Zachary 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: joint dislocation Indication Mild or moderate shoulder adduction, internal rotation contracture deformity caused by paralysis, poliomyelitis and spastic paralysis, X-ray film shows that the bone of the shoulder joint has no lesions and joint dislocation, suitable for Serve surgery; but shoulder adduction, Severe internal rotation, long course of disease, deformity fixation should be used for shoulder and internal rotation contraction. Surgical procedure 1.Serve surgical procedure (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. Shoulder harvest, internal rotation contraction (1) On the basis of the Serve operation, the anterior wall of the shoulder joint is completely cut, and the attachment point of the latissimus dorsi and the large round tendon is removed and cut off on the inner side of the pectoralis major muscle, and then the upper 1/3 of the upper arm is longitudinally The incision reveals the long head and lateral head space of the triceps, and the phrenic nerve is 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.