RU2264185C1 - Method for treating ordinary humeral luxation - Google Patents

Abstract

FIELD: medicine, traumatology.

SUBSTANCE: one should isolate a tendon of long caput of humeral biceps muscle, perform a Z-shaped tendinous dissection to form a canal in area of a minor humeral tuber and fix a proximal tendinous segment upon surgical collum of humerus in middle physiological position or at 5-10° internal rotation with percutaneous sutures, distal tendinous segment should be applied through the canal developed in area of a minor humeral tuber to be fixed to minor humeral tuber. The innovation in question enables to prevent relapses.

EFFECT: higher efficiency of therapy.

1 cl, 2 dwg, 2 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in surgical treatment of the usual dislocation of the shoulder.

Despite the large number of known methods of surgical treatment of the usual dislocation of the shoulder, the development of effective, affordable, simple, less traumatic methods remains an urgent task.

A known method of treating a habitual dislocation of the shoulder, including the formation of a tunnel in the head of the humerus and laying in it the tendon of the long head of the biceps of the shoulder. At the same time, a tendon is dissected, the humerus is raised to the position of hypercorrection, the tendon is sutured to create a duplicate of the ends and the upper limb is fixed in the mid-physiological position using a compression-distraction apparatus until the tendon is fused (Application No. 99112883, IPC A 61 V 17/56, BIPM No. 12, 2001).

However, this method has the following disadvantages:

1. hypercorrection in the future can lead to restriction of movements in the joint and complicates postoperative rehabilitation treatment;

2. fixation by the device complicates the method and creates inconvenience for patients (difficulty wearing, caring for the device, discomfort). In addition, additional channels are created in the bones for knitting needles, and therefore, there is a risk of infection, which can lead to spoke osteomyelitis;

3. the difficulty of determining when it is necessary to remove the apparatus, since there are no reliable data on tendon fusion. And this in the future can lead to relapse of the disease.

The aim of the invention is to increase the effectiveness of treatment, preventing relapse of the disease, simplifying the method, reducing the risk of complications.

This goal is achieved by isolating the tendon of the long head of the biceps of the shoulder, produce a Z-shaped dissection of the tendon. A channel is formed in the region of the small tuber of the humerus. Then fix the proximal segment of the tendon on the surgical neck of the humerus in the average physiological position or with a small (5-10 °) internal rotation of transosseous sutures. The distal tendon segment is passed through the canal formed in the region of the small tubercle of the humerus, and fix it to the small tubercle of the humerus.

Comparative analysis with the prototype showed that the proposed solution differs from the known one in that the channel is formed in the region of the small tubercle of the humerus, produce a Z-shaped dissection of the tendon, while the incision along the length of the tendon is at least 3 centimeters, and then the proximal segment of the tendon is fixed on the surgical the neck of the humerus in the average physiological position or with an internal rotation of 5-10 ° transosseous sutures, and the distal segment of the tendon is carried out through the channel formed in the region of the small tuber of the brachial braid ty, and fix it to the small tubercle of the humerus.

Thus, this treatment method meets the criteria of the invention of "novelty."

The analysis of patent and specialized literature showed that the proposed technical solution differs not only from the prototype, but also from other technical solutions in this and related fields. So the authors have not found ways to treat the usual dislocation of the shoulder, including the proposed techniques. Namely, they allow to achieve the goal - to increase the effectiveness of treatment, prevent relapse of dislocation, simplify the method and reduce the risk of complications due to the fact that the implementation of the method does not require a compression-distraction apparatus.

This method can be used in the treatment of habitual dislocation of the shoulder in surgical hospitals.

Therefore, the proposed solution meets the criteria of "inventive step" and "industrial applicability".

The method is as follows.

