RU2158557C2 - Method for performing plastic repair of ligaments in the cases of acromial clavicle end dislocation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves forming one vertical canal in each clavicle and scapular acromion of 5 mm diameter. Lavsan ribbon is brought under the coracoid process of the scapula. External end of the lavsan ribbon is brought from behind and from top to down through the canal in the clavicle and then, from down to top through the canal in the acromion. The internal lavsan ribbon end is brought from down to top through the canal in the clavicle. Ribbon ends are tied. The knot is immersed into the clavicular canal. EFFECT: all claviculoacromial joint ligament portions repaired; reliably fixed articulation ends; reduced risk of postoperative complications. 1 dwg

Description

 Usage: in medicine, namely in traumatology, for the effective treatment of dislocations of the acromial end of the clavicle. In order to increase the reliability of fixation, reduce the duration of the operation and reduce complications in the acromial end of the clavicle and acromion, the scapula is formed along one of the vertical channels with a diameter of 5 mm. Using a conductor, under the coracoid process of the scapula, an Mylar is conducted, the outer end of which is drawn from the back and from top to bottom through the canal in the clavicle, then from bottom to top through the canal in acromion. The inner end of the tape is carried out from the bottom up through the channel in the clavicle, the ends of the tape are tied with a surgical unit. The dislocation is corrected, the knot is pulled and displaced into the canal on the collarbone.

The invention relates to medicine, namely to traumatology, for the treatment of dislocations of the acromial end of the clavicle. The analogues of the proposed method are:
I. Method of ligament plasty of the acromial end of the clavicle according to Bennel.

The disadvantages of this method include:
1) form three channels in the clavicle and acromion, which increases the resistance when sliding the tape through them, reducing the tension of the tape;
2) apply a tape from the wide fascia of the thigh, as a result, an additional injury is applied and the operation is complicated. Under continuous tension, the fascia tape is stretched;
3) a large amount of plastic material is required for ligament plasty, and replacing the fascia with alloplastic material increases the risk of possible postoperative complications.

 II. Lavsanoplasty for the treatment of dislocations of the acromial end of the clavicle according to A.V. Vorobyov (1987).

The disadvantages of this method include:
1) surgery is performed using an additional incision;
2) with plastic clavicle-acromial ligament, a tape is wound around the acromion, in which the direction of the force vector does not coincide with the axis of the joint:
3) the tape entwined around the acromion can shift and relax the tension created:
4) a large amount of plastic material is used, which increases the likelihood of postoperative complications.

As a prototype, the method of surgical treatment of dislocations of the acromial end of the clavicle according to K.B.Bom (1969) was chosen:
- form on one channel in the clavicle and acromion;
- a decrease in the number of bone canals reduces the sliding of the tape along them, which increases its tension;
- less plastic material is used for plastic ligaments.

The disadvantages of the method include:
1) the plasticity of all portions of the ligaments of the clavicular-acromial joint is not performed, as a result of which the instability of the acromial end of the clavicle remains unstable:
2) there is a need for additional immobilization for a long time:
3) the knot is tied over the area of the clavicular-acromial joint, where there is a small amount of soft tissue, increasing the likelihood of bedsores, suppurations and ligature fistulas.

 The purpose of the invention is to increase the reliability of fixation, reducing the duration of the operation and reducing postoperative complications.

 The invention is illustrated by the drawing and lies in the fact that in the acromial end of the clavicle and acromion of the scapula is formed along a vertical channel with a diameter of 5 mm With the help of a conductor, a mylar ribbon is drawn under the coracoid process, the outer end of which is drawn from the back and from top to bottom through the canal in the clavicle, then from bottom to top through the canal in acromion. The inner end of the tape is carried out from the bottom up through the channel in the clavicle, the ends are tied with a surgical unit. The dislocation is corrected, the knot is pulled and displaced into the canal on the collarbone.

Technique for implementing the method
Epauletic section with exposure of the acromioclavicular joint and pterygoid process. Interponed soft tissues are removed from the joint, if present, and a torn disc. In the acromial end of the clavicle, retreating 2-3 cm from the articular surface, a vertical channel with a diameter of 5 mm is formed with a drill, going somewhat obliquely, from the inside out. The same channel is formed in the acromion, the channel travels from the outside to the inside. With the help of a conductor, an Ivansan tape is held under the coracoid process, the outer end of which is drawn from the back and from top to bottom through the canal in the clavicle, then from bottom to top through the canal in acromion. The inner end of the tape is carried out from the bottom up through the channel of the clavicle, the ends of the tape are tied with a surgical unit. The dislocation is corrected, the knot is pulled and displaced into the canal on the collarbone.

 Immobilization with a plaster cast or torocobrochial dressing for two to three weeks.

 Thus, in relation to the prototype, the method has distinctive features and, therefore, meets the criterion of "novelty."

Distinctive features of the prototype:
Symptom 1. All portions of the clavicular-acromial joint ligaments are restored, which allows reliable fixation of the articular ends.

 Symptom 2. Eliminates the need for long-term immobilization of the limb.

 Symptom 3. The knot is tied and immersed in the canal on the clavicle, which reduces the risk of possible postoperative complications.

Concrete example
Patient A., 23 years old, was admitted for a complete dislocation of the acromial end of the right clavicle. Sports injury, two weeks ago. Operated, produced plastic ligaments of the acromial end of the clavicle by the proposed method, dislocation is completely eliminated. Immobilization with a plaster cast for three weeks. The wound healed by primary intention. Discharged on the 12th day after surgery.

 Long-term results were tracked after four years. No complaints, movement in the right shoulder joint in full, continues to play sports. On the control radiographs, the ratio of the articular ends of the right clavicular-acromial joint is correct, there are no signs of arthrosis.

Positive effect
The application of this method improves the reliability of fixation of the articular ends of the clavicular-acromial joint by restoring all portions of the ligaments of the acromial end of the clavicle, reducing the invasiveness of operations, reducing the likelihood of postoperative complications, and improving long-term treatment results.

Claims (1)

 A method for ligament plastic surgery during dislocations of the acromial end of the clavicle, including fixing the acromial end of the clavicle, the formation of vertical channels in the clavicle and acromion of the scapula, characterized in that they form one channel with a diameter of 5 mm, under the coracoid process of the scapula, an Ivory tape is made, the outer end of which is carried out behind and from top to bottom through the canal in the clavicle, then from bottom to top through the canal in acromion, the inner end of the tape is drawn upwards through the canal in the clavicle, the ends of the tape are tied, the knot is immersed in the canal in the clavicle e.