Method for correcting neurogenic flexion contracture of elbow joint

FIELD: medicine.

SUBSTANCE: musculocutaneous vascularised and innervated island flap comprising the active greater teres muscle, a descending branch of the circumflex scapular artery, and the subscapular nerve is separated. The above flap is moved towards the elbow joint, with its muscular portion placed between the caput mediale and caput longum of the triceps muscle of the arm and anchored to a transition point of the tendon portion of the triceps muscle into the muscular one. The greater teres muscle is preserved attached to the humerus. As it may be required to bring the above flap down, it is possible to dissect away its attachment point of the greater teres muscle from the humerus. A tendon auto- or allograft is used to anchor the flap to the transition point of the tendon portion of the triceps muscle into the muscular one if the muscular portion does not appear to be long enough.

EFFECT: eliminating flexion contracture in the elbow joint and recovering the active flexion of the forearm in the motor unit deficiency.

4 cl, 7 dwg, 1 ex

 

The invention relates to medicine, namely to orthopedics, neurosurgery, plastic surgery, and can be used for the correction of complications of paralysis of the upper limb, such as flexion contractures of the elbow joint that occurs when the flexor spasticity (shoulder and biceps muscles in the upper arm) and weakness of the extensors (triceps brachii). Such a provision substantially reduces the possibility of her participation in an active function.

Spastic conditions occur when CNS lesions, brachial plexus, and the most frequent causes are: cerebral palsy, vascular brain lesions (stroke), traumatic brain and spinal injuries. For the correction of such conditions apply conservative treatment (orthotics, treatment with drugs (baclofen, Finlepsin), intramuscular injection of a botulinum toxin preparations), surgical treatment (1, 2). During surgical treatment it is important not only to eliminate contracture and passively straighten the elbow, but also to restore the tone of the extensor apparatus that is associated with significant technical challenges in terms of neurogenic lesions in the absence of the function of the triceps muscle. Extension of the elbow joint is usually performed lengthening of the tendon of the biceps muscle, fractional lengthening of the p�iceway muscles, the release of the joint capsule, collateral ligaments, the plasticity of the skin. To restore the tone of the extensor apparatus in paralysis of the triceps muscle you can also move a rear portion of the deltoid muscle, biceps muscle and the latissimus shoulder (1, 3). However, in the context of neurogenic lesions of the limbs there are situations when these motor units may not be used. For example, in cases when these muscles are paralysed or in the planning of the operation determined by the surgeon as necessary for recovery of other functions. Thus, it is not a rare situation when in a deficit of motor units in the area of reconstruction requires a choice of alternative variants (4).

The technical result is to improve the upper limb function; the elimination of flexion contractures of the elbow; in the restoration of active extension of the forearm in a deficit of motor units.

The result is achieved in that the isolated islet of skin and muscle and perfused innervated flap with the inclusion of active large round muscle, descending branch of the artery, the envelope of the blade, and subscapular nerve, after which the said flap is moved to elbow, stack muscular portion between the medial and long heads triggle�Oh shoulder muscles and sutured to the tendon transfer part of the triceps brachii muscle; mount large round muscle to the humerus retain; if necessary to bring the said flap may trim its site of attachment of the large round muscle from the humerus; to stitch the flap to the junction of the tendon part of the triceps muscle in muscle in case of insufficient length of the muscle tendon units use auto - or allograft.

The pictures show:

Fig. 1 - method for the correction of neurogenic flexion contracture of the elbow joint. Anatomy of a reconstruction zone:

position 1 is the beginning of the selection of cutaneous part of the flap and trim large round muscle from the angle of the scapula.

position 2 - the receptor location, area stitch the muscle end of the flap.

position 3 - cutaneous part of the flap.

position 4 - descending branch of the envelope of the shoulder artery.

Fig. 2 - Method of correction of neurogenic flexion contracture of the elbow joint. Clinical example. The marking of the flap before the operation.

Fig. 3 - method for the correction of neurogenic flexion contracture of the elbow joint. Clinical example. Look after transposition of the musculo-cutaneous flap.

Fig. 4 - method for the correction of neurogenic flexion contracture of the elbow joint. Clinical example. Skin plastic triangular flaps in the cubital fossa.

Fig. 5 - method for the correction of neurogenic� flexion contracture of the elbow joint. Clinical example. The position of the elbow before surgery (no movement).

Fig. 6 - method for the correction of neurogenic flexion contracture of the elbow joint. Clinical example. 9 weeks after surgery. Active flexion of the elbow after surgery (the closest result).

