RU2164099C2 - Method for repairing acromion - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves performing perosseous upper extremity osteosynthesis. Wires are used, two of which fix lateral acromion end, one wire fixing coracoid process and spine of the scapula and the second one fixing coracoid process and acromial portion of clavicle end, the third one fixing coracoid process and proximal portion of acromion. Acromion osteotomy is carried out. Distal fragment of acromion is moved in posteroexterior direction under control. EFFECT: increased acromion size; restored anatomic shape; prevented humerus dislocation and subluxation. 4 dwg

Description

 The invention relates to medicine, in particular to orthopedics, in particular, can be used in the treatment of subluxations or dislocations of the humeral head.

 There is a method of treating a habitual dislocation of the shoulder and the acromial end of the clavicle, including the use of a nylon tape, passing it through the channel in the sub-tubercular region of the shoulder, stitching the stripes of the tape and passing their ends through the channel in the acromial process of the scapula from the bottom up with the formation of the acromial-brachial ligament, in which the free ends of the inner and outer bands of the tape through the channels in the outer part of the acromial end of the clavicle from top to bottom and the inner part of the acromial process of the scapula from bottom to top, one of of the ends of the inner tape is passed through the canal of the clavicle from the bottom up and connected with the other free end drawn through the canal in the coracoid process of the scapula from the bottom up, the ends of the outer and inner strip of the tape are pulled and tied together (author certificate 570360, USSR. Method of treating the usual dislocation of the shoulder and acromial end of the clavicle).

 There is a method of treating dislocation of the acromial end of the clavicle and the usual dislocation of the shoulder, including mobilization of the shoulder joint, acromial end of the clavicle and the coracoid process of the scapula and fixation of the joints with an allograft, the latter being installed as a loop on the acromial end of the clavicle, the ends of the graft are carried out along the posterior surface of the shoulder joint to complete repositioning of the clavicle and hem to the lower edge of the articular cavity of the scapula, then on the front surface of the shoulder joint the free ends of t ansplantata under tension and a separately sutured together, wherein one end of a pre-around loop encircle the clavicle and scapula coracoid process (auth. svid. 1132927, USSR. A method of treating dislocation acromial end of the clavicle and habitual dislocation of the shoulder).

 There is a method of treating dislocations of the acromial end of the clavicle by holding metal knitting needles through the acromial end of the clavicle and fixing it to the scapula, in which the spokes are carried to the outer part of the spine of the scapula (ed. Certificate 615918, USSR. Method for treating dislocations of the acromial end of the clavicle).

 There is a method of conservative treatment of dislocation of the acromial end of the clavicle by passing the knitting needles through the acromial end of the clavicle and fixing its ends in a device in which the needle is fixed in a skeletal traction bracket, the bracket is placed in the axillary region and connected by a rigid spring, the other end of which is gypsum plaster cast to the inner surface of the elbow joint (ed. certificate. 1156656, USSR. A method of conservative treatment of dislocation of the acromial end of the clavicle).

 However, the known method only allows to increase the stability of fixation of the acromial process in the mid-physiological position, and is not intended to prevent subluxation and dislocation of the head of the humerus by increasing the size of acromion'a sufficient to create an anatomical obstacle to the displacement of the head of the shoulder backward and upward.

 The objective of the present invention is to develop a method for the reconstruction of acromion'a, which prevents the subluxation or dislocation of the head of the humerus by increasing the size of acromion'a sufficient to create an anatomical obstacle to the displacement of the shoulder head backward and upward.

 The problem is solved in that in the method of acromion reconstruction, including transosseous osteosynthesis of the upper limb belt, use needles, a pair of which fixes the lateral end of acromion'a, one spoke is the coracoid process and the spine of the scapula, the other is the coracoid process and the acromial end of the clavicle, and the third is the coracoid process and the proximal part of the process, then an acromion osteotomy is performed, and the distal fragment is dosed moved posteriorly - outwards.

The present invention is illustrated by a detailed description, diagram, specific example of execution with reference to the attached copies of x-rays, on which:
FIG. 1 shows a diagram of an osteosynthesis of an upper limb belt.

 FIG. 2 represents copies from the R-gram of the patient before treatment.

 FIG. 3 represents copies of the patient's R-gram during treatment.

 FIG. 4 represents copies of the patient's R-gram after treatment.

 The method of reconstruction of acromion'a is as follows.

 After preparation of the surgical field, osteosynthesis of the upper limb belt is performed.

