RU2223054C2 - Method for tendinous anastomosis - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics. SUBSTANCE: one should form tendinous sections, suture the thickness of tendinous sections in cross-sectional direction radially symmetrically in not less than two directions and planes of cross-sectional section, at winding access onto surface. One should withdraw free ends of ligature out of ends of tendinous sections. Then one should coaxially coincide, bring nearer and tighten tendinous sections at cross-sectional applying the ends of ligature as titanium nickelide with effect of super elasticity. The method enables to prevent rotation mobility and increase suture strength. EFFECT: higher efficiency. 6 dwg, 1 ex

Description

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

 Restoring the integrity of a damaged tendon as a result of an injury, surgery or for another reason is a separate task for surgery.

 A special requirement for the anastomosis - the connection of disparate segments of the tendons - is the mechanical strength of the connection. It is explained by the function of this organ - the transfer of mechanical (traction) forces. Strength depends, apart from physiological reasons, on the correctness of the reposition of tendon segments, the stitching pattern, the properties of the suture material and, in general, is the success of the operation. Depending on the nature of the tendon damage, the period that has elapsed since the injury, profession and age of the patient, the method of anastomosis and the suture scheme are chosen.

 There is a simplified method for anastomosis of tendons (Lange sutures) [1], including the formation of segments of the tendon by suturing and returning suture material from the end of one segment by injecting the second segment into the end and removing both ends on the lateral surface of the latter (Fig. 1).

 This method is simple to implement and is applicable with low requirements for the strength of the seam. Its disadvantage is the high specific pressure of the suture material on the tendon tissue, leading to an increased possibility of tissue eruption and insolvency of the operation.

 A more complex method is known for anastomosis of tendons (Kuneo suture) [1], which consists in flashing the prepared segments of the tendon with a cross stroke of suture material with the withdrawal of its ends from the end of each segment (figure 2). The structure of the suture material developed in the thickness of the fabric creates a lower specific pressure on the fabric than in the first analogue and therefore can create greater strength of the seam.

 The disadvantage of this method is the increased complexity of the suture material. The fixation of the ends in one plane makes it possible to rotate the segments of the tendons relative to each other.

 A known method of anastomosis of tendons (Kozakova suture) [1], adopted by the greatest similarity with the proposal for a prototype. It includes flashing the prepared segments of the tendon in diameter in one direction, one plane of the cross section (figure 3), the twisted development of the seam with access to the lateral surface and the removal of the ends of the suture material from the ends of the segments of the tendon. After drawing closer, juxtaposing, tightening the segments with the free ends of the suture material, the anastomosis is completed by wound closure, limb immobilization and subsequent physiotherapy.

 Like analogue 2, the method has a drawback - an increased possibility of rotational shift of tendon segments.

 A significant drawback of these analogues, including the prototype, is the low surgical quality of the suture material used - fine silk, thin capron or lavsan. These materials are irreversibly stretched when wetted with body fluids, weaken the screed of anastomosed fragments, i.e. aggravate the aforementioned rotational mobility, reduce the viability of the operation in relation to the strength properties of the seam.

 The technical result of the proposed method of anastomosis of the tendons is an increase in the strength of the formed suture.

 The specified technical result is achieved by the fact that in the method of anastomosis of the tendons, including the formation of segments of the tendons, flashing them with suture material in the transverse direction with an entwining exit to the surface and removing the free ends of the suture material from the ends of the segments of the tendons, coaxial matching, convergence and tightening of the segments of the tendon the ends of the suture material, the flashing of the segments of the tendons is carried out radially symmetrically in at least two directions and planes of the cross section Ia, tightening the tendon segments cross superimposed free ends of the suture, which is used as titanium nickel alloy with the effect of superelasticity.

Figure 4 presents a diagram of the suture material - two in each segment of a scattered tendon. With this number of threads carried out in two spaced apart planes of the cross section at an angle of 90 ^o (sections 1). Next, the threads are repeatedly brought to the lateral surface of the tendon along a winding (spiral) path (sections 2), injected into the thickness and removed from the ends of the segments (sections 3).

