RU2732091C1 - Tendon suture application method - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, particularly to traumatology. Access to the tendon is performed, a suture is applied with a thread and a needle. Needle with loop thread is introduced in transverse direction, in the center of tendon stump, from the edge of tendon stump, form a first loop. Tendon stump is enveloped on the left and on the right with a thread, the first enveloping loops are formed, the needle with the loop thread is wrapped around the tendon stump and passed through the first loop, the first loop is tightened and a knot is formed, the thread is blocked. Further, needle with loop thread is repeatedly wrapped around tendon stump, tendon stump is enveloped with left and right with thread, second covering loops are formed, needle is pricked in transverse direction from the back side to the center of the tendon stump, deviating from the first prick to the edge of the stump of the tendon. Parts of the loop thread coming out of the first loop from the first blocking assembly are crossed behind the needle with the threads made in the transverse direction to form a double locking loop which is tightened. Needle with loop filament is stuck in lengthwise direction with needle prick in middle of cross section of tendon stump.EFFECT: method increases strength of the seam while reducing traumatism of application, by increasing the number of cores, which contributes to more uniform distribution of load, as well as suture contains threads, carried out through locking loops on opposite side, which after forming the assembly form pairs of enveloping loops, reducing load on the assemblies themselves, redistributing it to adjacent loops.1 cl, 8 dwg

Description

The field of technology.

The invention relates to medicine, in particular to traumatology, can be used in the treatment of injuries (ruptures, detachments) of tendons.

State of the art.

Tendons transmit forces from muscles and are subjected to significant mechanical stress, which is periodically repeated many times. The damaged tendons are sutured. Under load, forces lead to stretching of the nodes and sutures, as a result, diastasis may appear between the connected ends of the tendon. Known seams require increased mechanical strength and resistance to polycyclic stress.

End-to-end tendon sutures are known to be used for fresh tendon ruptures. For example, Kuneo seam, Kessler, Savage, Krakow, Baker, Adelaide, Lee, Tsuge, whip suture. Some elements of the above sutures can be used to reinsert the tendons when they are torn off.

Cuneo seam (Source [1]: Surun cas de suture secondaire des tendons flechisseurs ducinquieme doigt. Cunéo B., Tailhefer. Bulletin set memoires de la societe de chirurgie. 1925; 51: 959-963), Kessler seam (Source [ 2]: The "grasping" technique for tendon repair. Kessler I. Hand. 1973 Oct; 5 (3): 253-5), suture after Savage (Source [3]: In vitro studies of a new method of flexor tendon repair Savage R .: J Hand Surg Br. 1985 Jun; 10 (2): 135-41.), Suture according to Krakow (Reference [4]: A new stitch for ligament-tendon fixation. Brief note. Krackow KA, Thomas SC , Jones LC. A. J Bone Joint Surg Am. 1986 Jun; 68 (5): 764-6. Source [5]: Ligament-tendon fixation: analysis of a new stitch and com-parison with standard techniques. Krackow KA, Thomas SC, Jones LC Orthopedics 1988; 11: 909-17). These sutures are two- or four-core sutures with one or two pairs of knots immersed between the stumps of the damaged tendon. They contain 2 or 4 longitudinal threads, with one or two pairs of knots, There is a known method of applying a tendon suture with locking loops according to Krackow (source [6]: Sereda AP Treatment of fresh ruptures of the Achilles tendon. Types of tendon sutures. Figure 50. Method execution of a twisting tendon suture with locking loops according to Krackow Figure 51. Variations of a twisting tendon suture with locking loops according to Krackow Website of the Traumatology and Orthopedics Clinic of the I.M.Sechenov First Moscow State Medical University, access mode http://travmaorto.ru/ 270.html), can be made with one thread or be two seams located one above, around or on top of the other at a certain angle. Also, the number of tiers (“monomers”) of loops may differ - from two or more. The classic Krakow suture consists of 3-4 pairs of blocking loops that evenly distribute the load on the tendon rupture area due to the mutually symmetrical arrangement of loops and threads. After suturing the proximal and distal stump of the injured tendon, two nodes are formed, located between the stumps of the tendon at the joint line. The modification of the Krakow-Giftbox suture differs in that after stitching the stumps of the tendon, the threads are passed to the opposite side through the tendon fibers, where nodes are formed at a distance from the rupture zone. Thus, the Krakow-Giftbox seam is a four-core seam with knots located far from the rupture zone.

Disadvantages of analogues [1; 2; 3; 4; five; 6] consist in insufficient tensile strength and tensile strength under cyclic loads. In this case, the use of three or four pairs of loops on each side of the torn tendon forces to devascularize an extended section of the tendon, which disrupts the nutrition of the cells and leads to tissue degradation. With the passage of time and an increase in the load on the loops, the threads tighten, squeezing the bundles of tendon they cover, weakening the loop, therefore, the more loops are used in the suture, the greater the loss of tension under load and the higher the likelihood of diastasis between the stumps of the tendon. Due to the presence of longitudinal suture elements, the tendon loses its flexibility and elasticity. The nodes located outside the trunk prevent the sliding of the tendon in the thickness of the tissues.

