Shoulder joint tuberculosis debridement and fusion

Surgical treatment of shoulder joint tuberculosis for shoulder joint tuberculosis removal and fusion. The shoulder muscles are rich and the blood supply is good. Although the scope and extent of the activity is large, but the weight is less than the lower limbs, the incidence is lower. At the same time, the central or marginal bone tuberculosis of the humeral head or the humeral large nodules is rich in the shoulder joint muscles, the blood supply is good, and the tuberculosis lesions are easily controlled. If the tuberculosis lesion is not controlled, it can be extended to cause total joint tuberculosis. Early total joint tuberculosis is an indication for the removal of lesions. Surgical treatment can not only cure the lesion quickly, but also preserve some useful joint functions. Treatment of diseases: shoulder joint tuberculosis Indication Shoulder joint tuberculosis lesion removal and fusion is applicable to: 1. Total joint tuberculosis over 12 years old. 2. Late shoulder joint joint tuberculosis. 3. Total joint tuberculosis of the shoulder joint, X-ray film showed that the bone end destruction was heavier, but the lesion was still or strong to non-functional. Surgical procedure Debridement The lesions cleared the same shoulder tuberculosis. However, the incision differs depending on the method of fusion. 2. Joint fusion Extra-articular, intra-articular, and intra-articular fusion can be selected depending on the situation. 3. Extra-articular fusion The main application has been rarely applied in the years before the anti-mite drug invention, and the following several procedures are representative: (1) Watson-Jones method: longitudinal incision along the lateral side of the shoulder joint, 12 to 15 cm long. From the midpoint of the acromioclavicular joint, the deltoid muscle fibers were longitudinally split, and the muscles were attached to the acromion. The muscle fibers at the outer end of the clavicle and the scapula were subperiosteal, revealing the outer clavicle, the shoulder and the large nodule. The outer end of the shoulder was made into a rough surface of the bone, and the humeral large nodule was cut along the sagittal plane with a bone knife to open a bone groove 2.5 cm wide and 2.5 cm deep, and the base was still connected to the tibia. Finally, an incomplete fracture is caused in the clavicle and the shoulder, and the outer end of the rough shoulder is inserted into the enlarged nodule bone groove. (2) Putti-Scaglietti method: the incision from the shoulder ganglion through the shoulder peak to the outside of the shoulder joint, revealing the scapula, shoulder and tibia. A large groove is made in the humerus. The scapula bone wing is then chiseled and slid outward to allow it to be inserted into the enlarged sacral nodule. (3) Brittain method: The patient is lying on his stomach and the elbow is suspended from the edge of the operating table. An arched incision was made along the axillary edge of the scapula and the posterior edge of the deltoid muscle. The medial head of the triceps was found in the upper part of the upper arm, and the subperiosteal dissection was performed to reveal the upper end of the humeral shaft about 5 cm. Then cut the small round muscle to reveal the axillary margin of the scapula. A bone hole is drilled in the upper part of the humerus, and the scapula is placed on the edge of the scapula. The bone graft removed from the humerus is placed in the hole. 4. Intra-articular fusion (1) Massart method: surgical approach for the removal of the same shoulder joint lesions, but the humeral head and shoulder joint cartilage is removed, and the humerus is cut into strips for bone graft fusion. (2) Lance method: It is a method of embedding bone graft by using two tibia bone strips embedded in the shoulder and the condyle respectively from the large nodule. (3) Key method: After the lesion is removed, the screw is inserted into the shoulder blade through the humeral head, and the Kirschner wire can also be used for cross-fixation, and the surrounding strips are bone grafted. 5. Joint internal and external fusion After the tuberculosis is completely removed, the bone grafting inside and outside the joint is performed. The bone graft source is mostly used in China. The bone grafting method includes intercondylar bone grafting, shoulder-to-peak internodal bone grafting, acromion condyle and large nodule bone bridge. The above method may be selected one or two as appropriate.

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