RU2527361C2 - Method of treating old injury of supraspinatus tendon and device for implementing it - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics for treating old injuries of supraspinatus tendon. The method involves approaching a shoulder joint, detecting a tendon defect, mobilising a distal end of the tendon, forming parallel canals in a greater tubercle of humeri. A cone-shaped deepening is formed in a place of sclerous insertion ground of the greater tubercle. After fixing sutures are delivered through bone canals on a humeral periosteum, a device for treating old injuries of supraspinatus tendon. The device comprises a handle connected to a rectangular plate curved after an outer surface of the humerus with through holes for sutures, screws and nails. Cone-shaped pins are placed in the corners of the plate. The fixing sutures are delivered into the holes of the plate temporary fixed by means of the handle and cone-shaped pins within an exit of the fixing sutures to be tightened. The plate is raised slightly and reduced along a slope of the greater tubercle with pulling the fixing sutures up optimally to achieve an immersion of the distal end of the supraspinatus tendon into the cone-shaped deepening. The plate is temporary fixed with the nails, and then the conically threaded screws The temporary fixing elements and handle are removed, and the wound is closed in layers.

EFFECT: method and device enable reducing the length and invasiveness of the surgical intervention; reducing a length of the rehabilitation stage of treatment, minimising a probability non-union of the tendon and bone, providing an abduction contracture of the shoulder joint and recurrent shoulder dislocation.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used for the surgical treatment of chronic injuries of the tendon of the supraspinatus muscle.

A known method of treating chronic damage to the tendon of the supraspinatus muscle according to the method of Vasiliev V.Yu. et al. (one). It provides for the mobilization and flashing of the torn end of the tendon with a two-row suture according to Kazakov (2). Then, a perceptual bone bed is formed at the site of natural fixation of the supraspinatus tendon, while part of the cortical layer of the large tubercle of the humerus is removed and a conical shape groove, 5 mm deep, is formed. Then, two parallel channels are formed in the head of the humerus, which proximal extend at the bottom of the groove described above, distally at the base of the large tubercle, and the direction of the channels coincides with the thrust vector of the threads. After that, the threads are passed into the canals, the ends are first brought to the cortical plate of the humerus, then through all layers of soft tissues to the skin and fixed in the external fixation apparatus, previously applied at the level of the middle third of the humerus. Filaments using distraction clamps perform distraction to subcritical tension of the filaments. At the distal end of the tendon, an X-ray contrast mark is set from a fragment of a Kirchner needle with a diameter of 1.5 mm by forming an impromptu U-shaped mini-clip, which is clamped strictly at the level of the end of the tendon of the supraspinatus muscle. After that, the wound is washed with saline and sutured in layers. The operated shoulder is fixed in the abduction position 60 with the help of a retracting stand from the Ilizarov apparatus parts, fixed at one end to the external fixation apparatus on the shoulder, and the other in the form of an abutment - to the iliac wing. After the operation, tendon distraction is performed at a rate of 1 mm per day, which is completed when the radiopaque mark enters the receiving bone bed on the head of the humerus. The end of distraction is controlled using an electron-optical transducer (EOP) or standard radiography of the shoulder joint in direct projection. After the mark has been detected on the bottom of the receiving bed of the large tubercle of the humerus, the system is stabilized for 3 days, then the apparatus is dismantled, and the ends of the threads are tied into a knot, which is immersed in a skin incision previously performed under local anesthesia and placed on the periosteum of the humerus bones. The method provides replacement of the defect and fixation of the tendon of the supraspinatus muscle in case of chronic injuries due to its own tissues, without using artificial implants or transposition of the tendons of other muscles of the rotational cuff of the humerus, thereby allowing atraumatic restoration of the function of the shoulder joint.

