RU2763668C1 - Method for applying a tendon suture - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics, and can be used to restore the integrity of damaged tendons. Retreating from the end of the tendon by 1.5-2.0 cm, thread is passed to the end of the tendon. Next, the thread is passed from the end to the opposite side of the tendon. Thus, a loop is formed at the end of the tendon. The second end of the tendon is stitched in the same way, but at the end when forming a loop, the thread is passed through the loop of the opposite end of the tendon. After that, the threads are tightened, the ends of the tendons are adapted, after adaptation, the ends of the threads are tied together. Then, on 2/3 of the perimeter of the tendon along the anterior surface through the edges of the outer peritendinium, an adaptive wrapping suture is performed using microtechnology.

EFFECT: method increases the strength of the suture, prevents the formation of adhesive processes and provides the possibility of unhindered sliding of the tendon in the bone-fibrous channel by eliminating the possibility of thread eruption, as well as by reducing the number of threads in the suture area of the tendon.

1 cl, 4 dwg, 1 tbl, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to restore the integrity of injured tendons of various localization.

A known method of suturing a tendon by drawing a thread in the transverse direction, then each end of the thread back in the transverse direction in the same plane with the formation of loops outside the tendon, through which the ends of the thread are inserted inside the trunk and into the end of one end of the tendon, followed by connecting the ends of the other thread, carried out in the same sequence through the other end of the tendon (AS SU No. 1814885, MKI5 A61B 17/56). [one].

The disadvantage of this method is the formation of corrugation of the surface of the tendon in the transverse direction due to the three-fold imposition of the thread in one transverse plane, which leads to the contraction of the tendon of the "pouch" type and the development of adhesions. In addition, when the ligatures are tightened, the tendon sections between the loop and the end surface are corrugated in the longitudinal direction, which leads to inaccurate adaptation of the connection and poor treatment results.

The closest to the claimed technical solution is the "METHOD OF APPLICATION OF A TENDON SUTURE IN DAMAGE TO THE FLEXOR TENDONS OF THE HAND" RU 2234877 [2], which includes passing the thread in the transverse direction, forming a loop with an overlap from the outer surface of the tendon, holding the end of the thread inside the trunk to the end of the tendon, forming a loop with overlap in the area of the end surface, passing the second end of the thread in a similar way, passing the thread in the same way at the other end of the tendon, tying the ends of the threads with the formation of an intrastem suture, applying an adaptive microsurgical suture to two thirds of the perimeter of the tendon from the palmar surface.

The disadvantage of the known method is the insufficient strength of the seam as a result of the possible eruption of the tendon tissue by the transverse thread.

The aim of the invention is to provide a method for adapting tendon ends with improved results in the treatment of tendon injuries.

The technical result of the claimed method is the elimination of thread eruption, which increases the strength of the suture, the reduction in the number of threads in the tendon suture area, preventing the formation of adhesive processes, the possibility of unhindered sliding of the tendon in the bone-fibrous canal.

The technical result is achieved by the fact that, departing from the end of the tendon by 1.5 - 2.0 cm, the thread is passed to the end of the tendon. Next, the thread is passed from the end to the opposite side of the tendon. Thus, a loop is formed at the end of the tendon. The second end of the tendon is stitched in the same way, but at the end, when forming a loop, the thread is passed through the loop of the opposite end of the tendon. After that, the threads are pulled together, the ends of the tendons are adapted. After adaptation, the threads are tied around the tendons, then on 2/3 of the perimeter of the tendon along the front surface, through the edges of the outer peritendinium, an adaptive twisting suture is performed using microtechnology.

The suture outside the area of tendon injury makes the suture stronger without disturbing the blood supply to the tendon, and the absence of loose threads and knots at the end of the tendon prevents the formation of adhesive processes.

In FIG. 1 shows a simulated first tendon, FIG. 2 shows two spaced tendons with a loop between them, FIG. 3 the ends are adapted, in FIG. 4 final view, where;

1 - the first end of the tendon,

2 - the first thread,

3 - loop on the first thread,

4 - the second end of the tendon,

5 - second thread,

6 - loop on the second thread,

7 - tied end of the first thread,

8 - tied end of the second thread.

Implementation of the invention:

The method is carried out as follows.

The site of tendon injury is exposed by one of the known methods using additional incisions. The ends of the tendon are brought out into the wound. At the first end of the tendon prepared for suturing, at a distance of 1.5 - 2.0 cm from the end of the tendon, the first thread 2 is passed to the end of the tendon. Next, the thread is passed from the end to the opposite side of the tendon. Thus, a loop is formed at the end of the tendon on the first thread 3. The second end of the tendon 4 is stitched in the same way, with the second thread 5 but at the end, when loop 6 is formed, the thread is passed through the loop of the first end of the tendon. After that, the threads are pulled together, the ends of the tendons are adapted. After adaptation, threads 7 and 8 are tied around the tendons. Then, on 2/3 of the perimeter of the tendon along the palmar surface, through the edges of the outer peritendinium, a microsurgical twisting suture with a 5-6/0 thread is performed, and an exact anatomical restoration of the tendon continuity is achieved. The imposition of a microsurgical suture on the posterior semicircle of the connection of the ends of the tendon is considered inappropriate. On the one hand, this does not increase the strength of the connection and increases the trauma and duration of the operation. On the other hand, the cicatricial adhesion process develops more often along the anterior (palmar) surface of the tendon, which requires careful modeling of this particular tendon surface.

