RU2557704C1 - Method of treating shoulder slip - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: slightly arciform incision is created along the anterior edge of the deltoid. The coracoids with attached muscles is exposed. The rotator cuff is incised along the intertubercular groove. A tendon of the caput longum of the biceps brachii is separated. The tendon of the caput longum of the biceps brachii is displaced inwards, and two ligatures are delivered under it. Sponge forceps are used to create a passage behind the subcapular muscle with two ligatures delivered through it, and tensioned to the coracoids. The wound is sutured in layers and covered with a retentive bandage for 4-5 weeks.

EFFECT: method enables reducing surgical injuries with using the reliable reinforcement of the anterior rotator cuff taking into account biomechanical features of the proximal shoulder.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and is intended for the treatment of habitual dislocation of the shoulder and the prevention of subsequent recurrent dislocations in the shoulder joint.

A habitual dislocation occurs after a primary traumatic dislocation in the shoulder joint with insufficient regeneration of the damaged joint capsule. Surgical treatment of the usual dislocation of the shoulder.

There are many known methods of surgical treatment of habitual dislocation of the shoulder, aimed at strengthening the front section of the capsule of the shoulder joint. So in the method according to the method of Andreev, after providing quick access to the anterior section of the capsule of the shoulder joint, the coracoid process of the scapula and the coraco-brachial, small pectoral muscle and short head of the biceps brachii attached to it are exposed. Using a chisel, a part of the coracoid process of the scapula with the coraco-brachial muscle attached to it and the short head of the biceps brachii are cut off. Then, cut-off muscles are drawn into the canal formed using the forceps and behind the subscapularis muscle, which are again fixed to the coracoid process. The wound is sutured in layers, with the application of a fixative dressing for 4 weeks [1]. According to the widely used Andreev-Boychev method, together with these muscles, the outer part of the pectoralis minor muscle is cut off. The subsequent course of the operation does not differ from the method described above [2]. Despite the widespread use in the clinic, the described methods of surgical treatment involve significant trauma to tissues, including bone tissue, associated with osteotomy of the coracoid process, and its subsequent screw osteosynthesis. Also known is a method of surgical treatment, which involves cutting off the tendon of the long head of the biceps of the shoulder from the superior tubercle of the articular process of the scapula, and fixing it to the coracoid process (Rosen-matte method) [3]. Wound closure is carried out according to general surgical rules with a bandage fixation also for 4 weeks. This method of treatment cannot be considered biomechanically sound, because involves cutting off from the place of attachment and moving the tendon of the long head of the biceps.

The closest to the claimed method is a method of treating a habitual dislocation of the shoulder according to Weinstein. This method consists in strengthening the anterior section of the joint capsule by moving the long head of the biceps muscle of the shoulder inside the tendon and suturing it to the joint capsule. In this case, after exposing the coracoid process and partial cutting off the muscles attached to it, the tendon of the subscapularis muscle is Z-shaped, the displaced tendon of the biceps muscle is laid under it, and sutured to the capsule of the shoulder joint [4]. The wound is sutured in layers, a fixing bandage is applied for 4 weeks. The advantage of this method of surgical treatment is the relative low invasiveness of the intervention and the reliability of fixation.

However, the use of this method of treatment is also associated with additional interventions on the soft tissues, with their dissection and subsequent suturing; for this reason, this method also cannot be considered biomechanically justified.

The essence of the invention lies in the combination of essential features sufficient to achieve the desired technical result, consisting in low invasiveness of the operation using reliable strengthening of the front section of the capsule of the shoulder joint, made taking into account the biomechanical features of the proximal shoulder.

The essence of the invention lies in the fact that a method of treating a habitual dislocation of the shoulder includes a slightly arcuate incision along the front edge of the deltoid muscle, exposure of the coracoid process with muscles attached to it, dissection of the capsule of the shoulder joint along the intercalcital groove, and isolation of the tendon of the long head of the biceps muscle. The tendon of the long head of the biceps muscle is displaced inward, two ligatures are held under it, using a forceps, a channel is formed behind the subscapularis muscle through which the ligatures are held, and they are tensioned to fix them to the coracoid process. Sutures are layered on the wound in layers, a fixing bandage is applied for 4-5 weeks.

The displacement of the tendon of the long head of the biceps inward, holding two ligatures under it, the formation, using the forceps, of the canal behind the subscapularis, with the passage of ligatures through it, fixed to the coracoid process, allows you to strengthen the front section of the capsule of the shoulder joint.

Carrying out ligatures under the tendon of the long head of the biceps without crossing the tendons of the muscles and cutting off the latter from the coracoid process of the scapula, significantly reduces the morbidity of surgical intervention.

The method is illustrated by illustrations, which show a diagram of the operation.

In FIG. 1 shows a view of the soft tissues of the shoulder before surgery, where 1 is the tendon of the long head of the biceps; 2 - the coracoid process of the scapula; 3 - tendon of the short head; 4 - biceps muscle of the shoulder.

In FIG. 2 - the outcome of the operation with transposition of the tendon of the long head of the biceps, where 1 is the tendon of the long head of the biceps; 2 - the coracoid process of the scapula; 3 - tendon of the short head; 4 - biceps muscle of the shoulder; 5 - ligatures of suture material.

The method is as follows. A slightly arcuate incision is made along the front edge of the deltoid muscle. Stupidly, without crossing the muscle bundles, the coracoid process with the muscles attached to it is exposed. The capsule of the shoulder joint is dissected along the inter-tubercle groove, the tendon of the biceps muscle is isolated and moved inwards. Two ligatures of suture material are brought under the tendon of the biceps muscle. Using forceps, from the coracoid process of the scapula, behind the subscapularis muscle, form a channel through which ligatures are drawn, and hem with tension to the coracoid process. Suture the joint capsule and soft tissue. Apply a dressing for 4-5 weeks after surgery.

Clinical example

Patient X., born in 1987 appealed to the GAUZ “RKB MZ RT” with complaints of frequent repeated dislocations in the right shoulder joint, which have become much more frequent recently. He works as a gymnastics coach in a school in the city. Diagnosis: habitual dislocation of the right shoulder with frequent relapses. Treatment at the Department of Traumatology, Clinical Hospital since 19.08. on August 29, 2013. Operation: Transposition of the tendon of the long head of the biceps of the right shoulder into the position of the anterior shoulder joint. Fixing bandage for 1.5 months. After removing the bandage - a comprehensive rehabilitation treatment. On control examinations in dynamics - the movement in the right shoulder joint in full, the patient returned to her previous work.

Information sources

1. Movshovich I.A. Operative orthopedics. M "Medicine", 1994, the operation Andreeva-Boycheva, p. 106

2. Ibid., P. 106.

3. Ibid., P. 106.

4. Ibid., Pp. 104-105.

Claims (1)

A method of treating a habitual dislocation of the shoulder, including a slightly arched incision along the front edge of the deltoid muscle, exposure of the coracoid process, with muscles attached to it, dissection of the capsule of the shoulder joint along the intercuscular groove, and isolation of the tendon of the long head of the biceps muscle, characterized in that two ligatures are brought under the ligature of the long head of the biceps muscle, while displacing the tendon inward, form a channel behind the subscapularis muscle using a forceps, ligatures are carried out in the formed channel and fixative coziness to the coracoid process, layerwise stitches on the wound, impose a fixative bandage for 4-5 weeks.

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