Closest to the proposed is a method of surgical treatment of damage to the tendon of the supraspinatus muscle, proposed by J. Boucher and K.J. Kessler (3). The essence of the known method is as follows: they perform surgical access to the shoulder joint, mobilize the distal end of the tendon of the supraspinatus muscle, stitch it with threads that are held in preformed parallel channels in the large tubercle of the humerus, the free ends of the threads are passed through the holes of two plates that are laid on periosteum of the humerus. The threads are connected to each other in a state of tension, and the underlying plates prevent the penetration of threads. The shape of the inner surface of the plates corresponds to the convex surface of the humerus. On the first and second plate holes are made. The first plate - a support with holes - is installed on the insertion site of a large tubercle of the humerus. The second plate is on the slope of a large tubercle of the humerus. Through channels are formed in the humerus, a rotating cuff of the shoulder is placed between the outer surface of the shoulder and the plate with holes at the level of the through channels in the humerus. Sutures are applied, passing through the channels in the humerus, the rotating cuff of the shoulder and the plate openings, the sutures are fixed with maximum tension, which ensures restoration of the function of the shoulder joint and reduces the possibility of eruption of sutures.

Closest to the proposed device for the treatment of damage to the supraspinatus muscle is the apparatus for repairing the rotational cuff of the humerus, which contains two support plates having an external, internal and lateral surface (3). The shape of the inner surface of the plate corresponds to the outer surface of the humerus. The shape of the outer surface of the plate corresponds to the inner surface of the plate. The side surface is located between the inner and outer surfaces of the plate. On the first and second plate holes are made. The first plate is a support with holes mounted on the outer surface of the humerus. The second plate is a support with holes mounted on the outer surface of the rotating cuff of the shoulder. Through channels are formed in the humerus, a rotating cuff of the shoulder is placed between the outer surface of the shoulder and the plate with holes at the level of the through channels in the humerus. Sutures are applied, passing through the channels in the humerus, the rotating cuff of the shoulder and the plate openings, the sutures are fixed with maximum tension, which ensures restoration of the function of the shoulder joint and reduces the possibility of eruption of sutures.

However, the known methods of surgical treatment of chronic damage to the tendon of the supraspinatus muscle and devices for their implementation have significant disadvantages, namely:

- There is no stage of the operation involving the preparation of the insertion site in the form of a cone-shaped recess to achieve a strong fusion of the tendon with the bone;

- Pulling the threads and tying the knot on a pre-installed plate leads to a weakening of their tension and an increased risk of maladaptation of the bone-tendon contact;

- The presence of osteoporosis of the proximal humerus in conjunction with the tension fixing the tendon of the supraspinatus muscle filaments do not exclude their eruption in the bone with the sliding of the plate in the proximal direction and the maladaptation of the bone-tendon contact.

Based on the current level of technology for the treatment of chronic injuries of the tendon of the supraspinatus muscle and devices for its implementation, as well as the need to eliminate the disadvantages of the known methods and devices, the task was to increase the effectiveness of treatment by reducing the invasiveness of surgical intervention, reducing the risk of nonunion of the tendon of the supraspinatus muscle with the humerus and the subsequent formation of contracture of the shoulder joint.

The problem is solved as follows.

Treatment of chronic injury to the tendon of the supraspinatus muscle of the shoulder joint includes access to the shoulder joint, identification of a defect in the tendon of the supraspinatus muscle, mobilization of the distal end of the damaged tendon, the formation of parallel channels in the large tubercle of the humerus, holding the fixing threads through the formed channels and holes of the plate, the threads are connected. New in the proposed method is that in place of a sclerotic insertion site of a large tubercle of the humerus, a cone-shaped recess is formed. After holding the fixing threads through the bone channels in the large tubercle of the humerus and the holes for holding the threads of the device plate according to claim 2, the ends of the threads are tied and pulled until the distal end of the tendon of the supraspinatus muscle is immersed in the conical depression formed in the tubercle of the humerus. Then carry out temporary fixation of the plate with knitting needles held through the holes for holding the spokes in the plate. After that, the final fixation of the plate and tendon of the supraspinatus muscle to the humerus is performed with counter-directed screws with a tapered thread, drawn through holes with a tapered thread on the plate. The protruding supporting elements of the plate are immersed in the periosteum of the humerus. Temporarily fixing elements are removed, the wound is sutured in layers.