A known method of applying a tendon suture according to Cassani (whip suture) (source [7]: US patent 20070250163 A1). The classic Cassani stitch is applied using a looped needle and consists of 3-4 pairs of wrap-around stitches formed after transverse pricks. After suturing the proximal and distal stump of the injured tendon, two nodes are formed between them. The suture was developed as a method of fixation of the tendon autograft in the anterior cruciate ligament plasty, thus being a suture for insertion of the tendon, and not for end-to-end tendon repair.

The seam [7] does not provide strength under heavy loads, which leads to eruption, rupture of the seam. The disadvantages of the seam [7] are as follows. 3-4 pairs of loops on each side force dissection and devascularization of an overly extended tendon. Covering loops are less stable than blocking loops due to tendon eruption, which leads to loss of tension and the formation of diastasis. The peculiarities of the suture technique force to position the nodes between the stumps of the tendon (or in the insertion zone), which leads to the distribution of the load on the node, while the node is the weakest zone of the suture. The seam has few modifications, which are limited only by the number of loops.

Thus, the technical problem is to ensure a firm connection of the ends of the damaged tendon without affecting its nutrition and function.

The essence of the technical solution.

The task to be solved by the technical solution is to increase the strength of the suture and its resistance to polycyclic loads, to reduce the injury of the tendon as a result of the suture.

The technical result consists in increasing the strength of the seam while reducing the trauma of the imposition. The method provides the necessary strength of the suture, the optimal ratio of its strength characteristics with less disturbance of the vital functions of the tendon, allows the stumps of the damaged tendon to join and keep them in a given position, improving the conditions of functioning and providing conditions for tissue regeneration. Seam variability is provided.

The technical result is achieved by the fact that in the method of applying a tendon suture access to the tendon is provided, a suture is applied with a thread 2 with a needle 1. A needle with a looped thread is injected in the transverse direction into the center of the tendon stump, retreating from the edge of the tendon stump, form the first loop. The tendon stump is covered on the left and right with a thread, the first covering loops are formed, the needle with a looped thread is wrapped around the tendon stump and passed through the first loop, the first loop is tightened and a knot is formed, the thread is blocked. Next, the needle with a looped thread is re-wrapped around the tendon stump, the tendon stump is covered on the left and right with a thread, the second covering loops are formed, the needle is injected in the transverse direction, from the back to the center of the tendon stump, retreating from the first injection to the edge of the tendon stump. The parts of the loop thread coming out of the first loop, from the first blocking knot, are crossed behind the needle with threads drawn in the transverse direction, forming a double blocking loop, which is tightened. A needle with a looped thread is inserted and passed in the longitudinal direction with the needle punctured in the middle of the cross-section of the tendon stump.

The method is illustrated by a description, examples of practical use and illustrations, which depict:

fig. 1 is a diagram, the first injection of the needle and the formation of the first loop when applying a suture;

fig. 2 is a diagram of the formation of enveloping loops and blocking of the thread in the first loop of the seam;

fig. 3 is a diagram, blocking the thread in the first loop of the seam, forming a knot;

fig. 4 is a diagram, the second needle is inserted, the formation of covering loops and blocking of the thread in the loop of the seam;

fig. 5 - diagram, view of the stitched tendon stump;

fig. 6 - diagram, view of the seam when connecting two stumps, after passing the threads on opposite stumps before adaptation;

fig. 7 is a diagram, when two stumps are connected, a view of the seam after tension and adaptation of the stump;

fig. 8 - diagram, suture for insertion of the tendon, passing the threads into the anchor fixture.

In figures 1 to 8, the numbers indicate:

1 - Needle;

2 - Loop thread;

3 - The first stump of the tendon;

4 - The second stump of the tendon;

5 - First loop;

6 - Blocking node;

7 - The first covering loops;

8 - Second covering loops;

9 - Double blocking loop;

10 - Point of puncture;

11 - Anchor lock;

12 - Nodes.

Implementation of the method.

Depending on the purpose of the surgical intervention and the size of the tendon, a two- and four-core suture with intra- and extra-barrel nodes can be applied using the claimed method. The number of locking loops and the length of the seam are variable. The suture is performed with an atraumatic needle 1 (Fig. 1) with a looped thread 2 (Fig. 1), or with a “blank” needle with a twofold thread charged into it.

