hip dislocation open reduction

Hip dislocation is divided into two categories: anterior dislocation and posterior dislocation. Clinically, it is post-dislocation. In general, the fresh dislocation of the hip joint, regardless of before and after, under the perfect anesthesia, the manual reset is very successful, and the curative effect is good. However, the old dislocation; there are large acetabular fractures or femoral head fractures, thus hindering the fresh dislocation of the manual reduction; or the sciatic nerve injury, or the fresh dislocation of the failure of the manual reduction, all need to be cut open. Old dislocation should also be performed at the same time as open reduction, joint fusion or artificial joint replacement according to the patient's age, occupation and pathological changes of the femoral head. Treatment of diseases: dislocation of the hip before anterior dislocation of the hip Indication Hip dislocation is divided into two categories: anterior dislocation and posterior dislocation. Clinically, it is post-dislocation. In general, the fresh dislocation of the hip joint, regardless of before and after, under the perfect anesthesia, the manual reset is very successful, and the curative effect is good. However, the old dislocation; there are large acetabular fractures or femoral head fractures, thus hindering the fresh dislocation of the manual reduction; or the sciatic nerve injury, or the fresh dislocation of the failure of the manual reduction, all need to be cut open. Old dislocation should also be performed at the same time of open reduction, according to the patient's age, occupation and pathological changes of the femoral head. Such as arthrodesis or artificial joint replacement, due to the lack of anterior dislocation, this section only introduces the open reduction of the posterior dislocation Surgery. Contraindications Older, combined with severe heart, liver, kidney and other diseases and difficult to tolerate surgery. Preoperative preparation 1. Sustained bone traction should be performed for about 1 week before the old dislocation. 2. Selection of exposure pathways: The anterior lateral exposure pathway or the posterior exposure pathway may be used to expose the hip dislocation. The former takes the supine position, and the manual reduction is convenient, but the dislocated femoral head is located behind the humerus, which is relatively deep and difficult to separate. The posterior side is generally exposed to the prone position, revealing the femoral head, sciatic nerve and acetabulum is relatively straightforward and easy; but the manual reset is not convenient. This difficulty can be overcome if the position is changed to the lateral or lateral prone position. Therefore, the anterior dislocation and some do not need to probe the sciatic nerve, do not need the internal fixation of the acetabulum after the fresh dislocation; or although the old dislocation, but the femoral head mobility is greater, you can consider the anterior lateral exposure. Conversely, after dislocation and sciatic nerve injury or large acetabular fracture, or dislocated femoral head above the acetabulum, and the activity is very small, consider the posterior side of the exposure. Surgical procedure 1. Position, incision and exposure: using the anterior lateral exposure pathway (see the lower extremity bone and joint exposure pathway), the patient is supine, the affected side of the lower back and hips are raised, and the operating table is 20 ° ~ 30 °. The anterior lateral incision is performed to remove the muscles in the medial and lateral sides of the humerus from the subperiosteal, and the distal side enters between the sartorius muscle and the tensor fascia, and the rectus femoris muscle, which is the front of the hip joint. When the posterior side is exposed, the patient takes a lateral or lateral prone position, so that the patient's abdomen is at an angle of 45° to the operating table. For the posterior incision, the gluteus maximus muscle, first explore the sciatic nerve, and separate and protect. The piriformis, the obturator muscles, and the superior and inferior temporalis tendons are cut from the greater trochanter and turned to the medial side to see the dislocated femoral head. 2. Separation of the femoral head and neck: When the hip is dislocated after the hip, the femoral head pierces the posterior joint capsule, which is located at the posterior superior side of the acetabulum. When the anterior lateral surface is exposed, the assistant gently turns the injured limb, and the surgeon uses his fingers to ascertain the position of the femoral head and its relationship with the surrounding tissue. Fresh dislocation After clearing the hematoma, look carefully for the reasons that prevent the reduction. Mostly, the displaced fracture block blocks the reduction, or a large joint capsule is involved in the acetabulum. Old dislocations require separation of adhesions around the femoral head and neck. First clear the neck without a strip of cord, you can cut a small mouth in the neck, and then close to the bone gradually separated from the femoral head until the femoral head and neck are free. Should be noted when separating: 1 Do not cut open the joint capsule of the distal 1/3 of the femoral neck to avoid injury to the blood vessels supplying the femoral head and neck; 2 the joint capsule is cut as much as possible to make the joint attached to the acetabulum The capsule is kept 0.5 to 1.0 cm for repair; 3 to avoid damage to the sciatic nerve. Occasionally, when the dislocation is placed, the sciatic nerve is placed in front of the femoral neck. If the cord is touched during separation, it should be carefully separated and identified, or stimulated with a needle, such as no muscle contraction, to prevent damage. When the posterior side is exposed, since the sciatic nerve has been separated and protected, and the femoral head and neck are exposed directly, the switch capsule can be cut under direct vision to gradually separate the adhesion around the femoral head and the neck. If there is a fracture of the upper rim of the acetabulum, the gluteal muscle can be peeled off under the periosteum and enlarged. 3. Clean the acetabulum: externally rotate the injured thigh so that the femoral head does not cover the acetabulum. The hematoma, granulation, scar tissue, small bone fragments and round ligaments in the acetabulum can be used with a knife, scissors or curette. Clear. Be careful not to damage the articular cartilage when removing. 4. Fracture treatment: There are usually three cases of posterior dislocation of the hip joint: 1 completely free small bone, should be removed. 2 femoral head fractures: often avulsion fractures of the round ligament, the defects caused on the femoral head are not on the weight-bearing articular surface, should be removed together with the round ligament, so as not to interfere with the reduction of the femoral head. Even the fracture block with weight-bearing articular surface is better than the reduction. Because the fracture block will cause ischemic necrosis after the reduction, and cause arthritis. 3 acetabular fractures: often triangular fractures of the upper rim of the acetabulum, rotationally displaced to the lateral and anterior sides. After reset, fix with 1 or 2 screws. The screw should be slanted upwards, pointing to the midline of the iliac crest to avoid penetrating the joint. 5. Reset: After separating the adhesion of the femoral head and neck, after thoroughly cleaning the acetabulum, the assistant fixes the pelvis and bends the hip. The surgeon pushes the femoral head with the hand pointing to the acetabulum and can be reset without difficulty. If it cannot be reset, the cause should be ascertained. Generally, the scars and adhesions are not enough, or the femoral head is clamped by the contracted joint capsule, which should be further loosened. At this time, it is forbidden to force the manual reset or use the leverage of the device such as the stripper to reset, so as to avoid the fracture or the damage of the articular cartilage surface. 6. Repair the joint capsule and suture: after the reset, the person maintains the position. Trim the joint capsule and fix it as much as possible. After suspending blood, suture layer by layer. complication joint pain.