RU2417061C1 - Method of treating shoulder-slip - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to orthopaedics in treating shoulder-slip. A rotator cuff is approached through an incision in an anterior surface of a shoulder joint. After external rotation of the shoulder, a longitudinal hollow is made with a blunt osteotome in an intertubercular region, wherein a long head of biceps is placed and fixed to the rotator cuff.

EFFECT: method prevents joint stiffness.

1 ex, 1 dwg

Description

The invention relates to medicine, in particular orthopedics, and for the treatment of habitual dislocation of the shoulder.

Frequent habitual dislocation of the shoulder is a common pathology of the shoulder joint as a complication of the initial traumatic dislocation, prone to relapse.

For the treatment of patients with habitual dislocation of the shoulder, more than 300 methods of surgical treatment are known. All of them can be divided into several main groups, among which: joint capsule surgery; operations to create ligaments that fix the head of the shoulder; bone surgery; muscle surgery combined operations.

The largest group of operations is tenosuspension. A variation of tenosuspension is the transposition and tenodesis of the tendon of the long head of the biceps of the shoulder under the large tubercle of the humerus according to the method of A.F. Krasnov.

A known method is a modification of this classical method, including the extraction of a tendon of the long head of the biceps of the shoulder, the formation of a bone leaf with a base in the tuberous region, the formation of a channel for laying the tendon at the base of the tendon, followed by its fixation, characterized in that the tendon is additionally sutured with a Kuneo suture from the upper and the lower poles to the center, the ends of the threads are carried out in the holes formed at the base of the bone leaf, tie them on the back side of the leaf [Pat. No. 2166917 of the Russian Federation, 7 MPK А61В 17/56. A transposition method with intraosseous reinforced autonodesis of the tendon of the long head of the biceps muscle in the treatment of the usual dislocation of the shoulder].

The method eliminates the disadvantages of the method of A.F. Krasnov, in which the movement of the tendon leads to stretching of the tendon fibers, the development of a degenerative process, the weakening of mechanical strength, relapses are reduced. However, the time of surgical intervention is increased and additional traumatization occurs during the formation of holes for holding threads at the base of the “sash”.

The known method of F.F.Andreev. In this case, the short head of the biceps muscle and the beak shoulder muscle are cut off from the coracoid process, they are passed through the canal behind m.subscapularis, and hemmed to the former location to the coracoid process.

B. Boychev, in addition to caput brevis m.bicipitis and m.coracobrachialis, moves the outer part of m.pectoralis minor, believing that the latter is largely opposed to shoulder head relaxation [Surgery of the upper limb. Chaklin V.D. Volume XI. Book 1. M .: Medgiz, 1960. P.158].

The methods are complex, suggest additional trauma.

A known method of operation according to Weinstein.

A large oblique incision is made between the pectoralis major and deltoid muscles.

From the top of this section, at an acute angle to it, an incision is made along the upper front slope of the small tubercle, cutting off the subscapularis muscle attachment to half, then the incision is rotated at a right angle and goes 4-5 cm in the middle of the subscapularis tendon. Finally, the incision is again rotated at a straight angle towards the neck of the shoulder and cross the second half of the tendon. The tendon of the long head of the biceps is thrown over the small tubercle and laid on the front surface of the head of the humerus. On this tendon, respectively, in the middle of the head of the humerus, a V-shaped suture is applied, the ends of which are brought out through the thickness of the subscapularis muscle and the layered sutures are tied [Chaklin V.D. Orthopedics. M .: Medgiz, 1957. P.532].

The method is multi-stage, traumatic.

There is a known method of Tkachenko, in which a skin incision is made along the groove between the deltoid and pectoralis major muscles. The tendon of the long head of the biceps muscle is exposed and taken on a gauze holder. Cross only the upper half of the tendon of the subscapularis muscle. A tendon of the long bicep head is placed into the incision, after which the dissected part of the tendon is sutured [Military traumatology and orthopedics. Leningrad, 1977. S. 245-247].

Despite the large number of known methods of surgical treatment of the usual dislocation of the shoulder, the development of effective, affordable, simple, less traumatic methods remains an urgent task.

The closest analogue of the present invention is a method of surgical treatment of a habitual dislocation of the shoulder, including the extraction of a tendon of the long head of the biceps, characterized in that the tendon is cleaned of peritononia and placed in a deep inter-tubercle groove, lining it on the sides with pieces of canned bone [Pat. No. 2223058 of the Russian Federation, 7 IPC А61В 17/56. A method of surgical treatment of habitual dislocation of the shoulder].