Fig. 7 - Method of correction of neurogenic flexion contracture of the elbow joint. Clinical example. 9 weeks after surgery. Active extension of the elbow after surgery (the closest result).

The method is as follows: on the anterior surface of the elbow in the cubital fossa perform a linear longitudinal access, visualize the tendon of the biceps muscle of the shoulder and extend its z-shaped, perform fractional lengthening of the shoulder muscles. If this is unable to achieve full extension, then perform the release of the capsule of the elbow joint, lateral, medial collateral ligament, release of the brachioradialis muscle and arthrosis elbow joint. After reaching full passive extension of the elbow on the skin cubital fossa cut out opposite triangular flaps, the wound is sutured. In the projection of the large round muscle at suprascapular region mark colonopathy flap. Mark the triangular opening formed by the edges of the big, small cu�glyme and long heads trigavou shoulder muscles, thereby delineate the point of exit of the artery, the envelope of the blade. Then mark the progress of its descending branches, and large, round muscle in the projection on the skin. Then over the lower edge of the latter start highlighting skin and fascial portion of the flap. Next, at the said flap includes a large, circular muscle, the fascia, the skin area above the muscle. The muscle is cut from the angle of the scapula and produce flap completely until the vascular pedicle by preserving incoming into the muscle of the supply branches of the artery, the envelope of the blade, and motor (subscapular) nerve. Attaching large round muscle to the humerus preserve (5). Optionally, if you want to reduce flap, (and/or) to change the point of fixation of a proximal end of the muscle, cut the large round muscle from its attachment to the humerus. In this case, the edge of the muscle is pre-sewn. Separate the muscle subperiosteal or (in the case) if the attachment of the plan to the bone, with a fragment of cortical bone. Raised flap rotating at the shoulder, where prolonged skin incision so that the muscular part of the said flap is formed between the medial and long heads trigavou shoulder muscles. In situation of extension in the elbow joint the free end of the muscle flap is stitched to the junction of the tendon part of the muscle. If you fail� the length of the muscle graft using autologous tendon or allograft. Cutaneous part of the flap is fixed with sutures to the skin of the shoulder. The donor wound is sutured in a line.

Postoperative management and conventional therapy for plastics islet musculocutaneous flaps. Immobilization plaster splint on the anterior surface of the shoulder and forearm in the position of extension in the elbow joint. The period of immobilization for 6 weeks. When using tendon grafts and in the presence of spasticity in the flexor forearm 8-9 weeks.

This method allows to improve the upper limb function by eliminating contractures of the elbow joint with the subsequent restoration of the tone of the extensor apparatus.

Clinical example: Patient D. 28 years with the diagnosis: consequences of severe traumatic brain injury, spastic left hemiparesis operated on the upper limb. Before the operation there was a lack of active and passive limitation of motion in the left elbow joint. In the analysis of muscle function detected the presence of spasticity in the biceps, shoulder and pectoralis muscles, flaccid paralysis (absence of contractile function) triceps, deltoid, latissimus muscles of the back and shoulder rotators. Contractility stored on the biceps, shoulder and big round muscles. At the elbow joint active extension is missing, the elbow is in flexion (to sharp corner)

The patient was fixed flexion contracture of the elbow, extend the humerus and the biceps muscle, performed a z-plasty skin elbow bend, and then for plastic surgery of the extensor apparatus in the position of the triceps muscle was transplanted a large round muscle according to the method described above. The graft had completely healed by primary intention. After 6 weeks the patient was allowed to begin physical therapy. Simultaneously, was initiated electrical stimulation, in which muscle contraction is obtained with transplanted muscle. Obtained nearest good functional result. In the period of 9 weeks the patient was able to actively straighten the forearm to angle of 150 degrees.

References

1. Morrey''s The Elbow and Its Disorders: Expert Consult, 4ed, - Saunders, - 2008, 1232 p.

2. B. B. Umnov, V. A. Novikov, A. B. Svozil Diagnosis and treatment of spastic hand in children with cerebral palsy: a literature review part 2. conservative and surgical treatment of upper limb // Traumatology and orthopedics of Russia. - 2011, - 3 (61). - P. 137-145.

3. Scott N. Kozin et al. Biceps-to-Triceps Transfer for Elbow Extension in Persons With Tetraplegia // J. Hand Surgery, - Vol 35A, - June 2010. - P. 698-675.

4. Hand surgery / Warwick et al. Guide. TRANS. angl. ed Rodomanova L. A., Moscow: Publishing house Panfilov Publ.; Knowledge lab, 2013. - 704 S.

