Green Scapula Depression

Green scapula scapula is used for the surgical treatment of congenital high shoulder scapula. Congenital high shoulder deformity (Sprengel malformation) refers to the normal position of the scapula corresponding to the thoracic bone, usually accompanied by scapular dysplasia and morphological abnormalities, and other parts of the deformity such as cervical ribs, cervical deformity and so on. About 1/3 of the sick children can be found that the shoulder vertebrae is a diamond-shaped bone or cartilage piece connecting the superior scapula and the adjacent spinous lamina spines. If the deformity is not serious and the shoulder joint dysfunction is also mild, surgery is not considered. On the contrary, different surgical methods must be chosen according to the age of the sick child and the degree of malformation in other parts. After the age of 3 is the best surgery period, as the age of the sick child increases, it will increase the difficulty of surgery. There are a variety of surgical procedures to correct this deformity. This section only describes the most common surgical procedures. Treatment of diseases: congenital high shoulder Indication Green Scapula Downward is suitable for: 1. Congenital high shoulder scapula, whose scapula is more than 2cm higher than the contralateral side and less than 120° shoulder abduction. 2. Age between 3 and 7 years old, able to tolerate the operator. Contraindications Sick children with obvious scapular scapula and those over 8 years old should not be treated. Otherwise, not only the surgical effect is not good, but also the traction brachial plexus injury may occur. Preoperative preparation Routine X-ray film, to understand the extent of the scapula elevation, whether there are shoulder vertebrae and their location, and whether there are congenital cervical deformity and cervical rib deformity. Surgical procedure Incision From the upper edge of the midpoint of the scapula ganglia 2cm, parallel to the scapular ridge to the spine edge, to the inner upper corner of the 2.5cm and then to the distal longitudinal extension, ending at the distal 5cm of the lower scapula. 2. Reveal the scapula Cut the skin and deep fascia along the incision line to reveal the stop of the trapezius muscle on the scapula. The extra-periosteal separation is performed, the stop of the trapezius muscle is cut off, and the marking line is sewn at the broken end for later suturing. The trapezius muscle is pulled inward to reveal the lifting of the scapula, the large and small muscles and the supraspinatus. The supraspinatus muscle was isolated from the periosteum in the sacral fossa. Take the muscle from the medial side to the outside until the scapula is notched, and take care to avoid damage to the blood vessels and nerves on the scapula. Then, an extra-periosteal procedure is still performed to detach the large and small rhomboid muscles from the superior and medial margins of the scapula. The upper edge of the scapula is gently pulled back, and the subscapularis of the anterior aspect of the scapula is exfoliated, so that the upper part of the scapula is completely exposed. 3. Excision of the upper part of the scapula Along the base of the scapula, the upper part of the scapula is removed with a bone knife, and the periosteum is removed. Following this, a fiber band that looks for the shoulder vertebrae and connects the scapula with the spinous processes or ribs is carefully explored. After finding the shoulder vertebrae, an extra-periosteal resection should be performed and the fiber band removed. 4. Separate the lower part of the scapula and move the shoulder blade down At the vertebral border of the scapula, an extra-periosteal separation is taken and the anterior serratus fiber is cut. When the lower scapula is separated, the upper latissimus dorsi muscle, at the distal end of the lower part of the trapezius muscle, is cut from the spinous process and pulled distally to reveal the lower scapula. The anterior serratus muscle is then cut at the attachment fibers, and any fiber band between the lower scapula and the chest wall is completely removed, so that the scapula is easily moved down. Then, drill holes in the inner 1/3 of the base of the scapula, and pass the thick steel wire with a length of about 90cm through the bone hole, and pull the two ends of the wire into a double-strand steel wire to make it pass behind the lower arm. The deep side of the latissimus dorsi muscles, which are obliquely inward and downward from the outside, are taken out from the skin at a distance of 7 cm from the distal end of the scapula, which is expected to be pulled down continuously for postoperative operation. The direction of travel of the wire should point to the middle of the hip on the opposite side. 5. Move the shoulder blade down and rebuild the muscle attachment point Move the scapula down to the desired position, placing the lower scapula at the deep side of the latissimus dorsi. Next, the cut muscle stop points are stitched in order. The anterior serratus muscle was first sutured to the scapula, and the anterior serratus was sutured to the upper part of the scapula spine. In the same way, suture the size of the rhomboid muscle and lift the scapula muscles, and pay attention to suturing the lower fibers of the trapezius muscle to the scapulae 2 to 3 cm away from the original stop point to increase the force of pulling the shoulder blade inward and downward. Keeping the position of the scapula down, and suspending the upper part of the trapezius muscle about 2.5 cm, can obtain the effect of the muscle extension. The latissimus dorsi muscle is covered with the lower scapula and sutured to the corresponding spinous process, or the proximal sulcus is sutured to the proximal spinous process, and the upper edge of the latissimus dorsi and the lower edge of the trapezius muscle are sutured intermittently. After complete hemostasis, the skin incision was layered and sutured, and a drainage strip and pressure bandage were placed.