Hip joint anterior dislocation

　　1. Etiology

　　When the lower limb is in excessive abduction and external rotation, the lever action can cause dislocation.

　　2. Pathogenesis

　　The mechanism of anterior hip dislocation mainly includes two aspects. The most common one is the excessive abduction and external rotation of the femoral head, when it reaches a certain degree, the greater trochanter collides with the superior margin of the acetabulum. At this time, a sudden abduction violence or a forward violence on the posterior side of the thigh can tear the anterior joint capsule, causing the femoral head to dislocate anteriorly, such as from a high place or when catching a football in football. Secondly, when the femur is abducted and externally rotated, the violence acting from the lateral side of the thigh to the medial side can also cause anterior hip dislocation. Even when lying on the back, the strong pressure acting on the thigh can cause the femoral head to dislocate forward through the lever action of the iliac and pubic sac ligaments (which constitute the 'Y' ligament), causing anterior dislocation. For example, a mechanic who is lying under a机车 and is suddenly crushed by a falling object can cause anterior dislocation. Bilateral anterior dislocation is an unexpected and rare type.

　　1. Fracture:Hip dislocation may be accompanied by acetabular fracture or femoral head fracture, and occasionally, femoral shaft fracture may occur simultaneously with hip dislocation.

　　2. Vascular injury:The complications of vascular injury are extremely rare, and anterior hip dislocation may occasionally cause compression symptoms of the femoral artery and vein. At this time, immediate reduction under sufficient anesthesia should be performed, and violence should be avoided during manipulation.

　　3. Ischemic necrosis of the femoral head:The inevitable joint capsule tear and patellar ligament rupture due to hip dislocation may affect the blood supply of the femoral head, with 10% to 20% of cases developing ischemic necrosis. Changes can be seen on X-ray films around 12 months, and it has been confirmed that early reduction can shorten the time of femoral head blood circulation damage, which is the most effective method to prevent femoral head necrosis. Clinical manifestations include persistent discomfort in the inguinal region and pain in hip internal rotation, limited movement. If measures are ineffective, necrosis will continue to worsen, eventually leading to severe traumatic arthritis. Severe pain may require joint fusion and artificial joint replacement.

　　4. Traumatic arthritis:This is a late complication, which is an inevitable result of ischemic necrosis. It can also occur in patients with hip dislocation and articular surface fracture. Generally speaking, patients should avoid excessive weight-bearing for 2 to 3 years after reduction of dislocation to delay or alleviate the occurrence of traumatic arthritis.

　　There is a clear history of trauma, the affected limb is in abduction, external rotation and flexion deformity, limb shortening, elastic fixation, swelling at the inguinal or obturator region, and the femoral head can be palpated. Some patients may have shock. X-ray examination: the femoral head can be found near the obturator or pubic ramus.

　　Go to bed early and get up early, exercise the body. Insufficient sleep can reduce the body's immune function and is also prone to excitement and inflammation, leading to external and internal injuries. Maintain a peaceful mind. In spring, it is taboo to be angry, and do not deal with things too hastily. It is necessary to maintain a peaceful mind at all times. Quit smoking, drink less alcohol and coffee. Smoking is most likely to damage the surface barrier of the respiratory tract, triggering disease attacks. Alcohol, tobacco, and coffee will stimulate nerve excitement, and some people want to use them to 'relieve tension and fatigue', but in fact, they weaken the body's resistance to disease. Pay attention to avoid accidental injuries and trauma.

　　In the diagnosis, in addition to relying on the clinical manifestations, auxiliary examinations are also needed. There are no related laboratory tests for this disease. X-ray examination can detect the femoral head near the obturator or superior ramus of the pubis, and the diagnosis can be confirmed. It should be highly regarded by both clinical doctors and patients.

　　1. What foods are good for the body for hip joint anterior dislocation

　　It is advisable to increase nutrition, eat more protein-rich foods such as fish, eggs, and soy products, and appropriately increase calcium. Drink more water, eat more vegetables and fruits such as green vegetables, celery, and bananas.

　　2. What foods should not be eaten best for hip joint dislocation

　　Avoid spicy foods such as chili and mustard. Smoking and drinking should be avoided.

　　(The above information is for reference only; for details, please consult a doctor.)

