SU1500277A1 - Method of treatment of habitual shoulder slip - Google Patents

Abstract

The invention relates to medicine, namely to orthopedics. In order to shorten the rehabilitation time by 1.5-2 times due to strengthening the anterior-internal division of the joint, it is exposed, removed from its bed, the tendon of the long head of the biceps of the shoulder is moved along with the formed tendon-muscle flap from the beak muscles and the short head in the groove of the humeral head with the cutting out of a non-free flap of bone and tissue, the tendon and flap are interconnected with the bone bed and overlaid with bone bone graft.

Description

The invention relates to medicine, more specifically to traumatology and orthopedics, and concerns methods for the operative treatment of habitual shoulder dislocation.

It is most advisable to apply the proposed method in patients with a large number of recurrent dislocation and a long duration of the disease.

The aim of the invention is to reduce the rehabilitation time by strengthening the anterior-internal part of the joint.

The procedure is carried out in the following manner.

The operation is performed by mask anesthesia.

Make a skin incision along the deltoid-pectoral sulcus 8–10 cm long, starting with the beak-shaped process of the scapula, leaving a large saphenous vein. After dissection of the fascia, following along the cut, blunt.

the muscle fibers are severed. In the area of the inter-cuspid groove, along the inner edge, the synovial vagina of the long head of the biceps of the shoulder and partially the capsule of the joint is opened. The tendon of the long head of the biceps brachialis is isolated, mobilized by careful release from adhesions to the vagina, taken on the holder and set aside.

The zone of the coracoid process of the scapula, with tendons attached to it, is exposed. From the tendons of the short biceps head and the beak-brachial muscles, they cut out a tendon-muscle flap with dimensions of approximately 7x2.5 xO, 7 cm with the base of the coracoid process of the scapula.

The cut out flap is sewn into the barrel of a barrel, and the resulting defect at the site of cutting out the flap is sutured with catgus.

Nd 4j

31500

Tom. With abduction of the shoulder up to 90 and external rotation in the area of the anatomical neck of the humerus, 2.5 cm indent from the inner edge of the base of the small tubercle of the humerus, from the capsule chisel and bone-periosteal -. Noah fabric cut out the flap with preservation of its integrity in the lower part, this flap is folded back and form under it, in the cancellous bone, a groove, to a depth greater than the size of the tube and tendons of the long biceps of the shoulder. The length of the gutter in the proximal part must be longer than the length of the flap, and additional recesses are formed at the site of insertion of the ligaments into the bone chute to prevent ligaments. The shoulder is centered in the articular cavity of the scapula.

Two formed bundles of tendon are placed in the formed gutter — LIA of the long biceps muscle of the shoulder and the tendons of the short biceps head and the beak-brachial muscle, pre-stitched together with catgut stitches, and fixed in the groove with lavsan threads. At the top, both formed bindings are closed with the left / yukut, sewn it to the edges of the trough.

The bed of the long-length head of the biceps of the shoulder is sutured with catgut. Conduct hemostasis. The wound is sutured in layers tightly. Immunize the limb with a Deso type for 2-3 days, which is then replaced with a plaster cast for up to 4 weeks.

P ROME Patient B., 40 years old, mountaineer, master of sports, was admitted for treatment with complaints of frequent dislocation of the right shoulder, a decrease in Tpy capacity, inability to continue athletic activity (the last 6 years before admission to the hospital. He was actively involved in sports with frequent relapses). Ill for 20 years.

A complex clinical, radiological and orthopedic examination was performed. Diagnosed: habitual dislocation of the right shoulder. The patient was operated according to the described method. Under mask anesthesia, a skin incision of 10 cm in length was made, starting with the coracoid process of the scapula down, along the deltoid-pectoral sulcus. After dissection of the superficial fascia, along the course of the incision, the muscle fibers are bluntly separated. Exposed front surface of the shoulder joint. In the area of the interminugular sulcus, the vagina is open; the tendons of the long head of the biceps muscle of the shoulder. The last overgrown spa but with the vagina is not elastic.

Produced mobilization and careful release of the tendons from adhesions to the vagina.

The zone of the coracoid process of the scapula is exposed. From the tendons of the short head of the biceps and the beak-brachial muscles, a tendon-muscle flap 7x2.5x7.0 cm in size was cut with the base of the coracoid process of the scapula and 1 cut flap sewn into a tube, the defect at the site of cutting out the flap is sutured with catgut.

In the case of abduction of the shoulder and external rotation, an indent of 2.5 cm inwards from the Small Hillock, a bone-periosteal flap is cut with a chisel through the capsule, preserving its integrity in the lower part and bent downwards.

Under the flap, in the cancellous bone, it is formed up to a depth of 1 cm and a length longer than the length of the bone-periosteal flap. Additional grooves are formed at the site of insertion of the ligament in the bone chute.

The shoulder is centered in the articular cavity of the scapula. The formed gutter contains the tendons of the long head of the biceps muscle and the tubule sewn together. They are fixed with a cross loop fastened with dacron filaments.

On top of this, the gutter and bundles are covered with a left flap, which is also lined with polyester fillets to the edges of the gutter. The bed of the long biceps biceps tendon was sutured with catgut.

Hemostasis. Layer wound seam. Immobilization of the limb with a Deso bandage for 3 days followed by replacement with a plaster cast for up to 4 weeks. From the 2nd day the patient was prescribed a course of physio. functional treatments for healthy limb segments, UHF for wounds, tonic and breathing exercises.

 Stitches are removed on the 10th day, healing by primary tension.

By removing immobilization. A course of comprehensive rehabilitation treatment was conducted. Restored after 3 months

full range of movements in the operated joint, increased muscle strength. Started to work on his specialty.

Examined after 1.5 years. No recurrence complaints. The performance and muscular strength were fully restored, he continued his sports activities, and participated in the ascent.

Claims (1)

Invention Formula A method of treating the habitual dislocation of the shoulder by exposing, removing from its bed, moving the tendon of the long head of the biceps of the shoulder, then fixing it to the new bed, forming a tendon-muscle flap from the beak-shoulder muscle and the short head of the biceps of the shoulder, followed by joining the long the edges, laying it in the bone gut of the humeral head and fixation, I distinguish it with the fact that, in order to shorten the rehabilitation period by strengthening the anterior-internal part of the joint, the gutter is formed in humerus olovke a hindered by cutting out a flap of bone and periosteal TKaHjj, laid therein tendon the long head of the biceps of the shoulder and the formed tendon-muscle flap, interconnect them to the bone and overlap them with the bone-supra-pedic flap.