 Three distal needles are drawn through the distal metaphysis of the humerus in a plane perpendicular to the longitudinal axis of the shoulder. The ends of each knitting needle are fixed in an annular support. Knitting needle 1 (Fig. 1) is passed through the coracoid process and the spine of the scapula, spoke 2 is passed through the coracoid process and the proximal part of acromion, spoke 3 is passed through the acromial end of the clavicle and the coracoid process.

 The acromial end of the clavicle and the spine of the scapula are fixed with a spoke 3. Soldering of the spoke 2 is placed outside. The ends of each spoke 1, 2, 3, drawn through the acromial end of the clavicle, the coracoid process and the spine of the scapula, are fixed in the arcuate support of the external fixation device (not shown in the diagram), which is installed in the sagittal plane, the annular and arc supports are interconnected.

 A longitudinal section of 3 cm in length cut through the skin layer, subcutaneous tissue, fascia. The deltoid muscle is bluntly stratified, exposing directly the shoulder process of the scapula. A transverse osteotomy of acromion is made with a direct chisel, 0.5 cm away from the clavicular-acromial joint in the distal direction.

 Through the lateral fragment of acromion, two parallel spokes of 4.5 are carried out with thrust pads from above from the inside outwards downward.

 The thrust pad of each spoke 4.5 is located directly on the surface of the distal acromion fragment. The distal ends of both spokes, brought to the outer surface of the upper third of the shoulder, are fixed on the additional support of the apparatus. Dosed movement of the additional support allows you to move the distal fragment of acromion 'a back - out. Distraction is carried out 5 days after surgery. The rate of distraction of 0.75 mm / day.

 After reaching the required size acromion'a continue fixing the shoulder apparatus transosseous fixation until complete mineralization of the obtained distraction regenerate.

 An example of the method.

 Patient K. is 13 years old. Diagnosis: Right-sided Erb paralysis, posterior dislocation of the shoulder.

 Sick from birth. At the age of 11 years, an operative lengthening of the right shoulder by 6 cm was carried out, after which the posterior dislocation of the shoulder occurred.

 Twice the shoulder was adjusted using the Ilizarov apparatus, but after the termination of osteosynthesis the shoulder dislocation recurred.

 The cause of recurrence of shoulder dislocation is the insufficient development of acromiona and paralysis of the posterior and middle anterior m.deltaidens.

 04/16/98, operation: Reconstruction of acromion by the proposed method.

 Transosseous osteosynthesis of the upper limb was performed. Three crossed needles were passed through the acromial end of the clavicle, the coracoid process, the spine of the scapula and the proximal part of acromion. The distal acromion fragment was fixed with two knitting needles. The free ends of the spokes held were fixed in the supports of the apparatus, which were interconnected with the possibility of movement.

 Elongation of the distal end of the shoulder process of the scapula began 5 days after the operation, lasted 45 days, as a result of which the size of acromion increased. The period of fixation by the transosseous fixation apparatus - 30 days above the shoulder head prevents the latter from moving up and back.

 The proposed method is marked by a low invasiveness of surgical intervention: a soft tissue incision does not exceed 3 cm; the method eliminates the use of foreign materials (in the form of lavsan ribbons, bone grafts and other materials). Osteosynthesis with a transosseous external fixation device using Kirschner spokes creates the conditions for reliable fixation and is easily removed after 1.5-2 months without additional limb injury. The patient is mobile during treatment.

 The proposed method allows to restore the anatomical forms of acromion'a to a size sufficient to create anatomical obstacles to the displacement of the shoulder head posteriorly and upward, and thereby restore the biomechanics of the shoulder girdle in a short time.

 The proposed method allows you to restore the anatomical form of acromion'a to a size sufficient to create anatomical obstacles to the displacement of the shoulder head backward and upward.

 In addition, the proposed method allows you to restore the biomechanics of the shoulder girdle, upper limb. The patient in the treatment process is mobile. The proposed method allows you to start active movement in the shoulder joint.

Claims (1)

 A method for reconstructing acromion, including transosseous osteosynthesis of the upper limb belt, characterized in that the needles are used, a pair of which fixes the lateral end of acromion, one spoke is the coracoid process and the spine of the scapula, the other is the coracoid process and the acromial end of the clavicle, and the third is the coracoid process and the proximal part of acromion'a, then osteotomy of acromion'a is performed, and its distal fragment is dosed backward-outwardly.

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