RU2454960C1 - Method of treating injured tendon with preservation of sliding function - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics. Injured tendon is exposed. Tendon suture is applied. Damaged part is wrapped with allogenic transplant of Alloplant series. As transplant applied is multi-layer transplant from single block of superficial and own fascia, obtained form area of allogenic donor shin or forearm. Transplant is fixed by lower layer in area of proximal and distal ends to tendon. In case of vast defect vaginal synovial membrane is restored by suturing multi-layer transplant of Alloplant series with uninterrupted atraumatic suture on edges of defect of vaginal synovial membrane in form of patch.

EFFECT: method ensures preservation of sliding function of tendon both in early terms, and in distant post-operative period, reduction of post-operative complications.

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Description

The invention relates to medicine, namely to regenerative surgery of damaged tendons.

With tendon injuries, a violation of the sliding apparatus (sliding function) occurs. In the absence of adequate plasticity, cicatricial fusion of the damaged part of the tendon with the synovial vagina is observed. In this case, sliding shells undergo cicatricial changes. It is known that the sliding of tendons is provided through synovial sheaths or sliding membranes. In the drawings of FIG. 1, FIG. 2 shows the principle of operation of sliding shells during tendon movement, where muscles 1, sliding shells 2, collagen bands 3, through which sliding shells 2, hyaluronic acid 4 are fixed between themselves in the space between the sliding shells. The arrows indicate the direction of movement of the sliding shells. In the surgical treatment of a damaged tendon, it is important to prevent the formation of gross connective tissue formations.

Currently, various methods have been developed to prevent the development of cicatricial contractures (GI Lavrishcheva Prevention of adhesion formation during tendon regeneration in the synovial vagina zone / GI Lavrishcheva, OK Bolotsev // Traumatology, Orthopedics. -1985. - No. 11. - C. 11. .29.31; Basov VZ Prevention of scar-adhesions in patients with severe injuries of tendons / V.Z. Basov, AMSigarev, Z.S. Ovchinnikova // VII Congress of Orthopedic Traumatologists of Russia: Abstracts - Novosibirsk, 2002. - T.1. - S.390-391).

The use of synthetic materials to restore the sliding properties of a damaged tendon is known. In particular, it is known to use the Noltrex synovial fluid endoprosthesis in the treatment of patients with injuries of the flexor tendons of the fingers in the synovial vagina zone. At the same time, through an additional puncture of the skin proximal to the main wound, an interstitial catheter was inserted to introduce a hydrogel (1.7 mm in diameter) along the entire length of the synovial canal. After the gel filled the space between the tendon and the walls of the synovial canal, the catheter was removed, the wound was sutured in layers (Paterikeev D.V. Use of the original noltrex tendon suture and endoprosthesis in the treatment of patients with damage to the flexor tendons of the fingers in the fibro-synovial region vagina / Traumatology and orthopedics of Russia, No. 4 (42), St. Petersburg, 2006. - S.64-68).

It is known to use a hydrophilic implant to restore a sliding apparatus. The specified gel-shaped implant was also inserted into the synovial cavity, filling the space between the tendon and synovial vagina. (The use of a biocompatible hydrophilic implant in the plastic of the sliding apparatus of the joint-ligament-tendon complex of the hand and forearm / N.V. Mitrofanov, S.G. Zagryadsky, P.S. Moiseev // Actual problems of traumatology and orthopedics: Materials of scientific conf., N. Novgorod, 2001, Part 1. S.260-262).

The disadvantages of these methods are the following:

1. Synthetic implants are foreign to the human body and support a chronic inflammatory process in the surrounding tissues at the border of the living environment and the polymer. At the end of these processes, a coarse-fibrous connective tissue capsule is formed around the implant (Results of correction of soft tissue defects with polyacrylamide gel / A.A. Adamyan, M.A.Sulamanidze, Yu.V. Romashov [et al.] // Annals of plastic, reconstructive and aesthetic surgery. - 2004. - No. 1. - P.23-31; Narins RS Injectable Skin Fillers / RSNarins, PHBowman // Clin. Plast. Surg. - 2005. - Vol.32, No. 2. - P .151-162).

2. The above methods involve the introduction of easily resorbable gels that provide glide in the early stages of tendon regeneration. At the same time, there is no prevention of the formation of adhesions in the long term.

A known method of forming a sliding apparatus of the tendons of the flexors of the hand and fingers (application 2001112076, IPC F61B 17/56, publ. 02.20.2003), which transplanted a blood-supply fascial flap from the lateral surface of the chest on the chest-back artery. However, this method is traumatic.

