RU2238052C2 - Method for surgical restoration of active antebrachial bending at duchenne-erb paralysis - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: one should remove paralyzed brachial biceps by keeping the part of muscular belly in distal department, and in proximal section - the tendon of short caput. One should isolate bipolar flap of the broadest muscle of back upon nervous-vascular pedicle. Transferred flap should be of tubulized form. One should transfer isolated flap into fascial bed of removed brachial biceps, fix tubulized flap by distal department towards kept part of muscular belly, moreover, the latter should be placed inside transferred tubulized flap, and towards the tendon of distal department of removed paralyzed brachial biceps. One should fix tubulized flap by proximal section-tendon to the kept tendon of short caput of removed brachial biceps, moreover, tendons should be applied one above another. The method enables to increase reliability of fixation and increase contractile capacity.

EFFECT: higher efficiency of restoration.

1 ex

Description

The invention relates to medicine, namely to neurosurgery, and can be used to restore active flexion of the forearm in violation of the function of the biceps of the shoulder (DMP) due to traumatic damage to the upper brachial plexus (VOPS) - Erba-Duchenne paralysis.

A known method of restoring active flexion of the forearm in traumatic injuries of VOPS (Erba-Duchenne paralysis), including the removal of paralyzed DMP with preservation of the distal tendon, the allocation of a bipolar flap of the latissimus dorsi muscle on the neurovascular leg, giving the selected flap a tubular shape, moving the selected flap in the fascial bed of the removed DMF and fixation of the tubular flap with the distal and proximal sections, while the distal section of the muscle flap is fixed onets a distal end with a stored remote tendon paralyzed PMD and proximal - tendon directly to the periosteum of the coracoid process of the blade (1).

However, the known method has low reliability of fixing the displaced muscle flap due to the failure of the sutures, which often leads to separation of the distal and proximal sections of the displaced flap.

These shortcomings are associated with the fact that the periosteum of the coracoid process of the scapula is not strong enough, it becomes loose and tears when suturing during fixation of the proximal section. When the distal section is fixed, the width of the muscle abdomen of the flap being moved is much larger than the distal tendon that was preserved when the DMF was removed. Seams cut through the muscle, squeeze it, disrupt its blood circulation and innervation at the level of fixation, which leads to cicatricial degeneration of muscle tissue and a decrease in contractility.

The objective of the invention is to ensure the reliability of fixation and eliminate the reduction of contractility of the displaced muscle flap by increasing the viability of the fixing sutures and preventing the development of circulatory disorders and innervation in the suture area.

The essence of the invention lies in the fact that to solve the problem in a method for the surgical restoration of active flexion of the forearm with Erb-Duchenne paralysis, including the removal of paralyzed DMP with preservation of its distal tendon, the isolation of a bipolar flap of the ShMS on the neurovascular leg, giving the selected flap a tubular shape, moving the flap into the fascial bed of the removed paralyzed DMP and fixing the tubularized flap with the distal and proximal sections, the difference is that when paralyzed DMP is removed, a part of the muscle abdomen is retained in the distal part, and the short tendon and the tubular flap are fixed in the proximal part to the saved part of the DMP abdomen, while the muscle abdomen is placed inside the displaced tubularized muscle and to the distal tendon, and the proximal - the tendon to the saved tendon of the short head of the removed DMP, while the tendons are superimposed on each other.

The invention is as follows.

A linear incision is made along the front surface of the upper third of the shoulder with a length of 8.0 cm. A short head of the DMF is distinguished, the tendon of which is cut off, departing from the coracoid process of 6-7 cm, then the long head and its tendon in the inter-tubercle groove, which is cut off from the extraarticular tubercle of the scapula. In the subsequent stupidly, without dissection of the fascia, the upper third of the DMF is isolated with cutting off the musculoskeletal nerve.

Perform a linear incision 5-6 cm long in the lower third of the shoulder along the front surface. Stupidly, without dissection of the fascia, the middle third and lower third of the DMP are isolated. Retreating 3.0-4.0 cm from the distal tendon, cut the muscle abdomen of the DMF, which is removed from the fascial bed.

