RU140724U1 - TOOL FOR SURGICAL TREATMENT OF PERIPHERAL TUNNEL BRUSH SYNDROMES - Google Patents

Abstract

A tool for the surgical treatment of peripheral tunnel syndromes of the hand, consisting in the fact that it is made of a bioinert rod at the same time with a knurled handle, a rod, while the working side of the rod is curved for 5-6 cm outwards relative to the operated ligament at an angle of 160-170 °, working the end for 1.2-1.5 cm is made in the form of a hook, which has a double-edged sharpening along the inner arc, which is protected by a rigid spring V-shaped plate made of wear-resistant material with a width of 0.3-0.4 cm and a thickness of up to 0.2 see one hundred It is rigidly connected to the plate surface of the rod, and its opposite free end is in contact with the cutting edge of the hook.

Description

The proposed utility model relates to medicine, namely to orthopedics and traumatology, and can be used when performing minimally invasive surgical interventions on the hands with carpal tunnel syndrome, including using endoscopic techniques.

Among the peripheral tunnel syndromes (PTS), carpal tunnel syndrome (SZK, compression-ischemic median nerve neuropathy) occupies a significant place. In terms of frequency of occurrence, it ranks first, accounting for 45% of all PTS [Agasarov LG, “On the diagnosis of tunnel hand syndromes”. Text. / L.G. Agasarov, E.A. Chuzavkova, A.A. Maryanovsky // The attending physician. -1999.-№1, p.52 - 55], [Agasarov LG, “Tunnel syndromes: clinical and pathogenetic characteristics, diagnosis and treatment.” Text. / L.G. Agasarov, E.A. Chuzavkova // Ros.med. Journal.-1999a. Number 3. pg. 48 - 53]. The cause of SCS in 78% of cases is an incorrectly healed fracture of the radial bone in a typical place, fractures and dislocations of the wrist bones, that is, in the vast majority of cases, SCC is post-traumatic [Hand Surgery, Volkova AM, vol. 2, p. 88, 1993 ]. The palm of the allocation of SZK into an independent nosological unit is traditionally given to Western colleagues. So, M.J. McArdle in 1950, for the first time pointed out the connection of the syndrome with compression of the median nerve by the hypertrophic transverse ligament of the palm in the carpal tunnel. He also described the therapeutic tactics of dissecting this ligament for decompression of the nerve and noted its effectiveness, which was later confirmed by other doctors M.Kremer et al. (1953), R. Tanzer (1959), etc. [R. Luchetti, P. Amadio (Eds.), Carpal Tunnel Syndrome, Springer-Verlag Berlin Heidelberg 2007, History of Carpal Tunnel Syndrome, P.C. Amadio]. The history of surgical treatment of carpal tunnel syndrome goes far back to 1913, when, as a result of an autopsy of patients with bilateral atrophy of the tenar muscles, Marie and Foix proposed surgical treatment - decompression of the nerve by dissecting the transverse wrist ligament [Marie P, Foix C ( 1913) Atrophie isolee de l'eminence thenar d'origine nevritique, role du legamente anulaire anterieur du carpe dans la pathogenie de la lesion Revue. Neurol 21: 647]. Later in 1930, Learmonth first described a case of surgical decompression of the median nerve in carpal tunnel syndrome [Learmoth JR: The principle of decompression in the treatment of certain deseases of peripheral nerves. Surg. Clin. North am. 13: 905, 933]. 36 years later, in 1966, Phalen was the first to report about 439 patients who underwent 654 operations for carpal tunnel syndrome [Phalen GS (1966) The Carpal Tunnel Syndrome. Seventeen years experience in diagnosis and treatment of six hundred fifty-four hands J Bone Joint Surg 48A: 211]. This was the first major and detailed work devoted to this problem.

Despite a significant number of treatment methods for this pathology, the results do not always satisfy the patient and the doctor, because the consequence of surgical treatment is prolonged disability, a decrease in the quality of life due to relapses, incomplete and prolonged medical and social rehabilitation.

