RU2703905C1 - Surgical method of chronic anterior instability of the shoulder joint - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to traumatology and orthopedics and can be used for surgical management of chronic anterior instability of shoulder joint. Tendinocerebral flap with its base turned towards the coracoid process is cut out from the biceps tendon short tendon. Cut out flap is sutured into a tube and sutured to an exit point of a flap formed of a convex portion of a greater tubercle, a displaced tendon of the long head of the biceps.

EFFECT: method makes it possible to create dynamic stabilization.

1 cl, 1 dwg

Description

The invention relates to medicine, namely to traumatology, and can be used in the surgical treatment of chronic anterior instability of the shoulder joint.

Closest to the claimed solution is the operation by A.F. Krasnov (A.F. Krasnov, V.M. Arshin, V.V. Arshin - Traumatology. Handbook - Rostov-on-Don 1998, pp. 307-309), the meaning of which is to mobilize the tendon of the long head of the biceps of the shoulder muscle and placing it in a groove created under the bone leaf from a large tubercle of the shoulder. The clinical effect of this operation is associated with increased stability of the shoulder joint.

With this method, the percentage of relapses reaches 30% due to the lack of strengthening of the front-inner part of the capsule of the shoulder joint.

The technical result is the improvement of treatment results by creating a dynamic stabilizer.

The technical result is achieved by cutting out a tendon-muscle flap from the tendon of the short head, the base facing the coracoid process, then the cut flap is sutured into a tube and sutured to the exit site of the displaced tendon of the long head of the biceps. By cross reinforcement and dynamic stabilization of the shoulder joint.

THE INVENTION IS EXPLAINED BY THE FIGURE

The figure depicts a phased operation:

1. Access and mobilization of the tendon of the long head of the biceps of the shoulder.

2. The formation of a bone sash from a large tubercle.

3. The formation of the gutter for transposition of the tendon.

4. Transposition of the tendon. Cutting out a flap from the short head of the biceps with the base facing the coracoid process.

5. Closure of the bone leaflet, fixation with transossal sutures.

Suturing the flap to the displaced tendon.

The method is carried out as follows.

They access the tendon of the long head of the biceps of the shoulder, mobilize it and pull it inwards on the gauze loop (1). From the convex part of a large tubercle, a bone sash is formed, the base facing outward (2). In the bone surface exposed after turning the flaps open, a vertical groove is formed parallel to the inter-tubercle groove, 1.5-2 cm outward from it, having a breadth of the size of the biceps tendon (on average 0.8-1.5 cm) (3). The tendon of the long head of the biceps muscle is moved into it, fixed with a thin catgut to the surrounding soft tissues (4). Then the tendon is covered with a bone sash and sewn to the bed with 2-3 transosseous sutures with chrome-plated catgut. From the tendon of the short head of the biceps muscle, a tendon-muscle flap is cut out (on average 7 × 2.5 × 0.5 cm), facing the base to the coracoid process. The cut flap is sutured into the tube with a thin catgut and sutured to the exit site of the displaced tendon of the long biceps muscle head (5) (Fig. 1).

EXAMPLE OF SPECIFIC PERFORMANCE

1) Patient V., born in 1980, was admitted to the orthopedic and traumatology department of the City Clinical Hospital No. 4 of Kursk on 08/08/2015.

On admission, complaints of pain in the right shoulder joint prevailed. The pain gradually intensified after daily exercise, was aching, pulling in nature, slightly decreased after prolonged rest.

A history of repeated dislocations of the humerus was observed (6-8 times a year)

After a clinical, radiological and MRI examination, the diagnosis was made: Chronic anterior instability of the right shoulder joint. An MRI scan showed no damage to the articular lip and an impression fracture of the humeral head.

Due to the fact that the patient was dominated by a clinic of chronic anterior instability of the shoulder joint, an operation was performed - Plastic surgery of the anterior wall of the shoulder joint. (August 11, 2015).

