A method of surgical repair of active flexion of the forearm with paralysis, erb-duchenne

 

(57) Abstract:

The invention relates to medicine, namely to surgery, and can be used for surgical repair of active flexion of the forearm with paralysis, ERB-Duchenne. Remove paralyzed two-headed muscle of a shoulder. Retain deletion in the distal part of the muscle of the abdomen, and in the proximal tendon of the short head. Distinguish bipolar flap the latissimus neuro-vascular pedicle. Give displaced flap tuboitaliano form. Move selected fascial flap in the bed of the remote biceps muscle of the shoulder. Fix mobilisierung flap distal division to the saved part of the muscle of the abdomen, while the muscle belly place internally displaced mobilisierung flap, and to the tendon distal to the remote paralyzed biceps muscle of the shoulder. Fix mobilisierung flap proximal division of the tendon saved to the tendon of the short head of the remote biceps muscle of arm, with tendon impose on each other. The method allows to increase the reliability of fixation, increase contractility.

The invention relates to medicines is Arsenii functions of the biceps muscle of the arm (SLE) due to traumatic injuries of the upper section of the brachial plexus (VOPS) - palsy ERB-Duchenne.

There is a method of recovery of active flexion of the forearm with traumatic injuries VOPS (paralysis of ERB-Duchenne), including the removal of the paralyzed SLE with preservation of the distal tendon, the allocation of bipolar flap latissimus (SMB) on neuro-vascular pedicle, giving the selected flap tuboitaliano form, moves the selected fascial flap in the bed of the remote SLE and fixation mobilisierung flap distal and proximal departments, with distal muscle flap fixed end-to-end with preserved distal tendon remote paralyzed SLE, and the proximal division of the tendon directly to the periosteum of the coracoid process of the scapula (1).

However, the known method has a low reliability of fixation of displaced muscle flap because of the insolvency of the joints, which often leads to separation of the distal and proximal displaced flap.

These shortcomings stem from the fact that the periosteum of the coracoid process of the scapula is not strong enough, defibered and breaks when suturing during fixation of the proximal. When you commit gistaminovogo when uninstalling DMP. Seams cut muscle, squeeze, break its circulation and innervation at the level of fixation, which leads to scar degeneration of muscle tissue and reduce contractility.

The objective of the invention is to provide a reliable fixing and Troubleshooting reduce contractility of the displaced muscle flap by increasing the viability of the locking seams and prevent the development of impaired blood circulation and innervation in the joints.

The invention consists in that in order to solve the problem in the method of surgical repair of active flexion of the forearm with paralysis, ERB-Duchenne, including the removal of the paralyzed SLE with the preservation of its distal tendon, the allocation of bipolar flap SMB on neuro-vascular pedicle, giving the selected flap tuboitaliano form, the movement of the flap in the fascial bed remote paralyzed SLE and fixation mobilisierung flap distal and proximal sections, the difference is that when you remove paralyzed SLE in the distal retain part of the muscle of the abdomen, and in the proximal tendon of the short head and mobilisierung flap f is placed tuboitaliano muscle and tendon distal, and proximal division of the tendon saved to the tendon of the short head of the remote SLE, with tendon impose on each other.

The invention is as follows.

Perform linear incision on the anterior surface of the upper third of the shoulder length 8,0 see Emit short head SLE, the tendon of which is cut off, departing from the coracoid process of 6-7 cm, then the long head and its tendon in libparanoia groove, which is cut from nadstavna tubercle of the scapula. In subsequent stupidly, without dissection of the fascia distinguish the upper third of SLE with the separation from her skin and muscle nerve.

Perform linear incision with a length of 5-6 cm in the lower third of the shoulder on the front surface. Stupidly, without dissection of the fascia produce selection middle third and lower third of SLE. Departing 3.0-4.0 cm from the distal tendon, cut muscle belly of the DMP, which is removed from the fascial bed.

Make a linear incision on the outer edge SMB from armpit to X ribs. Emit the outer (skin), then internal (rib) surface of the lateral third and medial third of the SMB on neuro-vascular pedicle. Cut tendon SMB from the lesser tubercle of the humerus, the muscle otdeljajuca medial edge and distal.

To ensure sufficient mobility neuro-vascular pedicles its allocation is carried out for not less than 6.0-7.0 cm and the intersection of the branches of the chest-dorsal artery to the anterior teeth, the muscle. Selected muscle flap fold and stitch along the edge, forming mobilisierung flap.

Mobilisierung flap SMB move under the skin of the axillary fossa in fascial bed remote SLE. While the proximal division of the muscle flap is stitched for the ligature is carried out in the wound of the upper third of the shoulder, the distal - fascial bed to elbow.

Moved mobilisierung flap SMB first fixed distally. The distal tendon and stretch muscle of the abdomen, which leave a length of about 3.0-4.0 cm after removal of DMP, stitch the tendon suture the ends of the ligatures which are escorted to the plane of cut muscles. Then the same ligature stitch U-shape moved mobilisierung flap SMB, to the distal of which is immersed area of the muscle belly remote SLE. Additionally impose a few stitches between the distal tendon remote paralyzed SLE and distal division moved a muscle flap. After fixation of the distal Tabuleiro is replica in the elbow joint is 90-100, and the forearm is in supination.

Then the tendon mobilisierung muscle flap in the position of the tension placed on top of the tendon of the short head of the remote SLE during 6,0-7,0 cm and fixed thereto interrupted sutures. Neuro-vascular pedicle displaced flap must remain without tension with good ripple of the chest-dorsal artery.

Operational wounds sutured in layers and put a plaster bandage from the shoulder joint to the metacarpal bones of the hand in the position of flexion of the forearm at an angle of 90 and supination.

The invention is illustrated specific clinical example.

Example. Patient T., 1954 R., case history No. 1207 2000, he Received an injury of the left brachial plexus 7.12.1999 was Hospitalized in the neurosurgery Department of the Institute of neurology, neurosurgery and physiotherapy MH RB 4.08.2000, the clinical-neurological and paraclinical examination revealed palsy ERB-Duchenne left. In accordance with the claimed method transaction (later, 9 months after injury of the brachial plexus) bipolar moving mobilisierung flap of the lateral one third and medial third of the SMB on neuro-vascular pedicle in the fascial bed remote proposalsounds SLE, the proximal part of the tendon saved to the tendon of the short head of the remote SLE, while tendons are superimposed on each other for 6 see

The patient is examined after 5 months after surgery. Active flexion of the left forearm at the elbow joint was recovered from 0 to 150 and muscle strength 4 points.

The source of information

1. Sidorovich P. P. Modern aspects of transposition of the latissimus as a method of surgical treatment of traumatic injuries of the upper section of the brachial plexus. In: Actual problems of neurology and neurosurgery. Vol.1 - Minsk, the Belarusian Nauka, 1999, S. 108-112.

A method of surgical repair of active flexion of the forearm with paralysis, ERB-Duchenne, including the removal of the paralyzed biceps muscle of the shoulder with preservation of the distal tendon of the Department, the allocation of bipolar flap the latissimus neuro-vascular pedicle, giving displaced flap tuboitaliano form, moves the selected fascial flap in the bed of the remote biceps muscle of the shoulder and fixing mobilisierung flap distal and proximal sections, the difference is that when you remove the double-headed m is th head, and mobilisierung flap fixed distal division to the saved part of the muscle of the abdomen, while the muscle belly place internally displaced mobilisierung flap, and to the tendon distal to the remote paralyzed biceps muscle of the shoulder and proximal division of the tendon saved to the tendon of the short head of the remote biceps muscle of arm, with tendon impose on each other.

 

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