RU2626197C1 - Method of treatment of front shoulder dislocation in patients with erbe's paresis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: moving the tendon of the long head of the biceps arm muscle to the inside and sew it into the fold of the capsule of the shoulder joint. Z-shaped lengthen the tendon of the subscapular muscle. Move a large round muscle on the vascular-neural bundle through the subcutaneous canal, formed in the armpit, onto the anterior surface of the shoulder joint and fix it to the beak-like process of the scapula and anterior portion of the deltoid muscle.

EFFECT: method reduces the risk of relapse of the dislocation.

11 dwg

Description

The invention relates to the field of medicine, namely to orthopedics and traumatology.

There is a method of treating a habitual dislocation of the shoulder (anterior dislocation), which consists in strengthening the anterior section of the capsule of the shoulder joint by moving the tendon of the biceps of the shoulder muscle inside the tendon and suturing it into the fold of the capsule of the shoulder joint, as well as the Z-shaped extension of the tendon of the subscapularis muscle (Movshovich I. A. Operative orthopedics // M., Medicine, 1994. - S. 104-105).

The disadvantage of this method is the high percentage of relapses in the postoperative period due to insufficient stabilization of the shoulder joint.

The objective of the invention is to eliminate anterior dislocation of the shoulder in patients with Erb paresis and the prevention of its relapse.

The technical result of the task is achieved by the fact that in the method of treating anterior dislocation of the shoulder in patients with Erb paresis, the inside of the tendon of the long head of the biceps muscle of the shoulder is moved and it is sutured to the fold of the capsule of the shoulder joint, the Z-shaped extension of the tendon of the subscapularis muscle, as well as the movement of the large round muscles on the neurovascular bundle through the subcutaneous canal formed in the armpit, on the anterior surface of the shoulder joint and fixation to the coracoid process of the scapula and anterior her portions of the deltoid muscle.

Fig. 1 - photo of the patient before surgery.

Fig. 2-6 - stages of the operation.

Pos. 1 - blade, pos. 2 - the big round muscle, pos. 3 - the neurovascular bundle of the large round muscle, 4 - the humerus, 5 - the subscapularis muscle, 6 - the tendon of the long head of the biceps of the shoulder, 7 - the coracoid process of the scapula.

Fig. 7-11 - the result of treatment 6 months after surgery.

A method for the treatment of anterior dislocation of the shoulder in patients with Erb paresis is as follows.

The operation was performed on patient X., 15 years old, with a diagnosis of Parez Erb on the left. Clinically, there was a lack of active movements in the left shoulder joint, anterior dislocation of the humeral head, restriction of passive movements in the shoulder joint, lack of active flexion in the elbow joint, a significant limitation of the patient’s self-care.

A layered incision was made from the lower angle of the scapula (1) in the proximal direction to the posterior axillary line. The large round muscle (2) was isolated on the neurovascular bundle (a.subscapularis, n.subscapularis) (3) and cut off from the lower corner of the scapula, preserving the attachment point to the humerus (4). A section in the projection of the deltoid-thoracic groove. The tendon of the subscapularis muscle (5) was isolated and Z-shaped elongated. An overstretched capsule of the shoulder joint was identified and an arthrotomy was performed along the inter-tubercle groove. The tendon of the long head of the biceps of the shoulder (6) is displaced inwards from the small tubercle of the humerus. The shoulder is rotated outward. The tendon of the long head of the biceps of the shoulder (6) is laid on the capsule of the shoulder joint and hemmed into its fold. The subscapular tendon (5) is stitched end-to-end. The distal end of the large round muscle (2) on the neurovascular bundle (3) is moved through the subcutaneous canal in the axillary region to the front surface of the shoulder joint and is fixed to the coracoid process of the scapula (7) and the anterior portion of the deltoid muscle. A layered arcuate incision along the posterior-medial surface of the elbow joint. Hemostasis. Layered stitches on the wound. Graduate in a wound. Aseptic dressing. Gypsum dressing such as Deso.

The development was carried out 6 weeks after the operation, which included exercise therapy (with the development of passive and active movements in the elbow and shoulder joints), massage, muscle electrical stimulation, wearing an orthosis on the shoulder joint for 6 months. A follow-up examination after 6 months showed stability of the shoulder joint, active abduction and flexion in the shoulder joint of 20 degrees, active flexion in the elbow joint of 90 degrees, improved self-care capabilities.

The positive effect of the invention is to improve active movements in the shoulder joint, restore active flexion in the elbow joint and improve the ability of self-care in children with Erb paresis.

Claims (1)

A method for treating anterior dislocation of the shoulder in patients with Erb paresis, including moving the tendon of the long head of the biceps muscle of the shoulder and suturing it into the fold of the capsule of the shoulder joint, Z-shaped extension of the tendon of the subscapularis muscle, characterized by moving the large round muscle on the neurovascular bundle through the subcutaneous canal formed in the armpit, on the front surface of the shoulder joint and fixation to the coracoid process of the scapula and the anterior portion of the deltoid muscle.

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