RU2209047C2 - Method for treating brachial deformations in patients with aftereffects as a result of acute hematogenous osteomyelitis - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology. SUBSTANCE: one should carry out S-shaped cutaneous incision in the upper brachial third, conduct osteotomy parallel to growing area of brachial caput, mobilize tendinous parts of brachial biceps muscle, isolate distal brachial fragment in coupling-like way subperiosteally, after that one should simultaneously remove spatial disorders in shoulder articulation with the help of apparatus for external fixation and wedge in distal brachial fragment into proximal one into preformed opening. As for brachial shortening and residual torsion, they should be removed due to corticotomy and osteoclasia at the level of inferior third of affected segment that improves functions of shoulder articulation and tendinous-muscular apparatus, restores shoulder's length. EFFECT: higher efficiency of therapy. 4 dwg

Description

 The invention relates to medicine, namely to traumatology and orthopedics.

 There is a surgical method for treating deformation of the humerus by applying the Ilizarov apparatus on the affected segment, consisting of a half ring and a ring, and performing oblique transperiosteal osteotomy in the middle third in the sagittal plane from top to bottom, from top to bottom (Ilizarov G.A., Kaplunov A.G. , Kalyakina V.I. Shoulder lengthening // Theoretical and practical aspects of transosseous compression and distraction osteosynthesis. - Kurgan, 1976. - P. 112-113).

 However, this treatment method is accompanied by the absence of rigid fixation of the proximal fragment of the humerus, the technical difficulties of surgical intervention due to the anatomical and functional features of the segment, a rather high percentage of complications, among which the most common are the displacement of fragments of the humerus, the appearance of paresis of the radial nerve, the development of varus deformity ( Vvedensky S.P., Tochilina N.B. On the method of surgical lengthening of the shoulder // Organization and treatment of children with orthopedic diseases and injuries -. Leningrad, 1990. -S.25-27).

 There is also a method of treating deformities of the humerus with the help of a spoke-rod apparatus (Vvedensky S.P., Tochilina NB. To the method of surgical lengthening of the shoulder // Organization and treatment of children with orthopedic diseases and injuries. - Leningrad, 1990. - S. 25-27), taken by us as a prototype. The essence of the method is to introduce a threaded rod in the frontal plane in the direction from the outside inwards through the proximal fragment of the humerus of the humerus, but slightly lower than the initial cross-spoke. With the help of a “flag”, its end is attached to a semicircle, creating a perpendicular cross with spokes held in the sagittal plane. The osteotomy of the humerus is performed without taking into account the varus deformity and shoulder torsion.

However, this method has the following disadvantages:
- the method does not provide for the restoration of anatomical relationships in the shoulder joint (elimination of varus deformity and torsion of the humeral head);
- does not restore normal proportions of the tendon-muscle complex of the shoulder;
- due to the anatomical features of the shoulder, knitting needles in the upper third is possible only front to back with a small cross in a plane close to the sagittal, which does not provide stable fixation of the proximal fragment of the humerus;
- transperiosteal osteotomy of the humerus in the middle third is fraught with damage to the radial nerve and impaired blood circulation, thereby leading to a slowdown in the formation of regenerate;
The objective of the invention is to improve the function of the shoulder joint, eliminate cosmetic defects, restore shoulder length, stop the development of compensatory disorders of posture, prevent disability.

 The task is achieved by the fact that a rational S-shaped skin incision is made in the upper third of the shoulder, which, after eliminating the torsion of the proximal shoulder, acquires a linear shape, mobilization over the long and short heads of the biceps of the shoulder, in turn, eliminates their torsion after eliminating torsion deformation of the shoulder bones, a distal fragment at the level of the osteotomy of the upper third of the humerus stands out muft-like subperiosteal, an osteotomy is made parallel to the growth zone of the head of the pl cha, after which the spatial disturbances in the shoulder joint are simultaneously eliminated and the distal fragment of the humerus is wedged into the proximal, having previously formed a recess in it corresponding to the size of the spike of the distal fragment, and the shortening and residual torsion of the humerus is eliminated with corticotomy and osteoclasia at the level of the lower third of the affected segment.

 In FIG. 1 shows a diagram of access to the humerus, projection of the rods.

 In FIG. 2, 3 shows a diagram of a method for treating deformation of the humerus.

 In FIG. 4 shows the location of the tendon parts of the long and short heads of the biceps of the shoulder muscle before their mobilization (A) and after (B).

