs for 3 days. 4. Preoperatively, the anteversion angle, the hip valgus angle, the selected capping site, the hip osteotomy site, and then the surgical design of the femoral or hip bone osteotomy angle and the size of the bone graft should be determined. 5. Prepare blood 200 ~ 600ml. Surgical procedure 1. Correction of the osteotomy: After the bone is cut, the number of rotation angles needs to be corrected. The following two methods can be used: (1) After determining the plane of the osteotomy, the circumference of the femur is the circumference, and a longitudinal bone mark of 90° apart from each other at the outer side of the femoral cortex and the midpoint of the anterior side is drilled [Fig. 1 (1)]. Then, the femur was cut, and the corrected angle of the preoperative design and the intraoperative correction (measured femoral neck anteversion angle -15°) was used to correct the distal segment of the external femur using the indication of the bone mark [Fig. 1 (2)]. (2) Firstly rotate the lower extremity so that the femoral head is facing the center of the acetabulum. The femoral neck is inclined forward by about 15°. A Kirschner wire is drilled in the horizontal position of the femoral neck in the plane of the osteotomy, and the femur is corrected in the plane. Drill a different Kirschner wire in front. The horizontal needle is held in place by a special person to prevent the femoral head from rotating. After the osteotomy or wire saw is sawn, the lower segment of the osteotomy is externally rotated, so that the two needles are at the same level, and the tibia is examined in the forward direction. The connection between the anterior superior iliac spine and the first and second toes is measured through the midpoint of the humerus. Correction is satisfactory. 2. Internal fixation: Fix the side of the femur with a 4-hole plate screw in the rotation correction position, so that the end of the osteotomy is in close contact. 3. Stitching: Rinse the wound and suture the incision in layers. Fixed with hip half-grain plaster. complication infection.