Shoulder Arthrodesis

1. Due to joint trauma, inflammation, degeneration, etc., the joint surface is disproportionate, causing severe joint dysfunction, or stubborn joint pain, affecting work and life, non-surgical treatment is invalid, and other surgery is not suitable. To maintain joint mobility, joint fusion should be performed. For example, severe arthritis caused by intra-articular fractures of the lower extremities, and there are a large number of scars in the surrounding soft tissue after septic arthritis, and it is not suitable for surgery such as arthroplasty. 2. Adult all-tubular tuberculosis, joint surface destruction, it is estimated that the joint function can not be preserved, joint fusion can be performed at the same time as the lesion is removed; and there are deformities, which can correct the deformity at the same time. 3. Muscle spasm caused by neuropathy or injury, causing severe instability of the joint, affecting the whole limb function, and simple tendon metastasis is not enough to maintain joint stability and restore sufficient effective function. Fixing local joint can improve limb function. Perform joint fusion. For example, after the anterior horn polio of the spinal cord, the upper limbs can not be lifted. If the shoulder joint is fixed in the functional position, the function of the upper limb can be improved by sliding the shoulder between the shoulders. 4. Congenital or acquired spinal deformity (such as hemivertebra, scoliosis, lumbar spondylolisthesis, etc.), in order to prevent the development of deformity, early laminectomy can be performed, or after deformity correction. Treatment of diseases: shoulder joint dislocation shoulder tuberculosis Indication 1. Due to joint trauma, inflammation, degeneration, etc., the joint surface is disproportionate, causing severe joint dysfunction, or stubborn joint pain, affecting work and life, non-surgical treatment is invalid, and other surgery is not suitable. To maintain joint mobility, joint fusion should be performed. For example, severe arthritis caused by intra-articular fractures of the lower extremities, and there are a large number of scars in the surrounding soft tissue after septic arthritis, and it is not suitable for surgery such as arthroplasty. 2. Adult all-tubular tuberculosis, joint surface destruction, it is estimated that the joint function can not be preserved, joint fusion can be performed at the same time as the lesion is removed; and there are deformities, which can correct the deformity at the same time. 3. Muscle spasm caused by neuropathy or injury, causing severe instability of the joint, affecting the whole limb function, and simple tendon metastasis is not enough to maintain joint stability and restore sufficient effective function. Fixing local joint can improve limb function. Perform joint fusion. For example, after the anterior horn polio of the spinal cord, the upper limbs can not be lifted. If the shoulder joint is fixed in the functional position, the function of the upper limb can be improved by sliding the shoulder between the shoulders. 4. Congenital or acquired spinal deformity (such as hemivertebra, scoliosis, lumbar spondylolisthesis, etc.), in order to prevent the development of deformity, early laminectomy can be performed, or after deformity correction. Contraindications In addition to the general contraindications for elective surgery, the following conditions should also be contraindicated: 1. Patients with osteoarthritis adjacent to the joint should not be used for arthrodesis. If the hip joint is fused, its activity can be compensated by the normal lumbar spine and knee joint to meet the needs of work and life activities. If the lower lumbar or knee joint is already stiff, hip fusion will cause great difficulty to the patient. 2. Among the same joints of the limbs, one side has a strong straight, and the contralateral side should not be subjected to arthrodesis. If the hip joints are fused on both sides, it will be very difficult to get up, lie, walk and sit. 3. Children's articular cartilage is rich, joint fusion is not easy to cause bone fusion, but also easy to damage the epiphysis, affecting growth and development; at the same time, children in the limb development stage and muscle sustained action, the fusion joint can be deformed again. Therefore, children under the age of 12 should not undergo arthrodesis. Preoperative preparation 1. Arthrodesis may actually include a series of operations such as lesion removal, joint fusion, bone transplantation, and correction of deformity, so it is a complicated operation. Therefore, the surgical plan should be determined according to these surgical requirements, comprehensive consideration, try to get a surgery, a cut to solve the problem, in order to achieve the best results at the least cost. 2. Loss of activity after joint fusion can cause the patient's ideological concerns, and should be dispelled before surgery: the fusion of a joint that affects the function of the limb will improve the function of the entire limb. 3. The joints of the shoulders, hips and other large joints have more bleeding during the operation, and there is a possibility of shock. A certain amount of blood should be reserved before surgery. When the elbow and knee joints are operated, the inflatable tourniquet is used to keep the field clear for the operation. 