Serve surgery

Most of the shoulder joint contractures are adduction and internal rotation, which have a great influence on normal activities. In addition to fractures, tuberculosis and other factors, there are two major categories of traumatic degeneration and paralysis, and the treatment methods are different. Treatment of diseases: shoulder joint tuberculosis Indication Mild or moderate shoulder adduction and internal rotation contracture deformity caused by labor paralysis, poliomyelitis and spastic paralysis. X-ray films show that the bones of the shoulder joint are free of lesions and joint dislocation, suitable for shoulder adduction and internal rotation contraction Solution; but the shoulder adduction, internal rotation is severe, the course of disease is long, the deformity fixation should use Zachary surgery. Surgical procedure 1. Shoulder harvest, internal rotation contraction (1) Incision: The anterior incision of the shoulder joint. From the shoulder peak, along the subclavian transverse incision to the condyle; curved down, along the deltoid leading edge to the lower edge of the pectoralis major. (2) After incision of the deep fascia, the deltoid muscle and the pectoralis major muscle were bluntly separated, and the pectoralis major tendon was cut parallel to the humeral shaft in the lower part of the incision, and the deltoid and pectoralis major muscles were opened with a retractor, which was visible in the deep layer. The temporalis and biceps brachial muscles attached to the condyle are combined with the iliac crest, and are cut at a distance of 1 cm from the condyle. If the condyle is too long, the condyle can be cut down to 0.5 to 1 cm of bone, and then the distal end will be broken. The end is turned downwards to reveal the subscapular tendon attached to the small nodule of the tibia. Operation here should avoid damage to the agitation, veins and nerves behind the pectoralis minor muscle. (3) Insert a curved hemostatic forceps or slotted probe from the deep side of the lower edge of the subscapularis tendon and the joint capsule to protect the joint capsule and cut the tendon along the groove. At this time, the passive abduction and external rotation of the shoulder joint can generally reach the normal range. 2. Zachary surgery steps (1) On the basis of the implementation of shoulder adduction and internal rotation contraction, the anterior wall of the shoulder joint is completely cut, and the attachment point of the latissimus dorsi and the great round tendon is removed and cut off on the inner side of the pectoralis major muscle, and then on the upper arm. A longitudinal incision was made in the upper third of the posterior side to reveal the long head and lateral head space of the triceps, and the phrenic nerve was isolated and retracted. A fissure is separated outside the humerus at the lateral head attachment portion, sufficient to pass the tendon of the latissimus dorsi and the great round muscle, and a thin bone piece of the periosteum is picked up by the osteotome on the posterior aspect of the humerus, and the free latissimus dorsi and the great round tendon are passed through. The rupture that has been made under the triceps tendon is sewed under the thin bone piece that has been lifted on the outer arm of the upper arm. (2) suture the cut tendon, completely stop bleeding, flush the wound with isotonic saline, and suture the subcutaneous tissue and skin in turn.

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