RU2421169C1 - Method of treating flexion-extension contracture of fingers - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics. Flexion contracture is eliminated by dissection of pathologically changed aponeurosis on palm and fingers from two-level transversal skin incision and palm aponeurosis to subaponeurotic space. The first incision is made in middle part of palm on entire length of aponeurosis. The second incision is made parallel to the first one in distal part of palm on the width of degenerated cords. With additional oblique incision transversal incisions are connected and degenerated aponeurosis cords are dissected on palm. Longitudinal incision is made from distal transversal incision on palm to middle phalanx, on middle line of finger, which is in maximal flexion contracture. Finger-wide shaped incision is made, degenerated cords on it are dissected. In order to eliminate extension contracture, capsule of distal interphalangeal joint on finger back between lateral parts of extension apparatus is cut. Redressment of joint is performed. Nail phalanx is fixed transarticularly by means of wire in functionally favourable position at angle of 160 degrees. ^ EFFECT: method makes it possible to restore functions of fingers in full volume, reduce treatment terms. ^ 1 ex, 5 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and is intended for the treatment of patients with Dupuytren's contracture of the fingers.

The treatment of Dupuytren's contracture is reduced to eliminating the deformation and restoring the function of the hand.

Most domestic and foreign authors in achieving this goal prefer an operative method of treatment, which involves excising a pathologically altered palmar aponeurosis and eliminating the flexion contracture of the fingers [1].

However, in cases of the extension of the nail phalanx during Dupuytren's contracture of the fingers, the elimination of flexion contracture after excision of the pathologically altered palmar aponeurosis does not lead to the elimination of the extension of the nail phalanx, and after this operation, patients are dissatisfied, since when bent into the fist, the tip of the over-extended finger will not be extended into a palm.

The prototype of the claimed method is a “Method for the treatment of flexion contracture of fingers” [2]. In order to restore the function of the hand on the palm, a two-level cross-section of the skin and palmar aponeurosis is performed to the subaponeurotic space. The first is in the middle part of the palm, the entire width of the aponeurosis, with the elimination of flexion contracture by extension of the bent fingers to a possible angle. The second incision parallel to the first is made in the distal part of the palm to the width of the degenerated cords with the further elimination of contracture of the fingers in the metacarpophalangeal joints. An additional oblique incision connects the transverse incisions, excises the degenerate aponeurosis strands in the palm of the hand, and makes a longitudinal incision from the distal transverse incision in the palm to the middle phalanx along the midline of the finger, which is in maximum flexion contracture. Make a shaped incision to the width of the finger, excised degenerate cords on it, skin wounds are sutured by moving the skin flaps. The disadvantage of this method is that the extensor contracture of the finger in the distal interphalangeal joint cannot be eliminated, because of which the function of the finger suffers, since the tip of the overextended finger does not rest on the palm of the hand when bent.

The invention consists in a combination of features sufficient to achieve the desired technical result, consisting in a significant reduction in treatment time and restoration of the patient's ability to work by reducing the stages of the operation.

The aim of the invention is to restore the function of the finger of the hand by eliminating the pronounced extensor contracture of the finger in the distal interphalangeal joint.

The essence of the invention lies in the fact that a method of treating flexion-extensor contracture of the fingers includes the elimination of flexion contracture by excision of a pathologically altered aponeurosis in the palm and fingers from a two-level cross-section of the skin and palmar aponeurosis to the subaponeurotic space. The first dissection is in the middle part of the palm over the entire width of the aponeurosis. The second incision parallel to the first is made in the distal part of the palm to the width of the degenerated cords. An additional oblique incision connects the transverse incisions and excises the reborn aponeurosis cords in the palm of the hand. A longitudinal incision is made from the distal transverse incision in the palm of the hand to the middle phalanx along the midline of the finger, which is in maximum flexion contracture. Make a shaped incision to the width of the finger, excised reborn cords on it. To eliminate extensor contracture, a capsule of the distal interphalangeal joint is dissected on the back of the finger, between the lateral portions of the extensor apparatus, the joint is reduced, the nail phalanx is fixed transarticularly with a spoke in a functionally advantageous position at an angle of 160 degrees. Stitches on the wound. Limberg skin grafting on a finger.