Operation progress:

1. Under aseptic conditions, an anterior vertical, slightly curved outward incision is made along the projection of the inter-tubercle groove in the mid-physiological position of the limb, exposing the tendon zone of the long biceps head. After dissection of the transverse ligament, the aforementioned tendon is mobilized in the region of the entrance to the joint cavity at the top until it passes into the muscle abdomen below, for which a tendon of the pectoralis major muscle is cut by a third of the width.

2. The mobilized tendon on the gauze loop is pulled inwards. From the convex part of a large tubercle, a bone sash is formed, the base facing outward. A bordering incision is made along the upper, inner, and lower sides of the bulge of the large tubercle.

3. A wide thin osteotome implanted through an incision in the periosteum, osseous leaflet is cleaved and turned away 80-90 ° outward. The connection of the bone leaf with the periosteum and muscles is preserved from the outside.

4. In the bony surface exposed after turning the sash off, a vertical groove is formed parallel to the inter-tubercle groove, 1.5-2 cm outward from it, having a breadth of the size of the biceps tendon (on average 0.8-1.5 cm). The walls and ends of the artificial groove align. The tendon of the long head of the biceps is moved into it. The displaced tendon should be located under the capsule, intraarticularly, have a uniform entrance and exit from the bone groove without sharp angles. Before entering and exiting the groove, the tendon is fixed with a thin catgut to the surrounding soft tissues. In order to prevent malnutrition of the tendon tissue, do not take more than a third of the diameter of the tendon into the suture and tighten the joints. Then the tendon is covered with a bone sash, it is put in place and sewn to the bed with 2-3 transosseous sutures with a chrome-plated catgut.

5. From the tendon of the short head of the biceps, a tendon-muscle flap is cut out (on average 7 × 2.5 × 0.5 cm), facing the base to the coracoid process. The cut flap is sutured into a tube and sutured to the place of exit from the cusp of the displaced tendon of the long head of the biceps. The remaining short head of the biceps of the shoulder is sutured with catgut to ensure hemostasis. The dissected transverse inter tubercular ligament and the upper edge of the dissected tendon of the pectoralis major muscle are sutured. The wound is sutured in layers tightly with catgut interrupted sutures.

The postoperative period without features. Active movements in the shoulder joint are allowed 2 weeks after surgery.

Observation of the patient to date has shown a good result: the absence of recurrence of dislocation of the humerus for 2 years.

2) Patient I., born in 1984, was admitted to the orthopedic and traumatology department of the City Clinical Hospital No. 4 of Kursk on 02.22.2015.

On admission, complaints of pain in the right shoulder joint, inability to perform active and passive movements in the joint prevailed.

A history of 3 dislocations of the shoulder over the past six months was observed.

After a clinical, radiological and MRI examination, the diagnosis was made: Chronic anterior instability of the right shoulder joint. An MRI scan showed no damage to the articular lip, rotational cuff, and impression fracture of the humeral head.

Due to the fact that the patient was dominated by a clinic of chronic anterior instability of the shoulder joint, an operation was performed - Plastic surgery of the anterior wall of the shoulder joint. (February 25, 2015).

The postoperative period without features. Active movements in the shoulder joint are allowed 2 weeks after surgery.

Observation of the patient to date has shown a good result: the absence of recurrence of dislocation of the humerus for 1.5 years.

Thus, the task was achieved by transplanting the transplant of the short head of the biceps of the shoulder, creating a dynamic stabilizer and strengthening the front wall of the shoulder joint.

Claims (1)

A method for surgical treatment of chronic anterior instability of the shoulder joint, including forming from the convex part of a large tubercle of the bone leaflet, moving the tendon of the long head of the biceps muscle and covering it with bone bone leaf, characterized in that a tendon-muscle flap is turned out of the tendon of the short head of the biceps muscle, facing the base to the coracoid process, then the cut flap is sutured into a tube and sutured to the exit site of the displaced tendon of the long head of the biceps mouse tsy.

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