shoulder internal arthrodesis

Shoulder joint arthroplasty is used for late limb function reconstruction of childbirth brachial plexus injury. Late upper limb functional reconstruction surgery for childbirth brachial plexus injury involves functional reconstruction of the shoulder, elbow, and wrist joints. Treatment of diseases: instability of the shoulder joint Indication Shoulder joint arthroplasty is suitable for: 1. After the upper arm brachial plexus is injured, it causes permanent paralysis of the muscles that control the ankle joint, resulting in a deformity of the shoulder. 2. Control the main muscles of the scapula - anterior serratus and trapezius muscle normal or muscle strength level 4, can produce good "shoulder chest wall joint" activity, compensate for the movement limitation caused by shoulder joint fixation, and can avoid the shoulder blade Obvious appearance deformity. 3. This surgery can be performed when the age is 5 years or older. 4. The position of the shoulder joint fixation in children should be 45 ° ~ 55 °, flexion 20 ° ~ 25 ° and external rotation 15 ° ~ 25 °. Contraindications When the function of the hand and elbow joint is seriously impaired and the function reconstruction cannot be performed, it is of no practical significance to do the shoulder joint fixation. This operation should not be performed. Preoperative preparation According to the position of the shoulder joint, the shoulder gypsum plaster is used before surgery. When the plaster is shaped, it is cut open and removed for later fixation after surgery. Surgical procedure Incision A shoulder-to-shoulder longitudinal incision is made centering on the acromioclavicular joint. From the outside of the scapula, stop at the lower third of the deltoid muscle. 2. Reveal Cut deep fascia and reveal deltoid and scapula. The muscle is separated from the shoulder to the muscle of the deltoid muscle by about 4 to 5 cm. In the case of pre-rotation arteries and veins, it should be ligated and cut. Pull the deltoid muscle fibers to the sides, showing the shoulder, acromioclavicular joint and shoulder joint capsule. The origin of the subperiosteal stripping deltoid muscle was taken, so that the shoulder peak, the distal third of the clavicle and the cortical bone outside the scapula were completely revealed. Cut off the rotator cuff muscle at the upper end of the humerus, longitudinally cut the switch sac and dislocate the ankle. 3. Remove articular cartilage and internal fixation Use a bone knife or scalpel to remove the cartilage tissue at the articular cartilage of the humeral head and the large nodules of the humerus. Be careful not to damage the tarsal plate. In particular, the medial tarsal plate of the humeral head is close to the articular surface and should not be damaged. Then the articular cartilage is removed and the subchondral bone is exposed. Then, insert two Kirschner wires from the humeral head outward and downward, through the humeral head, the tarsal plate and the lateral metatarsal of the humerus, and pierce the upper 1/3 side of the upper arm until the end of the Kirschner wire is exposed. The skull of the skull is 0.5 to 1.0 cm. At this time, the upper arm is abducted by 90°, that is, the upper arm forms a 90° angle with the trunk, and the humeral head is kept in close contact with the glenoid, and the upper arm is flexed and externally rotated by 25°. At this position, the head is determined to be tight. In the case of contact, the Kirschner wire is inserted into the glenoid for 2 to 3 cm. 4. Close the incision An assistant was used to maintain a 90° abduction of the shoulder joint, a fixed position of 25° external rotation and flexion, completely stop bleeding, and suture the incision layer by layer.

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