RU2690605C1 - Method of recovering active motions in elbow joint in patients with congenital multiple arthrogryposis - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: method refers to medicine, namely to traumatology, orthopedics and pediatrics, and can be used for restoration of active motions in elbow joint in patients with congenital multiple arthrogryposis. A monopolar transposition of the proximal portion of the greater pectoral muscle on the neurovascular bundle is performed, followed by anchoring it to the proximal end of a distal portion of the greater pectoral muscle and to a small pectoral muscle with a fixation of the muscular graft to the biceps muscle of the shoulder.EFFECT: method provides restoration of active elbow flexion by performing a monopolar transposition of a proximal portion of a greater pectoral muscle on a neurovascular bundle.1 cl, 7 dwg, 1 ex

Description

The invention relates to medicine, namely to orthopedics and traumatology.

There is a method of restoring active flexion of the forearm in patients with damage to the brachial plexus, which consists in the bipolar transposition of the pectoralis major muscle together with the pectoral minor muscle on the common neurovascular bundle with fixation to the coracoid process of the scapula and the distal tendon of the biceps muscle (Tsai TM, Kalisman, M., Burns, J., Klelnert HE Restoration of the elbow flexion by pectoralis major and minor transmission (J Hand Surg 1983; 8: 186-90).

The disadvantages of this method is the large invasiveness of the operation.

There is a method of restoring active flexion of the forearm in patients with arthrogryposis, which consists in transposing the distal part of the pectoralis major muscle together with the pectoral minor muscle on the common neurovascular bundle together with the aponeurosis fragment of the rectus abdominis muscle to the biceps muscle of the shoulder with fixation to the radius (RF patent # 2503416 dated 03/27/2012).

The disadvantage of this method is that with hypoplasia of the distal portion of the pectoralis major muscle, this method does not allow restoring active flexion in the elbow joint.

The objective of the invention is the effective restoration of active flexion in the elbow joint in patients with congenital multiple arthrogryposis.

The technical result of the task is achieved by the fact that in the method of restoring active movements in the elbow joint in patients with congenital multiple arthrogryposis, including a monopolar transposition of the distal part of the pectoralis major muscle and pectoralis major muscle on the common neurovascular bundle, it is proposed to perform a monopolar transposition of the proximal portion of the pectoralis major muscles in the neurovascular bundle, followed by stitching it to the proximal end of the distal part of the pectoralis major muscle and to the small chest th muscle and muscle graft fixation to the biceps muscle.

Fig. 1 - the anatomical structure of the pectoralis major muscle

pos. 1 - the proximal portion of the pectoralis major muscle,

pos. 2 - distal portion of the pectoralis major muscle.

Fig. 2 - anatomical structure of the pectoralis major and pectoral muscles

POS. 2 - distal portion of the pectoralis major muscle, pos. 3 - small pectoral muscle, pos. 4 - rr.pectorales a.thoracoacromialis, pos. 5 - n.pectoralis medialis, pos. 6 - n.pectoralis lateralis, pos. 7 - III-V edge.

Fig. 3 and 4 - view of the limb before the operation.

Fig. 5 - isolated graft of pectoralis major and pectoral muscles

pos. 8 - neurovascular bundle (n.pectoralis medialis, n.pectoralis lateralis, rr.pectorales a. Thoracoacromialis).

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

The way to restore active movements in the elbow joint in patients with congenital multiple arthrogryposis is as follows.

The operation was performed on a patient M., 2 years old, diagnosed with Congenital multiple arthrogryposis with lesions of the upper limbs. The absence of active flexion in the left elbow joint was clinically noted.

An arcuate incision is made on the ribcage on the left along the lower edge of the pectoralis major muscle. At the border between 2-3 ribs, the muscle is divided into proximal 1 and distal parts 2. r.superior a is identified. thoracoacromialis and n.pectoralis lateralis to the proximal portion 1. Identify rr.pectorales a.thoracoacromialis, n.pectoralis lateralis and n.pectoralis medialis to the isolated distal part of the pectoralis major muscle 2 and the pectoralis major muscle 3. Identify the neurovascular bundle to the distal part pectoralis major muscle 2: motor branches n.pectoralis medialis and rr.pectorales a. thoracoacromialis. The distal part of the pectoralis major muscle is cut off at the sterno-costal joints. The pectoralis minor muscle is distinguished 5 and is cut off from 3-5 ribs. The proximal part of the pectoralis major muscle 1 is cut off from the humerus, keeping the neurovascular bundle intact and stitched to the proximal end of the distal part of the pectoralis major 2. Formed muscle autograft, including the distal major muscle, the pectoralis major muscle, the proximal part of the pectoral muscle 4 transferred in the subcutaneous canal to the front surface of the shoulder and fixed to the biceps muscle of the shoulder 5 at an angle of flexion in the elbow joint 150 degrees. Stitches to the wound. Immobilization plaster cast on the Turner.

After 4 weeks, immobilization with a plaster cast is completed and remedial treatment is prescribed.

The positive effect of the invention consists in the restoration of active flexion in the elbow joint and the improvement of the patient’s self-care ability.

Claims (1)

Method for restoring active movements in the elbow joint in patients with congenital multiple arthrogryposis, including a monopolar transposition of the distal portion of the pectoralis major muscle and the pectoralis major muscle on the common neurovascular bundle, characterized by the monopolar transposition of the proximal portion of the pectoralis major muscle on the neurovascular bundle followed by stitching it to the proximal end of the distal portion of the pectoralis major muscle and to the small pectoral muscle with fixation of the muscle graft to the biceps oh shoulder muscle.

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