A device for implementing a method of treating chronic damage to the tendon of the supraspinatus muscle contains a patch plate 1, curved in accordance with the outer surface of the humerus with through non-threaded holes 9 for holding the fixing threads.

The plate 1 is equipped with a handle 2 fixed to the plate 1 by means of an opening 4 in the central part of the plate. At the corners of the plate 1 there are protruding supporting elements 6, which are conical in shape.

The handle 2 is removable and curved in such a way that the short shoulder 3 of the handle 2 is intended for insertion of a screw 5 through the longitudinal hole to fix it on the plate 1, and the long shoulder is used to hold the handle 2 of the surgeon.

On both sides of the hole 4 in the Central part of the plate 1 is made of threaded holes 7 having a tapered thread. Screws 8 with a conical thread are inserted into the holes 7 with a conical thread for the final fixation of the plate 1 to the humerus. The longitudinal axis of the holes 7 with a tapered thread are placed in the same plane and intersect at an angle of 25-45 degrees (see the appendix to the description of the application, Figs. 1, 2, 3).

We explain the significant distinguishing features of the proposed method for surgical treatment of chronic damage to the tendon of the supraspinatus muscle and device for its implementation.

The formation of a cone-shaped deepening of the humerus of the humerus on the site of the sclerotic insertion site is necessary for more tight contact of the tendon with bone tissue, which improves the regeneration process and ensures complete fusion at the point of attachment of the bone and tendon of the supraspinatus muscle.

The application of the proposed device to the periosteum of the humerus with the help of the protruding supporting elements after holding the fixing threads through the bone channels and holes in the plate, followed by free binding of the threads without tension, allows you to form a strong knot that does not untie from excess tension when adapting the tendon to the bone.

The use of a pre-fixed, in the central hole of the plate, removable handle, curved in such a way where the short shoulder is designed to insert a screw through the longitudinal hole to fix the plate, and the long shoulder to hold the surgeon’s hand, allows the plate to be freely manipulated in the wound and allows you to find a plane, necessary for tensioning the threads previously tied into a strong knot, pulling the threads at an angle to the long axis of the humerus, while maintaining a parallel arrangement of the plates s in relation to the plane of the cortical plate of the humerus.

Fixing the plate to the handle through a central hole having a diameter of 7 mm and a screw with a diameter of also 7 mm installed in the opening of the working part of the short shoulder of the handle allows you to freely remove the handle from the plate and continue the main stage of fixation, as well as the use of a diameter of 7 mm in the handle increases versatility use tool.

The use of a rectangular plate with angled protruding cone-shaped support elements from 3 to 5 mm long is necessary for its fixation in the humerus, as well as to prevent the plate from slipping in the proximal direction under the action of elastic resistance of the supraspinatus tendon during any manipulations with plate, as well as creating the possibility of temporary di-fixation, for example, Kirchner spokes. The length of the protruding support elements from 3 to 5 mm excludes the movement of the plate, for example, due to osteoporosis both directly during fixation and for a long time after the end of the operation.

Raising the plate by the handle and lowering it to a distance of no more than 0.5 cm along the slope of the large tubercle of the humerus ensures optimal tension of the fixing threads and to immerse the distal end of the tendon of the supraspinatus muscle into a cone-shaped depression formed in the tubercle of the humerus.

The use of temporary fixing elements, for example, Kirchner spokes inserted through non-threaded holes with a diameter of 1-3 mm, located at the corners of the plate, after tensioning the threads and adapting the tendon to the bone, allows you to remove excess tension in the surgeon's hand before the main stage of fixing the plate with threads to the bone in the region of the slope of the large tubercle of the humerus and prevents the displacement of the plate from a fixed place before its main fixation.

