RU2459592C1 - Method of tendon suture application - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics. Two pairs of threads are passed mutually perpendicularly into both segments, inside trunk to affected surfaces of tendon, with formation in place of introduction and along the way 4 loop-like knots on each thread through the surface of external membrane. Threads are brought out through edge of external membrane. Ends of threads are tied up with knots.

EFFECT: method ensures increase of reliability and strength of affected tendon connection, simplification of suture application.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used for primary and secondary recovery operations on the tendons of the hand and fingers.

There is a method of applying a tendon suture by forming two pairs of loop-like nodes of the thread and an additional circular suture that adapts (accurately matching) the ends of the tendon (Patent RU No. 2290886, publ. 10.01.2007, VD Patrikeev. Using the original tendon suture and synovial fluid endoprosthesis in the treatment of patients with injuries of the flexor tendons of the fingers in the synovial vagina zone. Traumatology and orthopedics of Russia. 2006. No. 4. P.64-68).

The disadvantages of the prototype: insufficient strength of the fixation of the ends of the tendons, the violation of its sliding properties, a long time for application, the need for subsequent fixation of the hand splint until the tendon is fused.

Effect: increasing the reliability and strength of the joint of a damaged tendon, simplifying suturing.

This result is achieved by the fact that in both segments of the tendon mutually perpendicular intrapartum to the damaged surfaces of the tendon, spend two pairs of threads extending through the edge of the outer sheath of the tendon, forming at the insertion point and along the loop along 8 loop-like nodes (i.e., 4 loop-shaped nodes on each thread) through the surface of the outer shell, and the ends of the threads are tied with adaptive (exactly matching) nodes.

The method is depicted in the diagram, where Fig. 1 shows the passage of threads when applying a tendon suture, Fig. 2 is the final stage of suturing. On them are indicated: 1 - damaged ends of the tendon, 2 - threads, 3 - loop-like nodes, 4 - outer sheath of the tendon, 5 - adaptive sutures.

The method is as follows.

15 mm from the damaged end of the tendon 1, transverse to its axis, two threads 2 are inserted mutually perpendicularly, for example, kapron threads No. 3, which are carried out further intra-barrel to the end surface of the tendon, forming four loop-like at the insertion point along (through 10 mm) node 3, overlooking the surface of the outer shell 4. Loop-shaped nodes 3 capture no more than a fifth of the tendon fiber. At the end of the tendon, the filaments 2 extend over the edge of the outer sheath 4. Similar manipulations are repeated on another segment of the tendon. The opposite ends of the threads are tied, forming four adaptive nodes 5 of the damaged ends of the tendon. Using the proposed method allows to increase the strength of fixation of the damaged ends of the tendon due to the imposition of eight loop-shaped nodes on each segment. The intra-barrel arrangement of the threads does not violate the slip of the tendon. The suture performs two functions at once: super-strong fixation and the necessary adaptation of the damaged ends of the tendon, which allows not to impose a splint and begin movement immediately after the operation.

Case Studies

Example 1. Patient K., 37 years old. Diagnosis: stale damage to the flexor tendons of the 4th - 5th fingers of the right hand at the level of the wrist joint.

The operation was performed: a zigzag section in the lower third of the forearm with the transition to the hand. The ends of the damaged flexor tendons of the 4 and 5 fingers are highlighted and refreshed. At the proximal ends of both the deep and superficial flexor tendons, retreating 15 mm perpendicular to each other, two nylon filaments are placed, which are located intraluminally and brought out at the end through the outer sheath. At the point of introduction of the threads and after 10 mm, four loop-shaped nodes are made, facing the outer shell. Similarly held threads at the distal ends of the tendons. The ends of the same name threads are sewn with interrupted seams. Achieved strong fixation and the necessary adaptation of the ends of the tendons. After the operation, passive started, and after the edema subsides, the active movements of the fingers. The long-term result of the treatment was found to be good - the strength and amplitude of the movements of the 4 and 5 fingers were restored.

Example 2. Patient W. 21 years. Diagnosis: chronic damage to the tendon of the long flexor of the 1st finger of the right hand at the level of the main phalanx.

The operation was performed: long flexor tendonoplasty with a graft of a muscle tendon straining the palmar aponeurosis. The proximal end of the graft is stitched with a long flexor with a tendon suture from two pairs of kapron filaments held in each segment mutually perpendicularly, intraductively. Each thread is made of four loop-shaped nodes, after which they formed eight fixing and four adaptive nodes on the outer shell of the stitched ends of the tendon. The distal end of the graft is fixed to the nail phalanx subperiosteally. The outcome of the operation is positive. The strength of the 1st finger and the flexion of the distal phalanx were restored.

Example 3. Patient S., 42 years old. Diagnosis: a cut wound to the base of the 1st finger of the left hand with damage to the tendon of the long flexor.

Surgery: primary surgical treatment of the wound. A seam of two pairs of kapron threads is sutured to the damaged tendon. The latter are carried out perpendicular to each other, intrasternally, with eight loop-shaped nodes on each side. The ends of the threads are brought to the edge of the outer sheath and connected by nodes, adapting the damaged edges of the tendon. The front wall of the bone-fibrous canal is excised for 2 cm. Sutures on the skin wound. In the postoperative period - early active-passive movements without splinting of the limb. The long-term result of the treatment was recognized as good, the movements and strength of the finger were restored.

Claims (1)

A method of applying a tendon suture by forming loop-like nodes and connecting the ends of the threads, characterized in that two pairs of threads are mutually perpendicular to both segments of the tendon, intra-barrel to the damaged surfaces of the tendon, forming 4 loop-like nodes on each thread through and through 4 the surface of the outer shell, the threads are brought out over the edge of the outer shell and the ends of the threads are knotted.