RU2458648C1 - Method of treating dislocation of acromial end of clavicle - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics. Fixation of acromial end of clavicle by introduction of screw rod, provided with support site in frontal plane through distal part of acromial end of clavicle into base of scapula neck.

EFFECT: method ensures reduction of risk of injury to subclavian artery, veins and brachial plexus, creation of reliable fixation of acromioclavicular joint and reducing impact on acromial end of clavicle by introduction of minimal amount of osteofixers into the most optimal anatomical area without application of external elements of construction.

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Description

The invention relates to the field of surgery, traumatology and orthopedics, in particular to the treatment of dislocations of the acromial end of the clavicle.

Known methods of treating dislocation of the acromial end of the clavicle using various designs for fixing the clavicular-acromial joint, which provide for the holding structure through the spine of the scapula, through the coracoid process of the scapula, through the acromia process of the scapula. So, there is a known method of treatment by reduction of the acromial end of the clavicle in an open way, in which the AO screw is screwed into the coracoid process of the scapula through the drilled hole in the acromial section of the clavicle (Müller M., Algover M., Schneider R., Willinger X. Guide to internal osteosynthesis. - M., 1996 - P.436). In this case, gypsum immobilization of the upper limb is required for the period prior to the fusion of torn ligaments, since the coracoid process has a spongy structure and small size, especially in patients with an asthenic physique.

A known method of treating dislocation of the acromial end of the clavicle using an external fixation apparatus, which involves holding the spokes through the acromial process of the scapula, the acromial end of the clavicle and fixation in the apparatus for transosseous osteosynthesis (patent RU No. 2210332, IPC АВВ 17/60). The disadvantage of this method is that the fixation of the acromioclavicular joint is carried out by crossing knitting needles carried out transarticularly and through a large array of soft tissues of the deltoid region of the shoulder. This in the future often leads to the development of complications: pain in the projection of the deltoid muscle of the shoulder, arthrosis of the acromioclavicular joint and inflammation of the soft tissues in the deltoid muscle of the shoulder. In addition, when fixing fractures in this way, the needles pass through the lesion, which sharply increases the risk of infection. With the closed reduction of the dislocation of the acromial end of the clavicle, technical difficulties arise, dynamic correction of the position of the clavicle during treatment is impossible, and maintaining the rigidity of fixation is difficult.

A known method of treating dislocation of the acromial end of the clavicle by external transosseous osteosynthesis, in which a console screw-rod is screwed into the spine of the scapula at the level of its upper third in the sagittal plane back and front perpendicular to the axis of the clavicle, the second screw-rod is screwed into the metaphyseal section of the acromial end of the clavicle into sagitis the plane in the direction from front to back from bottom to top, perpendicular to the axis of the clavicle, the third to the acromial end of the clavicle, outward from the previously installed retainer, in the frontal plane spine in the direction outside-in bottom-up, on the axis of the clavicle (patent RU №2206288, IPC A61V 17/56). The disadvantages are the invasiveness of the method, the likelihood of damage to the neurovascular bundle, as well as the presence of bulky external fixation elements.

There is a method of treating dislocation of the acromial end of the clavicle using an external fixation apparatus, which involves conducting osseous fixators with thrust pads into the acromial process of the scapula and clavicle, characterized in that rods with locknuts are used as osseous fixators, one of which is made with a curved end, and as thrust sites use a plate with holes for the rods, while performing the introduction of the rods percutaneously through the holes in the plate in the acromial end of the scapula and in the proximal the th end of the clavicle vertically, the rod with a curved end is inserted transarticularly with the capture of the acromial process of the scapula from the lower surface, then reposition is carried out simultaneously by creating a traction using rods with subsequent fixation of the structures of the acromioclavicular joint (patent RU No. 2409328, IPC АВВ 17/56) . The disadvantages are trauma, the presence of external fixation elements.

There is also known a method of treating fractures of the acromial end of the clavicle using an external fixation device, providing transosseous osteosynthesis, in which the rod is inserted in the frontal plane at the base of the coracoid process of the scapula into the region of its neck, a bunch of spokes is inserted into the distal section of the clavicle through both cortical layers in the same plane , the rod and a bunch of knitting needles are fixed in the fixation nodes of the external fixation apparatus, by rotating the nuts on the rod, the acromial end of the clavicle is repositioned (patent R U No. 2299701, IPC A61B 17/60). The installation of the outer shaft in the neck of the scapula at the base of the coracoid process, in which there is the largest mass of compact and spongy substance, provides a strong fixative-bone connection for the entire treatment period. However, there is a risk of damage to the subclavian artery and veins, as well as the brachial plexus. Common disadvantages of all these methods include attaching external elements of structures to the clavicle, which can cause a threat of wound infection (suppuration, osteomyelitis), pain at the site of fixing structures, in addition, they create inconvenience during functional treatment and household inconvenience.

