RU2318462C1 - Method for surgical therapy of subcutaneous tendinous ruptures of long caput of biceps muscle of arm at its insufficient length - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: it is necessary to have the access towards median third of humerus. One should suture the tendon with tendinous suture at the whole distance, in intertubercular groove one should drill the foramens at the angle of 45° by forming them as a cone, the ligatures of tendinous suture should be applied through these foramens. Due to tightening the ligatures it is necessary to reconstruct muscular tonicity, moreover, ligatures should be bound by forming a blocking knot. The innovation provides the reconstruction of articular biomechanics, improved fixation and excludes tendinous curvature and disorders in its circulation.

EFFECT: decreased traumatism of operation.

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Description

The present invention relates to medicine, namely to traumatology and orthopedics, and relates to the fixation of the torn tendon of the long head of the biceps of the arm of the shoulder to the inter-tubercle groove with insufficient length.

A known method of surgical treatment of subcutaneous tendon ruptures of the long head of the biceps of the shoulder with insufficient length, consisting in fixing the tendon to the surrounding tissues, to the coracoid or acromial processes using lavsanoplasty (see Kaplan A.V. Damage to bones and joints. - M., 1979, p.206-207).

However, this method is traumatic, technically complex and makes it difficult to perform lavsanoplasty.

Closest to the proposed technical solution is a method consisting in dissecting soft tissues in the upper and middle third of the shoulder, removing the torn tendon into the wound, dissecting it in the frontal plane for 3-4 cm, introducing into this "cleavage" a fine mesh lavsan tape 10 wide mm, drilling two holes in the inter-tubercle groove at an angle of 90 ° and fixing one end of the tape to the muscle, and the second end trans-axially in the area of the inter-tubercle groove of the humerus (see Movshovich I.A. Operative orthopedics: P a guide for doctors. M., 1994, p.118).

However, the known method is traumatic, since two large-diameter holes are made in the humerus, which leads to a bend of the tendon and a violation of its blood supply. In addition, a foreign body (tape) of a significant size remains in the tendon fixation zone.

The objective of the proposed invention is to reduce the invasiveness of the operation, the exclusion of the bend of the tendon and violation of its blood supply.

The problem is solved due to the fact that the holes are drilled at an angle of 45 °, forming them in the form of a cone, and the tendon is fixed in the holes by a blocking unit.

The essence of the method is illustrated by drawings, where figure 1 shows the selection of the tendon of a long head and the imposition of a tendon suture; figure 2 - drilling holes in the inter-tubercle groove of the humerus; figure 3 - holding the threads of the tendon suture through the holes of the humerus and tying the blocking node.

The method is as follows.

Through a small linear incision along the front surface of the middle and upper third of the shoulder, tendon 1 of the long head of the biceps muscle of the shoulder is exposed and, after its revision, the entire length is sutured with kapron thread 2 with a tendon suture (Fig. 1). Then, a hole 3 is drilled in the lower part of the inter-tubercle sulcus 3 through the anterior cortical layer with a drill with a diameter of 3.2 mm at an angle of 45 °. Using a larger diameter cutter, deepen the hole 3, forming it in the form of a cone. Drill 1.5 mm from the outer-lateral surface of the crest of the inter-tubercle groove drill a hole 4 in the direction of the hole 3, depending on the length of the tendon 1 (figure 2). Tendon 1 is pulled by the strand 2 of the tendon suture and fixed transosseously in the opening 3. Tension of the strands 2 restores muscle tone and ties the strands, forming a blocking unit 5 (Fig. 3). After suturing the surgical wound, the limb is fixed with a plaster cast from the scapula of the opposite shoulder girdle to the base of the fingers at an angle of flexion of 90-100 ° in the elbow joint for 3-4 weeks, followed by a course of exercise therapy and FTL.

Clinical example. B-th Zn.A.R., 53 years old, (case history No. 212793) turned to the Nizhny Novgorod Research Institute 5 days after an injury with complaints of pain in the upper 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 when he dropped the severity (log) from the shoulder. Immediately there were pains in the area of the right shoulder joint, a decrease in the strength of the right hand. Two days later, he drew attention to hemorrhage along the anteroposterior surface of the right shoulder. 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 easily displaced in the lateral directions. When the flexors of the forearm are tensioned, the biceps muscle in the form of a roller moves to the middle and lower third of the shoulder.

The strength of the right hand is 90% of the strength of the left (the right-handed patient), the maximum arbitrary force of the flexors of the right forearm is 85%, the extensors are 105%, the arch supports are 80%, the pronators are 90%.

Diagnosed with tearing of the tendon of the long head of the biceps of the shoulder. In this regard, the operation of the proposed method.

The postoperative course is smooth without complications. The wounds healed by primary intention. Immobilization after removing the sutures with a Deso plaster cast lasted 3 weeks, then a course of restorative physiotherapy and kinesitherapy was carried out.

The amplitude of active movements in the shoulder and elbow joints was restored, the patient started 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 voluntary force of the flexors of the right forearm is 102%, extension is 105%, supination is 113%, pronation is 108%.

The proposed method reduces the invasiveness of surgical intervention, simplifies the technique and increases the reliability of the operation, reduces treatment time. The method is simple, effective and can be implemented in any trauma hospital.

Claims (1)

A method for surgical treatment of subcutaneous tendon ruptures of the long head of the biceps of the shoulder with insufficient length, including access to the middle third of the humerus, making holes in the intercusal groove and fixation of the tendon, characterized in that the tendon is stitched along the entire length of the tendon suture, holes are drilled in the intercusal groove at an angle of 45 °, forming them in the form of a cone, conduct the tendon suture through the holes, tension the threads to restore muscle tone and tie the threads, forming a block ruyuschy node.

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