RU2393807C1 - Tendon suture technique - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, and more specifically to tendon suture techniques. Two sutures fold double are delivered inside the trunk across the tendinous fibres to form loops and free suture ends on one lateral face of the different tendon ends. Then the free suture ends are passed inside the trunk transversally to the tendinous fibres maximally close to anterior and posterior surfaces of the tendon. The free suture ends are passed through the loops to form the sutures over the trunk and therethrough at proximal and distal ends of the tendon. The opposed lateral faces of the different tendon ends are knotted.

EFFECT: method ensures higher strength of the tendon suture, provides optimum conditions for primary tendon union.

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Description

The present invention relates to medicine, namely to surgery.

There is a method of applying a tendon suture according to Kuneo, which consists in holding the thread with two straight needles at the ends in the transverse direction through the tendon, departing 1.5-2 cm from its end, piercing the tendon obliquely with one and the other needle with crossing the thread in the thickness of the tendon, removing the ends of the suture through the end of the tendon, similarly holding the suture at the other end of the tendon and tying the ends of the sutures with the formation of intra-trunk sutures (see Ostroverkhov G.E., Bomash Yu.M., Lubotsky D.N. tomia. - Kursk; Moscow: AOZT Litera, 1996, p. 195).

However, the known method is notable for the complexity associated with the crossing of threads inside the tendon. When a tendon suture is applied according to Kuneo, the suture material passes among the tendon bundles in the longitudinal plane, and under load, the tendon tissue is subject to significant eruption and bursting. The technique of suturing requires maximum exposure of the ends of the tendon to provide wide access to the damaged area, which in practice leads to additional incisions in the central and peripheral directions. Unreasonably wide access increases the invasiveness of the operation, exacerbates existing vascular disorders in the lesion area, enhances proliferative processes and slows the restoration of tendon integrity.

Closest to the proposed invention is a method of applying a tendon suture according to Lange, which consists in passing the thread through the proximal part of the tendon in the transverse direction, performing additional injections and conducting both ends of the thread parallel to the course of the tendon fibers to the cut, leading the ends of the thread to the lateral surface of the distal part of the tendon and the tying of external nodes (see Movshovich I. A. Operative orthopedics: (A guide for doctors). - M .: Medicine, 1983, p.15).

This method has significant disadvantages. The resulting seam has a low mechanical strength, which is due to the passage of suture material among the tendon bundles in the longitudinal plane, as a result of which, when loaded, the tendon tissue is exposed to significant penetration and bursting, which increases the risk of tendon suture failure. In addition, the suture is applied using one thread, and if it is damaged in any area, the integrity of the stitched tendon is completely violated.

The objective of the invention is to increase the mechanical strength of the tendon joint, the creation of optimal conditions for the primary fusion of the tendon.

The problem is solved due to the fact that in a method that involves sequentially passing the thread through both ends of the tendon in the transverse and longitudinal directions with tying on the lateral surface of the tendon, two folded in half strands are inserted intra-hole parallel to the course of the tendon fibers with the formation of loops and free ends of the threads on one the lateral side of the different ends of the tendon, spend the free ends of the threads intra-barrel transverse to the course of the tendon fibers as close to the anterior and posterior surface as the veins, thread them through the loops with the formation of suprastem and transosseol stitches at the proximal and distal ends of the tendon, tie knots on opposite lateral sides of different ends of the tendon.

The essence of the proposed technical solution is illustrated by drawings, where figure 1 shows the formation of loops and free ends of the threads on one side of the different ends of the tendon; figure 2 - the formation of suprasternal and transosmal transverse stitches at the distal end of the tendon; figure 3 is the final view of the stitched tendon.