A linear incision is made along the outer edge of the ShMS from the axillary fossa to the X rib. The outer (skin), then the inner (costal) surfaces of the lateral third and middle third of the ShMS on the neurovascular leg are distinguished. The TMS tendon is cut off from the small tubercle of the humerus, the muscle itself is separated from the large round muscle and is intersected using bipolar coagulation according to the selected flap along the medial edge and distally.

To ensure sufficient mobility of the neurovascular leg, its selection is carried out for at least 6.0-7.0 cm and the intersection of the branch of the pectoral-spinal artery to the anterior dentate muscle. The selected muscle flap is folded and stitched along the edge, forming a tubular flap.

A tubular flap of the ShMS is moved under the skin of the axillary fossa into the fascial bed of the removed DMP. In this case, the proximal part of the muscle flap for stitched ligature is carried out in the wound of the upper third of the shoulder, the distal - in the fascial bed to the elbow joint.

The displaced tubularized flap of the ShMS is first fixed distally. The distal tendon and the area of the muscle abdomen, which is left about 3.0-4.0 cm long after removal of the DMF, is stitched with a tendon suture, the ends of the ligature of which are brought into the plane of the muscle incision. Then, the U-shaped displaced tubular flap of the ShMS is flashed with the same ligature, into the distal sections of which the portion of the muscle abdomen of the removed DMP is immersed. Additionally, several sutures are placed between the distal tendon of the removed paralyzed DMP and the distal section of the displaced muscle flap. After fixation of the distal section of the tubular flap, the ShMS, pulling the proximal tendon, create such a tension in which the forearm flexion in the elbow joint is 90 ° -100 °, and the forearm itself is in the supination position.

Then the tendon of the tubularized muscle flap in the tension position is laid over the tendon of the short head of the removed DMP for 6.0-7.0 cm and fixed to it with interrupted sutures. The neurovascular leg of the displaced flap should remain without tension with a good pulsation of the chest-dorsal artery.

Surgical wounds are sutured in layers and put on a plaster cast 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 by a specific clinical example.

Example. Patient T., born in 1954, medical history No. 1207 2000. He received a left brachial plexus injury on December 7, 1999. He was hospitalized in the neurosurgical department of the Research Institute of Neurology, Neurosurgery and Physiotherapy of the Ministry of Health of the Republic of Belarus on August 4, 2000. In case of clinical neurological and paraclinical examination revealed Erb-Duchenne paralysis on the left. In accordance with the claimed method, an operation was performed (9 months after a brachial plexus injury) bipolar movement of the tubular flap of the lateral third and middle third of the VMS on the neurovascular leg into the fascial bed of the removed paralyzed DMP with fixation of the distal section to the part of the muscle abdomen and distal tendon of the removed paralyzed DMP, proximal - tendon to the saved tendon of the short head of the removed DMP, while the tendons were superimposed on each other for 6 cm.

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

Sourse of information

1. Sidorovich P.P. Modern aspects of transposition of the latissimus dorsi as a method of surgical treatment of the consequences of traumatic damage to the upper brachial plexus. On Sat Actual problems of neurology and neurosurgery. Issue 1 - Minsk, Belorussian Navuka, 1999, pp. 108-112.

Claims (1)

A method of surgical restoration of active forearm flexion with Erba-Duchenne paralysis, including removal of a paralyzed biceps of the shoulder muscle with preservation of the distal tendon, isolation of the latissimus dorsi latissimus flap on the neurovascular leg, giving the displaced flap a tubular shape, moving the selected flap to the fascial bed shoulder muscles and fixation of the tubular flap by the distal and proximal sections, the difference is that when you remove the two-headed the shoulder muscles in the distal section retain part of the muscle abdomen, and in the proximal section, the short head tendon and the tubular flap are fixed with the distal section to the stored part of the muscle abdomen, while the muscle abdomen is placed inside the displaced tubular flap, and the distal biceps tendon of the distal biceps muscles of the shoulder, and the proximal part - the tendon to the saved tendon of the short head of the removed biceps of the shoulder, while the tendons overlap each other .