Method of treating shoulder slip

FIELD: medicine.

SUBSTANCE: slightly arciform incision is created along the anterior edge of the deltoid. The coracoids with attached muscles is exposed. The rotator cuff is incised along the intertubercular groove. A tendon of the caput longum of the biceps brachii is separated. The tendon of the caput longum of the biceps brachii is displaced inwards, and two ligatures are delivered under it. Sponge forceps are used to create a passage behind the subcapular muscle with two ligatures delivered through it, and tensioned to the coracoids. The wound is sutured in layers and covered with a retentive bandage for 4-5 weeks.

EFFECT: method enables reducing surgical injuries with using the reliable reinforcement of the anterior rotator cuff taking into account biomechanical features of the proximal shoulder.

2 dwg, 1 ex

 

The invention relates to medicine, namely to traumatology and orthopedics, and is intended for the treatment of habitual shoulder dislocation and subsequent prevention of recurrent dislocations of the shoulder joint.

Luxation occurs after undergoing a primary traumatic dislocation of the shoulder joint with insufficient regeneration of damaged joint capsule. The treatment of habitual dislocation of the shoulder is operational.

There are many known methods of surgical treatment of habitual dislocation of the shoulder, aiming at the strengthening of the anterior capsule of the shoulder joint. So in the method according to the method of Andreev after securing operational access to the anterior part of the capsule of the shoulder joint strip coracoid process of the scapula and attached Rostral-shoulder, pectoralis minor muscle and short head of the biceps brachii. With a gouge, cut off part of the coracoid process of the scapula with attached Rostral-shoulder muscle and short head of the biceps brachii. Then formed using the forceps channel behind the subscapularis muscle hold the severed muscles, which again is fixed to the coracoid process. The wound is sutured in layers, with the imposition of fixing bandages for 4 weeks [1]. According to the widely used method of Andreev-Boycheva, together with the above muscles cut off the outer part of the �scarlet pectoral muscle. The subsequent course of the operation does not differ from the method described above [2]. Despite widespread use in the clinic, describes methods of surgical treatment involve significant trauma to the tissue, i.e., bone tissue associated with osteotomy of the coracoid process, and its subsequent osteosynthesis screw. Also known method of surgical treatment that involves the cutting off of the tendon of the long head of the biceps brachii of the upper tubercle articular process of the scapula, and its fixation to the coracoid process (method Rosen-Stein) [3]. Wound closure is carried out according to General rules with fixation bandage also for 4 weeks. This method of treatment cannot be considered biomechanically justified, because involves the culling from the point of attachment and displacement of the tendon of the long head of the biceps.

Closest to the claimed method is a method of treatment of habitual dislocation of the shoulder by Weinstein. This method is to strengthen the anterior part of the capsule of the joint by moving medially to the tendon of the long head of the biceps brachii and suturing it to the capsule of the joint. Thus, after exposure of the coracoid process and partial clipping from the last part attach to it a muscle, Z-shaped cut through the tendon of the subscapularis muscle, ukladam�Ute displaced tendon of the biceps muscle, and sutured to the capsule of the shoulder joint [4]. The wound is sutured in layers, superimposed fixation bandage for 4 weeks. The advantage of this method of surgical treatment is the relative minor trauma intervention and reliable fixation.

However, the use of this method of treatment is also associated with additional interventions on soft tissue with dissection and subsequent suturing; for this reason, this method also cannot be considered to be biomechanically sound.

The invention consists in the combination of essential features, sufficient to achieve the desired technical result, consisting in minor trauma operation with robust strengthening of the anterior capsule of the shoulder joint, is made subject to biomechanical features of the proximal shoulder.

The invention consists in a method of treatment of habitual dislocation of the shoulder includes a slightly curved incision along the anterior edge of the deltoid muscle, the exposure of the coracoid process with its attached muscles, the dissection of the capsule of the shoulder joint on the intertubercular groove, the allocation of the tendon of the long head of the biceps. Slip of the tendon of the long head of the biceps medially, it is carried out under two ligatures, with the help of forceps, form� channel behind the subscapularis muscle, through which the conduct of the ligature, and the tension is fixed to the coracoid process. The layers are stitched to the wound, apply the mixing on for 4-5 weeks.

The displacement of the tendon of the long head of the biceps medially, holding under him two ligatures, formation, using forceps, the channel behind the subscapularis muscle, the conduction through him ligatures, which can be fixed to the coracoid process, helps to strengthen the anterior part of the capsule of the shoulder joint.

Conducting ligatures under the tendon of the long head of the biceps without crossing the muscle tendons and cut off the latter from the coracoid process of the scapula, significantly reduces the trauma of surgery.

The method is illustrated by illustrations, which shows a diagram of the operation.

Fig. 1 shows a view of the soft tissues of the shoulder prior to surgery, where 1 is the tendon of the long head of the biceps; 2 - coracoid process of the scapula; 3 - the tendon of the short head; 4 - shoulder biceps.

