RU2495640C1 - Method of tendon endoprosthetics of finger deep flexor muscle - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology-orthopedics, in particular to hand surgery. Method includes ablation of remnants of flexors on finger, bouginage of ginglymoid ligaments of finger, laying tendon endoprosthesis and its fixation. Only distal end of tendon endoprosthesis is fixed to nail phalanx, and its proximal end is freely laid to the level of middle third of palm in preliminarily formed longitudinal canal in soft tissues of palm. Finger is flexed, and free end of prosthesis on palm must move in proximal direction, with extension of finger - movement in reverse, distal, direction. Proximal ends of damaged flexors are sutured together and fixed to canal wall at the level of middle third of palm.

EFFECT: method makes it possible to form full value canal for tendon plasty.

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Description

The invention relates to medicine, namely to traumatology - orthopedics and hand surgery.

The well-known "Method of two-stage tendoplasty of the flexors of the fingers" [1], in which at the first stage a silicone prosthesis is placed in the tendon bed of the damaged deep flexor, the ends of which are fixed distally to the nail phalanx, proximal to the distal end of the damaged flexors at the palm level. However, in the process of functioning of the flexor tendons, the prosthesis breaks off from the fixation site to the nail phalanx, or it breaks at any level. At the same time, due to traction of the flexor tendons, the torn proximal part leaves in the direction of the forearm. The resulting prosthesis defect is quickly filled with scar tissue, the fixed ends of the prosthesis become motionless, like a rod, become like spacers on the palmar surface of the operated finger, which prevents even passive bending of the finger. Such a forced position of the finger leads to the restriction of movements in the interphalangeal and metacarpophalangeal joints, the development of extensor contracture of the finger, which makes it meaningless to perform the second stage of tendoplasty.

The essence of the invention lies in the combination of distinctive features sufficient to achieve the desired technical result, which consists in actively forming a full-fledged tendon channel not only on the finger, but also on the palm, which provides the possibility of subsequent tendoplasty of the deep flexor, prevents the development of extensor contractures of the finger, "pulling" of the tendon and scarring of the flexor muscles of the damaged finger.

The essence of the invention lies in the fact that the method of tendon arthroplasty of the deep flexor of the finger includes the removal of the remains of the flexors on the finger, bougie blocking ligaments of the finger, laying the tendon endoprosthesis and fixing it. Only the distal end of the tendon endoprosthesis to the nail phalanx is fixed, and its proximal end is freely placed up to the level of the middle third of the palm in a preformed longitudinal channel in the soft tissues of the palm. The finger is bent, while the free end of the prosthesis on the palm should move in the proximal direction, when the finger is extended, it should move in the opposite, distal direction, the proximal ends of the damaged flexors are sutured together and fixed to the channel wall at the level of the middle third of the palm.

Fixing only the distal end of the tendon silicone prosthesis to the nail phalanx provides the possibility of reciprocating movement of the prosthesis during flexion or extension of the finger, which contributes to the active formation of the tendon channel from the tip of the finger to the middle third of the palm.

The free laying of the proximal end of the prosthesis to the middle third of the palm in the formed soft tissue channel contributes to the formation of the channel not only on the finger, but also on the hand, and also provides the free end of the silicone prosthesis with the possibility of complete passive flexion and active extension of the finger due to longitudinal reciprocating movements.

Visual fixation of the movement of the free end of the prosthesis on the palm during flexion and extension of the finger serves as a check of the correct placement of the prosthesis.

Stitching of the proximal ends of the superficial and deep flexors and their fixation at the level of the middle third of the palm against the canal wall preserves the muscle tone of the damaged tendons, prevents the tendon from “jerking” and wrinkling, and also contributes to the maximum preservation of the maximum length of damaged flexors, which is necessary, subsequently, for tendoplasty lost deep finger flexor.