Performing in the central part of the plate on both sides of the hole in its central part threaded holes with a conical thread, the longitudinal axes of which lie in the same plane and intersect at angles of 25-45 degrees, and then screws with a conical thread of 5.0 mm in diameter are inserted additional fixation of the screws to the plate is necessary for the final fixation of this plate to the humerus.

Patent research on subclasses A61B 17/56 and analysis of scientific and medical information reflecting the current level of surgical treatment of chronic damage to the tendon of the supraspinatus muscle did not reveal methods and devices identical to those proposed. Thus, the proposed method of surgical treatment and device for its implementation are new.

The interconnection and interaction of the essential methods of the proposed method and device for its implementation ensure the achievement of a new technological medical result in solving the problem, namely, reduce the duration and invasiveness of surgery on the shoulder joint, reduce the duration of the rehabilitation phase of treatment due to reliable fixation of the tendon, and also increases universality treatment technologies, that is, minimize the likelihood of non-fusion of the tendon with the bone and niya abduction contracture of the shoulder joint. Thus, the proposed technical solution has an inventive step.

The technology is intended for specialists who are familiar with basic reconstructive interventions on the capsule-ligamentous apparatus of the shoulder joint and the main methods of immersion osteosynthesis, i.e. specialists of traumatology and orthopedic departments of hospitals at the city, regional and republican levels, and can also be reproduced repeatedly. The manufacture of the device can be mastered by the medical industry and greatly facilitate the work of the surgeon.

The essence of the proposed method and device is illustrated by drawings, which show the following:

Figure 1 - General view of the device in front;

Figure 2 is a General view of the device from the side;

Figure 3 - fixing plate, view from the inner surface;

Figure 4 - a device temporarily fixed on the humerus at the exit of the threads;

5 is a device fixed in the region of the slope of the large tubercle of the humerus with Kirschner spokes;

6 is a device mounted at a fixed location;

Fig 7 - radiographs of patient B (a - before treatment; b - after treatment, axial projection; c - after treatment, direct projection);

Fig. 8 - ultrasound of the shoulder joint of patient B before treatment (a - lateral projection, b - direct projection).

A device for implementing the method of treating chronic injuries of the tendon of the supraspinatus muscle contains a rectangular plate 1, curved in accordance with the outer surface of the humerus (see the appendix to the description, figure 3). The plate 1 is fixed to the handle 2 by means of an opening 4 in the central part of the plate 1 having a diameter of 7 mm. The removable handle 2 is bent so that the short shoulder - the working part 3 - is designed to be inserted through the longitudinal hole of the screw 5 to fix the plate 1 to the handle 2, and the long shoulder - to hold the hand of the surgeon. The removable fixation of the handle 2 is carried out by a screw 5 having a diameter of 7 mm. At the corners of the rectangular plate 1 there are protruding support elements 6 of a conical shape, from 3 to 5 mm long. On both sides of the Central hole 4 is made of threaded holes 7 having a tapered thread. The longitudinal axis of the holes 7 with a tapered thread lie in the same plane and intersect at an angle of 25-45 degrees. Screws 8 with a tapered thread are inserted into the holes 7. At the corners of the plate 1 there are through non-threaded holes 9 with a diameter of 1-3 mm for introducing the fixing elements 10, for example, Kirchner spokes, and holes 11 for removing the threads on the outer surface of the plate 1 (see the appendix to the description of Figures 1, 2, 3).

Apply the proposed device as follows.