In patients with a habitual dislocation of the shoulder, the tendon of the long head of the biceps of the shoulder muscle is isolated, a Z-shaped tendon is dissected, and the incision along the length of the tendon is 3 cm or more. A channel is formed in the region of the small tuber of the humerus. Then fix the proximal segment of the tendon on the surgical neck of the humerus in the average physiological position or with a small (5-10 °) internal rotation of transosseous sutures. The distal tendon segment is passed through the canal formed in the region of the small tubercle of the humerus, and fix it to the small tubercle of the humerus. Figure 1 and 2 presents the main stages of the operation, where

1 - humerus

2 - shoulder blade

3 - tendon of the long head of the biceps of the shoulder

4 - proximal tendon

5 - distal part of the tendon

Example 1. Patient V.V., 56 years old

Ds: habitual dislocation of the shoulder on the right

From the anamnesis: received an injury 15 years ago. During this time, about 30 episodes of dislocations occurred, which were first corrected in a hospital under general anesthesia, and later the patient learned to eliminate the dislocations himself. The last episodes of dislocations happened even in a dream.

The patient underwent diagnostic arthroscopy, in which Bankart III damage was revealed, damage to the cartilage of the head of the humerus and the articular cavity of the scapula.

The patient was treated with a habitual dislocation of the shoulder according to the proposed method.

A section of 8 cm in length allowed access to the right shoulder joint, a tendon was isolated, and cartilage lesions were rehabilitated. A Z-shaped incision was made along the length of the tendon, equal to 3 centimeters. A channel was formed in the region of the small tubercle of the humerus. Then the proximal tendon segment was fixed on the surgical neck of the humerus in the average physiological position with transosseous sutures. The distal tendon segment was passed through a canal formed in the region of the small tubercle of the humerus, and fixed to the small tubercle of the humerus with transosseous sutures.

The postoperative period was uneventful. After 3 months at the control examination: no complaints, movement in the right shoulder joint in full.

During the observation period (3 years), there are no complaints at the control examinations, movements in the joint are not disturbed, there was no relapse of dislocation.

Example 2. Patient K.Z., 48 years old

Ds: habitual dislocation of the shoulder to the left.

From the anamnesis: I received an injury 9 years ago. During this time, about 27 episodes of dislocations occurred, which were first corrected in a hospital under general anesthesia, and later the patient learned to eliminate dislocations himself.

The patient underwent diagnostic arthroscopy, in which Bankart III damage was revealed, damage to the cartilage of the head of the humerus and the articular cavity of the scapula.

The patient was treated with a habitual dislocation of the shoulder according to the proposed method.

A section of 8 cm in length allowed access to the left shoulder joint, a tendon was isolated, and cartilage lesions were rehabilitated. Made a Z-shaped section along the length of the tendon, equal to 4 centimeters. A channel was formed in the region of the small hump of the humerus. Then, the proximal tendon segment was fixed on the surgical neck of the humerus in the average physiological position with transosseous sutures. The distal tendon segment was passed through a canal formed in the region of the small tubercle of the humerus, and fixed to the small tubercle of the humerus with transosseous sutures.

The postoperative period was uneventful. After 3 months at the control examination: no complaints, movement in the left shoulder joint in full.

During the observation period (3 years), there are no complaints at the control examinations, movements in the joint are not disturbed, there was no relapse of dislocation.

The proposed method was used in the treatment of habitual dislocation of the joint in 8 people. The method showed high treatment effectiveness: the movements in the operated joint were restored in full, there were no relapses of dislocations during the dynamic observation (2-3 years).

Claims (2)

1. A method of treating a habitual dislocation of the shoulder, including the formation of a channel in the humerus, the allocation of the tendon of the long head of the biceps of the shoulder, dissection of the tendon and laying of the tendon in the formed channel, characterized in that the channel is formed in the region of the small tubercle of the humerus, produce a Z-shaped dissection tendons, then fix the proximal segment of the tendon on the surgical neck of the humerus in the average physiological position or with internal rotation of 5-10 ° transosseous sutures, and the distal segment of the tendon conducted through a channel formed in the region of the small tuber of the humerus, and fix it to the small tuber of the humerus. 2. The method according to claim 1, characterized in that when the tendon is dissected, the incision along the length of the tendon is equal to 3 cm or more.

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