RU2285479C2 - Method for ligamentous plasty of distal radio-ulnar articulation at its chronic lesion - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: the present innovation deals with treating aftereffects in case of lesions in distal radial department. One should sample a tendinous "split-off" of ulnar extensor of wrist being upon distal pedicle, form a G-shaped canal longitudinally along the axis of elbow bone and transversely at coming into interosseous space, apply a tendinous transplant into this G-shaped canal. On coming towards interosseous space one should round transplant's free end through elbow bone from volar surface to be returned onto rear one in case of volar dislocation and through rear surface onto volar one - at rear dislocation. Transplant should be applied paraossally being transversely against radius to be fixed with tension. The innovation provides decreased traumatism of operation, increased fixation and decreased risk of transplant's rupture.

EFFECT: higher efficiency of plasty.

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Description

The invention relates to medicine, in particular to traumatology, in the treatment of the effects of damage to the distal radius of the radial bone with a rupture of the distal radiolactic joint. Several methods are known for the treatment of chronic injuries of the distal radial ulnar joint: 1) Darrach method - resection of the ulnar head along an oblique line from the base of the styloid process to the distal edge of the articular surface of the ulnar head; 2) the method of Moora - Darrach - hemi-resection of the head of the ulna when its articular surface is removed, but the styloid process and the entire internal part are preserved (Ashkenazi A.I. Surgery of the wrist joint. / Moscow: Medicine, 1990). Also known are the methods of Edelstein and Yu.Yu. Dzhanelidze (N.I. Reut, F.A. Kadyrov. Treatment of isolated injuries of the distal radiolactic joint. / Orthopedics traumatology and prosthetics, 1971, No. 4).

These methods contribute to the partial restoration of the function of the hand, including rotational movements, however, they have the following disadvantages: instability in the wrist joint - contributes to the development of deforming arthrosis, sagging and relapses of the disease.

The closest in essence to the proposed are the methods of Edelstein and Janelidze.

A well-known method of Edelstein is that the splinter of the tendon of the ulnar flexor is carried out on the rear of the head of the ulnar bone in its girth circularly and back to the palmar surface. Thus, the method is applicable only for dorsal dislocation of the ulnar head. Another negative feature of this method is the real threat of creating compression of the ulnar nerve caught in the loop.

The Dzhanelidze method associated with the isolation of old scars of a damaged ligamentous apparatus, fibro-cartilage complex from a conglomerate by excising a part of them and restoring residues is notable for its technical complexity and injuries. Replacing a triangular ligament with a split tendon in half is quite true, but with its soft-tissue fixation (to the ligament residues) it is not very reliable, it carries the risk of rupture and relapse.

Thus, these methods are characterized by excessive radicalism and trauma, unsatisfactory long-term results and insufficient treatment efficiency.

The technical effect of the invention is to reduce the morbidity of the operation and increase the effectiveness of treatment.

The claimed technical result is achieved by creating a solid fixation of the head of the ulna in the right position in the sigmoid notch (a kind of tenodesis) with reliable intraosseous and paraossal fixation of an autotendinous graft. This part of the triangular fibro-cartilaginous complex and ligamentous apparatus is restored, which is functionally insufficient in this particular case, since it is known that with the palmar dislocation of the head of the ulnar bone, the back portion of the radiolactic ligament suffers, and with the rear dislocations - the palmar portion. The operation is indicated if it is possible to restore satisfactory ratios in the distal radar-elbow joint and the need to stabilize the distal end of the ulna.

The compliance of the technical solution with the criterion of "novelty" is determined by the absence in the prior art of an identical technical solution to achieve the claimed result.

Compliance with the criterion of "industrial applicability" is determined by the effectiveness of the treatment of the consequences of damage to the distal radius of the radius, which supports the interest of the Health Service in them, ready to move on to the widespread implementation of the proposed method, for which it is advisable to obtain patent protection of a new development.