After holding the fixing threads through the channels on the periosteum of the humerus impose the proposed device, which contains a plate 1 of a rectangular shape, curved in a plane. The bend of the plate 1 corresponds to the outer surface of the cortical plate of the slope of the large tubercle of the humerus. The plate 1 has two through non-threaded holes 11 for holding threads fixing the tendon of the supraspinatus muscle (see the appendix to the description, figure 3). For the convenience of the surgeon, the removable plate 1 is pre-fixed to the handle 2 of the device, which is bent so that the short shoulder - the working part 3 - is intended to be inserted through the longitudinal hole of the screw 5 to fix the plate 1 to the handle 2, and the long shoulder to hold the hand of the surgeon (see the appendix to the description, figure 1, 2). A screw 5 with a diameter of 7 mm, held in a through longitudinal hole of the working part 3 of the handle 2, fixes the plate 1 to the handle 2 through the hole 4 with a diameter of 7 mm in the central part of the plate 1. Then, with the help of the handle 2 and the protruding supporting elements 6 of the conical shape, located the corners of the plate 1 device is immersed in the wound and installed on the periosteum of the humerus in the region of the slope of the large tubercle of the humerus. The protruding support elements 6 have a length of 3 to 5 mm. The fixing threads are conducted through holes 11 in the plate 1 and are connected. Then the plate 1 is lifted and lowered with the help of the handle 2. Press on the handle 2, immersing the protruding supporting elements 6 in a conical shape in the periosteum, and fixing elements 10 are inserted through the through non-threaded holes 9 with a diameter of 1 to 3 mm into the humerus. Then, continuously fixing screws 8 with conical thread are introduced through threaded holes 7 with conical thread. The threaded holes 7 are located on both sides of the Central hole 4 in the plate 1, the longitudinal axis of these holes lie in the same plane and intersect at an angle of 25-45 degrees.

The essence of the proposed "Method for the treatment of chronic damage to the tendon of the supraspinatus muscle using a device for its implementation" is as follows.

Perform standard layered surgical access to the fake space of the shoulder joint. A full-layer detachment of the tendon of the supraspinatus muscle is detected, mobilization and refreshment of its distal end is performed by transverse cutting off of the fibrous part with a scalpel. After that, measure the length of the tendon defect. The distal end of the tendon is stitched with a double-row suture according to Kazakov (3). In place of the sclerotic insertion site of the large tubercle of the humerus, parallel to the anatomical neck of the humerus, a cone-shaped recess of the following sizes is formed: 5 mm wide, 30 mm long, up to 5 mm deep. Then, in a large tubercle of the humerus, at a distance of at least 15 mm from each other, two parallel channels with a diameter of at least 2 mm are formed with a drill. Two bundles of filaments fixing the tendon of the supraspinatus muscle are distally carried out into the channels in the direction from the conical recess. After the threads are removed from the canals, they begin to prepare the main stage of tendon fixation. Prepare the proposed device in advance, the working part 3 of the handle 2 is fixed with a screw 5 in the hole 4 of the plate 1. Put the plate 1 on the periosteum at the exit of the threads, immersing the protruding support elements 6 of the conical shape in the periosteum. The bundles of threads are passed through the holes 11 of the plate 1. Without weakening the pressure of the plate 1 on the slope of the large tubercle of the humerus, bundles of filaments are connected into a knot, trying to adapt the distal end of the tendon of the supraspinatus muscle in the formed cone-shaped depression in the insertion area of the large tubercle of the humerus (see Appendix to the description, figure 4). The final adaptation of the distal end of the tendon in the cone-shaped recess is carried out by lifting the plate 1 by the handle 2 and lowering it to a distance of no more than 0.5 cm along the slope of the large tubercle of the humerus, optimally pulling the fixing threads, achieving immersion of the distal end of the tendon of the supraspinatus muscle into the conical recess. As the best adaptation of the distal end of the tendon of the supraspinatus muscle in the receptive bone bed of the humerus is achieved, without loosening the traction on the handle 2, re-press the plate 1 to the periosteum of the humerus, immersing the protruding supporting elements 6, and temporarily fix it, for example, with two Kirschner spokes 10, through two through non-threaded holes 9 in the plate 1 (see the appendix to the description, figure 5). Then, the plate 1 is permanently fixed in the reached position by two conical thread screws 8 inserted into the conical thread holes 7 in the plate 1. The longitudinal axis of the conical thread holes 7 lie in the same plane and intersect at an angle of 25-45 degrees (see Appendix to the description, Fig.6). After that, the handle 2 and the temporary locking elements 10, for example, Kirchner spokes, are removed. The fake space of the shoulder joint is washed and drained, the wound is sutured in layers. After the operation, the shoulder is placed on a wedge-shaped pillow in the abduction position of at least 60 °.