5. Surgical anatomy of upper to�of ecostay / Khovanov V. V., Travin, A., M.: "Medical", 1965. - 599 p.

1. Method of correction of neurogenic flexion contracture of the elbow joint, including consistent implementation of the typical procedures for the mobilization of the elbow joint, the humeral lengthening the muscles and tendons of the biceps, and skin grafting in the cubital fossa, characterized in that the isolated islet of skin innervated muscle flap based on the active big round muscles, including the subscapularis nerve innervating the muscle, after which the said flap is moved to elbow, stack muscular portion between the medial and long heads of the triceps muscle and sutured to the tendon transfer part of the triceps muscle in muscle.

2. A method according to claim 1, characterized in that save mount large round muscles to the humerus.

3. A method according to claim 1, characterized in that, if necessary, to reduce notirovannyh flap cut mount large round muscle from the humerus.

4. A method according to claim 1, characterized in that in case of insufficient length of the muscular portion of the flap to stitch it to the place of transition of the tendon part of the triceps brachii muscle, using autologous tendon or allograft.



 

Same patents:

FIELD: medicine.

SUBSTANCE: invention relates to traumatology and orthopaedics and can be applied for realisation of periacetabular triple osteotomy of pelvis in teenagers. Access to ischial and pubic bone is realised in projection of adductor muscles - longitudinal adductor access, in position of bending and abduction in hip joint. Tenomyotomy of adductor muscles is performed. In intermuscular space in blunt way performed is access to femur trochantin, where tendon part of iliolumbar muscle is exposed and its tenotomy is carried out. Branch of ischial bone, covered from outside with external obturator muscle, is identified under acetabulum. External obturator muscle is perforated. Ischial bone is bypassed with raspatories from inside and outside and oblique osteotomy is performed in front-to-back direction. Osteotomy of upper branch of pubic bone is performed. Osteotomy of ilium is performed from front access.

EFFECT: method makes it possible to reduce access trauma, provide realisation of surgery under conditions of hip head compression or its high position in case of dislocation.

8 dwg

FIELD: medicine.

SUBSTANCE: tendons of flexors and extensors of additional and basic rays are cut at the level of medium third of metatarsal bone and medium third of second instep bone respectively. Underdeveloped metatarsal bone of additional ray and underdeveloped first finger of base ray are removed. Anatomically correctly developed finger of additional ray is transferred on anatomically correctly developed metatarsal bone of basic ray. Flexor and extensor tendons of formed first ray are sutured at the level of medium third of formed ray. Fixation of transferred fragments is realised due to K-wires and gypsum bandage in medium position of foot to knee joint.

EFFECT: method ensures normal growth of first ray and support ability of foot.

9 dwg

FIELD: medicine.

SUBSTANCE: invention relates to traumatology and orthopaedics and can be applied for the treatment of purulent arthritis. Arthrotomy is carried out. Necrotised tissues, injured elements of the joint are ablated. Primarily a spacer from bone cement with an antibiotic is installed. The wound is sutured layer-by-layer. Drainage is carried out in portions, with the periodical closure of draining tubes in such a way, that drainage is realised for 5-10 min each hour on the first 2-3 days after operation. The spacer is replaced for the joint endoprosthesis after cupping the infectious process.

EFFECT: method makes it possible to reduce a risk of endoprophesies septic instability.

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely orthopaedics, and aims at treating a long-term rotator cuff injury. An incision 5-8 cm long is made from an inferior edge of a clavicle along an anterior surface of a shoulder along sulcus deltoideus (Ollier type) to access a rotator cuff. In an inner rotation position, the rotator cuff is sutured two or three times successively with the stitches transversely directed under each other to form a duplex rotator cuff segment.

EFFECT: invention enables reducing tissue injuries potentially accompanying a surgical intervention and the lengths of treatment and rehabilitation.

1 dwg, 2 ex

FIELD: medicine.

SUBSTANCE: point skin incision is made in a projection of a base of the 5th metacarpal bone, and a pin is inserted into a canal of the 5th metacarpal bone to reach a fracture level. That is followed by closed reduction of the fracture, and the pin is inserted transarticularly up to the level of a lower one-third of a proximal phalanx of a little finger.

EFFECT: more effective treatment ensured by the stable fixation of comminuted, spiral fractures and eliminating purulent-septic complications.

1 ex, 3 dwg

FIELD: medicine.