Dissection of the capsule of the distal interphalangeal joint on the back of the finger, between the lateral portions of the extensor apparatus, with joint reduction and fixation of the nail phalanx transarticularly with a spoke in a functionally advantageous position at an angle of 160 degrees provides the full amount of flexion of the fingers. The application of the proposed method allows to eliminate the pronounced extensor contracture of the finger in the distal interphalangeal joint (DMFS).

The method is illustrated by drawings.

View of the hand before surgery: figure 1 - from the palmar surface; figure 2 - from the elbow side. View of the brush after surgery: figure 3 - from the palm; figure 4 - position of the 5th finger after elimination of the flexion-extensor contracture; figure 5 is a side view of the brush.

The method is as follows. After appropriate treatment of the skin of the hand under regional anesthesia, Sol.Lidocaini 2% -30 ml eliminates flexion contracture by excising pathologically altered aponeurosis in the palm and fingers from a two-level cross-section of the skin and palmar aponeurosis to the subaponeurotic space. The first dissection is performed in the middle of the palm of the entire width of the aponeurosis. The second incision parallel to the first is made in the distal part of the palm to the width of the degenerated cords. An additional oblique incision connects the transverse incisions and excises the degenerated aponeurosis strands in the palm of the hand, and makes a longitudinal incision from the distal transverse incision in the palm to the middle phalanx along the midline of the finger, which is in maximum flexion contracture. Make a shaped incision to the width of the finger and excised reborn cords on it. Eliminate extensor contracture of the nail phalanx of the finger after dissecting the capsule of the distal interphalangeal joint on the back of the finger, between the lateral portions of the extensor apparatus, with joint reduction. The nail phalanx is fixed transarticularly with a spoke in a functionally advantageous position at an angle of 160 degrees. Stitches on the wound. Limberg skin grafting on a finger. Palmar gypsum splint. Medication and physiotherapy.

Clinical example.

Patient K-va, born in 1945, medical history No. 7076, TSHPU-guard, was admitted to the wrist department of the SRTT “WTO” on November 13, 2008 with a diagnosis of Dupuytren's contracture 4 fingers of the II degree, 5 fingers - III degree of the left hand , nail phalanx of the 5th finger in the hyperextension position (see Fig. 1-2). Operation 11/13/08. After appropriate treatment of the skin of the hand under regional anesthesia of Sol.Lidocaini 2% -30 ml with transverse incisions in the distal palmar fold, wedge-shaped incised incisions of the first order aponeurosis are wedge-shaped to 3-4-5 fingers. L-shaped incision on the 4th finger and, according to Limberg, on the 5th finger, the degenerated cords of the second order aponeurosis are isolated and excised, which eliminates the flexion contracture of the fingers. The pronounced extensor contracture of the 5th finger in DMFS is eliminated by dissecting the capsule of the distal interphalangeal joint on the back of the finger between the lateral portions of the extensor apparatus with redress. After eliminating the extensor contracture of the finger in DMFS, the nail phalanx is fixed transarticularly with a spoke in a functionally advantageous position at an angle of 160 degrees (see Figs. 3-4-5). Hemostasis during the operation; seams on the skin, local skin plastic according to Limberg on the 5th finger, rubber graduates, aseptic dressing, palmar plaster splint before removing the stitches, fixing the nail phalanx with a knitting needle for 4 weeks.

The postoperative period in patients with Dupuytren's contracture, operated on by the proposed method, is common for patients in this category.

Information sources

1. L.N. Bryantseva. Dupuytren's contracture. Leningrad, 1963, pp. 43-44.

2. RF patent No. 2343867.

Claims (1)

A method of treating flexion-extensor contracture of the fingers consists in removing the flexion contracture by excising a pathologically altered aponeurosis in the palm and fingers of a two-level cross-section of the skin and palmar aponeurosis to the subaponeurotic space, the first in the middle part of the palm, the entire width of the aponeurosis, the second the incision, parallel to the first, is made in the distal part of the palm to the width of the degenerated cords, an additional oblique incision connects the transverse incisions The degenerated aponeurosis strands in the palm of the hand are excised, a longitudinal incision is made from the distal transverse incision in the palm of the hand to the middle phalanx along the midline of the finger located in the maximum flexion contracture, making a shaped incision to the width of the finger, the degenerated strands are excised on it, characterized in that to eliminate extensor contracture dissect the capsule of the distal interphalangeal joint on the back of the finger between the lateral portions of the extensor apparatus, produce a joint reduction, fix the nail ph langu transarticularly with a knitting needle in a functionally advantageous position at an angle of 160 °.

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