The objective of the claimed invention is to reduce the morbidity, reduce the risk of damage to the neurovascular bundle with the introduction of a helical rod into the neck of the scapula, as well as improve the living conditions of the patient.

The technical result is the creation of reliable fixation of the acromioclavicular joint and the reponitive effect on the acromial end of the clavicle by introducing a minimum number of osteo-fixators into the most optimal anatomical region without using external structural elements.

This is achieved by the fact that in the method of treating dislocation of the acromial end of the clavicle, including closed reduction and fixation of the acromial end of the clavicle by means of a screw shaft inserted in the frontal plane into the neck region of the shoulder blade, soft tissue is cut above the clavicle and then introduced through the distal section of the acromial end of the clavicle the base of the neck of the scapula (cavitas glenoidale) of a helical shaft equipped with a thrust pad. This eliminates the risk of damage to the subclavian artery, veins and brachial plexus and ensures a strong fixative-bone connection for the entire treatment period, since there is a rather massive bone formation in the base of the neck of the scapula and there are no large neurovascular formations, and the screw shaft is held with a stubborn a platform through the distal section of the acromial end of the clavicle provides a reponitive effect on the acromial end.

Fig. 1 and Fig. 2 show the implementation of the method: Fig. 1 illustrates the beginning of the method, and Fig. 2 illustrates the end of the method. In the patient’s position on a healthy side under local anesthesia through a skin incision of 1.0-1.5 cm in the projection of the acromial end of the clavicle, departing from its distal end by 1-1.5 cm, make a hole in the clavicle for the diameter of the screw shaft (screw 60- 70 mm d = 2.5-3.0 mm). The screw rod 1, equipped with a thrust pad 2, is passed through the acromial end of the clavicle and screwed vertically down into the neck of the scapula as close as possible to the base of the articular surface of the scapula, thereby visually controlling the position of the clavicle relative to the acromial process of the scapula to the limits of the anatomical norm. The wound is sutured with 1-2 sutures. The upper limb is mobilized by the scarf.

Example 1

Patient S., 41, medical history No. 960, was admitted to the MGB “GBSMP” on September 25, 2010. The diagnosis was made: closed dislocation of the acromial end of the left clavicle. After the examination, an operation was performed - a closed reduction of the dislocation of the acromial end of the clavicle with fixation by the proposed method. The patient was discharged after 7 days for outpatient treatment. Functional treatment (LFK), physiotherapy were performed from the first day after surgery. Disability was restored after 8 weeks, the design was removed after 3 months. There are no complaints. Function in the shoulder joint in full.

Example 2

Patient M., 39 years old, medical history No. 1128, was admitted to the MGB "GBSMP" October 29, 2010

Diagnosed with closed dislocation of the acromial end of the right clavicle. After the examination, an operation was performed - a closed reduction of the dislocation of the acromial end of the clavicle with fixation by the proposed method. The patient was discharged after 5 days for outpatient treatment. Functional treatment (LFK), physiotherapy were performed from the first day after surgery. Disability was restored after 8 weeks, the design was removed after 3 months. There are no complaints. Function in the shoulder joint in full.

Thus, the proposed method of treatment is performed with minimal trauma in the damage zone, while the presence of elements connected to the damage zone is excluded, no rigid external immobilization is required, and functional treatment is possible from the first days after the operation. After completion of treatment, removal of the construct is also carried out with minimal trauma, which does not lead to hospitalization. The claimed method of treatment is devoid of the disadvantages that occur when using designs with external fixation elements, namely, it minimizes the risk of developing wound infection, reduces the risk of injury in the postoperative period, and is convenient for the patient in self-care.

Claims (1)

A method of treating dislocation of the acromial end of the clavicle, including closed reduction and fixation of the acromial end of the clavicle by means of a screw shaft inserted in the frontal plane into the neck region of the scapula, characterized in that the soft tissue is cut above the clavicle and then inserted through the distal section of the acromial end of the clavicle into the base of the neck the blades of a screw rod equipped with a thrust pad, thereby eliminating the risk of damage to the subclavian artery, veins and brachial plexus and provides strong connection - fixative - bone for the entire period of treatment.

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