Method for treating children suffering from juvenile rheumatoid arthritis for elbow joint flexion contracture

FIELD: medicine.

SUBSTANCE: method involves elongating arm biceps and brachial muscle in distal part. Brachioradial muscle is partially detached from the place of its attachment to achieve full forearm extension.

EFFECT: complete repair of mobility in articulation.

1 dwg

 

The invention relates to medicine, namely to orthopedics.

Widely used in clinical practice surgical method for the treatment of contractures of the joints of patients with arthritis, the essence of which consists in synovectomy - excision of the synovial lining of the joint with granulation tissue (see, for example, Ethicsline. Orthopaedic-surgical treatment of patients with non-infectious polyarthritis. Orthopedics, traumatology and prosthetics. - 1969. No. 6. - P.8-13). However, this manipulation aimed only at destruction of the joint pathological antigenic tumor, thereby reducing total and local activity of the process, but does not restore the lost function of a limb.

Also known is a method of treatment of contractures of the elbow joint in children with juvenile rheumatoid arthritis (JRA) (see, for example, Lunascan. Comprehensive orthopedic and surgical treatment of children with different variants of the flow of rheumatoid arthritis, Diss. MD, Leningrad. - 1989. - 396 S.), taken as a prototype. The method consists in synonymsalerlisin - excision of the hypertrophied synovium with granulation tissue and opening the joint capsule in the anterior joint, which ensures the removal of the joint pathological angiogenic lesion and partial elimination of contractures of Lokteva the joint.

The disadvantage of the above method, taken as a prototype, is incomplete elimination of contractures of the elbow joint, as preserved expressed its muscular component, due to the destructive and sclerotic changes of rheumatoid muscle tissue. This complicates the subsequent development of movements in the joint in children due to significant pain syndrome in the JURA.

The task of the invention consists in improving the treatment of flexion contractures of the elbow joint in children with JRA by restoring range of motion in the joint.

This object is achieved in that produce inovcapital elbow joint, extend the biceps and shoulder muscles in the distal partially prepare the chin from the insertion preclusive muscle that allows you to completely straighten the forearm.

The drawing shows a diagram of a method of treatment of flexion contractures of the elbow joint in children with JRA, where:

1 - two-headed muscle, tendon which the Z-shaped elongated;

2 - line Z-shaped incision of tendon lengthen the shoulder muscles;

3 - the original site of attachment preclusively muscles;

4 - position preclusively muscle after partial detachment from attachment.

The method is as follows. After dissection of the soft tissues of prednamerennoe elbow usepreview skin flaps. Cut transverse to the fascia Pirogov. Allocate the tendon of the biceps muscle (1), and Z-figuratively lengthen, which gives a significant extension in the elbow joint. Exposed tendon distal shoulder muscles (2) also extend Z-shape, which allows to further increase the amplitude of extension of the forearm. From this section highlight the proximal division of the insertion preclusively muscle (3) and prepare the chin over 1.0 cm, displacing the distal (4)that allows you to permanently eliminate muscle component flexion contractures of the elbow joint. The capsule in the anterior joint and excised hypertrophied synovial membrane and granulation tissue. Fully extends the forearm at the elbow joint. The tendon of the biceps and shoulder muscles sew. The wound is sutured in layers. The operated limb immobilised back in a plaster of Paris splint is placed in a reclined position for a period of 5-6 days. In the future, start dosed development movements in the elbow joint to the full restoration of its functions.

A method for the treatment of flexion contractures of the elbow joint in children with juvenile rheumatoid arthritis, in which synonymsalerlisin, characterized in that lengthen the biceps and shoulder muscles in the distal partially prepare the chin from the place of attachment of precautionsto to full extension of the forearm.



 

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