4. Inflammatory joint disease (such as tuberculosis, suppurative) should be applied preoperative antibiotics or anti-tuberculosis drugs to control the infection or prevent the recurrence of the resting lesion. 5. If the joint has soft tissue contracture, the deformity will not be easily corrected during the operation, and the joint will be difficult to reset. It is difficult to maintain stability even if it is barely repositioned; if it is strongly corrected during surgery, it will cause damage to nerves, blood vessels, etc. Postoperative muscle spasm, and even cause complications such as dislocation. Therefore, traction should be performed before surgery to overcome contracture as much as possible; and design the steps to relieve contracture during surgery. Surgical procedure 1. Position: supine position, head to the healthy side, the side of the scapula and the trunk under the stomach with sandbags, so that the shoulder of the disease leaves the operating table. 2. Incision, exposure: use the anterior medial incision of the shoulder joint (see the anterior medial aspect of the shoulder joint). The posterior end of the incision is appropriately extended 4 to 5 cm along the posterior edge of the deltoid muscle to expand the exposure. Along the incision, the deltoid muscle was cut from the clavicle, the shoulder and the scapula 0.5 cm below the starting point, and the flap was inverted backwards. When separating the posterior margin of the deltoid muscle, care should be taken to avoid damage to the phrenic nerve and the posterior circumflex artery through the lower edge of the small round muscle. The anterior side should protect the iliac, vein and nerve trunk descending from the condyle and the posterior iliac crest. . Then cut the transverse ligament, separate and pull the long head of the biceps tendon, cut the subscapularis muscle along the longitudinal direction of the humerus, and then cut the sacral sleeve and joint capsule horizontally to fully reveal the humeral head and shoulder blades. 3. Excision of cartilage surface, intra-articular fusion: if the joint has lesions, first external rotation of the upper arm, dislocation of the joint, removal of the diseased synovial membrane and joint capsule, the cartilage surface of the humeral head and shoulder blade is removed; the wound is removed, and the wound is removed. Residual cartilage debris, resetting the joints. If the articular surface is not opposite, try to repair the bone surface so that the rough bone surface can maintain close contact. If there is a defect in the articular surface, or the size of the corresponding surface is very disproportionate, it is very unstable after the reduction. It can be used from 1 to 2 Kirschner wires or screws to pass the humeral head from the humeral head to the scapula. The internal fixation is functional. Bit. 4. Extra-articular bone graft enhanced fusion: subperiosteal dissection of the humeral large nodules, large sacrificial nodules (maintaining the continuity of the base and tibia) along the sagittal plane for bone grafting. Then, part of the shoulder and the posterior edge of the scapula are stripped under the periosteum. When peeling, care should be taken to avoid damage to the transverse arteries of the scapula and the superior scapula located in the scapula. The surface of the acromion is chiseled, and then the bone piece corresponding to the slit of the long, wide and large nodule is cut and slid down. Embedded in the crack of the large nodule, forming a bridge-like connection between the shoulder and the large nodule. Thereafter, the shoulder joint should be maintained in a functional position by a person, and the space between the joints and the bone graft should be filled with cancellous bone fragments taken from the tibia or tibia. No obvious bleeding was observed, and the muscle flap was restored after the joint fusion position was appropriate. The needle tail fixed in the steel needle was bent and cut off the bone, and sutured layer by layer. 5. External fixation: Immediately after surgery, the abductor or chest gypsum is used to fix the diseased limb, and the shoulder joint is maintained at the functional position (abduction 45°60°, flexion 15°25°, external rotation 25°) and elbow Flexed 90°. complication Surgery can lead to joint dysfunction or intractable joint pain.