RU2216292C1 - Method for surgical treatment of luxation of acromial clavicular end - Google Patents

Abstract

FIELD: medicine, traumatology. SUBSTANCE: one should open acromial-clavicular articulation, external clavicular end and coracoid process, remove necessary soft tissues, carry out clavicular setting, conduct its fixation towards coracoid process, cut osseous-tendinous block out of allotransplant of patellar own ligament with large proximal osseous fragment; in acromial clavicular end, vertical canal is developed, superior opening of the canal should be additionally drilled, in coracoid scapular process the second canal is developed, distal fragment is sutured with caprone ligature, one should direct clavicles into developed canals to fix prepared osseous- tendinous alloblock, distal osseous fragment is perosseously sutured towards coracoid process. In acromial clavicular end and acromial scapular process it is necessary to form per two vertical canals and acromial-clavicular articulation should be fixed with P-shaped suture to provide articular function at no relapse of tension in ligaments developed. EFFECT: higher efficiency of surgical therapy. 2 dwg, 1 ex

Description

 The invention relates to medicine, namely to traumatology, and is intended for the treatment of dislocations of the acromial end of the clavicle.

 The prototype is the method of lavsanoplasty of the clavicular-acromial and clavicular-clavicular ligaments with dislocations of the acromial end of the clavicle according to Movshovich (Movshovich I. A. Operative orthopedics. Moscow - 1994, p. 93-94). However, when performing plastic surgery, a synthetic material (lavsan) that is foreign to the body, which is subject to stretching, is used. In addition, it becomes more difficult to fix the acromial end of the clavicle in the set position with various types of metal structures (knitting needles, screws) due to the possibility of damage to the mylar ribbons.

 Figure 1 presents a diagram of the procurement of alloblock.

 In FIG. 2 is a view after plasty and fixation of the acromioclavicular joint.

 The technical result is an improvement in the functional results of the treatment of dislocations of the acromial end of the clavicle.

 The specified technical result is achieved through the use of a bone-tendon allograft, cut from its own ligament of the patella. The graft is a tendon cord with fixed at the ends of different-sized bone fragments from the patella and tuberosity of the tibia (figure 1).

 The proposed method is as follows.

 Under general or high (interstitial) conduction anesthesia, an epauletoid cut from the posterior edge of the acromial process, bending around its apex, and further inwards 1 cm below the lower edge of the clavicle during its outer third expose the acromioclavicular joint, the outer end of the clavicle and the coracoid process.

 Eliminate interponing soft tissue from the clavicular-acromial joint and reduce the clavicle. To keep the clavicle in the correct position, it is fixed to the coracoid process with the help of a spongy screw with a washer. A bone-tendon block is cut out from an allograft with a large proximal bone fragment. In the acromial end of the clavicle, in the area of attachment of the coraco-clavicular ligament, a vertical channel is formed towards the anterior section of the coracoid process. The upper opening of the channel is additionally drilled with a drill of a larger diameter (corresponding to the diameter of the proximal bone fragment of the block). Such a reaming facilitates jamming of the bone fragment of the alloblock in the clavicle when it is carried out from top to bottom and there is no need for additional fixation. In the coracoid process of the scapula, an anterior channel is formed anterior to the fixation screw for conducting the bone-tendon alloblock. The diameter of the channel corresponds to the size of the distal bone fragment of the alloblock. The distal fragment is stitched with kapron thread. The prepared bone-tendon alloblock is carried out into the formed channels. In a state of light tension, the distal bone fragment is sutured to the coracoid process (Fig. 2). Two vertical channels are formed in the acromial end of the clavicle and the acromial process of the scapula, departing 0.5 cm from the articular surfaces. The acromioclavicular joint is fixed with a U-shaped conduction of kapron filament through the formed channels. After suturing the wound, the upper limb is fixed with a plaster thoracobrachial dressing for 5 weeks. The fixing screw is removed after 6 months.

In this way, 6 patients with closed dislocations of the acromioclavicular joints were operated on
Example 1. Patient X., 55 years old, was admitted to the clinic of traumatology and orthopedics of the Belarusian State Medical University on 06.03.2002 with a diagnosis of closed dislocation of the acromial end of the right clavicle. After the examination, he underwent surgery according to the proposed method. The patient is laid on his back. A roller is placed under the shoulder blade on the affected side. Under a high (interglacial) conduction anesthesia, an epauletoid incision from the posterior edge of the acromial process, enveloping its apex, and further inwards 1 cm below the lower edge of the clavicle during its outer third exposes the acromioclavicular joint, the outer end of the clavicle and the coracoid process. Eliminate interponing soft tissue from the clavicular-acromial joint and reduce the clavicle. To keep the clavicle in the corrected position, it was fixed to the coracoid process using a spongy screw with a washer. A bone-tendon block was cut out from an allograft with a large proximal bone fragment. In the acromial end of the clavicle, in the area of attachment of the clavicular-clavicular ligament, a vertical channel was formed towards the anterior section of the coracoid process. The upper opening of the channel was additionally drilled with a drill of a larger diameter (corresponding to the diameter of the proximal bone fragment of the block). In the coracoid process of the scapula, an anterior channel is formed anterior to the fixation screw for conducting the bone-tendon alloblock. The diameter of the channel corresponds to the size of the distal bone fragment of the alloblock. The distal fragment is stitched with kapron thread. A prepared bone-tendon alloblock was conducted into the formed channels. In a state of light tension, the distal bone fragment was sutured to the coracoid process. Two vertical channels were formed in the acromial end of the clavicle and the acromial process of the scapula, departing 0.5 cm from the articular surfaces. The acromioclavicular joint was fixed with a U-shaped holding of a silk thread through the formed channels. After suturing the wound, the upper limb was fixed with a plaster thoracobrachial dressing for 5 weeks. After removing the plaster cast, a course of rehabilitation treatment was carried out. After 4 weeks, movements in the right shoulder joint were restored. The fixing screw was removed after 6 months.

Claims (1)

 A method for surgical treatment of dislocation of the acromial end of the clavicle, including open reduction of the dislocation, fixation of the acromioclavicular joint with a U-shaped suture, plastic of the clavicular-clavicular ligament, characterized in that the clavicle is additionally fixed in the set position, a bone-tendon allograft is used as a graft, which they cut out from their own ligament of the patella, form a vertical channel in the acromial end of the clavicle, the upper hole of which is additionally drilled, and in the the second canal is formed, then an allograft is carried out from the first channel to the second until the bone fragment in the clavicle is jammed, and the distal end is sutured to the coracoid process.

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