ilioplasty

The pemberton operation is performed on the humerus of the upper part of the acetabulum. The bone is cut around the joint capsule, and the y-shaped cartilage is deep. The acetabular body is used as a hinge to push the upper part of the acetabulum forward and outward. , change the direction of the top of the tendon to stabilize the femoral head in the ankle. Treatment of diseases: femoral skull and tibial rickets Indication 1. Congenital dislocation of the hip, subluxation, combined with acetabular dysplasia, the femoral head can be towed to the yy line level. 2. Reducible congenital dislocation of the hip, large femoral head, small and shallow acetabulum, disproportionate head lice, or shallow acetabular acetabulum and acetabular angle exceeding 45°. Contraindications Those who are old and weak and whose physical fitness is not fake are careful. Preoperative preparation 1. Bone traction of the affected limb, so that the femoral head is pulled to the level of the acetabular y-shaped cartilage or below (confirmed by x-ray film). More than 3 years old, the method of traction and adductor muscle tension should be performed first. If the femoral head does not descend to the level of the y-shaped cartilage after traction, the lowering of the hip and the small muscles should be assisted. 2. Preoperative blood matching. 3. Prepare to pull the operating table and keep the operation under traction. Surgical procedure 1. Position, incision, exposure: use the anterior lateral approach of the hip joint (see the hip joint exposure pathway). The lower limbs are fixed on the traction foot plate of the traction operating table, and the perineum is placed on the column for reverse traction. After the incision, it is required to expose the inner and outer sides of the tibia of the tibia to reach the front and rear of the large ischial notch. 2. Open reduction: T-shaped incision on the anterior side of the joint capsule. Observe the shape of the joint capsule, the thickness of the capsule wall, the shape and size of the femoral head, and the shape of the acetabulum. Clear any soft tissue in the acetabulum that affects the reduction, such as: fatty fibers in the acetabulum, round ligaments, varus varus in the acetabular rim, and transverse ligaments in the infraorbital margin. The hip joint was removed under direct vision and the radiographic examination confirmed that the femoral head had fallen to the required level and reached the correct position within the acetabulum. It can be seen that there is a gap between the femoral head and the acetabulum, which is the height at which the acetabulum should descend. The value of the femoral neck anteversion angle should be measured again during the operation. If the anteversion angle is greater than 45°, the under-orbital bone correction should be performed (see under-rotor osteotomy). 3. Joint capsule formation: After reduction, the upper part of the hip joint is thickened and the excess joint capsule tissue is removed. The joint capsule that attaches the anterior, superior, and posterior acetabular rims is only 0.5 cm thick. 4. Acetabular formation: Insert the sciatic large incision under the periosteum with a toothed hip hook before and after the acetabulum to expose the inner and outer humerus. At the joint capsule edge (0.5 cm above the acetabular rim), a curved osteotomy line was made with a bone knife parallel to the acetabular rim. Then use the acetabular chisel to cut the bone along the line and until the y-shaped cartilage near the center of the acetabulum. While chiseling in, press forward and outward, gradually enlarge the intervertebral space of the outer plate to change the direction of the acetabulum. Finally, the y-shaped cartilage is used as the rotating hinge, and the acetabulum is pressed forward and outward, so that the acetabulum is moderately inclined to the front side, completely covering the femoral head, the sacral space disappears, and the acetabular index reaches zero. If the front side is not tilted enough, the cut bone end behind the humerus can be extended backward. 5. Bone graft: Cut the appropriate size of the triangular bone in the upper 1/3 of the anterior aspect of the humerus. A shallow bone groove is made on the lower part of the osteotomy, and the bone graft is trimmed and inserted into the space of the osteotomy along the trough to the vicinity of the y-shaped cartilage. Usually, the osteotomy gap is enlarged to 2.5 to 3 cm, and the residual space after bone grafting is filled with broken bone. If the bone graft is unstable after insertion, it can be fixed with 1 or 2 needles of Kirschner wire. At this time, the x-ray film should be confirmed to have a good reset, and the acetabular direction is satisfactory to end the operation. If there are any deficiencies, they should be corrected in time. 6. Stitching: Wash the incision thoroughly, soak the incision with 1:1000 benzalkonium solution for 5 minutes, rinse with normal saline, and absorb. The joint capsule was sutured and overlapped, and a certain tension was maintained. The catheter was placed in the incision with a No. 14 catheter, and the skin was taken out by a small incision for negative pressure suction. The incision was sutured layer by layer. 7. Gypsum external fixation: continue to carry out the hip-shaped gypsum fixation under the traction, or the semi-tilt plaster fixed, the upper edge needs to reach the milk line, down to the toe. The bone traction needle is fixed in the plaster to ensure no deformation after the acetabular formation and reduce the pressure on the femoral head.