Mclaughlin's method

The method of suturing the rupture of the rupture in the bone groove was proposed by McLaughlin in 1944, and achieved good clinical results. Therefore, it has been rapidly popularized and promoted. In Europe and the United States, this procedure is called Tendontobonythroughfixation. The method of embedding the rotator cuff in the bone groove was first proposed by Wilson in 1931. However, McLaughlin introduced various surgical methods in 1944 according to the condition of the tendon stump, and sutured it in the bone groove, which was called the McLaughlin method. Treatment of diseases: rotator cuff injury rotator cuff space split scapula body fracture Indication The ability to apply the McLaughlin method is based on shoulder arthroscopy and intraoperative judgment. Incomplete fracture, small fracture, medium fracture, large fracture, according to the nature of the fracture end, whether there is elasticity, adhesion and retraction, the affected limb is placed in the ptosis position, the retracted tendon is fully dissociated, and can be pulled to the humerus The nodules are approximately 1 cm in size and are their indications for surgery. Shoulder pain, especially nighttime pain, has a significant history of trauma, especially in young and middle-aged patients, before muscle atrophy (within 2 weeks of injury), early surgery can achieve good results. After conservative treatment, the muscle strength is low, the muscle atrophy is obvious, and the subacromial impingement syndrome is not improved. For those who have no obvious history of trauma, elderly people should be considered as degenerative fractures, first conservative treatment, but when the pain is severe and affects daily life, it can also be used as an indication for this method. Contraindications Can you consider the Mclaughlin method to repair the broken rotator cuff, not only according to the results of preoperative ultrasound, MRI, arthrography and arthroscopy, but also the size of the fracture, more importantly, to directly observe the fracture size of the rotator cuff during the operation. And the degree of decision and change at any time. Preoperative preparation 1. General anesthesia, lateral position, the affected side is upwards and slightly inclined to the front, so that the affected limb can move freely during the operation. 2. The shoulder, the condyle and the acromioclavicular joint were marked before operation. The skin was cut from the anterior lateral part of the acromioclavicular joint and the transverse finger was about 7-10 cm. Surgical procedure 1. General anesthesia, lateral position, the affected side is upwards and slightly inclined to the front, so that the affected limb can move freely during the operation. 2. The shoulder, the condyle and the acromioclavicular joint were marked before operation. The skin was cut from the anterior lateral part of the acromioclavicular joint and the transverse finger was about 7-10 cm. 3. Treatment of the deltoid muscle: on the lateral side of the incision, bluntly separate to the deltoid muscle, taking care not to damage the phrenic nerve. Confirm the attachment of the acromion of the deltoid muscle, confirm the position of the acromioclavicular joint with an injection needle, and cut the deltoid to the periosteum with an electric knife. Bluntly remove the deltoid muscle from the shoulder, pay attention to the continuity of the periosteum and deltoid muscle. The deltoid muscle is retracted to the medial side, and the sacral ligament is revealed. Before the severing, attention is paid to the apical branch of the thoracic and thoracic artery. 4. Subacromial angioplasty According to Neer's method, the anterior acromion is excised for a length of 2 to 3 cm. The osteotome and the acromion are at an angle of 45° and the thickness is about 0.9 cm. To prevent damage to the rotator cuff, the periosteum can be removed. The stripper is inserted under the shoulder to support the cut, and the cut end of the bone is smoothed with bone wax. 5. Treatment of the shoulder-slung sac: After the formation of the front shoulder peak, the under-shoulder gap is fully exposed, and the gap between the deltoid muscle and the synovial sac is peeled off, and the 2-needle suspension of the thick synovial sac is incision and needs to be kept slippery. The integrity of the sac is prevented from causing postoperative subacromial impingement syndrome after resection. However, when the synovial sac rupture has formed scarring, it can be removed to prevent postoperative adhesions and cause pain. 6. Treatment of the rotator cuff end: After confirming the location, size and degree of degeneration of the rotator cuff, the surgeon peels off the adhesion between the synovial sac and the rotator cuff again with his fingers. For cases of large fractures, it is necessary to pull the outer edge while peeling off, and it is necessary to avoid the rotator cuff tearing. After fully exfoliating, pull the broken end to the position of the greater tibia of the humerus, determine the suture site and make the broken end fresh, generally difficult to suture in situ, and use a bone knife to make a bone groove about 1cm away from the greater tibia. The length depends on the length of the broken end, and the depth is about 1 cm, and the broken end can be completely embedded. 7. The internal fixation of the fractured end of the bone is made with a 1.8mm Kirschner wire to drill 2 to 4 holes from the large nodule to the bone groove. The needle is fixed in the bone hole with the 18th needle, and the 7th can absorb the large curved needle. Under the guidance of the preset needle, the iliac crest suture is embedded in the bone groove. It is then stitched with an absorbable thread. 8. Fixation of deltoid muscles Use a Kirschner wire to drill 2 to 4 bone holes in the wedge-shaped resection of the acromion, and suture the deltoid muscle on the shoulder peak with a large curved needle of No. 7 absorbable line.

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