Putti-Platt Surgery

Recurrent dislocation of the shoulder joint is a common complication of traumatic shoulder dislocation, which usually occurs within 2 years after the original dislocation. It often causes recurrence of shoulder dislocation when subjected to slight external force. As the dislocation recurs, the joint becomes more and more unstable. The pathological changes of this injury include the rupture of the joint capsule, the defect on the anterior lip of the scapula, and the humeral head. Posterior lateral compression fracture. There is also a non-invasive dislocation, usually the shoulder joint is normal, and the muscle can be dislocated by a slight muscle pull. This dislocation often has anatomical developmental variations. The corresponding surgical methods should be adopted according to different pathological changes in treatment. Treatment of diseases: dislocation of the shoulder joint Indication Putti-Platt surgery is available for: 1. The anterior dislocation of the shoulder joint recurs frequently, affecting work and daily life. 2. There are only a few recurrences of dislocation, and the interval between dislocations is very long. Those who have little impact on work and life should not be operated. Those with special occupational requirements should be strictly weighed and carefully implemented. Surgical procedure Incision The anterior medial incision was made. The transverse section of the incision was from the lower edge of the acromion to the tip of the condyle. The descending segment was descended from the anterior border of the deltoid muscle or 1 cm above the deltoid to the deltoid nodules. 2. Exposing the joint The deltoid muscle is separated by the direction of the muscle fibers through the gap between the deltoid muscle and the pectoralis major muscle, or about 0.5 cm outside the anterior edge of the deltoid muscle; in order to make the incision clearer, the deltoid muscle attached to the outer third of the clavicle can also be cut. Lifting the deltoid muscle to reveal the condyle and the joint iliac crest and the biceps brachial plexus attached to it; use one of the following two methods to dissociate the sputum; 1 cm below the condyle, cut the diaphragm and sputum Joint sacral head with short head; or first drill a bone hole (for screw fixation) from the top of the condyle with a drill bit, and then break the condyle at the base of the condyle, so that the broken condyle The combined tendon is turned down, gently retracting the combined tendon downwards, and the external rotation of the humerus reveals the subscapularis. The lower and upper edges of the subscapularis muscle are dissected in turn, and the anterior and posterior arteries and phrenic nerves located below them should be noted when dissecting the lower edge. A nasal septum stripper is inserted between the subscapularis muscle and the joint capsule, and the two layers are bluntly separated. Sometimes the two layers are closely adhered to each other, and when the separation cannot be separated, it is not necessary to forcibly dissect the separation. 2 to 3 cm inside the tibial tuberosity, the two needles are sutured in the subscapular muscles with a thick thread, and the subscapularis and joint capsule are vertically cut between the traction lines, and the medial valve of the capsular ganglion is pulled to the medial side. At the same time, the external rotation of the humeral head and the leading edge of the glenoid can be revealed. 3. Exploring joint lesions Exploring the anterior humeral margin, such as a torn labrum and a fractured rim, can be trimmed with a small curette or a bone knife. Explore the degree of joint capsule relaxation; to correctly determine the tension of the suture. As for the sulcus fracture on the posterior side of the humeral head, it is generally not necessary to explore. Because of excessive external rotation, the brachial plexus will be excessively injured. In the operation, if the humerus is externally rotated to 60° to 70°, the sudden subluxation may be felt. Bouncing, this is caused by the fracture of the humeral head slid over the sacral margin. 4. Stitching the joint capsule and the subscapularis muscle The upper arm is adducted and the forearm is tightly attached to the chest to maintain the internal rotation position of the humeral head. The lateral scapula and the lateral flap of the joint capsule are sutured to the soft tissue of the scapula neck. The medial lobes of the joint capsule are then sutured to the superficial layer of the lateral flap, and the medial lobes of the subscapularis muscle are sewed on the rotator cuff near the large nodule or at the medial edge of the biceps sulcus. The suture tension is limited to the external joint of the shoulder joint only 45°; the short joint of the diaphragm and the biceps muscle is sutured to the original attachment point; if the original constricted condyle is fixed, it is fixed to the original position. The remaining layers of tissue are stitched according to the level. complication About half of the patients may have limited permanent external rotation of the upper arm.

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