RU2321361C2 - Method for surgical treatment of chronic dislocation of caput humerus - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: the present innovation deals with anterior-internal access to brachial articulation at transition onto subacromial space. Due to a flap-like incision one should dissect the cuff of rotators together with the group of tendons of external rotators to treat articular cavity against cicatrices and reset the caput into the cavity. Previously dissected fragment of rotators' cuff should be sutured in at forming duplicature of anterior wall of articular capsule along with lengthening the tendon of subscapular muscle. The shoulder should be suspended with the tendon of biceps long caput. The innovation improves functional-anatomical results of therapy in case of chronic brachial dislocations due to applying the complex of technical techniques directed to reconstruct the cuff of brachial rotators.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to treat chronic dislocations of the shoulder of any age.

The main way to treat a chronic dislocation of the shoulder is currently considered operational. The most frequently performed operation is an open reduction of the head of the humerus.

There is a method of open shoulder reduction (Yu.M. Sverdlov. Traumatic dislocations and their treatment, M., Medicine, 1978, p. 61). A hook-shaped skin incision from the coracoid process along the deltoid-thoracic groove exposes the shoulder joint. The tendon of the subscapularis muscle is intersected 2 cm inwards from the small tubercle, and after the shoulder head and the articular cavity of the scapula are separated from the scars, the head is put back into place, after which the wound is sutured. This operation does not meet the requirements of the biomechanics of the shoulder joint - the rotational cuff of the shoulder is not restored.

There is a method of open shoulder reduction (A.V. Aleinikov. Treatment of chronic dislocation of the shoulder. Nizhny Novgorod, 1995, p.12). The front access through the deltoid-thoracic groove exposes the shoulder joint, produces an osteotomy of the coracoid process with abduction of the muscles attached to it. Medial to the small tubercle transversely or Z-shaped intersect the tendon of the subscapularis muscle and after releasing the joint cavity from the scar tissue, the head of the humerus is set in its place. However, this method does not allow to reliably assess the condition of the external rotators of the humerus, which in the future will not restore the normal function of the shoulder joint.

The prototype of the proposed method is a method of open reduction of a chronic dislocation of the shoulder (A.S. No. 2164387 C2, RU, class A61B 17/56). An arcuate skin incision is made along the chest-groove groove with a transition to the subacromial space. Cut off the muscles from the coracoid process. The tendon of the subscapularis muscle is dissected in a Z-shape. Free the joint cavity from scars. Set the head into the cavity. Carry out transarticular percutaneous fixation of the head with knitting needles. Cross-linked tendons of external rotators are sutured with shortening. Suspend the shoulder with the tendon of the long biceps head. The tendon of the subscapularis muscle is sutured with lengthening.

The disadvantages of this method include injuries of access, fixation of the head of the shoulder with knitting needles, insufficient strengthening of the anterior section of the shoulder joint, which can lead to relapse of dislocation.

The objective of the invention is to restore the cuff of the shoulder rotators and reduce the morbidity of access.

The problem is solved in that in the method of surgical treatment of a chronic anterior dislocation of the shoulder, including front-internal access to the shoulder joint with a transition to the subacromial space, a rotator cuff with the back group of tendons of the external rotators is cut off with a patch-like incision, the joint cavity is freed from scars, and the head is inserted into the scars the cavity, the previously cut-off flap of the rotator cuff is sutured with the formation of a duplicate of the anterior wall of the joint capsule and transossal hemming to the head with elongated using the tendon of the subscapularis muscle, the shoulder is suspended by the tendon of the long head of the biceps.

Figure 1 schematically shows the location of the muscles of the internal and external rotators of the shoulder, where: 1 - the pectoralis major muscle, 2 - the latissimus dorsi muscle, 3 - the subscapularis muscle, 4 - the large round muscle, 5 - the posterior portion of the deltoid muscle and 6 - the infraspinatus muscle .

In Fig.2 is a diagram of the cut-off flap of the cuff of rotators, where: 7 - cut-off flap of the cuff of rotators.

Figure 3 - diagram of the hemming of the long head of the biceps, where: 8 - the hemmed tendon of the long head of the biceps, 9 - formed duplicate of the rotational cuff of the shoulder.

The method is as follows.

Anterior-internal access to the shoulder joint is made with a transition to the subacromial space. If necessary, cross the fibers of the anterior portion of the deltoid muscle. The tendon of the long head of the biceps is mobilized from the point of intersection with the tendon of the pectoralis major muscle to the point of attachment to the scapula. A flap-shaped incision cuts off the cuff of the rotators with the back group of tendons of the external rotators. Cicatricial tissues performing the joint cavity are excised. The head of the humerus is set. A damaged shoulder is rotated outward, a previously cut flap of rotator cuffs is fixed as medially as possible with the creation of a duplicate of the front wall of the joint capsule and transosseous suturing to the head with lengthening the tendon of the subscapularis muscle due to the shortening of the tendons of the external rotators, the shoulder rotates. The final stage is hemming the previously isolated tendon of the biceps of the shoulder to the acromial process of the scapula. The wound is sutured tightly with the introduction of active drainage through contraception. In the postoperative period, the limb is immobilized for 3 weeks in a plaster cast on a wedge-shaped pillow.

Clinical example. Patient Ch., 61 years old, case history No. 1120, was treated at the trauma unit of the STOB from 04/01/2005 to 04/18/2005.

Diagnosis at admission: A chronic dislocation of the left shoulder.

Dislocation duration was 3 months.

04/08/2005 - an open removal of the dislocation of the left shoulder was performed. The postoperative period without features. Immobilization of the operated shoulder with a plaster cast for 3 weeks. After removal of the plaster cast, exercise therapy classes were conducted. After 2 months of movement in the left shoulder joint are: lead 70 °, flexion 90 °.

Examined 8 months after surgery - no complaints, lead 90 °, flexion 90 °.

Claims (1)

A method for surgical treatment of a chronic anterior dislocation of the shoulder, including antero-internal access to the shoulder joint with transition to the subacromial space, clearing the joint cavity from scars, head reduction, characterized in that the rotator cuff with the back group of tendons of the external rotators is cut with a patch-like incision, the shoulder is rotated outwards , a cut flap of rotator cuffs is fixed as much as possible more medially with the creation of duplicature of the anterior wall of the joint capsule and transossal suturing to the heads ke.

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