Under anesthesia, by incision of soft tissues, access to the tendon at the site of injury (tear, rupture, detachment) is performed, stumps 3,4 are exposed (Fig. 1; 2; 3; 4; 5; 6; 7; 8) of the torn tendon. Suture stitching begins by stabbing the needle 1, in the transverse direction, into the center of the tendon stump 3, retreating along the midline from the edge of the tendon stump 3, at a distance of about 15 mm, form a loop 5 (Fig. 1). Needle 1 with looped suture 2 is wrapped around the tendon stump and passed through loop 5 (Fig. 2), blocking it, loop 5 is tightened (Fig. 3), forming knot 6. Tendon stump 3 is covered on the left and right with thread 2, and the first covering loops 7 (Fig. 3). Overhanging loops 7 tighten and block. Next, the needle 1 with looped suture 2 is re-wrapped around the tendon stump 3 (Fig. 4). Tendon stump 3 is covered on the left and right by thread 2, and the second covering loops 8 are formed (Fig. 4). The needle 1 is injected in the transverse direction, from the reverse side in the center of the tendon stump 3, along the midline, retreating from the first injection, to the edge of the tendon stump 3. The parts of the loop thread 2 coming out of the first loop 5, from the first blocking knot 6, are crossed behind the needle 1 with the threads 2 (Fig. 4) drawn in the transverse direction, form a double blocking loop 9 (Fig. 5), which is tightened. The needle 1 with threads 2 is injected and carried out in the longitudinal direction with the needle 1 punctured in the middle of the cross-section of the tendon stump 3, the puncture point 10 (Fig. 5). The stump of the 3rd tendon suture is now complete.

Further, when the tendon is torn off, the threads 2 are carried out into the bone canal and they are fixed, pulling the tendon to the place of separation. Or, when the tendon is torn off, the threads 2 are carried out into the anchor clamp 11 (Fig. 8), which is fixed at the point of separation by pulling the tendon. Injections can also be made in the opposite direction to form additional blocking loops.

The location of the puncture point 10 can be changed in order to more evenly distribute the load on the tendon: it is possible to position them closer to the periphery of the cross-section. To do this (in the case of using a looped thread), one of the threads is cut and charged into the blank needle, or removed from the eye of the blank needle and recharged. In the case of reinsertion of the tendon, the suture is completed at this stage.

In the case of a tendon suture, according to the end-to-end stump connection, the opposite tendon stump 4 (Fig. 6; 7) is stitched in the same way as the tendon stump 3 (described above), with another needle and thread. The stumps of the 3rd and 4th tendons are combined. Intra-trunk nodes are formed between the stumps 3 and 4 of the tendon, or the threads 2 are carried out from the stump 3 to the opposite stump 4 with the formation of additional blocking loops and the formation of off-trunk nodes 12 (Fig. 7) that can be immersed in the thickness of the tendon. The threads are pulled up and, together with the needle, are removed far from the rupture zone. The threads are tied in knots, cut off, removing needles and unclaimed thread remains.

Stumps 3 and 4 are stitched according to the principle of symmetrical arrangement of threads. In the rupture of the tendon, four threads (veins) are formed (Fig. 7). Needles with threads of one stump 3 are carried out on the opposite stump 4 (Fig. 6; 7).

The most suitable suture material is a braided multifilament looped suture on a non-traumatic needle, the thickness of which depends on the thickness of the sutured tendon, but in the absence of a looped suture, a twisted suture and charged into a “blank” needle can be used.

The suture obtained by the claimed method is four-core with threads located symmetrically relative to the transverse and longitudinal sections of the tendon. An increase in the number of veins (threads passing intra-trunk through the cross-section of the tendon) contributes to a more even distribution of the load, since symmetrically drawn threads hold equal portions of the tendon, preventing the formation of weak spots. The seam contains threads passed through the blocking loops from the opposite side, which, after forming a knot, form pairs of enveloping loops, reducing the load on the knots themselves, redistributing it to adjacent loops. Removing knots 6,12 from the rupture zone in itself increases the strength of the seam. The suture is less extended than the known analogs, which has a positive effect on the vitality of the tendon and its regenerative potential. Nodes 6,12 are immersed deep into the fibers of the tendon, less prevent the sliding of the tendon. In the case of using the suture for insertion of the tendon, it remains possible to position the knot off-stem and reverse block the suture.

The method provides an increase in the strength of the seam while reducing the trauma of the imposition. The method provides the necessary strength of the suture, the optimal ratio of its strength characteristics with less disturbance of the vital functions of the tendon, allows the stumps of the damaged tendon to join and keep them in a given position, improving the conditions of functioning and providing conditions for tissue regeneration. Seam variability is provided.

Claims (1)

A method of applying a tendon suture, in which access to the tendon is performed, a suture is applied with a needle, characterized in that a needle is inserted with a looped suture, in the transverse direction, into the center of the tendon stump, retreating from the edge of the tendon stump, form the first loop, the tendon stump cover the left and right with a thread, form the first covering loops, the needle with a looped thread is wrapped around the tendon stump and passed through the first loop, the first loop is tightened and a knot is formed, the thread is blocked, then the needle with a looped thread is re-wrapped around the tendon stump, the tendon stump is covered on the left and on the right with a thread, form the second covering loops, inject the needle in the transverse direction, from the reverse side to the center of the tendon stump, retreating from the first injection to the edge of the tendon stump, parts of the loop thread coming out of the first loop, from the first blocking knot, are crossed behind the needle with threads drawn in the transverse direction, form d a warming blocking loop, which is tightened, a needle with a looped thread is injected and held in the longitudinal direction with a needle punctured in the middle of the cross-section of the tendon stump.

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