Operations on a musculoskeletal system

Description:

Operative measures on a musculoskeletal system are undertaken for the purpose of elimination of the inborn and acquired deformations and recovery of function of extremities. The medical discipline called by orthopedics is engaged in it.

Long time the orthopedics used only conservative methods of treatment. Hippocrates has a classical description of dislocations and changes, a rachiocampsis, congenital dislocation of a hip and a clubfoot. By means of bandages, extension, special devices, hydrotherapeutic procedures he tried to obtain treatment of patients. Various conservative methods of treatment of deformations were applied by Asklepiad, Tsels, Galen. In the 3rd century Antillus entered crossing of sinews into treatment of deformations. In 1641 Mr. Isaak Minnus revived operational orthopedics after Antillus, having offered a myotomy at a wryneck, and in 1769. The park for the first time executed a resection of a knee joint. In Russia the first scientific work on operational orthopedics is performed by N. I. Pirogov (1840) who published data on an Achilles tendon tenotomy with a histologic research. Implementation at the end of the last century in medical practice of anesthesia, an asepsis, and also X-ray analysis, promoted bystry development of operational orthopedics. In 1900 I. Turner opened in St. Petersburg the first orthopedic clinic with introduction of teaching orthopedics in Army medical college.

Now the children's orthopedics is engaged in studying of an etiology and pathogeny of various inborn and acquired deformations, prevention and elimination of deformations of bodies of a support and the movement and recovery of their function at children.

Among the acquired deformations injuries of nerves and a disease of a nervous system (a polymyelitis, spastic paralysis), injuries of a skeleton and a disease (osteomyelitis, tuberculosis) give big disability. The correct and timely treatment of injuries and diseases – the main condition of the prevention of deformations of bodies of a support and the movement.

Muscle and sinews operations:

Myotomy, tenotomy – a section of muscles or sinews for the purpose of their lengthening and elimination of contractures. The myotomy is more traumatic, can be followed by bleeding and formation of a hematoma. Preference should be given to a tenotomy. The sinew can be dissectly slantwise, across and Z-shapedly.

- A tendinous myoplasty – replacement of the paralyzed muscles with healthy muscles with antagonists. It is that the sinew of not paralyzed muscle moves to other surface and is hemmed to a sinew of the paralyzed muscle or to a bone in a point of fixing of a sinew of the paralyzed muscle. The sinew should not be bent since the myodynamia will fall at the same time. It is better to carry out a sinew in the tunnel of the hypodermic cellulose providing good sliding. Examples:

At paralysis of a razgibately brush and fingers (damage of a deep branch of a beam nerve) of a beam and elbow sgibatela of a brush carry out under skin on the back of a forearm, bending around its beam and elbow edge, and connect to a sinew of the general razgibatel of fingers and sinews of a long razgibatel and abductor of the I finger.

At paralysis are transferred by the four-head of a muscle of a sinew of a two-headed and harmonious muscle to a front surface and are hemmed to a patella or a sinew by the four-head of a muscle.

At paralytic horse foot (paralysis of razgibatel) make separate change of heads of a gastrocnemius muscle on the back of foot. The matter is that heads of a gastrocnemius muscle can be divided on a median furrow on medial and lateral without disturbance of their blood supply and an innervation. According to each head allocate the related part of an Achilles tendon. Sinews via hypodermic tunnels are transferred to the back of foot, extended and fixed to tarsus bones by means of mylar tapes.

- The tendinous seam is applied at an injury of sinews and as a component of operation of lengthening of sinews after a tenotomy.