SUBSTANCE: formed concave spherical cutters are used to process end faces of bone fragments of the forearm to enlarge a contact area to a graft. An open reduction of the fragments involves measuring an existing defect in between. The graft of the required dimensions is created; the end faces of the graft are processed with convex spherical cutters of the similar radius. After the open reduction is completed and the graft is embedded between the fragments, the optimum contact area of the bone and graft is aimed. External or internal fixation is carried out to create compression between the fragments and graft and to ensure an extra stability of the maximum contact by shaping the end faces of the graft and fragments spherical.

EFFECT: method enables increasing fixation stability, providing the early functional load, and recovering the adjoining joint function.

4 dwg

FIELD: medicine.

SUBSTANCE: group of inventions refers to traumatology and orthopaedics and is applicable for subchondral strained reinforcement. The first version: one end of at least two pins is inserted subchondrally through articular surface fragments above a bone defect up to its cortical layer. The mechanical strain is generated in the pin; an arched curve is formed at an outer end of each pin, whereas a free linear segment of the pin thereafter is inclined by 45-60 degrees to a long axis of the bone, and then pressed to the bone with a clamp element by means of screws. The second version: one end of each pin is brought until it comes out from the opposite side of the bone, and a support pad is formed thereon; each pin is pulled up to contact the support pad to the opposite cortical layer of the bone; the pin is pulled up by its outer end; that is ensured by forming the arched curve of the pin at the end of each pin opposite the support pad and fixing it by at least two loops around the axis of the pin rod; the arched curve is bent to the bone, whereas the free linear segment of the pin end is placed on the surface of the bone surface for fixation thereto.

EFFECT: group of inventions enables preventing the secondary fragment displacement.

3 cl, 8 dwg

FIELD: medicine.

SUBSTANCE: not longer than 3 cm skin cut is performed above place of rupture on posterior surface of shin. Crucifirm sutures are applied on proximal and distal ends of Achilles tendon transcutaneously in front plane in such a way that one cruciform suture is located in deep and another - in superficial layer of Achilles tendon ends. Ends of Achilles tendon are brought into wound by threads, which are used to additionally apply blocking knots on proximal and distal tendon ends in order to prevent eruption of cruciform sutures. Threads are tightened and tied to each other, approaching tendon ends. Tendon ends are additionally strengthened with U-shaped sutures.

EFFECT: method increases accuracy of matching fragments of Achilles tendon by width and by length, reduces risk of injuring sural nerve.

3 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely orthopaedics and traumatology for eliminating an extension contracture of a wrist combined with flexion contractures and an ulnar deviation of triphalangeal fingers in the children suffering arthrogryposis. The method involves a corrective shortening extension osteotomy of metacarpal bones within distal metaphyses with excising a fragment as a trapeze. A greater base of the trapeze is directed radially.

EFFECT: method improves the gripping function by eliminating the contractures of the wrist joint and triphalangeal fingers.

16 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to traumatology and orthopaedics and can be applied for the single-step transiliac elongation of a lower extremity. The lower edge of the semiluna notch is osteotomated with the formation of an insection to the base of the anterior-lower spine. Rearward from the sciatic notch the ischium is sawed to the arc-like line with the formation of a saw cut. An external cortical plate is sawn on the external surface of the iliac bone from the insection to the saw cut, with the formation of a line of transverse osteotomy. The insection and the saw cut are connected on the internal surface of the ilium by a line of arc-like osteotomy of the internal cortical plate, passing in front of the semilunar notch upwards - on the internal edge of the ilium wing, then down its crest and downwards - on the posterior part of the iliac bone, with an indent from the arc-like line with the formation of a tongue-shaped bone flap. The external and internal cortical plates are moved with respect to each other in the saggital plane for distant, equal shortening of the extremity.

EFFECT: method makes it possible to reduce a risk of recurrence, and reduce the term of rehabilitation.

4 dwg

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should isolate and dissect the tendons of anterior tibial and long fibular muscles to dissect the tendon of posterior tibial muscle against the site of fixation and direct it towards plantar rear area in front of internal ankle through the tunnel in subcutaneous fiber, then one should subcutaneously direct dissected tendons of anterior tibial and long fibular muscles onto plantar rear area to suture them so to leave free the tendinous end of posterior tibial muscle which should be intraosseously fixed to median wedge bone that keeps the process of foot repulsion during walking.

EFFECT: higher efficiency of therapy.

