hip joint incision and drainage

The position of the hip joint is deep, and there are many anatomical layers. There are important nerves and blood vessels in the vicinity, and the exposure is complicated. The drainage is not easy to be smooth, and should be treated in detail. Treatment of diseases: hip osteoarthritis osteomyelitis Indication 1. After a few days of puncture and flushing, there was no improvement or improvement in systemic and local conditions. 2. Pus viscous or fibrin deposition, can not be used for puncture washing therapy. 3. Arthritis is caused by the spread of adjacent osteomyelitis, and osteomyelitis needs to be treated together. Contraindications There are serious obstacles to the coagulation mechanism. High blood pressure, diabetes, and some bleeding-prone diseases. Preoperative preparation 1. Apply a sufficient amount of sensitive antibiotics to the body for more than 24 hours. If necessary, supportive therapy such as blood transfusion and infusion should be given to improve the body's resistance. 2. Local braking is one of the important measures in the acute phase, which can curb the spread of lesions, relieve pain, prevent deformity and pathological dislocation of joints, and use skin traction or external plaster fixation. The former can also reduce the compression and necrosis of articular cartilage. . 3. It is necessary to perform joint puncture as early as possible, which not only helps to confirm the diagnosis, but also understand the types of pathogenic bacteria and their sensitivity to antibiotics, so as to choose effective antibiotics. 4. Cases should be examined by x-ray examination to understand the damage of bone and joints in order to determine the treatment policy. Surgical procedure 1. Position: prone position. 2. Incision, exposure: It is best to use the posterior incision. The advantage of this incision is that when the patient is supine, the drainage port is at a low position, and the pus outflow is smooth (only for joint incision or negative pressure drainage, or hip abscess combined with anterior lateral abscess, the anterior or Lateral incision). The specific exposure steps can be seen in the way of the hip joint exposure, but the incision should be shortened, and the sciatic nerve should not be injured when exposed. The joint capsule can be revealed by separating the short external rotation muscle layer. 3. Cut the switch capsule and clear the pus: the joint capsule is easy to identify when it is full of pus, and the appearance is bulging, and there is a sense of tension. After the puncture is confirmed, it can be cut longitudinally along the longitudinal axis of the femoral neck or cut into a ten-shaped shape to attract the pus that is poured out. The joint capsule is thoroughly rinsed with a large amount of saline, and the joint space can be inserted into the thin tube to be flushed with water. Pull and rotate the thigh to the outside, partially expose the acetabulum and femoral head, neck, check the destruction of articular cartilage, remove residual cellulose membrane and necrotic, free cartilage fragments, granulation tissue should be scraped. 4. Drainage: Determine the placement of the drainage strip according to the extent of lesion invasion and the nature of the pus. If the joint lesion is lighter, fibrin exudation is less, the joint capsule can be sutured, and 1 or 2 cigarettes are drained outside the capsule. If the synovial inflammation is heavier, the joint capsule and the incision can be sutured by placing two thin plastic tubes in the joint. The plastic tube exposed on the outside of the skin is protected with sterile gauze, and is ready for postoperative irrigation, drainage, and medicinal application. If the joint is severely damaged or the pus is thick, it can be used for intra-articular drainage. The cigarette is drained at the joint capsule incision, and the joint capsule is not sewed, or the open edge of the joint capsule is directly sutured on the gluteal muscle fascia. drainage. The sutured joint capsules were all made of chrome gut. complication Joint pain.