RU2340303C2 - Method of prosthetics of tendons - Google Patents

Abstract

FIELD: medicine; orthopedy and traumatology.

SUBSTANCE: carry out longitudinal sections on a tendon with depth of 2/3 of diameter of a tendon and length of 1.5 cm in which immerse a site of a graft made from polypropylene mesh. The graft represents a rectangle in length on 3 cm exceeding the size of a diastase between the tendon extremities, combined in the form of a duplicate, having width of 1/3 of diameter of a tendon and stitched by a continuous suture from non-absorbable suture material. Fix the graft with torous sutures from a non-absorbable suture material to the tendon with restoration of integrity of a slipping surface of the tendon. In a similar way a graft sew in other extremity of a tendon with restoration of its necessary length. The free site of the graft which has been not shipped in the extremities of the tendon is preliminary turned with a found autofascia flap with edges fixed on length a continuous torous suture from an absorbable suture material.

EFFECT: provision of durability of a suture, prevention of development of cicatrical adnations of a graft with surrounding tissues.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and is used in the surgical correction of various traumatic injuries when tendon plastic is required.

There is a method for repairing tendons (Chernov A.P., Chernov A.A., Zaitsev R.V. “Method for repairing a tendon of the long head of the biceps of the shoulder”, patent for invention No. 2151112), in which the place of rupture of the tendon is isolated, the tendon is opened muscle sheath of the tendon of the long head of the biceps of the shoulder. Free the ends of the damaged tendon from adhesions. Stitch the ends of the tendon. The junction of the tendon is blocked with an autograft on the feeding leg. An autograft is formed from the end of the muscle abdomen. The disadvantages of this method include: 1) a limited scope and, therefore, the impossibility of widespread use in surgical interventions on tendons of smaller diameter; 2) does not guarantee sufficient strength in the area of the tendon joint; 3) long-term disability of patients.

A known method of treating injuries of the Achilles tendon (Imamaliev A.S., Osipova S.V., Tishin S.P., Imamalieva G.A. “A method for treating rupture of the Achilles tendon according to A.S. Imamaliev”, patent for invention No. 94004933) taken as a prototype. Longitudinal sections along the outer edges of the Achilles tendon fragments reveal its torn ends.

From the aponeurosis of the calf muscle, a flap is cut out that is connected with the bed in the distal section. A longitudinal tunnel is cut under the base of the flap, into which a flap is pulled, which, like the defect of the calf muscle, is sutured with rare sutures, and the wound is sutured tightly layer by layer. The disadvantages of this method include: 1) its use does not allow to restore a shortened tendon and does not guarantee sufficient strength in the area of the tendon suture, which can lead to its eruption and divergence of the ends of the stitched tendon; 2) long periods of disability of patients.

The aim of the present invention is: prosthetics of a damaged tendon in the presence of diastasis between its ends to restore range of motion, ensuring strength in the area of the tendon suture, which allows the use of a dosed functional load on the operated limb in the early postoperative period, preventing the development of cicatricial adhesions of the graft with surrounding tissues, reducing the time inpatient treatment and patient disability.

This goal is achieved by compensating for the shortening of the injured tendon by replacing the defect with a combined graft consisting of a rectangular polypropylene mesh folded in the form of a duplicate 1/3 of the diameter of the tendon, the free portion of which is wrapped with a pre-cut autofascation flap (for example, a wide fascia of the thigh). In this case, the fascia, undergoing connective tissue transformation, plays the role of a kind of shell that prevents the formation of cicatricial fusion of the polypropylene mesh with the surrounding tissues.

Figure 1 shows a duplicate of a polypropylene mesh;

Figure 2 shows the immersion of the transplant site from a polypropylene mesh and fixing it with interrupted sutures to the tendon with restoring the integrity of the sliding surface of the tendon;

Figure 3 presents the stitching of the graft from a polypropylene mesh at the other end of the tendon with the restoration of its required length;

Figure 4 shows the wrapping of a free portion of the graft from a polypropylene mesh with a pre-cut autofascation flap, the edges of which are fixed along the length of a continuous interrupted suture.

The method is as follows:

A skin incision is made in the projection of the tendon, the distal and proximal ends of the tendon are freed from scar tissue in case of chronic traumatic injuries. The size of the diastasis between the ends of the tendon is measured.

A rectangular flap is cut from a polypropylene mesh 3.0 cm longer than the diastasis between the ends of the tendon, folded in the form of a duplicate (Fig. 1) so that the width of the graft from the polypropylene mesh is equal to 1/3 of the tendon diameter, and stitched along the length with a continuous suture from non-absorbable suture material.

At one end of the tendon, a longitudinal incision is made by a depth of 2/3 of the diameter of the tendon, 1.5 cm long, into which a section of the polypropylene graft is immersed and fixed with interrupted sutures from a non-absorbable suture material to the tendon with restoration of the integrity of the sliding surface of the tendon (Figure 2) . Similarly, a graft of polypropylene mesh is sutured to the other end of the tendon with the restoration of its required length (Figure 3).

The free portion of the graft from the polypropylene mesh, not immersed in the ends of the tendon, is wrapped with a pre-cut autofascation flap, the edges of which are fixed along the length of a continuous interrupted suture from absorbable suture material (Figure 4). The wound is sutured in layers.

Clinical trials of the proposed method revealed such advantages of the method as:

1) allows you to effectively lengthen the tendons to ensure full range of motion;

2) ensuring the strength of the tendon joint area;

3) the ability to use in the reconstruction of tendons with any diastasis between the distal and proximal segments;

4) ensuring early dosed functional load:

passive movements on the 2nd day after surgery; active on the 3rd day after surgery;

5) prevention of the formation of connective tissue adhesions of the transplant with surrounding tissues;

6) reducing the time of inpatient treatment and patient disability.

Claims (1)

A method for prosthetics of the tendons, including dissection of the tendon, insertion of the graft, its stitching with the tendon, characterized in that the tendons perform longitudinal cuts with a depth of 2/3 of the diameter of the tendon and a length of 1.5 cm, into which the portion of the graft is immersed from a polypropylene mesh, which represents a rectangle 3 cm longer than the diastasis between the ends of the tendon, folded in the form of a duplicate, 1/3 of the diameter of the tendon wide and stitched with a continuous suture from a non-absorbable suture material, the graft is fixed with interrupted sutures from a non-absorbable suture material to the tendon with restoration of the integrity of the sliding surface of the tendon, the graft is sewn into the other end of the tendon in a similar way with restoration of its required length, and the free portion of the graft, not immersed in the ends of the tendon, is wrapped with a pre-cut autofascial flap, fixed along the length of a continuous interrupted suture from absorbable suture material.

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