Fig. 2 - operation Exodus with the transposition of the tendon of the long head of the biceps, where 1 is the tendon of the long head of the biceps; 2 - coracoid process of the scapula; 3 - the tendon of the short head; 4 - shoulder biceps; 5 - ligature suture material.

The method is carried out as follows. Make a slightly curved incision along �perednemu edge of the deltoid muscle. Stupidly, without crossing the muscle bundles expose the coracoid process to attach to it muscles. Cut through the capsule of the shoulder joint on the intertubercular groove, allocate and move medially, the tendon of the biceps muscle. Under the tendon of the biceps muscle down two ligatures, suture material. Using the forceps, from the coracoid process of the scapula, subscapularis muscle behind, form a channel through which the conduct of the ligature, and sutured with tension to the coracoid process. Sutured to the joint capsule and soft tissue. Impose a retentive bandage for 4-5 weeks after surgery.

Clinical example

Patient X., (1987) turned to SAHI "RCH MOH" with complaints of frequent repeated dislocations in the shoulder joint, is much more frequent lately. Has been coaching gymnastics at one of the schools of the city. Diagnosis: habitual dislocation of the right shoulder with frequent relapses. Treatment in the trauma unit with RCB 19.08. on 29.08.2013 G. Operation: Transposition of the tendon of the long head of the biceps of the right shoulder in the position of the anterior part of the shoulder joint. Fixing bandage for 1.5 months. Upon removal of the dressing - comprehensive restorative treatment. At the control examination in the dynamics of motion in the shoulder joint in full, the patient returned to his old job.

Sources of information

1. Movshovich I. A. Operative orthopedics. M "Medicine", 1994, operation Andreeva-Boycheva, p. 106

2. Ibid., p. 106.

3. Ibid., p. 106.

4. Ibid., pp. 104-105.

A method for the treatment of habitual dislocation of the shoulder, including a slightly curved incision along the anterior edge of the deltoid muscle, the exposure of the coracoid process, attach to it with muscles, dissection of the capsule of the shoulder joint on the intertubercular groove and the allocation of the tendon of the long head of the biceps, characterized in that the two ligatures nuzzled under the tendon of the long head of the biceps, shifting the tendon medially, forming the channel behind the subscapularis muscle with the help of forceps, the ligature is carried out in a formed channel and fixed to the coracoid process, the layers are stitched to the wound, apply the mixing on for 4-5 weeks.



 

Same patents:

FIELD: medicine.

SUBSTANCE: group of inventions relates to traumatology and orthopaedics. A set of instruments for the protection of the popliteal artery in the operation of arthroscopic reconstruction of the posterior cruciate ligament includes a guide-pin, which is sharpened from both ends, with a sharpening from one end being trihedral; the device for the protection of the popliteal artery, consisting of a working part and a handle, rigidly fixed at the right angle to each other, with the working part representing a cylindrical rod, which at the free end has a flattened section with through holes, located at an equal distance from each other, at an angle to the longitudinal axis of the working part, the flattened section of the working part is smoothly curved at an obtuse angle; a limiter on a cannulated drill, representing hollow cylinders of the different height with an internal diameter, corresponding to the drill diameter. A step-by-step formation of the tibial bone tunnel is realised. The operated extremity is bent in the knee joint at the right angle. Beginning of the tibial tunnel is determined more laterally and lower than the tibial tuberosity and formed at an angle of not less than 55° to the articulate surface of the tibia. The guide-pin is passed with the sharp trihedral sharpening forward, then removed and introduced with the other end forward. After that, the device for the protection of the popliteal artery is introduced through the posterior-medial access, and the guide-pin is wedged in the closest to it hole of the flattened section of its working part. Limiters are successively put on the drill, with the number of limiters being selected in such a way that the part of the drill, free from the limiters, corresponds to the tibial tunnel length. The cannulated drill is passed along the guide-pin, fixed in the device for the protection of the popliteal artery, and the tibial tunnel is formed.

EFFECT: group of inventions makes it possible to reduce a risk of injuring the popliteal artery, reduce a risk of purulent-inflammatory complications.

2 cl, 1 ex, 10 dwg

FIELD: medicine.

SUBSTANCE: osteotomy is performed with exposing the distal ulnar metaphysis by a long linear incision 3.0-4.5 cm along the ulnar surface. Distal ulnar osteotomy and intraoperative single-step redressment are performed through the approach created at 3.0 cm above the ulnar styloid at an angle of 45°. The radiocarpal joint is fixed with an orthosis for 2-2.5 weeks.

EFFECT: method enables reducing the number of intraoperative injuries, gaining in the radiocarpal motions as much as possible, avoiding metal structures to be applied, and reducing the immobilisation length.

2 ex, 1 dwg

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

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, 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!