The method of treatment of injuries of the distal tendon of the biceps muscle of shoulder

 

(57) Abstract:

The invention relates to medicine and can be used in traumatology, in particular in the treatment of lead distal tendon. Entity: form a channel in the neck of the radial bone in the sagittal plane from the rear access, one end of allosauroidea brought out through the channel formed in the neck of the radial bone, the other around the radial bone through the interosseous gap on the front surface of the elbow joint. Then in the tendon-muscular part of the biceps muscle of the shoulder in the frontal plane stupid form a channel. Carried out through the ends of allosauroidea, tension, restore muscle tone and tie that provides restoration of function of the elbow joint, muscle tone, increasing the mechanical strength of fixation of the distal tendon and the early development of the affected limb.

The invention relates to medicine and can be used in traumatology, in particular in the treatment of lead distal tendon.

There is a method of treatment of detachment of the distal tendon of the biceps muscle to the shoulder by dissection of the soft tissues in the lower third of the shoulder and on the back surface of the upper third of the pre is Oh bones through the wound on the forearm (ed.St. The USSR №825026, 1981).

However, the method is quite traumatic, as required for fixing the exposure of the radial tuberosity bones, in addition there is a shortening of the tendon, which affects the functional properties of the upper limb, the strength of the weld is insufficient due to razvlechenija tendons, and prolonged immobilization can lead to contracture of the elbow joint.

There is a method of recovery of rupture of the distal tendon of the biceps muscle to the shoulder by replacement of damaged tendon allograft with bone, which is carried out through the channel formed in the elbow bones and the end of the tendon with bone is fixed to the outer surface of the elbow bone, the other end of the graft is carried out through the interosseous space between the radial and ulnar bones and two-headed muscle of a shoulder, sew in the form of duplicatory to the muscle and the remaining part of the tendon, SU 1120972, publ. 30.10.1984.

However, fixation of the graft to the elbow bone is significantly weakened function supination of the forearm, since changes in physiological point of fixation of the tendon leads to muscle imbalance between spinymouse and planiruusim muscles, additionally, it is impossible early recovery lecheniya function of the elbow joint by increasing the mechanical strength of fixation of the tendon and reduce the morbidity, and early development of the affected limb is solved as follows.

In the method of treatment of injuries of the distal tendon of the biceps muscle to the shoulder by replacement of damaged tendon allograft conducted through channels formed bone and biceps muscles of the shoulder and fixation to the distal tendon, according to the technical solution of the channel formed in the neck of the radial bone of the posterior approach in the sagittal plane, the ends of allosauroidea carried out through one channel formed in the neck of a radial bone, the other around the radial bone through the interosseous gap on the front surface of the elbow joint.

The use of allograft allows you to restore the anatomical length of the tendon. Forming a channel in the neck of the radial bone of the posterior approach in the sagittal plane reduces the invasiveness of the surgery (excludes the possibility of nerve damage), and holding the ends of the allograft through the formed channel and around the radial bone through the interosseous space (formed loop) output on the front surface of the elbow joint increases the strength of fixation of the allograft, and through him, and fixation of the distal tendon to the radial bone is fixation of the distal tendon provides restoration of anatomical functions: Shebalino-extension and rotational movements in the elbow joint. In addition, anatomical fixation and increase the fixation strength of the distal tendons allow early (2-3 days after surgery) to develop limbs. The period of immobilization of the limb is reduced from four to two to three weeks in comparison with analogues.

Thus, the proposed method allows you to restore the continuity and normal srednetehnologichnym the tone of the distal biceps tendon and the muscles of the shoulder and thereby provide conditions for the early development of the affected limb.

The method is as follows.

Front S-shaped access expose the distal portion of the biceps muscle of the shoulder, bring in the wound stump of the tendon (often the stump of the tendon is the fibrous channel and with a slight pull is easily derived in the wound). Through the channel in muscle (educated outside preclusively, inside - round pronation, rear shoulder muscles) narrow Elevator rasclaat soft tissue around the neck of the radial bone from the interosseous space. The periosteum does not prepare the chin. From the rear access expose the proximal division of the radial bone and the distal end of the Elevator. Drill (4 mm) form a channel in the neck of the radial bone in chittenango previously silo ends of allosauroidea brought out through the channel formed in the neck of the radial bone and around the radial bone through the interosseous gap on the front surface of the elbow joint. Then in the tendon-muscular part of the biceps muscle of the shoulder in the frontal plane stupid form a channel, carried out through the ends of allosauroidea, tension, restore muscle tone and tie. Single interrupted sutures additionally sew the ends of allosauroidea and the stump of the tendon of the biceps muscle.

Sew operational wounds and limb is fixed with a plaster splint angle bending 90-100 in the elbow joint for 2-3 weeks. With 2-3 days appoint an isometric exercises, and after a week or movement in the wrist and shoulder joints.

Thus, the proposed method provides a complete anatomic restoration of the function of the elbow joint, the mechanical strength of fixation of the distal tendon and early development of the affected limb.

Example. Sick,, 44,, I. B. No. 99603, was admitted with a diagnosis of subcutaneous avulsion of the distal tendon of the biceps muscle of the right shoulder. Production trauma - tried to hold heavy rack.

Operation performed by the proposed method and plaster immobilization Longuet for 3 weeks. The postoperative course smooth. From the 3rd day isometric exercises, after removal of the plaster splint - physical therapy. OSMO is stanovkin tone the biceps muscle of the shoulder. Working in their field.

The method of treatment of injuries of the distal tendon of the biceps muscle to the shoulder by replacement of damaged tendon allograft conducted through channels formed bone and biceps muscles of the shoulder and fixation to the distal tendon, wherein the channel is formed in the neck of the radial bone of the posterior approach in the sagittal plane, the ends of allosauroidea carried out through one channel formed in the neck of the radial bone, the other around the radial bone through the interosseous gap on the front surface of the elbow joint.

 

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