RU2238053C1 - Method for treating affected distal tendon of brachial biceps - Google Patents

Abstract

FIELD: medicine, traumatology.

SUBSTANCE: one should form a canal in radius' cervix in sagittal plane out of posterior access, one end of allotendon should be withdrawn through the canal developed in radius' cervix, another - around the radius through interosseous space onto anterior surface of elbow joint. Then in tendinous-muscular part of brachial biceps in frontal plane one should form a canal bluntly to pass the ends of allotendon through it, due to tension one should restore muscular tonicity followed by binding to provide the restoration of elbow joint's function, muscular tonicity, increased mechanic fixation strength of distal tendon and early training of affected limb.

EFFECT: higher efficiency of therapy.

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Description

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

A known method of treating the separation of the distal tendon of the biceps of the shoulder by dissecting soft tissues in the lower third of the shoulder and on the back surface of the upper third of the forearm, holding the tendon from the wound on the shoulder to the wound on the forearm and fixing the tendon to the tuberosity of the ulna through the wound on the forearm (aut. USSR No. 825026, 1981).

However, the method is rather traumatic, since fixation requires exposure of the tuberosity of the radius, moreover, a tendon shortening occurs, which impairs the functional properties of the upper limb, suture strength is insufficient due to tendon fracture, and prolonged immobilization can lead to elbow joint contracture.

There is a method of repairing the rupture of the distal tendon of the biceps of the shoulder muscle by replacing the damaged tendon with an allograft with a bone, which is passed through the formed channel in the ulna and the end of the tendon with a bone is fixed to the outer surface of the ulna, the other end of the graft is passed through the interosseous gap between the radius and ulna and biceps muscle of the shoulder, sew in the form of duplicate to the muscle and the preserved part of the tendon, SU 1120972, publ. 10/30/1984.

However, when the transplant is fixed to the ulnar bone, the supination function of the forearm is significantly weakened, since a change in the physiological point of fixation of the tendon leads to muscle imbalance between the supination and penetrating muscles, in addition, early reconstructive treatment is impossible due to the long term immobilization of the limb.

The task - a complete anatomical restoration of the function of the elbow joint with an increase in the mechanical strength of tendon fixation and a decrease in trauma, as well as the early development of a damaged limb - is solved as follows.

In the method of treating injuries of the distal tendon of the biceps of the shoulder by replacing the damaged tendon with an allograft conducted through the formed canals of the bone and biceps of the shoulder and fixing to the distal tendon, according to the technical solution, the channel is formed in the neck of the radius from the posterior access in the sagittal plane, the ends of the allotendin are held one through the formed channel in the neck of the radius, the other around the radius through the interosseous gap to the front surface of the elbow joint .

The use of an allograft allows you to restore the anatomical length of the tendon. The formation of a channel in the neck of the radius from the posterior access in the sagittal plane reduces the invasiveness of the operation (the possibility of nerve damage is excluded), and the passage of the allograft ends through the formed channel and around the radius through the interosseous gap (a loop is formed) leading to the front surface of the elbow joint increases the fixation strength allograft, and through it the fixation of the distal tendon to the radius, while the fixation of the distal tendon occurs at the anatomical point ( ugristost radius). This fixation of the distal tendon provides restoration of anatomical functions: flexion-extensor and rotational movements in the elbow joint. In addition, anatomical fixation and an increase in the fixation strength of the distal tendon allow the development of the limb in the early stages (from 2-3 days after the operation). The period of limb immobilization is reduced from four to two to three weeks in comparison with analogues.

Thus, the proposed method allows to restore the continuity and normal mid-physiological tone of the distal tendon and biceps of the shoulder and thereby provide conditions for the early development of a damaged limb.

The method is as follows.

The anterior S-shaped access exposes the distal part of the biceps of the shoulder, removes the tendon stump into the wound (often the tendon stump is in the fibrous canal and, with a slight pull-up, is easily removed into the wound). Soft tissues around the neck of the radius from the side of the interosseous space are stratified by a narrow elevator through the canal in the muscles (formed from the outside by the brachioradial, from the inside by a round pronator, from the back by the brachial muscle). The periosteum is not exfoliated. From the posterior approach, the proximal radius and the distal end of the elevator are exposed. A drill (4 mm) form a channel in the neck of the radius in the sagittal plane (forearm give supinated position). Using a wire guide and a previously elevator, the ends of the allotomy are brought out through the formed channel in the neck of the radius and around the radius through the interosseous gap to the front surface of the elbow joint. Then, in the tendon-muscle part of the biceps of the shoulder in the frontal plane, a canal is bluntly formed, the ends of the allotendin are drawn through it, the muscle tone is restored by tension, and knotted. Separate interrupted sutures also sew the ends of the allotendin and the stump of the tendon of the biceps.

The surgical wounds are sutured and the limb is fixed with a gypsum splint at a bending angle of 90-100 ° in the elbow joint for 2-3 weeks. From 2-3 days, isometric gymnastics is prescribed, and after a week - movements in the wrist and shoulder joints.

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

Example. Patient G., 44, I.b. No. 99603, was admitted with a diagnosis of subcutaneous detachment of the distal tendon of the biceps of the right shoulder. Industrial injury - tried to maintain a heavy stance.

The operation of the proposed method and the immobilization of a plaster cast for 3 weeks were performed. The postoperative course is smooth. On the 3rd day, isometric gymnastics was prescribed, after removal of the plaster casts - exercise therapy. Examined 1.5 months after surgery. Movement in the shoulder and elbow joints restored in full. Restored tone of the biceps of the shoulder. He works in his specialty.

Claims (1)

A method for treating injuries of the distal tendon of the biceps of the shoulder by replacing the damaged tendon with an allograft conducted through the formed canals of the bone and biceps of the shoulder and fixing to the distal tendon, characterized in that the channel is formed in the neck of the radius from the posterior approach in the sagittal plane, the ends of the allotendin carry out one through the formed channel in the neck of the radius, the other around the radius through the interosseous gap to the front surface of the elbow joint.