Method for surgical treatment of perosseous tendinous ruptures of brachial rotator muscles

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should perform reposition of osseous fragments at simultaneous reinforcing their thickness with porous titanium nickelide implants. Then one should perform osseous fixation of apophysotendinous stump with titanium nickelide clips at shape memory effect. In particular case, reinforcing should be fulfilled due to implanting elastic porous titanium nickelide plate. In paticular case, reinforcing could be performed due to implanting finely granulated porous titanium nickelide at granules size being 0.1-2 mm. In particular case, reinforcing should be carried out due to implanting elastic porous titanium nickelide plate and finely granulated porous titanium nickelide at granules size being 0.1-2 mm.

EFFECT: higher efficiency of fixation, decreased traumaticity.

3 cl, 2 dwg, 1 ex

 

The invention relates to medicine, namely to the technique of traumatology and orthopedics.

Short Rotatoria the shoulder muscles - supraspinatus, infraspinatus and small all involved in bringing rotational and lateral movements of the arm at the shoulder joint, are attached to Apophis - large tubercle of the humerus tendon. The latter form, in combination with associated bone the greater tubercle of the organic composition known in anatomy as episodereally complex. Muscles and episodereally complex when tagzania of the upper limb have high mechanical loads and beyond (traumatic) cases destroyed. The location of the gap is determined by the etiology of the disease. For example, for the case of osteoporosis, with a concomitant traumatic dislocation, impressionne fractures of the greater tubercle with a margin apatitonefelinovoj complex and education apatitonepheline stump up to 50% of recorded cases. Traditionally, these injuries are called transosseous tendon ruptures (figure 1). The arm at the shoulder joint loses active mobility, the patient becomes incapacitated.

Restoration of function of the injured shoulder is, as a rule, surgical methods, technical essence of which is constantly being improved.

Known to the persons of surgical treatment of transosseous tendon ruptures rotatory muscles of the shoulder [1], including the extirpation of bone fragments all over

volume impresionado of fracture of the greater tubercle of the humerus, forming an ordered package tendons and fixing the latter in the bed of the deleted fragments.

The disadvantages of the method: the inferiority of the function of the shoulder joint due to the defect of the head, the high invasiveness of the surgery, low worth fixing apatitonepheline stump due to its sharp bend on the edge of the defect and opportunities leaf tissue becoming necrotic.

There is a method of surgical treatment of transosseous tendon ruptures rotatory muscles of the shoulder [2], including the restoration of the destroyed Apophis by reposition of bone fragments and extramedullary fixation apatitonepheline stump external screws.

The disadvantages of the method is low viability repair of bone defect and, as a consequence, the low mechanical strength of the greater tubercle. Low strength of fixation apatitonepheline stump screws in osteoporotic bone and subintegerrima bone recovered defect.

There is a method of surgical treatment of transosseous tendon ruptures rotating shoulder muscles, improved compared with the equivalent [2] by introducing an additional structural element in the form of 8-shaped wire loop, covering the head of the square is the U.S. bone and supporting Apatitskogo stump [3].

Operation vysokoaromatichnyj requires wide exposure of the humerus. High probability of resorption subintervals bone fragments recovered bone tubercle. High specific pressure of the wire on the bone tissue complicates the situation is the possibility of cutting. By the greatest similarity technical nature of this analogue is selected for the prototype proposal.

The technical result of the invention is reducing injuries, improving the viability of the operation.

This technical result is achieved in that in the method of surgical treatment of transosseous tendon ruptures rotatory muscles of the shoulder, including the restoration of the destroyed Apophis and extramedullary fixation apatitonepheline stump, the restoration of the destroyed Apophis is carried out by reposition of bone fragments in combination with reinforcement of their strata of porous implants of titanium nickelide, extramedullary fixation apatitonepheline stump carry straps Nickel-titanium shape memory effect.

Preferably reinforced with thick raionirovannykh bone fragments implantation elastic porous plate Nickel-titanium.

Preferably reinforced with thick raionirovannykh bone fragments implantation of a fine-grain porous titanium nickelide size is renal 0.1 to 2 mm.

Preferably reinforced with thick raionirovannykh bone fragments implantation elastic porous plate Nickel-titanium and fine-grain porous titanium nickelide with granule size of 0.1 to 2 mm.

The novelty of the proposal amount to an additional structural feature is the reinforcement thickness raionirovannykh bone fragments porous objects Nickel-titanium, and other technical means of plate fixation apatitonepheline stump. Done by the authors of the proposal study morphological patterns during implantation nikolicristanovic objects show that osseointegration, i.e. the reparative processes in the destroyed bone tissue in the presence of such are more active, wealthy, form a stronger consolidation and, ultimately, lead to an increase in mechanical strength, in this case, Apophis.

