METHOD OF SURGICAL TREATMENT OF HABITUAL SHOULDER DISLOCATION

摘要

FIELD: medicine.;SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics, and can be used in surgical treatment of habitual shoulder dislocation. Operation is performed under arthroscopic control. Patient is laid on healthy side. Extremity to be operated is hung in 30-45° abduction with 2-4 kg load on the axis of operated extremity and external rotation. Punctures are made to provide posterior, anterior and lateral access into joint cavity. Posterior access is provided by puncture with approximately 5 mm diameter, which is started 1.5-2 cm lower and 1 cm more medial than posterior angle of acromial process of scapula and directed ventrally with orientation at the top of coracoid process. Anterior access is made by puncture which is 1.0 cm more lateral and 1.0 cm downward from the top of coracoid process. Lateral access is performed by additional up to 3 cm long cut, in projection of tendon of long biceps head. Arthroscope with blunt trocar is introduced through posterior access and arthroscopy is performed in physiological solution, pumped into joint cavity via anterior access under pressure 60 mm WC. Tendon bed is opened via lateral access and tendon is brought outward from the section of bone tissue, intended for formation of bone canal. After that, on exposed bone tissue installed is conductor, through which wire is passed in direction of joint surface of humerus head and after wire reaches the specified point, which is controlled by means of arthroscope, formed is bone canal, whose outlet is located on the line, connecting upper point of intertubercular sulcus and lower point of anatomical neck of humerus, for 1/3 of length of said line from its upper point. Face is removed on the canal outlet. Through canal passed is loose end of lavsan tape, which is laid around tendom from top downwards on the tendon section, located on 1/3 of the length of the line, connecting upper point of intertubercular sulcus and lower point of anatomical neck of humerus, measuring from the point of tendon attachment to cavity of scapula. After that, sutures are applied on the lower side of tendon without damaging its mesentery. Then, loose end of lavsan tape is broughgt through bone canal in reverse direction. Protruding ends of lavsan tape are tightened and contact of tendon and lavsan tape is tightly pulled to bone canal outlet. After that, ends of lavsan tape are fixed near bone canal inlet by means of screw lock, introduced into inlet hole of canal, with tightened lavsan ends.;EFFECT: method ensures reduction of trauma, reduction of operation duration, preservation of complete mobility of humerus in joint, elimination of possibility for humerus head to move beyond the limits of joint surface, which contacts with it, reduction of terms of post-operative rehabilitation.;3 cl, 1 ex, 6 dwg