The essence of the proposed method lies in the fact that a tendon of the elbow extensor of the brush and a distal radiolbow joint are distinguished from an incision along the dorsum of the hand in the region of the head of the ulnar bone. If necessary, an open reduction of the dislocation of the ulnar head is performed. From the tendon of the ulnar extensor of the hand (figure 1, a) is a fence "flakes" of the natal pedicle (figure 1, b). In the head of the ulnar bone with a thin drill, a L-shaped channel is made longitudinally along the axis of the ulnar bone and transversely with the exit in the subatribal zone into the interosseous space (Fig. 2, c).

Auto-tendon graft - flap with a distal fixation point, with the help of a curved needle and thread is carried out in the L-shaped channel. After reaching the side of the interosseous gap, the free end bends around the ulnar bone from the palmar surface and returns to the back with the palmar dislocation and through the back surface to the palmar - with the back dislocation. Next, a small raspator is carried out paraossally at the level of the transverse part of the canal in the head of the ulna along the dorsal surface of the radius with palmar dislocation (figure 3) and palmar - with the back dislocation (figure 4). The free end of the graft is stitched and clamped paraossally across the radius to the opposite side, where with tension and with the positioned position of the ulnar bone is fixed "on the roller" (Fig.3-g). The distal radiolbow joint is fixed with needles (Fig. 3, 4-d). In the postoperative period, gypsum immobilization is applied for 4 weeks.

Clinical example

Patient A., 43 years old, was admitted to the admission department of RosNIIITO with a diagnosis of Closed fracture of the distal metaepiphysis of the right radius with displacement. A closed manual reposition was performed, immobilization with a plaster cast. A satisfactory position of the fragments was achieved on the control Pr-grams. Subsequently, the fracture consolidated, but the inconsistency of the distal radiolbow ulnar joint with the posterior subluxation of the ulnar head was manifested. He applied for help 4 months after the injury with complaints of limitation of the range of rotational movements and pain in extreme positions of pronation and supination, and a decrease in the grip power of the fingers.

An operation was performed according to the described method with fixation of the distal radiolactic joint with knitting needles and a plaster cast for up to 4 weeks. After a short course of rehabilitation treatment, almost the full volume of rotational movements without pain was achieved, the grip force was restored. Examined after 1 year: the effect of the operation is preserved in full.

Literature

1. N.I. Reut, F.A. Kadyrov. Treatment of isolated injuries of the distal radiolbow joint. / Orthopedics traumatology and prosthetics, 1971, No. 4.

2. Sachs H.O., Lavrov V.I. Errors and complications in the treatment of pseudarthrosis of the bones of the forearm and impaired function of the hand and wrist joint. / Modern methods of treating injuries and diseases of the hand. - M., 1975.

3. Kozlov I.A., Korshunov V.F., Shelukhina L.I. Long-standing dislocations and fractures-dislocations of the radial bone in the distal radiolbow joint and their treatment. // Orthopedics traumatology and prosthetics, 1989, No. 1.

4. Arenberg A.A., Kaplan M.N. Isolated dislocation of the ulnar head. // Orthopedics, traumatology and prosthetics, 1976, No. 12.

5. Ashkenazi A.I. Hand surgery / Moscow: Medicine, 1990.

Claims (1)

A method for plastic surgery of ligaments of a distal radiolbow ulnar joint, including a “flake” of a tendon of the elbow extensor of the hand on the distal leg, channel formation in the ulnar bone, conducting a tendon graft through the channel, characterized in that a L-shaped channel is formed longitudinally along the axis of the ulna and transversely with the exit in the interosseous space, conduct a tendon graft in the L-shaped channel, after going to the side of the interosseous space, they bend around the free end of the graft through the ulna with the palm of the hand surface and return to the back with a palmar dislocation and through the back surface to the palmar - with a back dislocation, a transplant is carried out paraossally across the radius and is fixed with tension.

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