RU2477093C1 - Method of surgical treatment of subcutaneous rupture of distal tendon of biceps brachii - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to traumatology. Essence of claimed method lies in the following: the first cut of skin is performed on anterior surface of shoulder in the lower third. Tendon of biceps brachii is exposed distally, end is sewn with allotransplant, which is dissected longitudinally into two portions. The second cut is made on posterior surface of elbow joint in projection of head of radius, neck of radius is cleared from periosteum. Obtained wound is connected with first tunnel formed in soft tissues, through which split transplant is passed: one portion is passed on posterior surface of neck of radius, the other - on the anterior one. Both ends of transplant are placed on external surface of radius and sewn to each other in form of loop, and sutured to bone.

EFFECT: method simplifies transplant fixation and reduces trauma of tissues.

2 ex, 3 dwg

Description

The invention relates to medicine and relates to a method for the surgical treatment of injuries of the musculoskeletal system, in particular ruptures of the distal tendon of the biceps of the shoulder muscle.

A known method for the treatment of ruptures of the distal tendon of the biceps of the shoulder according to I. A. Movshovich, which consists in the fact that a splint of the distal end of the biceps of the shoulder is sewn lavsan tape 10 cm wide with 6-8 lavsan sutures, which is distal through the bone channel formed in radius, and is fixed by a loop and 4 dacron seams. Immobilization with a plaster cast for 4 weeks (1).

The disadvantage of this method is that for the plastics of the distal tendon of the biceps of the shoulder, synthetic lavsan is used, the bone channels significantly weaken the anatomical strength of the radius and can cause a pathological fracture.

Also known is a method of autoplasty of the distal tendon of the biceps of the shoulder with the long palmar muscle, proposed by K. N. Wilhelm.

The essence of this method lies in the fact that to fix the tendon to the radius in the bone canal, a long palmar muscle is used, which is taken on the same arm. Plaster cast immobilization for 4 weeks (2).

The disadvantage of this method, as well as the method of I. A. Movshovich, is the presence of a bone channel in the radius, weakening its anatomical strength, and additional trauma due to taking a graft from the forearm of the same arm of the patient.

There is a method for fixing the distal end of the tendon of the biceps of the shoulder, proposed by V.K.Kalnberzom. In this method, an allograft is used, which is sutured to the distal end of the biceps of the shoulder, then is circled around the neck of the radius in the back and stitched in the depth of the wound (3).

This method is taken as a prototype, as it has significant features common with the proposed method.

The disadvantages of this method are the difficulty and excessive trauma when stitching the ends of the graft, due to the fact that you have to expand the surgical wound and operate in its depth, causing additional trauma to the soft tissues and lengthening the time of the operation.

The aim of the invention is to increase the effectiveness of surgical treatment of subcutaneous rupture of the distal tendon of the biceps of the shoulder.

This goal is achieved by the fact that the allograft stitched with the distal end of the biceps tendon is dissected longitudinally into two portions. After that, one of the servings is carried out around the neck of the radius in the back and is taken out into the wound. Then both portions are stitched together in a loop and fixed to the bone from the outside.

The method is accompanied by graphic material. The figure 1 shows a diagram of the stitching of an allograft with a distal tendon of the biceps of the shoulder and its splitting into two portions; figure 2 - diagram of the ends of the allograft around the neck of the radius; figure 3 - scheme for stitching the ends of the graft on the outside of the radius in the form of a loop and stitching them to the bone.

The graphic material shows:

1 - distal tendon of the biceps of the shoulder;

2 - allograft;

3 is a diagram of stitching an allograft and a distal tendon of the biceps of the shoulder;

4 is a diagram of splitting an allograft into two portions;

5 - skin incision along the posterior surface of the elbow joint;

6 - the head of the radial bone;

7 - radius;

8 - the neck of the radius;

9 - holding the ends of the graft around the neck of the radial bone;

10 is a diagram of the stitching of the ends of the graft around the neck of the radius in the form of a loop and with the bone.

The method is as follows.

1. The first skin incision is made along the front surface of the shoulder in the lower third, up to 7-8 cm long. The distal tendon of the biceps muscle of the shoulder (1) is isolated, the end is sutured with an allograft (2) with a thickness of at least 0.8 cm, which is cut longitudinally into two servings (3) (figure 1).

2. A second incision is made along the posterior surface of the elbow joint in the projection of the head (6) of the radius (7), with a raspator, the neck of the radius (8) is removed from the periosteum. The resulting wound is connected to the first tunnel formed in soft tissues, through which a split transplant (2) is passed (9): one portion along the posterior surface of the radius of the radius (8), the second along the front (Fig. 2).

