RU2728562C1 - Surgical method of chronic anterior instability of the shoulder joint - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to traumatology and orthopedics, and can be used for surgical management of chronic anterior instability of shoulder joint. Access to tendons of a long and short head of biceps is applied. Tendomuscular flap with its base turned towards the coracoid process is cut out from the tendon of biceps short head. Cut out flap is sutured into a tube and sutured to a place of an exit from intertubercular groove of a tendon of a long head of biceps.EFFECT: method enables improving the clinical effectiveness ensured by cross reinforcement of an anterior part of the shoulder capsule and its stabilization.1 cl, 3 dwg, 2 ex

Description

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

There are many treatments for chronic anterior shoulder instability. The closest to the stated 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 brachii and placing it in a groove created under the bony valve from the large tubercle of the shoulder. The clinical effect of this operation is associated with increased stability of the shoulder joint.

The disadvantage of this method is that the percentage of relapses reaches 30% due to the lack of strengthening of the anterior-inner part of the shoulder joint capsule.

The technical result of the invention is to improve the results of treatment by creating a dynamic stabilizer.

The technical result is achieved by cutting out a tendon-muscular flap from the tendon of the short head of the biceps muscle, facing the base to the coracoid process, then the cut out flap is sutured into a tube and sutured to the place where the tendon of the long head of the biceps muscle exits the intertuscular groove. As a result, there is a cross-strengthening of the anterior-inner part of the shoulder joint capsule and its dynamic stabilization.

THE INVENTION IS EXPLAINED BY THE FIGURE

The figure shows the phased course of the operation:

1. Access to the tendon of the biceps brachii.

2. Cutting out a flap from the short head of the biceps muscle with the base facing the coracoid process and suturing it to the place where the tendon of the long head of the biceps exits the intertubercular groove. The upper edge of the dissected tendon of the pectoralis major muscle is sutured

3. Layer-by-layer wound closure with interrupted sutures.

THE METHOD IS CARRIED OUT AS FOLLOWS

Access is made to the tendon of the long head of the biceps brachii (1).

From the tendon of the short head of the biceps muscle, a tendon-muscle flap (on average 7 × 2.5 × 0.5 cm) is cut out, facing the base to the coracoid process. The cut out flap is sutured into a tube with a thin catgut and sutured to the point where the tendon of the long head of the biceps muscle exits from the intertuscular groove. The upper edge of the dissected tendon of the pectoralis major muscle is sutured (2).

The wound is sewn up tightly with catgut interrupted sutures in layers (3). (figs 1, 2, 3)

EXAMPLE OF A SPECIFIC PERFORMANCE

1) Patient V., born in 1985, was admitted to the orthopedic and traumatology department of the City Clinical Hospital No. 4, Kursk, 03.09.2016.

At admission, complaints of pain in the right shoulder joint prevailed. The pain gradually increased after daily physical activity, was aching, pulling in nature, slightly decreased after prolonged rest.

History of repeated dislocations of the humerus (6-8 times a year)

After clinical, X-ray and MRI examination, the diagnosis was made: Chronic anterior instability of the right shoulder joint. MRI examination revealed no damage to the articular lip or an impression fracture of the humerus head.

Due to the fact that the patient was dominated by the clinic of chronic anterior instability of the shoulder joint, the operation was performed - Plastic anterior wall of the shoulder joint. (09/07/2016).

Operation progress:

1. Under aseptic conditions, an anterior vertical, slightly outwardly curved incision is made along the projection of the intertubercular groove in the mid-physiological position of the limb, the tendon zone of the long head of the biceps muscle is exposed. After a third of the width, the tendon of the pectoralis major muscle is dissected to provide access to the short head of the biceps muscle.

2. From the tendon of the short head of the biceps muscle, a tendon-muscular flap (on average 7 × 2.5 × 0.5 cm) is cut out, facing the base to the coracoid process. The cut out flap is sutured into a tube and sutured to the tendon of the long head of the biceps. The remaining short head of the biceps brachii is sutured with catgut to ensure hemostasis. The upper edge of the dissected tendon of the pectoralis major muscle is sutured. The wound is sewn up tightly in layers with catgut interrupted sutures.

The postoperative period was unremarkable. Active movements in the shoulder joint are allowed 2 weeks after surgery.

The observation of the patient to date has shown a good result: no recurrence of dislocations of the humerus for 2 years.

2) Patient I., born in 1988, was admitted to the orthopedic and traumatology department of the City Clinical Hospital No. 4, Kursk on July 27, 2015.

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

She had a history of 3 shoulder dislocations in the last six months.

After clinical, X-ray and MRI examination, the diagnosis was made: Chronic anterior instability of the right shoulder joint. MRI examination revealed no damage to the articular lip, rotator cuff, or impression fracture of the humerus head.

Due to the fact that the patient was dominated by the clinic of chronic anterior instability of the shoulder joint, the operation was performed - Plastic anterior wall of the shoulder joint. (30.07.2015).

The postoperative period was unremarkable. Active movements in the shoulder joint are allowed 2 weeks after surgery.

Observation of the patient to date has shown a good result: no recurrence of dislocations of the humerus within 3 years.

Thus, the set task was achieved by transposition of the graft of the short head of the biceps brachii muscle, creating a dynamic stabilizer without the formation of a bony leaflet.

Claims (1)

A method of surgical treatment of chronic anterior instability of the shoulder joint, including access to the tendon of the long and short head of the biceps brachii, characterized in that a tendon-muscle flap is cut out of the tendon of the short head of the biceps muscle, facing the base to the coracoid process, then the cut out flap is sutured into a tube and sutured to the exit site of the intertubercular groove of the tendon of the long head of the biceps.

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