TENODESIS (tenodesis; Greek tenon a sinew, a vein + desis binding) — the operation consisting in stabilization of a joint in functionally advantageous position by restriction of its mobility by means of sinews. Sinews fix to the bones forming a joint; thus they play a role of additional ligaments of joint.
The indication to T. paralysis or injury of muscles, recovery of function is to-rykh it is impossible. It can be applied at the isolated injury of sinews of a deep sgibatel of one of fingers of a brush to stabilization of a distal interphalangeal joint. Most often T. make at the paralytic drooping foot owing to injury of a spinal cord or peripheral nerves (sciatic, general fibular), at effects of poliomyelitis.
T. an ankle joint and front department of foot carry out generally by V. D. Chaklin's method. Under intra bone anesthesia by a slit on a front surface of the lower third of a shin bare and cross sinews of a front tibial muscle and long razgibatel big and other fingers of foot. In front department of a tibial bone 5 cm higher than an ankle joint drill two cross channels. Via the lower channel by means of the tendinous conductor or Deshan's needle spend the free end of a sinew of a front tibial muscle and, holding foot in the provision of a dorsiflexion, hem it with a tension to distal department of a joint. Via the second channel carry out sinews of a long razgibatel of fingers, to-rye sew at a tension with a sinew of a long razgibatel of a thumb. The wound is sewn up and the extremity is immobilized a plaster bandage on 4 weeks, then on 2 weeks — a removable back splint.
The thinned sinews of the paralyzed muscles quite often in connection with stretching lose ability to fixing. Therefore it is reasonable to use for T. an ankle joint allotransplant from a sinew of a fibular muscle. For carrying out such operation by a slit bare the lower third of a tibial bone, in to - a sort drill the cross channel. Then make cuts on the outer edge of foot at the basis of the V plusnevy bone and at the level I of a tarsal (plusneklinovidny) joint — on an inner edge of foot. Through the bases of all plusnevy bones drill the cross channel and enter into it allotransplant. The ends carry out it subcutaneously kpered from anklebones and remove in shin wound. One of the ends of a sinew is stretched via the bone channel, foot is given the provision of a dorsiflexion and the ends of a sinew are sewed among themselves with the maximum tension. Sinews under skin are sewed among themselves (see. Tendinous seam ) at the level of an ankle joint. Operation yields resistant favorable result.
See also Sinews .
Bibliography: Danilova L. A. Transwasps-grease gomotenodez at drooping paralytic ст©пе, in book: A homoplasty in travmat. and the orthoitem, under the editorship of A. P. Vereshchagin, page 170, L., 1972; Degtyareva S. I. A method of stabilization of a nail phalanx at the isolated injury of sinews of deep sgibatel of fingers of a brush, in book: Aktualn. vopr., travmat. and the orthoitem, under the editorship of M. V. Volkov, century 1, page 17, M., 1970; H and to l and V. Dy's N Orthopedics, book 1, page 75, M., 1957.
L. N. Bryantseva.