The method is illustrated by photographs, where in FIG. 1 shows a view of a brush before surgery; figure 2 - fixing the distal end of the prosthesis to the nail phalanx of the finger; figure 3 - laying the proximal end of the tendon prosthesis at the palm level; figure 4 is a view of the brush after surgery;

The method is as follows.

After anesthesia, from the lateral wave-like access, the remains of the flexor tendons are removed on the finger. By bougieu restore the lumen of the block-like ligaments on the finger. A silicone tendon prosthesis is placed in the tendon bed of the finger. The distal end of the prosthesis is fixed with an immersion suture to the remains of the deep flexor on the nail phalanx. The prosthesis is carried out through the block-like ligaments of the finger, and its proximal end is laid, in a preformed, longitudinal channel in the soft tissue of the hand, at the level of the middle third of the palm. To verify the correct placement of the prosthesis, the finger is bent, while the free end of the prosthesis moves along the palm of the hand in the proximal direction; when the finger is extended, the proximal free end of the prosthesis moves in the palm of the hand in the opposite direction. The proximal ends of the finger flexors are sutured together and fixed to the channel wall in the middle third of the palm. Wounds are sutured tightly. Alcohol dressing. Gypsum. Skin sutures for 14 days.

Clinical example.

Patient A-va, 53 years old, medical history No. 15426, 05/21/2012, was admitted to the traumatology department No. 2 GAUZ RKB MH RT with a diagnosis of chronic damage to the flexors of 4 fingers of the right hand for 5 months. prescription. From the anamnesis: 5 months ago I cut my hand with a knife. In the district hospital, a primary tendon suture was applied, but after 4 weeks the tendon suture failed. The finger has ceased to actively bend (Fig. 1). 05/23/2012, in the trauma unit No. 2 GAUZ RKB MH RT, the patient underwent surgery according to the method described above. After anesthesia, the remains of the flexor tendons on the damaged finger were removed from the lateral wave-like access, and the lumen of the block-like ligaments on the finger was restored by bugging. A silicone tendon prosthesis was placed in the tendon bed of the finger. The distal end of the prosthesis was fixed with immersion thread to the remains of the deep flexor on the nail phalanx. The prosthesis on the finger was passed through the block ligaments of the finger, and its proximal end was laid in the longitudinal channel at the level of the middle third of the palm, previously formed in the soft tissues of the hand. The correct placement of the prosthesis was checked as follows: when bending the finger, the free end of the prosthesis moves in the proximal direction along the palm of the hand; when the finger is extended, the proximal free end of the prosthesis moves in the opposite, distal, direction along the palm, i.e. the prosthesis in the channel makes reciprocating movements synchronous to the process of flexion-extension of the finger. The proximal ends of the finger flexors were stitched together and fixed to the channel wall in the middle third of the palm. The wound was sutured tightly. Alcohol dressing. Gypsum. Skin sutures for 14 days.

Thus, the proposed method of tendon endoprosthetics of the deep flexor of the finger of the hand promotes the active formation of a full-fledged tendon channel not only on the finger, but also on the palm, prevents the development of extensor contractures of the finger, optimizes the conditions for subsequent tendoplasty of the deep flexor, prevents “pulling” of the tendon and scarring of the muscles flexors of the damaged finger.

Information sources

1. RF patent №2138214, BIPM No. 27, 1999, p. 155.

Claims (1)

A method of tendon endoprosthetics of a deep flexor of the finger of a finger, including removing residual flexors on the finger, bougie blocking ligaments of the finger, laying of the tendon endoprosthesis and its fixation, characterized in that only the distal end of the tendon endoprosthesis is fixed to the nail phalanx, and its proximal end is freely laid to the level thirds of the palm into the preformed longitudinal channel in the soft tissue of the palm, bend the finger, while the free end of the prosthesis in the palm should move sya in the proximal direction during extension finger - moving in reverse, distal, direction, the proximal ends of the damaged flexor sewn together and fixed to the wall of the channel at the level of the middle third of the palm.

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