METHOD FOR AUTOPLASTY OF DEFECTS IN THE GLENOID CAVITY OF THE SCAPULA IN REVERSE ARTHROPLASTY OF THE SHOULDER JOINT

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics, and can be used for autoplasty of defects in the glenoid cavity of the scapula during reverse shoulder arthroplasty. In the preoperative period, the spatial visualization of the affected structures of the shoulder joint is determined by the method for multilayer spiral computed tomography with the identification of the anatomical features of the shape and structure of the shoulder joint and the articular cavity, the nature of the defect and the missing volume of the bone mass of the articular cavity of the scapula are visualized. The state of the surrounding soft tissues, vascular and nervous structures that are not visualized when performing multilayer spiral computed tomography is assessed using magnetic resonance imaging. The pain syndrome, range of motion of the shoulder joint and the functional state of the deltoid muscle are assessed. Surgical intervention is carried out in the position of the patient sitting on the operating table with an angle between the patient's body and hips of 90° and with a roller in the popliteal region, access to the deltoid muscle is performed by performing an incision of the skin and subcutaneous tissue 5.0-5.9 cm long from the edge of the acromion linearly along the outer surface of the shoulder distally to the level of the projection of the greater tubercle. The anterior and middle bundles of the deltoid muscle are separated. the head of the humerus is mobilized with preliminary suturing and preservation of the tendons of the rotator muscles of the shoulder, the shoulder is rotated outward by 25-35°. Applying pressure along the axis of the humerus in the proximal direction with the forearm bent at an angle of 90°, dislocation and removal of the proximal metaepiphysis of the shoulder into the wound are carried out. Resection of the head of the humerus is performed, using retractors, the humerus is brought down with visualization of the articular surface of the scapula with the cartilaginous lip. Perform visual, manual and instrumental assessment of the parameters of the defect and the amount of loss of bone mass of the glenoid cavity of the scapula. An incision is made in the skin and subcutaneous fat in the projection of the iliac crest. The muscle fibers are separated and the surface of the ilium is visualized. A bone autograft of the required size is taken, hemostasis with layer-by-layer suturing of the wound. An autograft is modeled with cleaning of the cortical layer, and after processing the articular surface of the scapula with cutters, taking into account the size of the defect in the glenoid cavity of the scapula, the simulated autograft is implanted on the defect of the articular cavity. The installation of metaglene and other components of the reverse endoprosthesis is performed. layer-by-layer suturing of the wound is performed. In the presence of a massive deficiency of the bone mass of the glenoid cavity of the scapula and medialization of the bone site for implantation of metaglene, the autograft is additionally placed along the guide pin, along which a channel is drilled through the graft to accommodate the metaglen pin and mataglen is inserted into the body of the scapula through the center of the autograft, taking into account the angle of inclination of the glenoid cavity of the scapula and anatomical data of the patient to ensure that the autograft adheres to the surface of the bone mass deficiency. The metaglene is fixed with fixing screws to the scapula and the installation of the endoprosthesis components is completed. If the tendons of the rotator cuff are preserved, they are reconstructed.;EFFECT: method provides sufficient preservation of the patient's motor activity in the early postoperative period, minimally invasive surgical access in case of reverse shoulder arthroplasty and reduction of surgical aggression and tissue injury, as well as anatomical restoration of the shape and function of the structures of the shoulder joint and reduction of the patient's hospitalization period due to the techniques of the autoplasty method. defects of the glenoid cavity of the scapula in reverse arthroplasty of the shoulder joint.;3 cl, 3 ex