A scalpel was taken as the closest analogue of the instrument, with the help of which an open method of treating SZK is performed, which consists in performing intravenous or regional anesthesia, 4-6 cm skin access to the pathological focus - the transverse ligament of the wrist, dissection of the ligament, revision of the carpal canal and Guillon canal with ulnar stenosis nerve, layered suturing and drainage of the wound if necessary [Hand Surgery, Volume 2, AM Volkova, 1993, pp. 99-103]. With this approach, the following disadvantages of using a scalpel are noted: the possibility of significant trauma, consisting in cutting the skin over a considerable length to ensure sufficient visualization; danger of damage to the main neurovascular bundle, flexor tendons; the possibility of prolonged postoperative wound healing and marginal necrosis of the skin; a long period of postoperative rehabilitation of the patient.

Tasks: reducing the period of surgical intervention, reducing injuries, improving and simplifying the work of the surgeon, reducing the time of medical and social rehabilitation of the patient.

The essence of the method of surgical treatment of PTS is that the proposed tool is made of a bioinert rod at the same time with a knurled handle. In this case, the working side of the rod for 5-6 cm is bent outward relative to the operated ligament at an angle of 160-170 degrees, the working end for 1.2-1.5 cm is made in the form of a hook, which has a double sharp sharpening along the inner arc, which is protected by a rigid spring V-shaped plate of wear-resistant material with a width of 0.3-0.4 cm and a thickness of up to 0.2 cm, one side of the plate is rigidly connected to the end of the rod, and its opposite end is in contact with the end of the cutting edge of the hook.

Technical result: the proposed tool allows to reduce the treatment period by 45%, virtually eliminate postoperative complications, create convenience for the surgeon and the time of surgical intervention, provide a significant reduction in intraoperative trauma and the terms of medical and social rehabilitation of the patient, since this method allows you to use this model with minimally invasive surgical operations, and the curvature of the rod at the working end creates the convenience of manipulation during surgery, which greatly facilitates AET operational reception surgeon. The protection of the blade also ensures the exclusion of additional trauma to nearby tissues. The accepted sizes of the hook, the rod, the slope of the working end are justified by scientific research and confirmed in practice when testing the tool.

For a better understanding, a general view of the tool is shown in FIGS. 1 and 2, where 1 is a general view of a tool having a shaft with a knurled handle; 2 - the springy side of the protective V-shaped plate; 3 - the base of the V-shaped plate, rigidly fixed to the rod; 4-hook with double sharp sharpening; 5 - a branch of the main vessel in cross section; 6 - subcutaneous fat.

Figure 2 shows the tool in the operating state of the Node A, where 7 is the transverse ligament of the wrist.

The tool is used as follows: the patient is placed on the operating table, the upper limb is taken to 90 degrees and laid on the table. The surgical field is treated three times with an antiseptic, a tourniquet is applied to the middle third of the forearm. The fingers of the brush are moved to the position of hyperextension. On the palmar surface of the forearm in the middle of its proximal fold, form the upper access with a scalpel, a skin incision of 0.5 - 0.7 cm. Carefully enter the working tool (1) through the puncture into the subcutaneous fatty tissue (6), bypassing the anatomical formations (5), then carefully bring it under the carpal ligament (7) to the desired exit point of the instrument. This point is projected onto the skin of the brush, it is 1 cm distal to the bisector of the angle formed by a straight line running along the third interdigital gap and a straight line running along the maximum allotted first finger of the brush. The working secant part of the instrument (Node A of Figure 1) is carried out subcutaneously under the distal edge of the carpal ligament (7), is installed in the working position with the blade up (Node A of Figure 2). By cautious pressing the ligament up, lower the V-shaped protective plate (2) and expose the cutting edge of the blade (4), then smoothly pull the tool over itself, the ligament is dissected. The protective plate of the instrument (2, 3) can be lowered only by contact with a hard edge, which in this zone is only the edge of the carpal ligament (7). The tool is removed, skin incisions are sutured. The peculiarity of using this model is that it can be used both for endoscopic operations and for subcutaneous dissection of the carpal ligament (7), performed “blindly”.

In 2% of cases, subcutaneous hematomas were recorded, they were drained and replaced with an aseptic dressing with a tighter one. The elevated position of the operated limb is recommended. The next day, the postoperative field was examined again, the presence of a hematoma was not determined. Assigned activation of the fingers. In other cases, active development of the brush on the next day after surgery. The average stay of bed days is mainly 1 day, sometimes 2 days.

