RU2471442C1 - Method of tendon fixation in case of its avulsion in combination with longitudinal rupture - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of traumatology. Method is performed by introduction of at least two fixing devices, implanted on both sides from the line of longitudinal tendon rupture, into bone in the place of tendon avulsion. After that, it and adjacent section of muscle are sewn with crossing, zigzag tension sutures in mesh-like way.

EFFECT: reduction of surgery trauma and increased strength of tendon fixation in case of its avulsion in combination with longitudinal rupture.

1 ex, 2 dwg

Description

The invention relates to medicine, in particular to traumatology, and can be used in the treatment of patients with injuries of the musculo-ligamentous apparatus.

There is a method of treating chronic injuries of the tendon of the quadriceps femoris muscle, providing for the formation of a horizontal canal in the patella, conducting an allograft through it, to which the tendon is then fixed (AS USSR No. 1217379, publ.: 03.15.86., Bull. No. 10).

However, the method is traumatic and does not provide the possibility of fixing the tendon in cases of its longitudinal rupture.

There is a method of fastening the tendon of the quadriceps femoris muscle with fresh injuries by transdermal fixation to the patella with loop-shaped U-shaped sutures that are blocked with a synthetic fiber screed (RF Patent No. 2144802, publ.: 01/27/2000.).

However, this method also provides for the formation of several intraosseous canals in the patella, which can lead to fragmentation, and does not provide the necessary strength of the tendon attachment in cases of longitudinal rupture.

The objective of the invention is to develop a method of fixation of the tendon at its separation, combined with a longitudinal gap, which reduces trauma and increases the bond strength of the damaged tendon.

This problem is solved by the fact that in the method, including fixing the tendon to the bone at the site of separation and securing it with suture material, the latter is attached to the bone by means of at least two fixators implanted on both sides of the line of longitudinal rupture of the tendon, after which it is stitched with a reticulum and adjacent muscle area with intersecting zigzag stretch seams.

The implementation of the method is illustrated by a description, an example of practical use and illustrative material, which shows:

figure 1 - diagram of the fixation of a damaged tendon;

figa, b, c. - the functional result of treatment by the proposed method of the patient with a separation of the tendon of the quadriceps femoris muscle, accompanied by its longitudinal rupture.

The method is as follows.

After anesthesia and treatment of the surgical field, a damaged tendon is accessed through a skin incision. Implantable fixators are inserted into the bone (Fig. 1), at the site of the tendon separation, so that they are located on both sides of the line of longitudinal tendon rupture. The ends of the suture material are attached to the introduced fixators - two or three threads each - and the tendon and adjacent area of the muscle are sutured with net-like intersecting zigzag sutures. After each seam, it is pulled up and the adjacent ends of the threads are tied together. The operation is completed by suturing the wound and performing control radiography.

The practical use of the method is illustrated by the following clinical observation.

Patient K., 38 years old, was admitted to the clinic of the RRC "WTO" them. Acad. G.A. Ilizarova with a diagnosis of tear of the quadriceps femoris tendon. An examination revealed a longitudinal rupture of the torn end over 3 cm. The patella is displaced up and out. Movement in the knee joint is active: flexion to 120, extension to 180 degrees.

To restore the integrity of the tendon and the function of the knee joint, the patient underwent surgery: the introduction of implantable fixators into the patella with the stitched tendon attached to it.

During the operation, after anesthesia and treatment of the surgical field, they made access to the damaged tendon. Two implantable fixators were inserted into the upper margin of the patella, placing them on both sides of the line of longitudinal rupture of the tendon. Two catgut threads were fixed to the introduced fixators and the tendon was sewn with them, as well as the adjacent distal section of the muscle with network-like intersecting zigzag sutures. After carrying out the seams, they tightened and the adjacent ends of the threads were tied together. The operation was completed by suturing the wound and performing control radiography.

In the postoperative period, for four weeks, the knee joint was fixed with a removable span; regular exercise therapy was performed with the patient with a gradually increasing load on the operated limb. As a result of treatment, the duration of which was 45 days, movements in the knee joint were active: flexion to 90, extension to 170 degrees. At the control examination after one year: movement in the knee joint in full, no muscle atrophy; the patient walks without limping, fully loading the limb. This allowed us to ascertain the anatomical and functional recovery.

Using the proposed method showed that its use reduces the invasiveness of surgical intervention and increases the strength of fastening of the damaged tendon during its detachment, combined with a longitudinal gap.

Claims (1)

A method of fixation of a tendon at its separation, combined with a longitudinal gap, including fixing the tendon to the bone at the site of separation and its fastening with suture material, characterized in that the suture material is attached to the bone by means of at least two fixators implanted on both sides of the longitudinal rupture line tendons, then reticularly stitching it and the adjacent muscle area with intersecting, zigzag stretch sutures.

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