3. Place both ends of the graft (2) on the outer surface of the radius (7) and sew together with each other in the form of a loop and stitch it to the bone with 4 sutures (10). Produce layered suturing of postoperative wounds (figure 3).

A plaster cast is applied from the metacarpophalangeal joints to the middle third of the shoulder in the position of flexion of the arm in the elbow joint to 90 ° and supination of the forearm for a period of 4 weeks.

The advantage of the proposed method from the known one is as follows: the operation is less traumatic, splitting the graft into two portions makes it technically simple to fix it from the outside to the neck of the radius and to reduce the time of surgery.

Clinical examples:

Patient I.M.P. 51 years old entered the traumatology department of the clinic of traumatology and orthopedics of Samara State Medical University on 10.06.2010. Case history No. 12498. He was injured on June 9, 2010. 06/14/2010, the operation was performed according to the proposed method: a first skin incision was made along the front surface of the shoulder in the lower third up to 7-8 cm long, the distal tendon of the biceps muscle of the shoulder was isolated, the end was stitched with an allograft with a thickness of at least 0.8 cm, which was dissected lengthwise in two servings; performed a second incision along the posterior surface of the elbow joint in the projection of the head of the radial bone, with a raspator, released the neck of the radial bone from the periosteum; the resulting wound was connected to the first tunnel formed in soft tissues, through which a split transplant was conducted: one portion along the posterior surface of the radius of the radius, the second along the front; placed both ends of the graft on the outer surface of the radius and sewn together in a loop and sutured to the bone with 4 sutures, performed layer-by-layer suturing of postoperative wounds. A plaster cast was applied from the metacarpophalangeal joints to the middle third of the shoulder in the position of flexion of the arm in the elbow joint to 90 ° and supination of the forearm for a period of 4 weeks.

After removal of the plaster cast, postoperative rehabilitation was performed. The result is good: complete active flexion in the right elbow joint. When examined 3 and 6 months after the operation, complete active flexion in the elbow joint is preserved, the strength of the biceps of the shoulder muscle is restored to 5 points.

Patient D.V.A. 43 years old entered the traumatology department of the clinic of traumatology and orthopedics of Samara State Medical University 11.11.2010. Case history No. 21587. He was injured on 11/11/2010. November 16, 2010, the operation was performed according to the proposed method: a first skin incision was made along the front surface of the shoulder in the lower third up to 7-8 cm long, the distal tendon of the biceps muscle of the shoulder was isolated, the end was stitched with an allograft with a thickness of at least 0.8 cm, which was dissected lengthwise in two servings; performed a second incision along the posterior surface of the elbow joint in the projection of the head of the radial bone, with a raspator, released the neck of the radial bone from the periosteum; the resulting wound was connected to the first tunnel formed in soft tissues, through which a split transplant was conducted: one portion along the posterior surface of the radius of the radius, the second along the front; placed both ends of the graft on the outer surface of the radius and sewn together in a loop and sutured to the bone with 4 sutures, performed layer-by-layer suturing of postoperative wounds. A plaster cast was applied from the metacarpophalangeal joints to the middle third of the shoulder in the position of flexion of the arm in the elbow joint to 90 ° and supination of the forearm for a period of 4 weeks.

After removal of the plaster cast, postoperative rehabilitation was performed. The result is good: complete active flexion in the left elbow joint. When examined 3 months after the operation, complete active flexion in the elbow joint is preserved, the strength of the biceps of the shoulder muscle is restored to 4 points.

Technical result: holding a split allograft stitched with the distal tendon of the biceps muscle around the neck of the radius and fixing it in the form of a loop helps to restore limb function: active flexion is complete, the strength of the biceps of the shoulder muscle is restored to 5 points.

The method can be used in trauma and orthopedic departments of hospitals in the treatment of patients with chronic ligament rupture.

Bibliography

1. Operative orthopedics / Movshovich I.A. // Moscow. - 1994, 118 p.

2. Des subcutane distal bizeps sehnenabriss / Wilhelm K.H. // Arch. Orthop. Traumat. Surg. - 1978, Bd. 91 - No. 3 223-228.

3. The method of surgical repair of rupture of the distal tendon of the biceps of the shoulder / Kalnberz VK // Bulletin "Discoveries, inventions, industrial designs" 1974 - No. 5, p. 43.

Claims (1)

A method for surgical treatment of subcutaneous rupture of the distal tendon of the biceps of the shoulder, including the use of an allograft that is sutured to the distal tendon of the biceps of the shoulder, characterized in that the allograft stitched with the distal end of the tendon of the biceps is dissected longitudinally into two portions, after which one of the portions is carried out the necks of the radial bone behind and lead into the wound, then both portions are stitched together in a loop and fixed to the bone from the outside.

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