The method of applying the tendon suture is as follows. A damaged tendon is secreted. Charge the needle in the middle of the thread. 1.5-2 cm away from the tendon cut and injected on the lateral surface of the proximal end 1 of the tendon, draw the folded in half thread 2 intraband parallel to the course of the tendon fibers through both ends of the tendon, thread 2 on the lateral surface of the distal end 3 of the tendon with the formation of a loop 4 and the free ends 5 and 6 of the thread 2 on one side at different ends of the tendon. They also retreat from the tendon section by 1.5-2 cm and inject them on the opposite lateral surface of the distal end of the tendon 3, draw the thread 7 folded in half in parallel with the tendon fibers through both ends of the tendon (in the opposite direction of thread 2), thread 7 on the lateral surface of the proximal end 1 of the tendon with the formation of a loop 8 and the free ends 9 and 10 of the thread 7 on the one hand at different ends of the tendon (figure 1). Sequentially charge the ends 9 and 10 of the thread 7 into the needle and inject the needle, shifting from the input of the thread in the distal end of the tendon 3 in the ventral (front) and dorsal (rear) directions by 2-3 mm, and spend one free end of 9 of the thread 7 transverse to the course of the tendon fibers as close as possible to the front, and the other free end 10 of the thread 7 to the back surface of the tendon with a puncture 2-3 mm from the loop 4, pass the free ends 9 and 10 of the thread 7 through the loop 4 of the thread 2 with the formation of transverse superbarrow stitches 11 , 12, 13, 14 and flip stitches 15, 16 (figure 2). Similarly spend the free ends 5 and 6 of the thread 2 at the proximal end 1 of the tendon. Then pull the free ends of the threads 2 and 7, bring together the ends of the tendon and tie the outer nodes 17 and 18 on opposite sides of the proximal and distal ends 1 and 3 of the tendon (figure 3).

Clinical example. Patient B. 4 months. He entered the Department of Pediatric Orthopedics of FSI "NNIIIT Rosmedtekhnologii" with a diagnosis of congenital clubfoot on the right 3 degrees at the treatment stage. In a planned order 08.07.2008 performed tenoligmentocapsulotomy on the right. The Achilles tendon is Z-shaped in the sagittal plane, the correct anatomical relationships in the talus and calcaneus in the frontal and sagittal planes are restored. The tendon is stitched in an elongated state according to the proposed method. The child was examined after 4 months. Stop in the correct position. Axial support is possible on all departments of the feet. Palpation is determined by the restoration of the anatomical integrity of the Achilles tendon throughout. Passive and active movements in the ankle joint in full. The child uses orthopedic shoes. Recovery treatment is ongoing.

The proposed method of applying a tendon suture provides high mechanical strength of the suture, prevents the razvonenie ends of the tendon and provides good adaptation between the proximal and distal fragments of the tendon. When applying a tendon suture, two folded in half threads are used, which in itself reduces the risk of a violation of the fastening properties of the suture, even if one of the threads is damaged. The maximum possible contact of the threads with the tendon tissues in conditions of minimal use of suture material (the presence of loops, suprastem and transosseous loops around the circumference of the tendon) significantly increases the mechanical strength of the suture, which allows it to be used in conditions of moderate tension of the tendon ends. The tension of the thread is transmitted both to the suprabarrel and transverse transverse stitches, grasping the tendon around its circumference, and to the intra-barrel stitches of the threads extending in the longitudinal direction, providing an even distribution of efforts from the suture material to soft tissues, without disturbing the blood supply and allowing creating optimal conditions for the primary tendon fusion. The suture technique is simple, based on the same type of movement and easy to learn.

Claims (1)

A method of applying a tendon suture, including sequentially passing the thread through both ends of the tendon in the transverse and longitudinal directions with tying on the lateral surface of the tendon, characterized in that two folded in half strands are inserted intra-hole parallel to the course of the tendon fibers with the formation of loops and free ends of the threads on one side different ends of the tendon, conduct the free ends of the threads intrasternally transverse to the course of the tendon fibers as close as possible to the anterior and posterior surfaces the veins, thread them through the loops with the formation of suprastem and transosseol stitches at the proximal and distal ends of the tendon, tie knots on opposite lateral sides of different ends of the tendon.

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