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首页> 外文期刊>Revista Brasileira de Ortopedia >Conceito de cura da luxa??o recidivante do ombro
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Conceito de cura da luxa??o recidivante do ombro

机译:复发性肩关节脱位的治疗概念

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Resumo O presente trabalho analisa as principais técnicas cirúrgicas empregadas no tratamento da luxa??o recidivante do ombro (LRO), com o objetivo de obter a normalidade da amplitude dos movimentos articulares e associar diferentes tempos cirúrgicos num único procedimento para obter uma capacidade funcional completa, sem comprometer a normalidade dos movimentos, por causa das suturas tensas usadas nas cirurgias de Putti‐Platt, Bankart, Latarjet, Dickson‐O’Dell e outras. Após cuidadosa revis?o desses métodos em uso, chegamos à conclus?o de que a {LRO} pode ser considerada resolvida quanto à porcentagem de cura (97%). Permanecem, no entanto, limita??es dos movimentos na grande maioria dos casos, aceitas até como necessárias para evitar recidivas. O nosso objetivo cirúrgico visa à obten??o de uma recupera??o funcional completa, atuar simultaneamente sobre as várias les?es anatomopatológicas e abandonar a ideia das chamadas “les?es essenciais”. A imobiliza??o do ombro operado será feita somente durante a cicatriza??o das partes moles em rota??o neutra. Com o uso de um enxerto ósseo pediculado dispensa‐se qualquer tipo de imobiliza??o prolongada, por causa da estabilidade obtida pela osteossíntese da coracoide no rebordo da glenoide, como na técnica de Latarjet. Essa nossa conduta, empregada desde 1959, consiste, portanto, na associa??o das várias técnicas com as quais se obtêm a cura sem limita??o dos movimentos, por causa da redu??o da tens?o nas suturas da cápsula e dos músculos subescapular e coracobraquial empregadas nas técnicas acima. Abstract This paper presents the main surgical techniques applied in the treatment of anterior recurrent shoulder dislocation, aiming the achievement of the normality of articulate movements. This was obtained by combining distinct surgical procedures, which allowed the recovery of a complete functional capacity of the shoulder, without jeopardizing the normality of movement, something that has not been recorded in the case of the tense sutures of the surgical procedures of Putti‐Platt, Bankart, Latarjet, Dickson‐O’Dell and others. The careful review of the methods applied supports the conclusion that recurrent shoulder dislocation can be cured, since cure has been obtained in 97% of the treated cases. However, some degree of limitation in the shoulder movement has been observed in most of the treated cases. Our main goal was to achieve a complete shoulder functional recovery, by treating simultaneously all of the anatomical‐pathological lesions, without considering the so‐called essential lesions. The period of post‐operatory immobilization only last for the healing of soft parts; this takes place in a position of neutral shoulder rotation, since the use of vascular bone graft eliminates the need for long time immobilization, due to the shoulder stabilization provided by rigid fixation of the coracoid at the glenoid edge, as in the Latarjet's technique. Our procedure, used since 1959, comprises the association of several techniques, which has permitted shoulder healing without movement limitation. That was because of the tension reduction in the sutures of the subescapularis, capsule, and coracobraquialis muscles.
机译:摘要本研究分析了复发性肩关节脱位(OLS)的主要手术技术,目的是获得正常的关节活动范围,并在单个手术中关联不同的手术时间以获得完整的功能。由于在Putti-Platt,Bankart,Latarjet,Dickson-O'Dell和其他手术中使用了紧密的缝合线,因此不会影响动作的正常性。在仔细检查了所使用的这些方法之后,我们得出的结论是,可以将 {LRO }视为治愈的百分比(97%)可以解决。但是,在大多数情况下,动作限制仍然存在,甚至为防止复发而必须接受。我们的手术目标是获得完全的功能恢复,同时对各种解剖病理学病变采取行动,并放弃所谓的``基本病变''的想法。只有在中性旋转的软组织愈合期间才能完成手术肩膀的固定。使用带蒂的骨移植物,由于在喙突边缘通过喙突骨合成获得的稳定性(如Latarjet技术),可以省去任何类型的长时间固定。因此,我们的行为自1959年以来一直使用,因此包括由于胶囊缝合线张力降低而实现的无限制移动而实现治愈的各种技术。以及上述技术中使用的肩cap下肌和胸臂臂肌。摘要本文介绍了用于治疗先前复发性肩关节脱位的主要外科技术,旨在实现关节运动的正常性。这是通过结合不同的外科手术程序而获得的,该手术程序可以在不损害运动正常性的情况下恢复肩部的全部功能,这在Putti-Platt外科手术的紧张缝合法中并未记录到。 ,Bankart,Latarjet,Dickson-O'Dell等。对所用方法的仔细审查支持了可以治愈复发性肩关节脱位的结论,因为已经治愈了97%的治疗病例。但是,在大多数接受治疗的病例中,已经观察到一定程度的肩膀运动受限。我们的主要目标是通过同时治疗所有解剖病理病变,而不考虑所谓的基本病变,来实现肩部功能的完全恢复。术后固定期仅持续于软部分的愈合。由于在Latarjet的技术中,由于将喙突坚硬地固定在盂盂边​​缘,从而使肩膀稳定,因此使用血管骨移植物消除了长时间固定的需要,因此在肩部旋转的中性位置就可以了。自1959年以来使用的我们的程序包括多种技术的结合,这些技术已使肩部愈合而无运动限制。这是因为肩s下,囊状和胸腔壁肌肉的缝合线张力降低。

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