RU2268015C1 - Method for lengthening brachial triceps muscle tendon - Google Patents

Abstract

FIELD: medicine, traumatology.

SUBSTANCE: the present innovation deals with treating unbending contractures of patient's elbow joint. It, also, deals with performing access to articular ends, removing ossificates and osseous branching of elbow process, arthrolysis and lengthening brachial triceps muscle tendon. One should partially dissect tendinous fixation against elbow process at developing its defect followed by substituting the defect at simultaneous lengthening the tendon due to cutting a tendinous-fascial bridge-shaped fragment at the width being correspondent to that of the defect mentioned, then the fragment should be shifted onto defect to be sutured with median edge of the tendinous defect that enables to carry out earlier functional therapy.

EFFECT: higher efficiency.

3 dwg, 1 ex

Description

The present invention relates to medicine, in particular to traumatology and can be used in the treatment of extensor contractures of the elbow joint.

A known method of lengthening the tendon of the triceps of the shoulder by the method of Z-shaped lengthening (I. A. Movshovich. Operational orthopedics, 1994, pp. 131-132).

However, the method is characterized by complete intersection of the tendon, which contributes to the development of triceps insufficiency at an early onset of movements in the postoperative period.

As a prototype, the method of tongue-like lengthening of the tendon of the triceps muscle of the shoulder according to Campbell was selected, which consists in cutting out of the tendon of the triceps muscle of the tongue-shaped flap with the base on the ulnar process and suturing the mobilized flap in the muscle with its shift downward in the position of the achieved flexion of the forearm (I.A.Movov. Operational Orthopedics, 1994, pp. 124-125).

However, the method has several disadvantages. Complete intersection of the tendon leads to a violation of its blood supply. Fixation of the crossed tendon with sutures requires prolonged immobilization of the limb in the postoperative period. Movement in the elbow joint begins 1-1.5 weeks after surgery. The likelihood of developing failure of the suture of the tendon, which contributes to the development of insufficiency of the extensor apparatus of the forearm.

The task of the invention is to reduce the morbidity of surgical intervention and the early onset of functional treatment in the postoperative period.

The problem is solved due to the fact that in the method, including access to the articular ends, removal of ossificates and bone growths of the ulnar process, arthrolysis partially cuts off the attachment of the triceps muscle tendon from the ulnar process, to replace the resulting defect and lengthen the tendon, the tendon-fascial bridges are cut out with a width corresponding to the width of the defect, the flap is displaced to the place of the defect and sutured to the medial edge of the tendon defect.

The method of lengthening the tendon of the triceps muscle of the shoulder is illustrated by drawings, where Fig. 1 shows access to the posterior-medial parts of the joint; figure 2 - cutting a tendon-fascial bridge-like flap; figure 3 - fixation of the flap at the defect site.

The method is as follows. The posterior arcuate incision 1 provide access to the posterior-medial parts of the joint (Fig. 1). To provide access to the deformed apex of the ulnar process, the tendon attachment of the 2 triceps muscle of the shoulder is separated from the medial and central surfaces of the apex of the ulnar process with the formation of its defect 3. The ossification, bone growths from the apex of the ulnar process are removed, the elbow joint is made arthrolysis. Restore the full amount of passive movements in the joint. To replace the defect 3 and lengthen the tendon 2 on the posterior lateral surface of the joint, a tendon-fascial bridge-like flap 4 is cut longitudinally from the lower third of the shoulder to the upper third of the forearm with a width corresponding to the width of the defect, but not less than 3-4 cm (Fig. 2) . The flap 4 is mobilized from the underlying tissues and displaced to the defect 3. The medial edge of the flap is connected to the inner edge of the defect by interrupted sutures 5 (Fig. 3). The operation is completed by thorough hemostasis and layer-by-layer suturing of the wound with fixation of the limb in the flexion position at an angle of 90-100 °.

Clinical example

Patient D., 47 years old, and.b. No. 191921. Diagnosis: extraarticular bone ankylosis of the left elbow joint after a burn. The forearm is fixed in the extension position at an angle of 20 °, there are no active and passive movements in the elbow joint. 05/31/2000, operation No. 153 was performed: mobilization of the elbow joint. During the operation, after access to the posterior parts of the joint to isolate and remove the massive ossificate, bone-connected with the posterior surface of the condyle of the shoulder, the apex of the elbow process and the “sprouting” place of attachment of the tendon of the triceps muscle of the shoulder, the tendon was partially cut off from the deformed apex of the elbow process. A tendon defect was formed 6 cm long and 2.5 cm wide. To replace the defect and simultaneously lengthen the retracted tendon of the triceps muscle of the shoulder on the posterior lateral surface of the joint, a tendon-fascial bridge-like flap 4 cm wide and length was cut from the own fascia of the shoulder and the stored lateral portion of the tendon. 10 cm, which is mobilized and moved to the place of the defect, is hemmed to its medial edge in the position of the achieved complete flexion of the forearm. Active movements started on the second day after surgery. Postoperative rehabilitation was carried out for 4 weeks. As a result, the volume of active movements in the left elbow joint was restored 0/30/140 ° (amplitude 90 °). Long-term result 1 year after surgery: active movements in the left elbow joint are possible in a volume of 0/15/145 ° (amplitude 120 °).

The proposed method allows to replace the resulting defect and lengthen the tendon of the triceps muscle with a longitudinally cut bridge-like flap without violating the integrity of its attachment to the shoulder and forearm. The moved flap is cut out from viable elastic tissues without disturbing their blood supply due to the longitudinal management of the incision. The flap is fixed in a new place by a series of longitudinal sutures along the medial edge of the flap, which do not bear significant dynamic load during forearm movements, which significantly improves the reliability of the flap fixation. The method allows you to start active movement in the elbow joint from the first days after surgery.

Claims (1)

A method of lengthening the tendon of the triceps muscle of the shoulder, including access to the articular ends, arthrolysis, removal of ossifications and bone growths of the ulnar process, characterized in that the attachment of the tendon of the triceps muscle from the medial and central surfaces of the apex of the ulnar process with the formation of a defect is cut out on the posterolateral dry surface of the joint -fascial bridge-like flap from the lower third of the shoulder to the upper third of the forearm with a width corresponding to the width of the defect, displace the flap in place of defects, the medial edge of the flap is connected to the inner edge of the defect.

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