The method is as follows: a skin incision along the front surface of the shoulder joint in the projection of the inter-tubercle groove in the mid-physiological position of the arm. At the first stage, the shoulder retreats outward, leading to the wound zone of the tendon of the long head of the biceps of the shoulder, and after dissection of the transverse ligament, the tendon is mobilized. At the second stage, the tendon is freed from adhesions and removed - scarify the membrane - peritonium. At the third stage, the inter-tubercle groove is deepened with the removal of the sliding apparatus (cartilage tissue). At the next stage, the tendon moves into a deep intermine fissure with the introduction of pieces of canned allogeneic bone graft into its edges. In this case, the displaced tendon is covered with bone grafts. At the fifth stage, the soft tissue tendon sheath is sutured with catgut sutures. Subsequently, after the tendon is fused with the bone, its proximal section will serve as the ligament of the shoulder.

The method achieves the fusion of the tendon with the humerus, restores the stability of the shoulder joint with gentle trauma.

The disadvantages of the method include the use and necessity of having an allograft, as well as additional trauma during the formation of a rather deep groove, when the cortical layer is also damaged. In addition, the joint is stiffened, as a result of which, after about a year, the amplitude of movement in the shoulder joint may suffer due to stiffness. Postoperative immobilization of the shoulder joint with Deso dressing, reinforced with plaster bandages, lasts 6 weeks.

The objective of the invention is to create a method that can reduce additional trauma, reduce the risk of possible complications and relapses, reduce the time of surgical intervention and the duration of rehabilitation.

The method is as follows.

Through an incision along the front surface of the shoulder joint, access to the capsule of the shoulder joint. With the usual dislocations of the shoulder joint, the tendon (long head of the biceps) is torn off and is movably in the scars, the capsule has healed. After external rotation of the shoulder in the inter-tubercle region (between the large tubercle and small tubercle), a notch (“groove”, dent, impression) is made by a blunt osteotome in the longitudinal direction. The long head of the biceps muscle is laid in it and fixed with 2 or 3 sutures to the joint capsule. Stitches on the wound. Headscarf for 3 weeks.

The drawing shows a stitched long head of the biceps into the groove between the large and small tubercles, where 1 is the humerus, 2 is the large tubercle, 3 is the small tubercle, 4 is the biceps muscle of the shoulder, 5 is the long head of the biceps, 6 are sutures.

Example.

Patient F., 25 years old, was undergoing treatment for a habitual dislocation of the right shoulder (in the anamnesis - 3 dislocation).

The operation was performed: under endotracheal anesthesia in the supine position, through a straight incision 10.0 cm long, access was made to the right shoulder joint. Outward rotation of approximately 15 °. Without opening the capsule of the joint, a blunt osteotome made a groove in the longitudinal direction in the inter-tubercular region, a long biceps head (tendon), isolated from scars, was laid and fixed to the joint capsule with 2 sutures. Stitches on the wound. Headscarf for 3 weeks. After 3 weeks, the kerchief bandage was removed. Treatment - physiotherapy exercises, physiotherapeutic treatment. After 2 weeks - to work. Builder by profession. It was observed 3 months - there was no relapse of shoulder dislocation.

The method allows you to automatically, when suturing, to eliminate the increase in the volume of the capsule, and also to recreate the course for the tendon of the long head of the biceps in the same anatomical place. Increases the effectiveness of the treatment method while reducing its invasiveness, because the intervention is performed only on soft tissues, without dissection of the joint capsule, without violating the trophism of the long biceps head throughout. In the place of impression on the humerus, both cartilaginous tissues and the cortical layer are preserved. The stitched head of the biceps is capable of physiological “floating” movements, which prevents the risk of subsequent joint stiffness.

Surgery time less than 40 minutes.

Within 8 years, 11 operations were performed using this method. No relapse was observed.

Claims (1)

A method of treating a habitual dislocation of the shoulder, including the allocation of a long head of the biceps muscle and placing it in the inter-tubercle groove of the humerus, characterized in that in the inter-tubercle region of the humerus in the longitudinal direction with a blunt osteotome, an impression is performed without dissection of the joint capsule, a long head is placed in the "dent" biceps muscle after isolation from scar tissue and fix it to the joint capsule.

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