The proposed method for the treatment of tendon of the supraspinatus muscle and a device for its implementation are illustrated by a clinical example.

Patient V., 28 years old, was admitted to the clinic GU SCRCM RAMS. Diagnosis: An elderly (3 months) tendon rupture of the supraspinatus muscle of the rotator cuff of the left humerus, combined shoulder contracture. The range of motion in the left shoulder joint, measured by the "0" - passing method ", is: lead / cast - 30/0/0. The clinic conducted a clinical and radiological examination of the patient.

On the roentgenogram of the left shoulder joint revealed: an usability of the cortical plate in the projection of a large tubercle, with signs of sclerosis. The joint gap is not changed. Conclusion: Signs of damage to the tendon of the supraspinatus muscle (see Appendix to the description, Fig.7, a). Additional research: an ultrasound of the shoulder joint was performed (see the appendix to the description, Fig. 8, a, b), in the pictures the arrows indicate:

1) the tendon of the supraspinatus muscle;

2) a large tubercle of the humerus;

3) subacromial subdeltoid bag;

4) deltoid muscle;

5) the absence of a tendon of the supraspinatus muscle at the site of attachment to a large tubercle with a complete gap.

Ultrasound Conclusion:

- the presence of an extensive hematoma filling the space between the head of the humerus and the deltoid muscle;

- focal thinning of the rotator cuff and sagging of the subacromial-fake bag at the rupture site (normally has a convex surface);

- displacement of the long biceps head (with breaks in the tendon of the subscapularis muscle);

- an increase in the gap between the bicep tendon and the tendon of the supraspinatus muscle and visualization of the bone and cartilage surface in the place where the tendon was previously attached (with ruptures of the anterior free edge of the supraspinatus muscle).

The operation of the proposed method. Surgery was performed under general anesthesia. Under aseptic conditions, in the patient’s position on the back, mobilization of the torn tendon of the supraspinatus muscle was performed through a typical arthrotomy through the deltoid-pectoral sulcus. The end of the supraspinatus tendon was refreshed. A receptive bone bed was prepared at the site of natural fixation of the tendon of the supraspinatus muscle by removing part of the cortical layer of the large tubercle of the humerus and a 5 mm conical depression was formed. When trying to adapt the tendon of the supraspinatus muscle to the receiving bed in the shoulder abduction position of 80-90 °, we determined the size of the tendon defect, which is 22 mm. After this, the freshened end of the tendon of the supraspinatus muscle was sewn with one durable Polyester thread No. 8 according to the Kazakov method (3), leaving two free ends of the thread. Then, in the head of the humerus with a drill and a spoke 2 mm thick, two parallel intraosseous canals were formed, spaced 15 mm apart. The longitudinal axis of the intraosseous canals coincided with the traction vector of the ends of the suture, fixed to the end of the tendon of the supraspinatus muscle, and proximally reached the apex of the conical deepening of the receptive bone bed. The ends of the thread were held separately in parallel intraosseous canals and brought to the surface of the cortical plate in the region of the slope of the large tubercle of the humerus. After holding the fixing threads through the bone channels, a device was placed on the periosteum of the humerus containing a handle connected to a rectangular plate with through holes, curved in accordance with the outer surface of the humerus. Then, the fixing threads were led into the holes of the plate, temporarily installed with a handle and protruding support elements of a conical shape in the exit zone of the fixing threads, which were subsequently tied into a strong durable unit (see the appendix to the description, Fig. 4). After that, the plate was lifted by the handle and lowered to a distance of 0.5 cm along the slope of the large tubercle of the humerus, optimally pulling the fixing threads. Having achieved immersion of the distal end of the tendon of the supraspinatus muscle into a cone-shaped depression formed in the tubercle of the humerus. Spent temporarily fixing elements, Kirchner knitting needles (see. Appendix to the description, figure 5). Then, tapered thread screws were inserted into the holes with a conical thread, firmly fixing the plate on the surface of the humerus (see the appendix to the description, Fig.6). Kirschner spokes and the handle of the device were removed, arthrotomy access was sutured in layers by interrupted sutures. The shoulder was laid on a standard CITO discharge bus in a 60 ° lead position.