Fixing apatitonepheline stump to such bone volume in any of the fastening element is more thorough. However nicelydestroyed brackets, due to the high biocompatibility of the material and increased in comparison with a screw contact surface, provide greater assurance technical result.

The choice of the form of reinforcing element is dictated by the specific conditions of the form of the bone defect, the size, number and shape of the bone f is agentov, biological condition of the bone tissue. Plate form implant gives the restored bone volume greater strength and a better retention drawn through his legs locking element. Fine-grain implant of porous titanium nickelide allows easier, faster and more uniformly reinforced with bone volume, especially when complex shape of the bone defect. The best results in strength of fixation is provided by a combination of plate and fine-grain titanium nickelide and preferably, if there are conditions in the above sense.

The size of the individual granules of porous titanium nickelide chosen experimentally and corresponds to the optimum process of osseointegration.

The illustrations presented:

Figure 1. Scheme transosseous tendon ruptures rotatory muscles of the shoulder; 1 - the bone defect at the place of Apophis; 2 - apatitskayua stump; 3 - the shoulder joint.

Figure 2. The operation stages of treatment transosseous tendon ruptures rotatory muscles of the shoulder:

And the restoration of Apophis;

B - overlay apatitonepheline stump;

In - fixing apatitonepheline stump.

Achievable technical result is confirmed by examples of specific implementations of the proposed method in the surgical treatment of transosseous tendon ruptures rotatory muscles of the shoulder in traumatologic the English Department of the clinical hospital №1, Novokuznetsk.

Example.

Patient W., 50 years old, was admitted to the hospital with a diagnosis: set a dislocated right shoulder, transosseous comminuted rupture of tendons rotatory muscles.

Under provodnikovym anaesthesia front access exposed the humeral head and held decompression subacromial space. Visual examination revealed impressiona cavity size 3×3 cm with multiple bone fragments in it. Rotatory muscles yellowish color, damaged bone fragments.

Surgery repair of bone defects and tendon ruptures using a round plate made of porous titanium nickelide 3 cm in diameter, 0.5 mm thick and porous fine-grain, nickelide titanium with a predominant grain size of 0.1-2 mm

The way during the operation carried out as follows.

Bone fragments, as much as possible their ordering and uniform filling gaps nikolicristanovic granules placed in the cavity of the bone defect. Over deponirovano volume laid the plate of porous titanium nickelide and on top of it is a large fragment (1×1.5 cm) Apophis (Pasa, B, figure 2). Imposed apatitskayua stump covered nikolicristanovic bracket, the legs of which permeated the whole deponirovannye volume of the bone defect and the thickness of the head bone (OSV, 2). Imposed adapting the seams on aponeuroses stretching and seams on the wound.

In the postoperative period for 5 weeks produced fixation of shoulder wedge-shaped cushion and the armband Thomas. History and x-ray examination of a patient 1 year after surgery revealed a fusion of the greater tubercle, anatomical congruence head bone, restoring full range of motion of the shoulder joint. Patient complaints there, from removal of fasteners refused, working at their current job as a fireman.

The results are shown and the number of similar operations indicate the reachability of the technical result and the readiness of the proposed method for wide clinical use.

The sources used in the compilation description:

1. Sklyarenko Mrs x "Surgery of the joints of the limbs", Kyiv "high school", 1975, p.205.

2. Caclin E, "fundamentals of operative surgery and traumatology", M.: Medicine, 1964, s.

3. Prudnikov PU fractures of the greater tubercle of the humerus, complicated podrulevymi paralysis // proceedings of the VI Congress of traumatologists and orthopedists CIS, Yaroslavl, September 14-17, 1993, s (prototype).

1. The method of surgical treatment of transosseous tendon ruptures rotatory muscles of the shoulder, including the restoration of the destroyed Apophis and extramedullary fixation of apatitskoj the Noah stump, characterized in that the restoration of the destroyed Apophis is carried out by reposition of bone fragments in combination with reinforcement of their strata of porous implants of titanium nickelide, extramedullary fixation apatitonepheline stump carry straps Nickel-titanium shape memory effect.

2. The method according to claim 1, characterized in that the reinforcement thickness raionirovannykh bone fragments carry out implantation of an elastic porous plate Nickel-titanium.

3. The method according to claim 1, characterized in that the reinforcement thickness raionirovannykh bone fragments carry out implantation of a fine-grain porous titanium nickelide with granule size of 0.1 to 2 mm.

4. The method according to claim 1, characterized in that the reinforcement thickness raionirovannykh bone fragments carry out implantation of an elastic porous plate Nickel-titanium and fine-grain porous titanium nickelide with granule size of 0.1 to 2 mm.



 

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