5 dwg, 1 ex

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: one should perform reposition of talus fragments followed by resection of articular surfaces of talus and calcaneus by maximally restoring anatomy of tarsal plantar department without forming any groove in talus and resecting wedge-like fragments with their wedge bottom towards the side being opposite to deformation. Then one should develop an autotransplant out of ileum's ala by taking into account the form of modulating resection at its length being from talus' posterior edge up to Chopart's joint without vascular pedicle. Autotransplant should be fixed due to applying Ilizarov's apparatus that enables to cure aseptic necrosis, pseudoarthroses, remove pathological foot's phenomena at shortened time for operative interference and narcosis, decreases traumaticity of operative interference at total decrease of therapy terms.

EFFECT: higher efficiency of therapy.

1 ex

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: one should perform incision along internal surface of talocrural joint, open internal ankle and distal tibial metaepiphysis, perform osteotomy of internal ankle, remove cartilages at articular surfaces of internal ankle and internal department of patient's talus, carry out fibular osteotomy being above incorrectly fused fracture, dissect distal fibular fragment outwards, perform osteotomy of incorrectly fused fracture of posterior tibial edge to be then repaired and osteosynthesized, remove cartilages from articular surfaces of fibula and tibia and talus, remove posterior-external subluxation of talus, conduct temporal transarticular fixation of talocrural joint with needles at correct position of talus, perform osteosynthesis of osseous fibular fragments after osteotomy fulfilled, fix external ankle with a screw to tibial and talus epiphysis, perform osteosynthesis of internal ankle, remove transarticularly introduced needles, fill talocrural fissure developed with osseous transplants developed out of anterior-external department of distal tibial metaepiphysis.

EFFECT: increased accuracy of reposition, improved conditions for fusion.

3 dwg

FIELD: medicine.

SUBSTANCE: method involves using wires as temporary fixing members. The wires are introduced reach the external cortical layer after setting the fracture for the period a permanent fixing member is under setting. The wires are removed from the opposite bone side with respect to the fixing member.

EFFECT: enhanced effectiveness in fixing and holding small-sized splinters; high reposition accuracy.

2 dwg

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

FIELD: medicine.

SUBSTANCE: method involves carrying out reduction and fixation of fractured bone fragments. At least two adjustable length rods are used. The rods have end heads and openings for making attachment to mandible. One of the heads is freely rotatable relative to the rod and the other one is movable along longitudinal rod axis. Reduction and fixation is made in positioned centric jaw relation. The rods are set between the mandible and maxilla to the right and left of the center at the level of failed second incisor and second bicuspid teeth.

EFFECT: reduced risk of traumatic complications; reduced periosteum detachment.

3 cl, 3 dwg

FIELD: medicine.

SUBSTANCE: method involves producing and transplanting and implantable segment containing mature cartilage tissue cells fixed on absorbable supporting matrix for repairing animal cartilage. The implantable segment has absorbable elastic supporting matrix for culturing and fixing living cells thereon. Instrument for introducing the implantable segment, having mature cartilage tissue cells on supporting matrix, into defective animal cartilage area, has clamps and external tubular envelope. The envelope has an end holdable by user and an end for making introduction into defective cartilage area. Holder and telescopic member are available in the envelope end holdable by user. Injection canal is partially embedded into the holder and projects beyond the holdable envelope end towards the end for making introduction. The clamps are attached to the telescopic member. They are well adapted for catching and releasing the implantable segment when telescopically moving the holder in the envelope.

EFFECT: enhanced effectiveness in arranging and fixing implantable segment in the implantation place.

47 cl, 11 dwg

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

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: in case of the suggested method of treating one should isolate extensor's tendon damaged in area of nail phalanx to suture it with a certain suture, the ends of ligature should be directed through oblique canal in nail phalanx to withdraw through the skin and fix them on S-likely curved free end of a needle that fixes the nail phalanx. In case of the present method of therapy it is possible to exclude the pressure upon soft tissues of volar surface of nail phalanx to prevent the development of scar-resulting bedsore and disorder of palpable sensitivity of patient's finger.

EFFECT: higher efficiency of therapy.

1 cl, 2 dwg

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should form a transplant out of femoral biceps' tendon, form an oblique-cross-sectional transfemoral canal in isometric area upon external femoral condyle, right to the front against insertion fibular collateral ligament, apply proximal end of crossed femoral biceps' tendon through this canal, fix the end of crossed femoral biceps' tendon upon internal femoral condyle. The method enables to prevent tendinous rupture at the site of its new fixation and avoid the loss of articular bending function.

EFFECT: higher efficiency of therapy.

2 dwg, 1 ex

Up!