Anterior approach hip fusion

With the maturity and popularity of hip replacement formation, it has opened up optimistic prospects for restoring hip function, but it is not suitable for joint replacement and shape failure due to age, occupation and disease limitations, such as joint damage caused by trauma and inflammation, bone defect, etc. By. Hip fusion still achieves good gait and satisfactory function. In 1938, after Watsonjone was fixed with a three-wing nail, it was gradually recognized that the internal fixation, the vibrating musculoskeletal bone graft and the osteotomy change line are important conditions for accelerating bone healing. At present, there are few applications for bone grafting alone, and bone grafting and various metal internal fixations, such as steel plate screws, bone bolts and Knowles nails, are widely used. Russul pointed out that internal and external fusion plus metal internal fixation is the best method. The position of hip fusion is generally 20° to 30° flexion, 0° to 5° abduction, and 0° to 15° external rotation. However, the child should be fixed in a straight position. Treatment of diseases: hip joint septic arthritis Indication Anterior Approach Hip Fusion is suitable for: 1. Hip joint tuberculosis causes severe joint damage or deformity. 2. Suppurative arthritis is cured, and the deformity is later. 3. Older hip dislocation, comminuted fractures, young people or manual workers who cannot reconstruct joints. 4. Hip joint dysplasia, pelvic osteotomy or high femur osteotomy failed. 5. Paralyzed dislocation of the hip, as well as congenital dislocation of the hip, is not suitable for joint replacement. 6. Joint replacement or other surgical failure. Contraindications 1. Lumbar vertebrae and lumbar vertebrae are obviously degenerated, pain and stiffness. 2. Hip joint purulent infection active period, ipsilateral knee joint stiffness. 3. The contralateral hip and knee have lesions. 4. Elderly patients with cardiopulmonary dysfunction, metabolic diseases and severe osteoporosis. Surgical procedure Incision Starting from the middle of the iliac crest, the anterior superior iliac spine is turned forward, and stops at the anterior lateral part of the middle thigh, which is 13-15 cm long. 2. Reveal the hip joint The skin, subcutaneous tissue and deep fascia were dissected, and the lateral femoral cutaneous nerve was found at the outer edge of the sartorius muscle at 1 to 1.5 cm below the anterior superior iliac spine, and freely protected. Separate the muscles from the sartorius muscle and the tensor fascia lata muscle, pull it apart from the sides, cut the periosteum along the iliac crest, stick the outside of the tibia, remove the fascia lata tensor and the gluteus medius and small muscles under the periosteum, and gauze stuffing to stop bleeding. . If there is hip flexion contracture deformity, the diaphragm should be peeled off inside the tibia. The gluteal muscle and the tensor fascia lata are pulled outward, and the sartorius muscle is pulled inward, that is, the rectus femoris muscle is seen, and the blunt dissection is separated and the deep circumflex and venous ligation are cut off. The anterior inferior iliac spine and the upper edge of the acetabulum cut the straight rectus straight and the starting point of the inverted head, and turned to the distal side, and the suture was fixed under the wound. It can be seen that the iliotibial muscle in the small trochanter is pulled inward to reveal the hip joint capsule. 3. Excision of cartilage surface bone graft fusion The switch capsule was cut along the hip joint to expose the upper edge of the femoral head, neck and acetabulum, and was peeled off to the periphery with a stripper. The round ligament is cut, the hip is adducted, and the external rotation dislocates the femoral head. The gauze strip is placed on the femoral neck, the femoral head and the acetabular joint cartilage surface are removed, the bone end is trimmed, and the femoral head is restored. Maintain hip flexion 10 ° ~ 15 °, rotate the neutral position, bone graft fixation. The bone grafting methods are: Hibb, Wilson, Ghormley, Hender, and the like. Fill the loose cancellous bone in the gap between the neck and the periphery of the femur. In the case of joint tuberculosis, streptomycin 1 g and isoniazid 100 mg should be placed in the wound. 4. Stitching and fixing Maintain the position of the hip joint, first suture the rectus femoris tendon, and then suture the layers. The hip "person" word is fixed by plaster.