What Is Rotationplasty?

Rotation angioplasty is used for the surgical treatment of congenital femoral hypoplasia.

Rotational angioplasty

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Rotation angioplasty is used for the surgical treatment of congenital femoral hypoplasia.

Chinese name

Rotational angioplasty

Foreign name

rotationplasty

Knee Arthroplasty; Van Nes Surgery

Pediatric Surgery / Congenital Lower Limb Deformation / Congenital Femoral Aplasia

81.21

Congenital hypoplasia of the femur is currently referred to as proximal femoral focal deficiency (PFFD). The incidence is 1 in 50,000 live babies. Focal defects of the proximal femur include a wide range of defects. Mild femurs show mild femoral dysplasia and severe femoral bones can cause complete femoral hypoplasia. The most common manifestations of PFFD are bone defects in the proximal part of the femur, hip instability, limb shortening, and abnormalities in other parts. Most children with PFFD disease, especially those with bilateral lesions, are associated with deformities such as fibula hemi-limb deformities and knee cruciate ligament hypoplasia, congenital valgus, congenital heart abnormalities, congenital spinal dysplasia and facial development bad.

The classification of focal femoral defects is as follows:

Aitken four-type classification (A, B, C, D) is one of the earliest classification methods:

Type A: The femoral head and acetabulum are normal, the femoral shortening is deformed, and the early X-ray film shows the absence of the femoral neck. With age, the cartilage femoral neck may ossify and heal itself, and it may also form pseudo joints. X-ray films showed severe hip varus and obvious limb shortening deformity.

Type B: Similar to type A, both the acetabulum and the femoral head are present, there is no osseous connection between the proximal femur and the femoral head, and a pseudo joint is formed.

Type C: acetabular dysplasia, absence of the femoral head, and shortening of the femur. There is a plexiform ossification cap on the proximal end of the femur.

Type D: Absence of acetabulum, femoral head and proximal femur. There is no plexiform ossification cap at the proximal femur.

Pappas (1983) nine-level classification, according to its severity, from complete loss of proximal femur (grade ) to mild femoral dysplasia (grade ), in order of classification, Pappas is equivalent to Aitken D Type; Pappas III is equivalent to Aitken B; Pappas IV and V are equivalent to Aitken A (Table 12.26.1.2-0-1).

Kalamchi's simplified five-type taxonomy:

Type : Femoral shortening deformity, hip joint intact; Type : Femoral shortening deformity, hip varus deformity; Type : Femoral shortening deformity, acetabulum and femoral head are well developed; Type : Hip joint absence, femur Segmental dysplasia; Type V: Complete absence of the entire femur.

Treatment should be highly individualized, with options ranging from amputation and prosthetic assembly to limb salvage surgery, limb extension, and hip reconstruction.

The stability of the hip joint is critical to the choice of treatment. For patients with both acetabulum and femoral head (Aitken type A and B), the purpose of the surgery is to restore continuity between the femoral head and the femur. If the proximal femur is small, it is best to postpone surgery until the femoral head and proximal metaphysis are ossified. In some patients, the femur is too short, and a single stage of the knee joint fusion is required to produce a single bone of the lower limb. At the time of surgery, bone graft fusion should be performed at the pseudo-joint due to the small bone segments available for fixation at the proximal femur.

For severe deformities of the femoral head or acetabulum (Aitken type C and D or Pappas grades and ), most scholars recommend not to attempt hip reconstruction. King recommends iliac femoral bone graft fusion and Chiari section. Orthopedics to create a bone bed that can accept the stump of the femur, so that the knee joint assumes the function of the hip joint. Steel et al. Believe that untreated children with Aitken C or D deformity will have progressive instability and proximal femoral displacement. Femoral closed osteotomy and patella femoral fusion should be performed to eliminate forward arching. deformity.

The prerequisites for extension of the affected limb or shortening of the contralateral limb can only be considered when the affected femur is intact and the hip joint is stable and stable. Gillespie and Torode suggested that limb extension should be considered only when the affected femur is at least 60% of the normal side. Ilizarov extension uses a circular external fixator that can be extended proximally or distally to effectively prevent subluxation of the knee or hip joint. For those with predicted limb lengths> 12cm, the extension can be performed in stages: the first stage is at the age of 4 or 5 years, the second stage is at the age of 8 or 9 years, and the third stage is at puberty. According to the predicted length of the normal lower limb of the sick child, the decision of whether to perform contralateral epiphyseal block operation is made.

If limb extension is not an option, foot amputation is feasible.

Van Nes introduced under-knee rotation angioplasty in 1950. This operation was first introduced by Borggreve in the 1930s. Kostuik et al. Have improved the operation. Later Gillespie and Torode made the procedure more suitable for PFFD reconstruction surgery. Knee joint fixation and tibial osteotomy are completed in the first stage. At the same time, the distal end of the tibial osteotomy is rotated 180 ° outwards, so that the ankle joint functions as a knee joint. "Knee joint" flexion. The total length of the femur, knees, and tibia should be equal to the length of the contralateral femur, but this is often not the case, so it is often necessary to take an ipsilateral block around the knee joint to make the length of the reconstructed lower limb equal to the length of the normal femur.

Rotoplasty is suitable for:

1. Unilateral congenital femoral hypoplasia, aged 12 years or older.

2. The femur is obviously shortened and deformed, but it is not suitable for limb lengthening.

3. Hip joint is stable and ankle function is good.

4. Accompanied by peroneal limb deformity, but the ankle joint range or arc reaches 90 °.

1. Bilateral congenital femoral hypoplasia, younger than 10 years old.

2. Femoral shortening deformity, limb extension should be done.

3. Hip instability and poor ankle function.

1. Routine preoperative examination.

2. Equipped with 400 600ml of blood.

3. Before undergoing this type of reconstructive surgery, the appearance of the calf after surgery may cause psychological disorders. It must be explained to the sick child and his parents before surgery, and it may be possible to return the rotated foot to its original position.

Epidural or general anesthesia. Supine position. It must be exposed from the palate to the toes. A tourniquet on the base of the thigh.

1. If the fibula is abnormal, the anatomical relationship between the common peroneal nerve and the fibula head may be abnormal. To avoid damage to the common peroneal nerve, free the common peroneal nerve proximally until the common peroneal nerve is at the starting point of the sciatic nerve and loosen the fascia tissue attached to the common peroneal nerve.

2. The proximal articular cartilage of the tibia can be removed under fluoroscopy without damage to the epiphyseal plate.

3. Use a bone drill to enlarge the femoral bone marrow cavity to prevent femoral fragmentation when driving into the intramedullary nail.

After rotation angioplasty, do the following:

1. Antibiotic treatment for 5-7 days.

2. Single hip herringbone fixation for 10-12 weeks.

3. If the rotation requirement cannot be met due to vascular distortion during the operation, the foot should be gradually rotated to the predetermined position by replacing the plaster with the intramedullary nail as the axis.

4. After the osteotomy has healed, assemble the knee prosthesis to move under the ground.

1. Common peroneal nerve injury.

2. Injury the epiphyseal plate.

3. Femoral fragmentation.

4. Distal blood flow disorders in the distal limbs.