The proposed tool has been tested for five years on over 100 patients. The results of operations fully confirmed the noted result in the application. Testing the instrument by a surgeon showed its convenience, simplicity during sterilization, performing surgical techniques, while the time of surgical intervention was reduced by 40% -45%, the rehabilitation time was halved, the number of postoperative complications decreased by 70% -75%.

The tool on a serial scale in the manufacture does not require significant material costs and is recommended for widespread use in practical health care.

Example 1. Patient Mironenko LF, born in 1952 Case history No. 3693. Received in General Clinical Hospital No. 3 on January 19, 2006 with a diagnosis of Post-traumatic compression-ischemic neuropathy of the median nerve in the carpal canal of the left hand. On the same day, an endoscopic ligamentotomy of the left hand retinaculum flexorum was performed using the proposed utility model. The patient was laid on the operating table, the left upper limb was taken to 90 degrees and laid on the table. We treated the surgical field three times with an antiseptic, put a tourniquet on the middle third of the left forearm. The fingers of the hand were taken to the position of hyperextension. On the palmar surface of the forearm in the middle of its proximal fold, the upper access was formed with a scalpel, a skin incision of 0.5 cm.Gently through the puncture, the working tool (1) was inserted into the subcutaneous fat (6). Next, the working secant part of the instrument (Unit A of Figure 1) was carefully brought under the distal edge of the carpal ligament (7) to the desired point of its exit, setting the blade up in the working position (Unit A of Figure 2). By careful pressure on the ligament, the V-shaped protective plate (2, 3) was lowered and the cutting edge of the blade (4) was exposed, then the tool was pulled smoothly onto itself, the latter was dissected. Stitches on the wound. The operation was successful. Discharged on January 20, 2006 with moderate swelling of the left hand. The pain syndrome is completely stopped. Healing by first intention. Sutures were removed on the 10th day after surgery. Long-term relapses due to this pathology were not detected.

Example 2. Patient Velichko V.Ya., born in 1943 The medical history No. 22755. He entered the General Clinical Hospital No. 3 on 05/05/2006 with a diagnosis of "Compression-ischemic neuropathy of the median nerve in the carpal tunnel on the right." On the same day, she performed an operation - endoscopic ligamentotomy of the right hand retinaculum flexorum using this tool. The patient was laid on the operating table, the right upper limb was taken to 90 degrees and laid on the table. We treated the surgical field three times with an antiseptic, put a tourniquet on the middle third of the right forearm. The fingers of the hand were taken to the position of hyperextension. On the palmar surface of the forearm in the middle of its proximal fold, the upper access was formed with a scalpel, a skin incision of 0.5 cm.Gently through the puncture, the working tool (1) was inserted into the subcutaneous fat (6). Next, the working secant part of the instrument (Unit A of Figure 1) was carefully brought under the distal edge of the carpal ligament (7) to the desired point of its exit, setting the blade up in the working position (Unit A of Figure 2). By careful pressure on the ligament, the V-shaped protective plate (2, 3) was lowered and the cutting edge of the blade (4) was exposed, then the tool was pulled smoothly onto itself, the latter was dissected. Stitches on the wound. Swelling of the right hand is moderate, pain is completely stopped. Discharged for outpatient treatment in satisfactory condition on May 6, 2006. Healing by first intention. Sutures were removed on the 12th day after surgery. Long-term postoperative results are satisfactory, no relapse.

Claims (1)

A tool for the surgical treatment of peripheral tunnel syndromes of the hand, consisting in the fact that it is made of a bioinert rod at the same time with a knurled handle, a rod, while the working side of the rod is curved for 5-6 cm outwards relative to the operated ligament at an angle of 160-170 °, working the end for 1.2-1.5 cm is made in the form of a hook, which has a double-edged sharpening along the inner arc, which is protected by a rigid spring V-shaped plate made of wear-resistant material with a width of 0.3-0.4 cm and a thickness of up to 0.2 see one hundred It is rigidly connected to the plate surface of the rod, and its opposite free end is in contact with the cutting edge of the hook.

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