RU2284782C1 - Method for treating the cases of distal arm biceps muscle tendon detachment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves taking one tendon cicatrix ligature and conducting it through canal drilled in spoke bone tuberosity, the second ligature being placed between the ulnar and spoke bone. Ligature ends are strained and tied.

EFFECT: reliable tendon fixation.

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Description

The present invention relates to medicine, namely to traumatology and orthopedics, and relates to the fixation of the torn distal tendon of the biceps of the shoulder with a sufficient length to the tuberosity of the radius.

Known methods for fixing the distal tendon of the biceps of the shoulder to the coronoid process of the ulna or to the tendon of the shoulder muscle (Kaplan A.V. Damage to bones and joints. - M., 1979, p.206-207), as well as to the radius (Movshovich I .A. Operative orthopedics: A guide for doctors. M., 1994, S. 118-120).

However, they are quite traumatic, the anterior wide access is technically difficult and dangerous, since it is performed in the immediate vicinity of the musculocutaneous, radial, median nerves and brachial artery with its division into branches. In addition, for transosseous fixation of the tendon to the tuberosity of the radius, wide access is required with a straight forearm, which makes it difficult to suture due to tension of the tendon, and the passage through the incision along the front surface of the ulnar region often leads to the subsequent formation of a hypertrophic or keloid scar.

Closest to the proposed technical solution is a method consisting in dissecting soft tissues in the lower third of the shoulder, extracting the torn tendon into the wound, applying a tendon suture, accessing the tuberosity of the radius along the posterior surface of the upper third of the forearm, conducting the tendon from the wound on the shoulder to the wound on the forearm and ligatures in the hole of the radius with cutting a bone wedge from the crest of the ulna and diluting the ends of the ligatures to drive a bone wedge between them with their subsequent fixation (see Diagnosis and treatment of subcutaneous injuries of the distal tendon of the biceps of the shoulder: Method. recommendations / (Gork. NIIITO, Gork. medical institute named after S.M. Kirov; Comp .: S.B.Korolev, Yu.D. Zhdakov) .- N.Novgorod, 1990.- P.5-11).

However, the known method has significant drawbacks: when the graft is taken, the adjacent ulnar bone is additionally injured, and if the graft is not in contact with the canal walls, there is a danger of ligature displacement, which leads to a tendon displacement from the attachment point. In addition, with very tight immersion of the wedge in the channel, damage to the threads is possible, which can cause the ligature to come off. This leads to a relapse of the displacement of the distal tendon of the biceps of the shoulder up.

The task of the invention is to ensure reliability of tendon fixation and reduction of treatment time.

The problem is solved due to the fact that in the method, including access to the tuberosity of the radius, applying a tendon suture, ligatures and fixation of the tendon, the external ligature is carried out through a channel drilled in the tuberosity of the radius, the internal ligature is brought into the interosseous gap between the ulna and the radius bones, the ends of the ligatures are pulled and tied.

The method is illustrated by drawings, which depict in figure 1 - the allocation of the distal tendon and the imposition of a tendon suture, figure 2 - drilling a through channel through the tuberosity of the radius, figure 3 - conducting an external ligature of the tendon suture through the channel of the radius in the wound on the forearm , Fig.4 - conducting internal ligatures between the radial and ulnar bones.

The method is as follows.

