RU2720820C1 - Method of stabilizing shoulder - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology, and can be used in treating shoulder instability. Through transverse incision 4.0 cm long by 2.0 cm above the scapula, a U-shaped suture is applied on the supraspinatus muscle, creating a duplicate of the supraspinatus muscle. Hemostasis. Sutures on wound. A U-shaped suture is applied through transverse incision 3.0 cm long by 1.5–2.0 cm below the scapula to create a duplicate of the infraspinatus muscle. Hemostasis. Sutures on wound.

EFFECT: method enables reducing the probability of postoperative complications, reducing the length of patient's recovery, reducing the costs associated with the surgical intervention ensured by a combination of the methods of the declared method.

1 cl, 3 ex

Description

The invention relates to medicine, namely to traumatology and relates to a method for stabilizing the shoulder.

About 200 different methods have been proposed for the treatment of habitual dislocations. Most of them have little or no use. All operations can be divided into the following five groups: 1) capsulorography; 2) tenosuspension; 3) operations in which additional reinforcing ligaments are created with local plastic techniques or free transplants; 4) plastic surgery on the capsule, joints and tendons, strengthening the bag of the joint and somewhat restricting movement in the shoulder joint; 5) bone transplantation and alloplasty to deepen the joint cavity and scapula [A. V. Kaplan. Closed injuries to bones and joints. - M .: Medicine, 1967; V.A. Reinberg. Traumatology problems. - Kiev, 1955; V.D. Chucklin. Upper limb surgery. M .: Medgiz, 1960; Yu.Yu. Janelidze. Limb surgery. M, 1953].

Operation Nicolas.

The long head of the biceps is dissected below the neck of the humerus. The central end of it, together with a strip of the coraco-brachial ligament, is sutured and passed through a drilled channel in the head of the humerus. The ends of a dissected long head are stitched. The performed tendon is jammed at the external bone channel with a pin.

Operations with the formation of ligaments have been proposed by a number of authors.

O.M. Sverdlov forms two ligaments: one of the coraco-brachial tendon, and the other by moving and fixing the tendon of the long head of the biceps.

Weinstein’s operation is as follows. An anterior incision is made corresponding to the groove between the deltoid and pectoralis major muscle. Having opened the inter-tubercle groove, the tendon of the long head from the capsule of the joint to the tendon of the pectoralis major muscle is exposed.

After that, the shoulder rotates outwards. The tendon of the subscapularis muscle is cut from the small tubercle by 4.5 cm to its entire depth.

In a small tubercle, this section, intersecting the inner half of the subscapularis muscle, is connected to the upper end of the section along the groove; the second half of the muscle is intersected in the depths of the wound, then the tendon of the long head of the biceps is mobilized in the direction of the small tubercle through the small tubercle, laid in front of the head and fixed with U-shaped sutures. The crossed tendon of the biceps is sutured.

Operation Putti-Plyatt, reminiscent of the operation of Bankart.

A skin incision is made along the outer third of the clavicle; from the inner end of the clavicle, the incision continues down the front edge of the deltoid muscle. The coracoid process of the scapula and tendon is exposed, the short head of the biceps muscle, the pectoralis and the coracorachial brachii are attached to it.

Drill a channel at a distance of 1, -2.0 cm from the apex of the coracoid process. With an acute osteotome, the apex of the coracoid process is separated with the tendons attached to it and displaced down and inside .... The sequel is even more traumatic. After surgery, the limb is immobilized in the internal rotation position for 3-4 weeks.

Operation with back habitual dislocation.

The deltoid muscle is cut off from the acromial process and scapula. The tendon of the infraspinatus muscle is cut off 1.5 cm from the point of attachment to the large tubercle of the shoulder. The central part of the tendon is hemmed with a mattress suture to the remainder of the tendon on the tubercle of the humerus.

All these operations are characterized by high invasiveness, technical complexity.