When using the method of applying the proposed tendon suture to a larger tendon (for example, the Achilles tendon), a thick nylon thread is used, and the twisting suture is performed with a prolene thread. The wall of the synovial sheath is partially excised. Sutures are applied to the skin, the wound is drained, which ensures a good outflow of wound contents. On the 3-4th day, a scab is formed along the line of the postoperative wound, under which complete epithelization occurs. The limb is fixed with a splint plaster bandage. Depending on the segment, after 2-4 weeks from the moment of surgery, sparing passive movements begin in adjacent joints. 1-2 weeks after the removal of plaster immobilization, the patient is allowed to perform dosed active movements under the supervision of a physiotherapist, and then independently. From 2-3 days after the operation, physiotherapy is carried out (magnetotherapy, laser therapy, vibromassage, UHF). After 3-4 weeks, patients are referred for outpatient treatment with detailed recommendations for rehabilitation treatment. After surgery, vascular and anti-inflammatory therapy is prescribed to accelerate regeneration and reduce the adhesive process. Monitoring the results of treatment is carried out after 2.6 months and 1 year. For clinical observation, 20 patients were selected (see table 1) with tendon injuries of various localization, of which 12 people were operated on using the proposed method of tendon suture to restore the tendon.

All treated patients did not experience complications associated with the incompetence of the tendon suture.

Example 1. Patient R., aged 46, was admitted to the Department of Hand Surgery of the Regional Clinical Hospital No. 2 of Khabarovsk due to an incised wound of the palmar surface of the middle phalanx of the third finger of the left hand. He was injured at work with a clerical knife 50 minutes before hospitalization. Examination revealed damage to the deep and superficial finger flexor tendons. The patient was taken to the operating room. Produced conduction blockade at the level of the wrist joint. A tourniquet was applied to the upper third of the forearm after preliminary raising the arm to reduce its blood supply. After a thorough dressing of the skin, the wound on the finger was expanded in the proximal and distal directions, taking into account the probable location of the ends of the tendon. The tendon sheath was opened without breaking the annular ligaments. A thorough debridement of the surgical wound was performed. The wound is abundantly washed with antiseptics. When the ends of the damaged tendon are displaced, blood clots, foreign microbodies, and tissue fragments are introduced into the vagina, if they are not removed, the risk of developing an inflammatory process, disturbing the sliding surface of the tendon and its bed, and the formation of adhesions is significantly increased. Using microsurgical techniques, the tendons were carefully processed. Under magnification, the irregularities of the end surfaces of the ends of the tendons were clearly defined. The ends of the tendon had a somewhat oblique direction towards the palmar side. Therefore, when the tendon suture is tightened until the anterior sections of the tendon ends come into contact, the posterior sections will experience increased mutual pressure, which negatively affects the outcome of treatment. Made tendon suture by the proposed method. Partially excised the wall of the synovial sheath, sutured to the skin to the rubber drainage. The hand was fixed with a dorsal splint bandage from the fingertips to the upper third of the forearm in the position of flexion of the fingers and hand up to 150-160 degrees. After 2 weeks, healthy fingers were released and sparing passive movements were allowed in the interphalangeal joints of the injured finger. After 3 weeks, the patient was allowed to perform dosed active movements under the supervision of an exercise therapy methodologist, and then independently. From the second day after the operation, physiotherapy treatment (magnetotherapy, UHF) was prescribed. The duration of inpatient treatment was 10 days. The patient received further treatment at the emergency room at the place of residence. The total period of disability was 42 days. A good result has been achieved. Finger function restored completely. The patient continues to work in his specialty (locksmith).

Industrial application. The proposed method of applying a tendon suture, which excludes thread eruption, reduces the risk of adhesion development, brings closer to a more ideal restoration of the sliding surface of the tendon, and improves the results of treatment of tendon injuries of various localization, will find application in traumatology and orthopedics.

Table 1 AREA OF DAMAGE SURGICAL TREATMENT METHODS TOTAL PROPOSED METHOD IN OTHER WAYS M F M F Deep flexor tendon of the finger 5 3 one 2 eleven The tendon of the long flexor of the 1st finger 2 - one 2 5 Achilles tendon 2 - one one 4 TOTAL 12 eight twenty

Claims (1)

A method for applying a tendon suture, which includes passing a thread with an indent from the end of the tendon by 1.5-2.0 cm intra-trunk to the end of the tendon, then the thread is passed from the end to the opposite side of the tendon with the formation of a loop at the end of the tendon, the second end of the tendon is stitched in a similar way, but at the end with forming a loop, the thread is passed through the loop of the opposite end of the tendon, after which the threads are pulled together, the ends of the tendons are adapted, after adaptation, the ends of the threads are tied around the tendons, then, on 2/3 of the perimeter of the tendon along the front surface, through the edges of the outer peritendinium, an adaptive twisting suture is performed using microtechnology.

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