 The structure of the internal seam developed due to the presence of several threads and their complex trajectory covers a large volume of tissue of the tendon segment, as a result of which the specific pressure of the thread on the tissue and the threat of its eruption during dynamic loads of the anastomosis zone are reduced. The high mechanical strength of the titanium nickelide filament and, therefore, its possible small volume (filament diameter) and high biocompatibility of the material make it possible to adapt the fabric safely under conditions of its saturation with a foreign material.

 The symmetry of the trajectory and the separation of the planes of individual transverse directions are intended to distribute evenly suture material in the thickness of the fabric.

 Cross application and contraction of the free ends of the suture material is stronger than in the prototype, fixes the segments of the tendons from the possibility of rotational mobility.

 The main contribution to the attainability of the technical result, both indirectly through the above distinguishing features, and direct - surgical quality - is made by the presence of titanium nickelide with the effect of superelasticity. The elastic property of the suture material, i.e. the constancy of tension in a large stretching interval provides stable compression of the anastomotic site after constriction. This is important during healing, when the swelling subsides and the threads of the traditional suture material (for example, silk) weaken the compression, creating a risk of insolvency.

 The above set of essential features of the method, along with the use of the strength of suture material to reduce its volume with a developed structure and, therefore, reduce ischemic effects, was not found in scientific, technical and patent information sources. This indicates that the proposal meets the criterion of "inventive step".

The illustrations show:
Figure 1. Scheme of the method of anastomosis of the tendon according to Lang
Figure 2. Scheme of the method of anastomosis of the tendon according to Kuneo.

 Figure 3. Scheme of the method of anastomosis of the tendon according to Kozakov (prototype).

 FIG. 4. Scheme of the method of anastomosis of the tendon according to the claims. 1-sections of the transverse conducting threads of suture material, 2 - sections of a twisted exit to the lateral surface, 3 - sections of the removal of the free ends of suture material.

 Figure 5. Tightening of the segments of the tendon.

 6. Photo demonstrating the volume of motion of the thumb after anastomosis of the tendon performed by the proposed method.

The attainability of the technical result is confirmed by the results of specific examples of the clinical application of the method in the microsurgery department of the Omsk State Medical Academy
Example: Patient D., 16 years old, was delivered to the department after 30 minutes. after trauma to the right hand, cut with glass. Transverse incised wound 2x0.6 cm, lack of active extension of the thumb.

 During the recovery operation, the method of anastomosis of the cut tendon was applied, which is specifically carried out as follows.

 Under conduction anesthesia, primary surgical treatment of the wound is carried out, the distal segment of the tendons of the long and short extensors of the thumb is isolated. From a separate incision on the forearm, the proximal segments of the tendon are brought out and through the tendon conductor to the wound. Anastomosis is carried out according to the method of the proposed method using titanium nickelide filaments with a diameter of 0.7 mm as a suture material. The strength of the anastomosis was checked directly on the operating table and there was no doubt about its high quality.

 Wounds are sutured, an aseptic dressing and a plaster splint are applied.

 In the postoperative period, the strength of the anastomosis is preserved. Active finger movements (Fig. 6) started from day 12, immediately after the removal of sutures. Rehabilitation measures have been launched, including a physical therapy complex, massage, paraffin baths. The patient transferred the treatment easily and returned to active work 1.5 months after the operation.

Sources of information
1. A multivolume guide to orthopedics and traumatology, M., v. 1, p. 412.

Claims (1)

The method of anastomosis of tendons, including the formation of segments of the tendon, suturing their thickness with suture material in the transverse direction with a winding exit to the surface and removing the free ends of the suture material from the ends of the segments of the tendon, coaxial matching, drawing together and tightening the segments of the tendons with the ends of the suture material, characterized in that the stitching segments of the tendons are carried out radially symmetrically in at least two directions and planes of the cross section, tighten the segments of the tendon from the cross m overlaying the ends of the suture material, titanium nickelide with the effect of superelasticity is used as the suture material.

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