The operated extremity was continued to be fixed for 6 weeks on the CYTO discharge bus. From the second day after the operation, physiotherapy was prescribed in the form of electrical stimulation of the supraspinatus muscle in the amount of 7 procedures. 2 weeks after surgery, an exercise therapy of the shoulder joint was prescribed with the restoration of active shoulder abduction (temporarily removing the CITO bus).

The result of treatment (see the appendix to the description, Fig. 7, b, c) of the patient by the proposed method was the restoration of almost completely lost active abduction in the shoulder joint in the amount of 90/0/0, which allowed the patient to return to active physical work. Relapse of dislocation in the long-term postoperative period was not observed.

Thus, the proposed "Method for the surgical treatment of chronic damage to the tendon of the supraspinatus muscle and a device for its implementation" in comparison with the known treatment technologies is less traumatic, easy to produce and allows you to return patients to active physical labor as soon as possible, to exclude relapse of dislocation in the shoulder joint.

Information sources

1. The method of surgical treatment of rupture of the tendon of the supraspinatus muscle: Pat. 2281706, Ros. Federation: IPC A61B 17/56 / Vasiliev V.Yu., Puseva M.E., Tkachenko A.V .; Applicant and patent holder Reconstruction Center and restore. Surgery VSNS SB RAMS. - No. 2004120002/14; declared 06/30/2004; publ. 01/10/2006, Bull. No. 15.

2. Method and apparatus for rotator cuff repair: Patent USA number 6514274 B1; Int. C1. A61B 17/04 / James Boucher, Kevin J. Kessler; Assignee: Arthrotek, Inc., Warsaw, IN (US); Appl. No .: 09/512/961; Filed: Feb. 25, 2000; Date of patent: Feb. 4, 2003.

3. Technique for the operation. Reference book / L.E. Kotovich [et al.]. - Minsk: 1985. - 27 p.

Claims (2)

1. A method of treating chronic injury to the tendon of the supraspinatus muscle of the shoulder joint, including access to the shoulder joint, identifying a defect in the tendon of the supraspinatus muscle, mobilizing the distal end of the damaged tendon, forming parallel channels in the large tubercle of the humerus, holding the fixing threads through the formed channels and holes of the plate, binding filaments, characterized in that in the place of a sclerotic insertion site of a large tubercle of the humerus, a cone-shaped recess is formed, after leading the fixing threads through the bone channels in the large tubercle of the humerus and the holes for holding the threads of the device plate according to claim 2, the ends of the threads are tied and pulled until the distal end of the tendon of the supraspinatus muscle is immersed in the conical depression formed in the tubercle of the humerus, then they are temporarily fixed the plate with knitting needles held through the holes for holding the knitting needles in the plate, after which the final fixation of the plate and tendon of the supraspinatus muscle to the humerus systematic way with screws with a conical thread drawn through the hole with a conical thread on the plate, was immersed in the periosteum of the humerus projecting supporting elements of the plate, the retaining elements temporarily removed, the wound sutured by layers. 2. A device for treating chronic damage to the tendon of the supraspinatus muscle contains a plate bent in accordance with the outer surface of the humerus, a handle fixed with a hole in the central part of the plate, through threaded holes for holding fixing threads, on both sides of the hole in the central part of the plate contains holes for holding knitting needles and holes with a tapered thread, the longitudinal axis of which is placed in the same plane with the intersection at an angle of 25-45 °, at the corners of the plate size scheny support members protruding.

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