Through a small incision in the lower third of the shoulder, the fascial sheath of the biceps muscle is opened on its front surface. Torn tendon 1 is removed into the wound. The end of the tendon 1 is stitched with a tendon suture, the ends of the ligatures 2 and 3 are clamped, the wound is closed with a sterile napkin (Fig. 1). On the border of the upper third of the forearm and the area of the elbow joint behind, along the crest of the ulnar bone, an incision of 5-6 cm is made. The forearm is bent to an acute angle and ultimately pierced. In this position, the site 4 tuberosity, from which the tendon 1 has come off, is turned posteriorly. From the outer surface of the ulnar bone with a raspator, the attachment of the ulnar muscle is separated and removed outside. In the depths of the wound with full pronation of the forearm, the tuberosity of the radius is exposed. Channel 5 with a diameter of 3-4 mm is drilled through the center of tuberosity and both cortical layers. The drill is removed from the wound (figure 2). They keep bending the forearm to an acute angle, moving the forearm to the supination position. In the depths of the wound, the opening of the canal 5 in the cortical layer of the radius bone is exposed opposite its tuberosity, through which a tendon conductor 6 is inserted into the drilled canal 5 with an opening at the end. Toward the end of the conductor 6 through the wound on the shoulder with a bent forearm at an angle of 90-100 ° deep down the tendon 1 enter the index finger, under the control of which the end of the conductor 6 is advanced into the wound on the shoulder. The outer ligature 2 of the tendon suture is fixed in the hole of the conductor 6 (figure 3). Removing the conductor back, the outer ligature 2 is carried out through the drilled channel 5 into the wound on the forearm. Then, the inner ligature 3 is removed between the ulnar and radius bones (Fig. 4). In the position of supination and flexion of the forearm, the ligatures 2 and 3 are pulled so that the end of the tendon 1 fits snugly to the place of its separation from the tuberosity site 4. The ends of the ligatures 2 and 3 are tied. After the operation is completed, the flexion-extensor movements of the forearm and its rotation are checked. Rotational movements of the forearm should be accompanied by a distinct movement of the distal tendon of the 1 biceps muscle.

Clinical example. B-th S-s V.YU., 33 years old (medical history No. 206130), turned to the Nizhny Novgorod Scientific Research Institute of Surgery 7 days after an injury with complaints of pain in the lower third of the right shoulder, aggravated by tension of the forearm flexors, decreased strength of the right arm. From the anamnesis it is known that the patient was injured while lifting weights. Immediately there were pains in the area of the right elbow bend and in the lower third of the right shoulder, a decrease in the strength of the right hand. Two days later, he drew attention to hemorrhage along the front-outer surface of the right forearm. Objectively: a patient of strong build (in the past he was actively involved in sports). The abdomen of the biceps of the right shoulder is pulled proximal, easily shifted in the lateral directions. When the flexors of the forearm are tensioned, the biceps muscle in the form of a roller moves to the upper third of the shoulder, while the strand of the distal tendon is palpated.

The strength of the right hand is 88% of the strength of the left (the patient is right-handed), the maximum arbitrary force of the flexors of the right forearm is 64%, the extensors are 112%, the arch supports 39%, the pronators 111%.

The diagnosis was made: separation of the distal tendon of the biceps of the shoulder from the tuberosity of the radius. In this regard, an operation was performed: reinsertion of the distal tendon of the biceps of the shoulder to the tuberosity of the radius, in which a hole was made with an external ligature through it, and the inner through the interosseous gap of the ulna and radius. The ligatures are stretched so that the end of the tendon fits snugly against the tuberosity, the tendon is fixed to the tuberosity in the flexion position of the forearm. Layered suture of the wound. Iodine. Aseptic dressing. Plaster cast in the position of flexion and supination in the elbow joint at an angle of 90-100 ° for 3 weeks.

The postoperative course is smooth without complications. The wounds healed by primary intention. Immobilization of the elbow joint lasted 3 weeks, then a course of restorative physiotherapy and kinesitherapy was carried out.

The amplitude of active movements in the elbow joint was restored, the patient began to work. No complaints. Performs any physical work.

The contours of the biceps of the shoulder on the right and left are identical. The strength of the right hand is 97% of the strength of the left, the maximum arbitrary force of the flexors of the right forearm is 102%, extension is 105%, supination is 113%, pronation is 108%.

The proposed method provides a reduction in the morbidity, simplifies the technique and increases the reliability of the operation, reduces the treatment time. The method is simple, effective and can be implemented in any trauma hospital.

Claims (1)

A method of treating distal tendon detachment of the biceps of the shoulder muscle, including posterior access to the tuberosity of the radius, suturing the end of the tendon, ligating the tendon suture through the radius bone and fixing the tendon, characterized in that one ligature of the tendon suture is carried out through the channel drilled into the tuberosity radial bone, the second ligature of the tendon suture is carried out between the ulnar and radial bones, the ends of the ligatures are pulled and tied.

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