RU2230507C2 - Method for surgical treatment of old ruptures of achilles tendon - Google Patents

Abstract

FIELD: medicine, traumatology.

SUBSTANCE: one should cut out a P-shaped flap out of tendinous strain of gastrocnemius muscle, scar and Achilles tendon. Scar regenerates should be shortened with crimping suture, flap should be folded in two parts and fixed towards the distal end of Achilles tendon to provide tonicity of triceps muscle of calf.

EFFECT: higher efficiency of surgical therapy.

5 dwg, 2 ex

Description

The invention relates to medicine and relates to methods for the surgical treatment of diseases and consequences of injuries of the musculoskeletal system, in particular patients with damage to the Achilles tendon.

Known methods of surgical treatment of chronic Achilles tendon ruptures.

1. The method of Chernavsky (IA Movshovich. Operational orthopedics M., 1994, p. 319).

A feature of the method is the cutting out of a U-shaped flap from a tendon extension of the calf muscle with a leg at the distal end. This flap is brought to the posterior surface of the tendon and overlap with it the defect. The disadvantages of the method: the tendon-muscle tension is not restored, scar tissue is not used to strengthen the graft.

2. Method S.I. Dvoinikova (AS No. 1191065 dated 11/15/85).

The essence of the method is the excision of the scar stitching the ends of the tendon with a capron or lavsan, strengthening the sutures with a tendon of the plantar muscle. The disadvantages of the method: the tendon of the plantar muscle is intimately soldered to the tendon of the triceps muscle (A. V. Kraev. Human Anatomy. M., 1978, No. 1, p. 281), therefore, it usually breaks at the same time as the Achilles tendon; with sutures and a thin tendon of the plantar muscle, it is difficult to keep the retracted triceps muscle of the lower leg in a given position.

3. Method A.F. Krasnova (AS No. 668674 dated June 25, 79).

The difference between the method: use a U-shaped flap and part of the scar for plastic. The scar is isolated and recesses are formed in it in the form of a “case”. The flap is carried out on the front surface of the tendon, placed in a “case” of scar tissue and fixed in the cleft of the distal end of the tendon.

This method is taken as a prototype.

The disadvantage of the prototype: does not restore optimal tendon-muscle tension (tonus of the triceps muscle of the leg).

The restoration of the optimal tension of the tendon-muscle complex is crucial in tendon-muscle plastic surgery (I. A. Movshovich. Operative orthopedics. M., 2994, p. 22; A.F. Krasnov, G.P. Kotelnikov, A.P. Chernov, Tendon-muscle plastic surgery in traumatology and orthopedics, Samara, 1999, p. 215).

The purpose of the invention is to restore a torn tendon using a scar and a tendon flap folded in half, to improve the function of the triceps muscle of the lower leg by creating optimal tendon-muscle tension.

The method is as follows. The skin and subcutaneous tissue are cut with a zigzag section along the posterior surface of the lower leg, along with a paratenon of 25-30 cm in length, the Achilles tendon and cicatricial regenerate throughout the section. The distal triceps triceps muscle is freed from adhesions in an acute and blunt way. From a tendon extension of the calf muscle, cicatricial regenerate and Achilles tendon, a flap on a leg 18-20 cm long is cut out (Fig. 1). The flap is taken down (Fig. 2), on the proximal and distal ends of the Achilles tendon and cicatricial regenerate impose an interlocking suture of Kuneo (Fig. 2) with a strong lavsan or silk thread. The foot is brought to the maximum flexion position. The ends of the threads are pulled to such a state that the distal and proximal ends of the Achilles tendon are as close as possible to each other (figure 3).

The ends of the threads are tied together. This restores the tendon-muscle tension lost due to the divergence of the ends of the Achilles tendon. The flap is doubled (Fig. 4) and fixed to the anterior portion of the Achilles tendon overlapping the suture area (Fig. 5). Reduce the defect in tendon stretching. Paratenone is restored over a tendon flap. After careful hemostasis, the wound is sutured in layers. After the operation, a lining gypsum dressing is applied from the tips of the fingers to the upper third of the thigh, while the foot is bent to an angle of 130 °, and the lower leg to an angle of 150 °. The immobilization period is 6 weeks.

Figure 1 shows the first stage of the operation - cutting out a U-shaped flap from a tendon extension of the calf muscle, cicatricial regenerate and Achilles tendon; figure 2 - suturing Kuneo on the front portion of the Achilles tendon and scar regenerate; figure 3 - corrugation of the cicatricial regenerate and tying threads, suturing the defect in the tendon stretch of the calf muscle; figure 4 - folding the U-shaped flap in half; 5 is a fixation folded in half of the flap to the front portion of the Achilles tendon.

The fundamental difference between the proposed method and the known one consists in creating the optimal tension of the tendon-muscle complex, densification and strengthening of the cicatricial regenerate by the method of corrugating tissues, in the formation of a U-shaped flap, including tendon stretching of the calf muscle, cicatricial regenerate, the back portion of the Achilles tendon, fixing it to the front servings of the Achilles tendon in a double folded position to increase strength.

The advantage of the proposed method over the known ones is as follows: the optimal tension of the tendon-muscular complex is restored using the less traumatic method - shortening the tissues without excising the scar.

At the same time, scar tissue additionally strengthens the tendon rupture site. A folded flap is twice stronger than a single layer used in known methods. Moreover, the wrapped part of the flap, located between homogeneous tissues, quickly rebuilds its structure in the postoperative period. In the aggregate, the method provides the conditions for obtaining a good functional result and reduces the possibility of relapse.

The proposed method with a positive effect was performed in two patients with a chronic rupture of the Achilles tendon.

1. Patient T., 35 years old, was admitted to the clinic of traumatology and orthopedics of the Samara Medical University on September 14, 2001. Diagnosis: chronic rupture of the right Achilles tendon. Four months have passed since the injury. On September 17, an operation was performed according to the proposed method, on October 26, a plaster cast was removed. Postoperative rehabilitation was carried out. The result is good.

2. Patient K., 32 years old, was treated in the clinic of traumatology and orthopedics of the Samara Medical University from September 20 to November 5, 2001 with a diagnosis of chronic rupture of the left Achilles tendon. The operation according to the proposed method. The result is positive.

The patient walks without limping, can stand on the toe of the foot of a damaged limb.

The method can be recommended in practical medicine.

Claims (1)

A method of surgical treatment of chronic Achilles tendon ruptures, including the use of a U-shaped flap of a tendon extension of the gastrocnemius muscle with its fixation to the distal end of the Achilles tendon, characterized in that the flap is cut from the tendon extension of the calf muscle, cicatricial regenerate, scar tissue tendon, Achilles tendon tendon, fold in half.

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