　　For fresh hip joint anterior dislocation, manual reduction is also the main method. The reduction must be rapid and timely, and attention should be paid to prevent the occurrence of shock. Open reduction is only used when manual reduction fails or when chronic hip joint anterior dislocation has formed.

　　First, manual reduction:

　　1. Addis method:The method of anesthesia is the same as that for hip joint posterior dislocation. The patient lies on his back, the assistant compresses the superior anterior iliac spine downwards, holds the hip and knee of the affected limb to 90°, internally rotates the limb to a neutral position, and applies continuous traction upwards, while gently swinging and internally rotating to slide the femoral head into the acetabulum. While maintaining upward traction, extend and flatten the thigh to a straight position, then the reduction is complete.

　　2. Push-pull method:Anesthesia is the same as before. The patient lies on his back, one assistant holds the pelvis, and another assistant holds the lower leg, flexing the knee to about 90°, gradually increasing the abduction and external rotation of the affected limb while exerting downward traction. The operator stands on the opposite side or between the two hips, pushing the femoral head towards the acetabulum with the palm of the hand, while simultaneously retracting the affected limb under traction. When the sound of the femoral head being reduced into the acetabulum is felt, it is already reduced, and the deformity disappears after the traction is relaxed.

　　3. Rotational method [Bigelow's method]:Anesthesia is the same as before. The operation steps are the opposite of posterior dislocation reduction. ① Abduction and external rotation; ② Repeated flexion of the hip and knee; ③ Adduction; ④ Internal rotation and straightening of the lower limb.

　　4. Postoperative management:Postoperative management is generally similar to that of posterior dislocation, but it is necessary to avoid the abduction of the affected limb when using a plaster trunk, hip brace, or skin traction for fixation.

　　Second, surgical treatment: For fresh or chronic hip joint anterior dislocation that fails to be reduced manually, open reduction can be performed.Surgical procedures use lumbar anesthesia, epidural anesthesia, or general anesthesia. The patient is placed in a supine position, and the pelvic side of the surgical side is elevated with a flat pillow.

　　1. Incision:Modified Smith-Peterson anterolateral incision is adopted.

　　2. Surgical procedure:Starting from the middle of the iliac crest, cut obliquely downward along the iliac crest, to the anterior superior iliac spine. Then push straight towards the patella direction for 15 to 18 cm, and then turn outward and backward to reach the level of the iliotibial band.剥离附着在髂翼内、外板上的肌肉群。内侧为腹内、外斜肌和髂肌，外侧为阔筋膜张肌和臀中、小肌。用纱布填充剥离后的间隙以止血。在髂前上棘下方找到股外侧皮神经，并将其向内牵开。在距髂前上棘约1cm处切断缝匠肌深入，游离股直肌上部，并暴露附着在髂前下棘及髋臼上缘的直头和反折头。在距起点约1cm处，剪断股直肌及其反折部，再将股直肌上部深层游离，注意保留股神经进入股直肌的分支，遂即将已充分游离的股直肌上部反转缝合在切口远端的筋膜上。在股直肌的深层为一层筋膜脂肪组织，其中有旋外动、静脉的分支。游离并结扎旋股外动、静脉的升支和横支，将切断的肌肉翻向下方，并向内侧牵开耻骨肌，即可露出脱位于闭孔或耻骨上支附近的股骨头，及保持完整的髂股韧带和关节囊裂口等。如为陈旧性脱位的病人，局部已被瘢痕、肉芽组织等所充填，股骨头已被瘢痕组织所包埋，髋臼内已有肉芽组织，关节囊已增厚不清。清除这些瘢痕与肉芽组织，切除一部分关节囊，以使股骨头容易复位。先将大腿慢慢内收，使股骨头与闭孔或耻骨上支分离，此时用手按压股骨头并向髋臼内推动，或以骨挺子进行撬动、使股骨头复位。如股骨头已发生缺血性坏死，应行关节融合术或成形术。用生理盐水冲洗切口，彻底止血，缝合切断的肌肉、皮下组织及皮肤。

　　3. Postoperative treatment:After surgery, skin traction should be used for 3 to 4 weeks, but it should be avoided to cause redislocation by the affected limb abduction. The treatment after removing the traction is the same as that of the posterior dislocation open reduction.