In FIG. 1, 2, 3, 4:
- position 1 - the angle of the proximal rods to the shoulder diaphysis;
- position 2 - the angle of the distal rods to the shoulder diaphysis;
- position 3 - view of the skin incision before the removal of torsion-varus deformity and after;
- position 4 - type of skin incision after the removal of torsion-varus deformity;
- position 5 - the level of the Kirschner spokes;
- position 6 - the moment of rotation of the distal fragment of the shoulder outward or inward, depending on the version of the torsion;
- position 7 - spatial location of the shoulder head before surgical treatment;
- position 8 - direction and level of osteotomy;
- position 9 - level of corticotomy and osteoclasia;
- position 10 - the spatial location of the shoulder head after surgical treatment;
- position 11 - the moment of wedging of the distal fragment of the humerus into the proximal in the formed recess;
- position 12 - the moment of elimination of the angle of the varus deformity of the shoulder head;
- position 13 - the location of the tendon parts of the long and short heads of the biceps of the shoulder before surgical treatment;
- position 14 - the location of the tendon parts of the heads of the biceps of the shoulder muscle after surgical treatment.

 The method is as follows.

Two threaded rods are drawn through the proximal part of the humerus 0.5 cm below the projected germinal zone at an angle to the diaphysis of the shoulder, which is preliminarily calculated from the skyogram to eliminate varus deformity. The rods are carried out in the front-side and rear-side surfaces of the shoulder, the angle between the rods is 90-100 ^o . Departing from the proximal rods distally 4 cm, two threaded rods are perpendicular to the axis of the diaphysis of the shoulder. The distal rods are carried out on the outer surface of the shoulder with an angle of 90-110 ^o between them. Two half rings from the Ilizarov apparatus are mounted, one on the proximal rods, and the second on the distal ones. In the interval between the half rings, an S-shaped skin incision is made along the anterolateral surface, subcutaneous fat, and bluntly pass between the deltoid and biceps muscles of the shoulder to the periosteum. With a raspator, a subperiosteal mufto-shaped fragment of the humerus from connective tissue growths stands out over 4 cm. A subperiosteal oblique osteotomy is made from top to inside parallel to the growth zone of the shoulder head. Mobilization is carried out over the long and short heads of the biceps of the shoulder, which gives them a physiological position and eliminates their torsion. After that, the varus deformation of the shoulder head is simultaneously eliminated by bringing the proximal half ring to the distal one, setting them parallel to each other, and the second action eliminates the shoulder torsion by rotating the distal half ring to the desired angle, according to the previously calculated on the skyogram, inside or outside, depending on of the position of the head of the shoulder, in the position of an anversion or retroversion. The resulting distal fragment with a sharp end spine is wedged by us into a depression previously formed by a drill in the proximal fragment of the humerus. Two arches are fixed by two bars, layered seams on the wound. A skin incision after eliminating torsion deformation takes a linear shape. In the lower third of the shoulder cross to each other, but perpendicular to the axis of the humerus in the supracondylar region, two Kirschner spokes are held, a ring is mounted. In the supracondylar region, a subperiostal corticotomy and osteoclasia are made through a 2 cm skin incision, and the residual torsion of the humerus is simultaneously eliminated. The entire spoke-rod apparatus is mounted. X-ray control is being done.

 After 5 days, distraction of 0.25 mm begins 4 times a day between the half-ring block and the apparatus ring at the level of the distal osteotomy.

The advantages of the proposed method for the treatment of deformation of the humerus are as follows:
- a rational skin incision was found that excludes the development of contractures in the postoperative period;
- clutch-like subperiosteal allocation of bone fragments and mobilization over the long and short heads of the biceps of the shoulder allows you to restore the normal ratio of the tendon-muscle complex of the shoulder;
- allows you to restore the correct anatomical relationships in the shoulder joint;
- adaptation of bone fragments, achieved by pre-drilling a recess and inserting a bone spike into it, allows quick consolidation without tension and additional laxative cuts on scarred soft tissues, rigid fixation with wedging fragments of the humerus, previously restoring the correct relationship in the shoulder joint, allows the patient to serve yourself from the first days after the operation;
- the centering of the distal fragment of the humerus after its osteotomy in the lower third to the position of the head of the humerus provides restoration of the anatomy and function of the tendon-muscle apparatus of the shoulder;
- when performing a subperiosteal corticotomy and osteoclasia in the lower third of the shoulder, development in the postoperative period excludes the development of radial nerve paresis and disturbance of the nourishing intraosseous vessels;
- the method is not technically complicated, sparing enough, so it can be used in the clinic for the treatment of deformities of the humerus.

Claims (1)

 A method for the treatment of deformation of the humerus, which consists in transverse osteotomy of the humerus, application of the apparatus and distraction of fragments, characterized in that an S-shaped skin incision, osteotomy of the humerus parallel to the growth zone of the shoulder head are mobilized, the tendon parts of the biceps of the shoulder are mobilized, the distal subperiosteal mucoid fragment of the humerus, after which they immediately eliminate spatial disorders in the shoulder-scapular joint and wedge in the distal fragment of the shoulder minutes bone proximal to a pre recess formed therein, and a shortening of the humerus and eliminate residual SARS using corticotomy osteoclasis and at lower third of the lesion.

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