There is a method consisting in shortening the muscles and strengthening the shoulder joint [Pat. 2285482 RF. A method of surgical treatment of habitual dislocation of the shoulder]. They carry out surgical access to muscle aponeurosis by releasing it from the subcutaneous tissue, and then transverse suturing of this muscle by the distal and proximal rows of suture loops by tightening each loop of its aponeurosis together with the underlying muscle tissue and then shortening the muscle by tightening the ends of the loops located in opposite ranks.

The proposed method should be selected individually, taking into account the nature and type of subluxation of the shoulder head.

The objective of the proposed invention is to expand the arsenal of methods for stabilizing the shoulder with low morbidity and reducing technical complexity, which reduces the likelihood of postoperative complications, reduces the recovery time of patients, reduces the costs associated with surgery, both the patient and the hospital.

The problem is solved by applying U-shaped sutures to the supraspinatus and infraspinatus muscles of the scapula in order to create duplicates.

The effectiveness of the proposed method is confirmed by examples of practical implementation.

Example 1. Patient S., 35 years old, athlete archer. Received with shoulder instability.

Under the m / a S. Novocaini 0.5% - 20.0 through a cross section 4.0 cm long 2 cm above the scapular bone spine, a U-shaped seam was applied to m. Supraspinatus (supraspinatus muscle) for the purpose of duplication. Hemostasis. Stitches on the wound. Then under the m / a S. Novocaini 0.5% - 15.0 through a transverse section 3.0 cm long, 1.5-2.0 cm below the scapular bone, a U-shaped suture was applied and a duplicate of the infraspinatus muscle was created. Hemostasis. Stitches on the wound. Bandage for 2 weeks. The operation lasted 25 minutes.

Example 2. Patient N., 47 years old, hunter. Received with shoulder instability.

Under the m / a S. Novocaini 0.5% - 20.0 through a cross section 4.0 cm long 2 cm above the scapular bone spine, a U-shaped seam was applied to m. Supraspinatus (supraspinatus muscle) for the purpose of duplication. Hemostasis. Stitches on the wound. Then, under the m / a S. Novocaini 0.5% - 15.0, a U-shaped suture was made and a duplicate of the infraspinatus muscle was created through a transverse section 3.0 cm long 2.0 cm below the scapular bone. Hemostasis. Stitches on the wound. Bandage for 2 weeks. The operation lasted 30 minutes.

Example 3. Patient K., 50 years old, domestic injury. Received with shoulder instability.

Under the m / a S. Novocaini 0.5% - 20.0 through a transverse section 3.5 cm long 2 cm above the scapular bone spine, a U-shaped seam was applied to m. Supraspinatus (supraspinatus muscle) for the purpose of duplication. Hemostasis. Stitches on the wound. Then under the m / a S. Novocaini 0.5% - 15.0 through a transverse incision 3.0 cm long 1.5 cm below the scapular bone, a U-shaped suture was applied and a duplicate of the infraspinatus muscle was created. Hemostasis. Stitches on the wound. Bandage for 2 weeks. The operation lasted 20 minutes.

The proposed method was implemented in more than 10 cases, relapse did not occur.

Thus, the creation of a 2-point duplicate, as it were, turns the joint into the third point of the living, elasticized, strengthened three-vertex “structure”, preventing, or at least reducing the likelihood of relapses in the joint stability. The operation is as gentle as possible for the patient (local anesthesia, short intervention time, short recovery period). And for these reasons - cost-effective.

Claims (1)

A method of stabilization of the shoulder, characterized in that through a transverse incision 4.0 cm long 2.0 cm above the scapular bone, a U-shaped suture is applied to the supraspinatus muscle, creating a duplicate of the supraspinatus muscle, the wound is closed, then through a transverse incision 3.0 1.5-2.0 cm below the spine of the scapular bone also impose a U-shaped suture, creating a duplicate of the infraspinatus muscle.