Acetabular capping

The acetabular capping procedure is an effective operation for the acetabular sac that is shallow and small, and the anterior, superior, and posterior margins cannot cover the congenital dislocation of the femoral head. Surgery is an artificial method of bone grafting on the upper semicircle of the acetabulum to widen, deepen the acetabulum and stabilize the joint. Treatment of diseases: acetabular fractures 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.). Contraindications Older, combined with severe heart, liver, kidney and other diseases and difficult to tolerate surgery. Preoperative preparation 1. Prepare the sterilized bone traction needle, bow, and rope for traction during operation. Surgery should be performed on the orthopedic surgery bed to prepare the perineum column and the foot traction frame. 2. During the operation, you must take x-ray film. Surgical procedure 1. Position: supine position, the sick side buttocks are 30° high. 2. Incision, exposure: can be exposed by the anterolateral or lateral incision of the hip joint (see the hip joint exposure pathway). Note that when the skin is sterilized and wrapped, the tibial trochanter is exposed for bone traction. 3. Acetabular capping: After the reduction and reduction, the excess joint capsule above is removed, but the joint capsule 1~1.5cm wide outside the iliac margin is required to cover the femoral head, and the joint capsule is thinned to 2mm and then sutured. (Too thick will make the gap between the bone graft and the femoral head too wide and prone to dislocation). If the acetabulum is too shallow and needs to be oversized, the humeral trochanter should be used for bone traction. The perineal column is reversed, so that the femoral head is lowered and maintained in the best plane. If necessary, confirm the photo. . Then, along the upper part of the acetabulum, the joint capsule is stopped 2 cm away from the hip bone, and a circular cut is used to cut a circular mark (the width should be able to cover the femoral head cartilage part), first cut along the hip bone surface 2 ~3mm thick bone piece, pressing down the chisel edge, making it a bone flap covering the femoral head with most incomplete fractures; if there is acetabular dysplasia, when the ossicle reaches the upper edge of the acetabulum, it goes inward along the dome Cut in until it is close to the femoral head. The fissures implanted under the humerus were embedded in the fissures. If they were unstable, they were fixed with K-wires. Finally, the x-rays were confirmed to be satisfactory, and the acetabular angles were reduced to normal. If the x-slice shows dissatisfaction, it should be adjusted until it is satisfactory. If the dislocation of the adult has not been reset, the soft tissue should be loosened before surgery. After the incision is revealed, the traction is performed during the operation, and the femoral head is pulled and maintained at the lowest plane under direct vision. Separate between the femoral head and the outside of the tibia until the point of contact. According to the size of the femoral head, the upper semicircular pedicled bone flap covering the femoral head is designed on the humerus surface or the false iliac crest. Because the bone flap is fan-shaped, it can be divided into 2 to 3 flaps and covered by the front method. The fissure is taken from the humerus in a thousand layers of cake, and finally the wedge-shaped sputum is used to fill the implant. The pedicled bone flap can also be perforated with a silk thread attached to the nearby joint capsule. 4. Stitching and external fixation: suture the iliopsoas tendon and the rectus femoris muscle after careful hemostasis. The adult false sputum apex only reveals that the tendon does not need to be sutured outside the humerus, and the incision is sutured layer by layer to keep the limb flexed slightly in the hip. Internal rotation and outreach position, knee joint extension position, for semi-tild plaster fixation. complication joint pain.