SHPRYONGELYA the DISEASE (O. K.
Sprengel, is mute. surgeon, 1852 — 1915; synonym: inborn high standing of a shovel, Shprengel's deformation which did not go down a shovel) — the malformation of a musculoskeletal system consisting in unusually high standing of a shovel is more often on the one hand that is followed by cosmetic defect and dysfunction of a shoulder girdle.
It is for the first time described by Eylenburg (M. M. Eulenburg) in 1863. In 1891 Mr. Shprengel allocated this malformation as a separate nosological form.
Frequent combination of III. with other malformations of a musculoskeletal system (wedge-shaped vertebrae, an union of vertebrae, defects of edges, a wryneck, etc.) give the grounds to carry Sh. to number of primary inborn deformations, to-rye are result of the disturbances which arose in the early period of an embryogenesis.
Main wedge, Sh.'s sign. consists that one of shovels is located above another on
6 — 8 cm, is reduced in sizes, it is deformed and turned around a sagittal axis. At the same time the bottom
corner of a shovel approaches a backbone, the lateral edge is inclined from top to bottom, the upper corner is located on lateral face of a neck that results in asymmetry of nadplechiya: on the party of deformation a shoulder girdle
of Fig. The girl of 5 years with a disease Shprengelya (contours of both shovels are led round by solid lines): and — the left shoulder-blade is located above right, reduced in sizes, displaced to a backbone, on the party of defeat the shoulder girdle is located above, than on the healthy party; — the same girl with the raised hands (sharply bounded function of the left shoulder joint).
it is located above, than on the healthy party (fig., a). At Sh., in addition to cosmetic defect, considerable restriction of movements of a hand owing to insufficient mobility of a shovel and a clavicle is noted (fig., b). Bilateral high standing of shovels meets seldom.
The main method of treatment — operational bringing down of a shovel. Conservative therapy has auxiliary character; it includes to lay down. gymnastics and massage for development at the child of a correct posture, strengthening of muscles of a shoulder girdle.
It is reasonable to carry out bringing down of a shovel in 5 — 6-year age, to emergence of secondary deformations and dysfunction of a shoulder girdle. More than 20 ways of operational bringing down of a shovel and its fixing on the new place are offered. The first attempt to reduce a shovel was made by V. Putti in 1908. Its method consisted in release of a shovel from surrounding muscles from the upper and medial party and fixation of a bottom corner to the VII—VIII edges. In the subsequent the additional section of muscles, an osteotomy of an akromion and a coracoid of a shovel, clavicle, a resection of a part of a shovel were made for simplification of process of bringing down of a shovel. Injury, frequent developing of paralyzes of an upper extremity, insufficient efficiency of operation were common faults of all these operations.
S. D. Ternovsky in 1955 offered operation, at a cut bringing down of a shovel is made after
release of upper and medial its edges from surrounding muscles and an osteotomy of a coracoid. The modification of this operation offered by V. L. Andrianov (1964) is that instead of skeletonization of a shovel make lengthening of the trapezoid, rhomboid and raising a shovel muscles. The front gear muscle is cut above from medial edge of a shovel, and below — at the place of an attachment to edges. After movement of a shovel to the new place both rags are sewed that excludes need for an additional scapulopexy to an edge.
In the postoperative period paresis of an upper extremity owing to damage of a brachial plexus at rough bringing down of insufficiently mobilized shovel is possible.
The forecast for life favorable; after operational treatment the form and function of a shoulder girdle improve, especially at regular to lay down. to gymnastics.
Bibliography: M. V. and
De Dov V. D wolves. Children's orthopedics, page 79, M., 1980; Ternovsky S. D. New modification of operation at inborn high standing of a shovel, Ortop. and travmat., No. 4, page 3, 1959; Eulenburg M. M. Hochgradige Dislocation der Scapula, Arch. klin. Chir., Bd 4, S. 304, 1863; Sprengel O. G. K. Die angeborene Verschiebung des Schulter-blattes nach oben, ibid., Bd 42, S. 545, 1891. JI. I. Samoylova.