Patent RU-2496440-C2 (RU)
Inventor: ROMANCHENKO ALEKSANDR VASIL EVICH
IPC: A61B17/56
Filed: 2011-07-22
Granted: 2013-10-27
Abstract: FIELD: medicine.SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics and can be used in operative treatment of habitual shoulder dislocation. Patient is laid on healthy side. Distraction of joint is performed by application of load 3-4 kg on arm axis with slight outward rotation. After that, punctures are made to provide posterior and anterior accesses into joint cavity. Posterior access is provided by about 5 mm puncture, which is started 1.5-2 cm lower and 1 cm more medially that posterior angle of acromial process of scapula and directed ventrally with reference to apex of coracoid process. Anterior access is provided with puncture 1.0 cm more laterally and 1.0 cm downward from apex of coracoids process. Anterior access is provided by puncture 1.0 cm more laterally and 1.0 cm downward from apex of coracoids process. After that, arthroscope is introduced into joint through posterior access. Its arthroscopy is carried out in physiological solution, forced into joint cavity under pressure 60 mm of water column, during which subacromial space is examined. After that, canal for introduction of working instrument is formed with realisation of lateral access, which is made after bringing extremity by up to 3 cm long cut in projection of subtubercular zone of shoulder to lower part of greater tubercle. Tendon bed is opened. Tendon is brought outwards to make formation of bone canal more convenient. After that, conductor is installed on exposed bone tissue. Tubular guide of conductor is oriented at point, located on the line, which connects upper point of intertubercular sulcus and lower point of anatomical neck of humeral bone to 1/3 of said line length from its upper point. Pin is passed through conductor in direction of joint surface of humeral bone head in such a way that its longitudinal axis coincides with direction of axis of scapula body, on which axis of blind bone canal, made in skeleton bone, closest to joint, will be located. Then, after outlet of pin into specified point, controlled by means of arthroscope, cannulated drill, by which bone canal is made both in humeral bone head and in scapula body, is passed on pin. Internal diameter of bone canal in head of humeral bone is made with possibility of free passage of first fixer, for instance, titanium self-tapping screw Fastin RC, and internal diameter of bone canal in scapula body is made with possibility of fixation of said fixer with its walls. Flexible surgical material is fixed by tying to first fixer. As surgical material used is suture non-absorbable material, for instance, triple thread Etibond 2.0. After that, fixer is passed through bone canal in head of humeral bone and fixed by screwing in aflush in bone canal of scapula. End of segment of flexible surgical material, projecting from hole of bone canal of humeral bone head, is tightened and fixed near canal inlet by means of second fixer of respective diameter, introduced into input hole of canal. Further, wound is layer-by-layer sewed with kapron after checking fixation of segment of flexible surgical material and imitation of shoulder head dislocation and confirmation of ligament consistency. In addition, after closing operation wound extremity is immobilised for 2 weeks in state of adduction in bending to 90° in ulnar joint with soft Dezo bandage.EFFECT: method ensures preservation of complete immobility of humeral bone in joint, reduction of operation time, elimination of possibility of shoulder head coming out beyond the limits of joint surface which contacts with it, reduction of trauma and reduction of terms of postoperative rehabilitation.3 cl, 1 ex, 6 dwg