| 摘要 |
FIELD: medicine, traumatology, orthopedics. ^ SUBSTANCE: the present innovation deals with introducing the needles through acromial process and scapular spine, fixing in proximal basic support, introducing the needles through the lower third of brachial bone and fixing in distal basic support, connecting basic supports with the help of telescopic bars; it , also, deals with carrying out dosed axial distraction of soft tissues at descending the caput of brachial bone from the state of wedging, introducing a rod into the upper third of diaphysis to carry out dosed lateral traction outwards, approaching basic supports, apparatus immobilization of reset caput of brachial bone followed by apparatus dismantling. Moreover, it is necessary to introduce a needle through coracoid process towards acromial process, and another needle - through scapular spine and acromial process; while assembling the apparatus it is important to orient proximal basic support by longitudinal axis of scapular articular cavity, through condyles of brachial bone one needle should be guided in direction from inside outwards at the support from internal side. Then one should detect the angle of pathological rotation of brachial bone, for example, in position of balance of internal and external rotators or turning the hand inwards for the angle of 30° against sagittal plane, or according to roentgenogram of brachial joint in axial projection by deviation against physiological norm of the angle between the plane passing through the edges of scapular articular cavity and normally against transverse axis of condyles. While connecting basic supports it is necessary to fulfill their relative rotation for the angle of derotation, as a rod one should apply a rod-hook which should be introduced perosseously with its working end by grasp of brachial bone's diaphysis at anterior luxations from anterior-internal side, and at posterior ones - from posterior-internal side of brachial bone. After that one should carry out lateral traction to achieve a clearance between articular surfaces in frontal plane that exceeds physiological norm of articular fissure for the value being not more than ¶*r/4 and not less than ¶*r/6, where r - the radius of brachial bone's caput. In the course of this type of therapy it is, also, possible to fulfill the following: install basic supports symmetrically against longitudinal axes of articular bones; guide the needle with intermediate support platform through the condyles of brachial bone at the level of VII and/or VIII in position 3-9 marked according to "Esperanto" system; additional guide the needle with support platform through the condyle of brachial bone in frontal plane being parallel to the first needle, moreover, the supports should be located oncomingly; additionally introduce the needle through scapular cervix. In case of anterior subarticular luxation one should carry out lateral traction only. The period for removing the apparatus of fixation should be determined according to the absence of reluxation of brachial caput, moreover, immobilization of the reset brachial caput with the help of the apparatus should be carried out for about 3-5 d. Before applying the apparatus it is important to fulfill roentgenogram of brachial joint in frontal and axial planes to detect the areas of maximal osseous thickenings, through which one should introduce the needles later. This innovation enables to correct induced pathological brachial rotation and reconstruct anatomo-functional relationships, as well. ^ EFFECT: higher efficiency of therapy. ^ 14 cl, 6 dwg, 1 ex |