A known method of treating a damaged tendon, in which a membrane limiter is used from the Alloplant biomaterial, is used to prevent scar formation during restoration of tendons of the flexors of the fingers in the synovial vagina. The essence of the method lies in the fact that after applying the tendon suture, the damaged part of the tendon is enveloped in Alloplant membrane. The latter is fixed to the tendon along the edges, after which the synovial vagina and all layers of the wound are sutured (Stasyuk AM Restoration of the flexor apparatus of the hand after damage to the tendons in the “critical zone” / AMStasyuk // VII Congress of Orthopedic Traumatologists of Russia: Abstracts of Novosibirsk, 2002) , T.2, S.295). It is known that allogeneic biomaterials of the Alloplant series, due to their regenerative properties, inhibit the growth of coarse-fibrous connective tissue, do not interfere with diffusion of tissue fluid and germination of blood vessels (RF Patent No. 2189257, IPC A61L 27/00, published on September 20, 2002).

The disadvantages of the prototype are:

1. The Alloplant series membrane limiter, which is a thin membrane made of connective tissue, has low elastically deforming properties (tensile strength, etc.).

2. This graft, being single-layer, does not perform the function of sliding shells in the long term.

The objective of the invention is to increase the effectiveness of the treatment of damaged tendons by maintaining sliding function.

The problem is solved by a method of treating a damaged tendon, including the allocation of a damaged tendon, applying a tendon suture, wrapping the damaged area with an alloplant allograft transplant, fixing it in the proximal and distal edges to the tendon, layer-by-layer suturing of the postoperative wound, in which, unlike the prototype, as a graft use a multilayer graft from a single block of superficial and intrinsic fascia obtained from the region of allogeneic donor tibia Whether forearm, and the graft is fixed to the lower layer of the tendon.

In the case of an extensive defect, the synovial vagina is restored by suturing the multilayer Alloplant transplant with a continuous atraumatic suture along the edges of the synovial vaginal defect in the form of a patch.

The specified technical result of the invention is achieved due to the following. The proposed multilayer transplant of the Alloplant series is made from a single block of the surface and intrinsic fascia of the allogeneic donor leg or forearm region. In these areas, sliding shells located between the surface and intrinsic fascia have 4-7 layers, providing maximum glide between the surface and intrinsic fascia. Free displacement of the layers relative to each other is possible due to the presence of hyaluronic acid 4 between them (Fig. 2) (Khodos AB Microvascularization of some fascial shells of the lower extremity of a person in connection with the doctrine of sliding systems: abstract of thesis ... Doct. Medical Sciences. - Krasnodar, 1970 .-- 36 p.).

By wrapping the damaged tendon with the proposed transplant, we ensure the preservation of the sliding function of the tendon both in the early stages and in the long-term postoperative period. This is due to the fact that the multilayer graft, even at the stages of substitution, can serve as sliding shells. While the Alloplant membrane prototype, which is a thin shell, sprouts connective tissue with the formation of adhesions in the long term, the sliding function of the tendon is violated precisely in the area of biomaterial transplantation.

The method is as follows. With fresh damage to tendons, for example, flexors of the hand, the wound is expanded in a segment of not more than 3 cm, the tendon sheath is opened. With chronic injuries of tendons, mobilizing operations (tenolysis, arthrolysis) are performed. Scars, pathologically altered tissues are excised, thorough hemostasis is performed. For applying a tendon suture, non-absorbable monofilament suture 3/0 is used. The damaged portion of the tendon is wrapped with a multi-layer Alloplant transplant. The graft is fixed in the proximal and distal region behind the lower layer to the tendon with an atraumatic thread 6 / 0-7 / 0 Vicryl. The wound is sutured in layers. If it is not possible to suture the tendon sheath, an Alloplant series multilayer graft is additionally placed on top of it and fixed along the edge with a continuous suture (Vicryl 6 / 0-7 / 0).

A multilayer transplant of the Alloplant series, made from sections of the leg or forearm of donor cadaveric tissue, is processed in a known manner (RF Patent No. 2189257, IPC A61L 27/00, publ. September 20, 2002), which ensures extremely low antigenic properties of the material while maintaining its bioplastic and physical and mechanical properties.

The proposed method operated on 25 patients with traumatic injuries of the tendons of the flexors of the fingers. In the early postoperative period, the following complications were observed. Pain was moderately expressed in 4 patients, edema in 3 patients, suppuration of the wound was not in any patient. Long-term treatment results were evaluated at least one year after the operation. Good results were achieved in 88% of cases, satisfactory in 8%, unsatisfactory 4%.

Thus, the proposed invention allows to increase the effectiveness of the treatment of a damaged tendon while maintaining sliding function due to the use of a multilayer transplant of the Alloplant series.

Claims (2)

1. A method of treating a damaged tendon, including the allocation of a damaged tendon, applying a tendon suture, wrapping the damaged area with an Alloplant transplant allograft, fixing it in the area of the proximal and distal edges to the tendon, layer-by-layer suturing of a postoperative wound, characterized in that a multilayer graft is used as a transplant from a single block of superficial and intrinsic fascia obtained from the area of an allogeneic donor leg or forearm, and fix the graft and the lower layer to the tendon. 2. The method according to claim 1, characterized in that in the case of an extensive defect, the synovial vagina is restored by suturing the multilayer Alloplant transplant with a continuous atraumatic suture along the edges of the synovial vaginal defect in the form of a patch.

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