METHOD OF SURGICAL TREATMENT OF POSTERIOR LINKED FRACTURE-DISLOCATIONS OF THE HUMERUS USING AN INDIVIDUAL METAL AUGMENT Russian patent published in 2023 - IPC A61B17/56 

FIELD: medicine, traumatology and orthopedics.

SUBSTANCE: invention can be used for surgical treatment of an osteochondral defect of the humeral head. In the preoperative period, visualization of the affected structures of the shoulder joint is carried out with the identification of the anatomical features of the shape and structure of the shoulder joint, the head of the shoulder and the glenoid with an assessment of its anatomical integrity, as well as the condition of the surrounding soft tissues, vascular and nervous structures, pain syndrome, range of motion in the shoulder joint and functional state of the deltoid muscle. Based on the results of computed tomography, the size and shape of defects in the head of the humerus and the articular process of the scapula are determined, the sizes and shapes of the replacing individual metal augment with a supporting leg are determined, the sizes and shape of the individual guide used in transplantation and fitting models are determined. The custom guide and fitting models are printed with the help of 3D printer from a biocompatible and non-toxic polymer material. An individual metal augment is made by printing with the help of 3D printer. The outer part of the individual metal augment for interaction with the articular surface of the scapula is polished. Surgical intervention is carried out in the position of the patient on the operating table “beach chair” with the incision of the skin and subcutaneous fat 7–8 cm long from the acromion linearly down. An access to the deltopectoral gap is performed. Deltoid and pectoralis major muscles are bred bluntly. The head of the humerus is mobilized with preliminary suturing and cutting off the subscapularis muscle of the shoulder. Access to the shoulder joint to the head of the shoulder and glenoid is provided. An open reduction of the head of the shoulder is performed with dislocation of the head of the shoulder into the surgical wound. The three-dimensional plastic model is compared with the bone structures of the patient. The individual guide is adapted to the defect of the humerus. Using an individual guide, a channel is formed to accommodate the support leg of an individual metal augment. An individual metal augment is fitted to the humerus and the individual metal augment is implanted into the head of the humerus using the press-fit method. Using an individual guide, the screws are placed with their blocking. The reliability of fixation of an individual metal augment is checked, the head of the humerus is repositioned, and the range of motion in the shoulder joint is checked. Refixation of the subscapularis tendon, layer-by-layer suturing of the surgical wound with fixation of the upper limb in the adducted position of the shoulder and internal rotation with a shoulder bandage for a period of 6 weeks with restriction of movement in the shoulder joint are performed. Acrylonitrile butadiene styrene ABS, or polyethylene terephthalate with PET-G glycol, or polylactide PLA is used as a biologically compatible and non-toxic polymeric material for the manufacture of an individual guide and fitting models used in transplantation, and an individual metal augment and fixing screws are made of titanium alloy VT6.

EFFECT: method provides anatomically accurate replacement of a defect in the bone tissue of the humeral head, a large range of active movements of the humeral head while counteracting the recurrence of dislocations of the humerus, preventing the development of arthrosis of the shoulder joint in the early stages, reducing pain and trauma during surgical treatment, as well as early social rehabilitation of the patient with a simultaneous increase in the quality of his life through the use of an individual metal augment and features of the method.

3 cl, 3 ex