RU2729716C1 - Method of fingers interstitial pressure measurement - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to surgery. Two points are marked on an affected phalanx which are points of injections for invasive measurement of interstitial pressure. On palmar surface along distal edge of interphalangeal and/or metacarpophalangeal folds in projection of edge of flexor tendons, and on rear surface in projection of distal edge of collateral ligament of metacarpophalangeal and/or interphalangeal joint along lateral or medial edge of extensors of finger extensors. Needle is pricked in a distal direction at an acute angle; after the puncture of the skin, the needle is introduced into the subcutaneous tissue in parallel to the bone and readings are taken from the manometer. Measurement is performed on back surface and palmar from any suggested point.EFFECT: invention can be used in surgical management of patients with finger injuries accompanied by acute tissue hypertension syndrome (ATHS).1 cl, 4 dwg, 1 ex

Description

The invention relates to medicine, namely to surgery, and can be used in the surgical treatment of patients with injuries to the fingers of the hand, accompanied by acute tissue hypertensive syndrome (OTGS).

OTGS is an acute pathological condition in which there is an increase in interstitial pressure in the fascial sheath, which leads to compression of blood vessels and nerves, tissue ischemia and, ultimately, necrosis. Depending on the severity of the development of the pathological process in the tissues, the outcome of the disease can be different - from minimal functional disorders to loss of a limb or even death. Irreversible changes in tissues occur in the next few hours from the moment of occurrence of OTGS, therefore its early diagnosis is a primary task for a doctor. Currently, there are no clear criteria, clinical guidelines for the diagnosis of OTGS. The clinical picture, anamnesis of trauma are taken into account, and only after a preliminary diagnosis of OTGS is instrumental invasive confirmation possible by measuring the interstitial pressure.

When OTGS occurs in the muscle-fascial cases of the upper or lower extremities, there are techniques for measuring pressure by introducing a needle connected to a manometer into muscle tissue. When the pressure rises above 35 mm Hg. the diagnosis of OTGS is established and surgical treatment is carried out, which consists in a wide dissection of the skin and fascial sheaths to create tissue decompression.

The anatomical feature of the fingers is the absence of muscles; therefore, the synovial sheaths of the flexors and extensors of the fingers, tendons, fascia and subcutaneous tissue with the skin are the substrate for the occurrence of OTGS, which complicates the measurement of interstitial pressure, in contrast to the measurement of interstitial pressure in the muscle-fascial sheath. In modern domestic and foreign literature, there is no description of the technique for measuring the interstitial pressure of the fingers.

Thus, improving the results of treatment of patients with OTGS of fingers of the hand remains an urgent surgical task.

There is a known method for measuring the interstitial pressure of the thenar hand, including invasive measurement with an 18 G needle connected to a manometer. (Hand Clin. 2018 Feb; 34 (1): 41-52.)

The known method is as follows.

After processing the operating field, a needle connected to the manometer is injected into the muscle-fascial case of the thenar, after which the readings of the interstitial pressure are taken, but this method does not allow diagnosing the OTGS in the fingers of the hand.

From the field of technology, no close analogue to the claimed technical solution has been identified.

The technical result of the proposed method is to provide the possibility of direct measurement of interstitial pressure in the fingers of the hand in the diagnosis of OTGS.

The technical result is achieved in that the method for measuring interstitial pressure in the phalanges of the fingers of the hand includes marking the injection points on the palmar surface along the distal edge of the interphalangeal and / or metacarpophalangeal fold in the projection of the edge of the flexor tendons of the fingers, and on the dorsum in the projection of the distal edge of the collateral ligament metacarpally -phalangeal and / or interphalangeal joint along the lateral or medial edge of the extensor tendons of the fingers. After that, the needle is injected in the distal direction at an acute angle, after puncturing the skin, the needle is inserted into the subcutaneous fat tissue parallel to the bone and the readings are taken from the manometer. Measurement is made on the dorsum and palmar from any suggested point.

Marking the injection points on the palmar and dorsal surfaces avoids damage to the anatomically important structures of the fingers (arteries, nerves, tendons and synovial sheaths) and the spread of infection.

The proposed method for measuring interstitial pressure makes it possible to accurately diagnose OTGS in the fingers of the hand, where there is no muscle-fascial sheath.

The essence of the applied method is illustrated by drawings, where schematically in FIG. 1 shows the palmar and dorsum of the hand; in FIG. 2 the needle is inserted in the distal direction at an acute angle; in FIG. 3 shows the back surface of the hand and the needle for measuring interstitial pressure is inserted into the subcutaneous tissue, FIG. 4 shows the palmar surface of the hand and the needle for measuring interstitial pressure is inserted into the subcutaneous adipose tissue

The method of measuring the interstitial pressure of the phalanges of the fingers of the hand is carried out as follows. Points are marked on the affected phalanx - these are the injection sites for invasive measurement of interstitial pressure, on the palmar surface along the distal edge of the interphalangeal and / or metacarpophalangeal fold in the projection of the edge of the flexor tendons of the fingers, and on the dorsum in the projection of the distal edge of the collateral projection of the metacarpophalangeal ligament / or interphalangeal joint along the lateral or medial edge of the extensor tendons of the fingers. After that, the needle is injected in the distal direction at an acute angle, after puncturing the skin, the needle is inserted into the subcutaneous fat tissue parallel to the bone and the readings are taken from the manometer. Measurement is made on the dorsum and palmar from any suggested point.

This method was applied in 17 patients in the period from 2018 to 2019. In 9 patients, an increase in interstitial pressure above 30 mm Hg was diagnosed. and decompression was performed, in 5 patients - from 20 to 30 mm Hg, in 3 patients - less than 20 mm Hg - these patients did not undergo decompression.

The method is illustrated by the following clinical example.

Patient I., 56 years old, was being treated in the surgical department of the FKU "TsVKG im. P.V. Mandryk "of the Ministry of Defense of the Russian Federation with a diagnosis of" osteoarticular panaritium of the proximal phalanx of the second finger of the left hand. " Considers himself sick for about 2 weeks, when he injured his finger in everyday life. I did not go to the doctor. In connection with increased pain in the second finger of the left hand, he turned to the surgeon of the polyclinic and was referred for inpatient treatment. Upon admission, the condition is satisfactory. Locally: visually in the region of the middle phalanx of the second finger of the left hand, hyperemia, swelling, local hyperthermia, painful palpation are determined. The osteoarticular panaritium of the second finger of the left hand was diagnosed. Before the operation, the needle puncture points were marked on the proximal phalanx of the second finger of the left hand to measure interstitial pressure. Interstitial pressure was measured on the dorsum and palmar surface. The result is 35 mm and 37 mm, respectively, of mercury. Acute tissue hypertensive syndrome was diagnosed. In addition to the operation (debridement, necrectomy, drainage), decompression incisions were performed along the lateral surfaces of the proximal phalanx of the second finger of the left hand. The wound healed by secondary intention. Discharged with recommendations under the supervision of a polyclinic surgeon. Control examination after 1 month. No complaints.

Claims (1)

A method for measuring interstitial pressure in the phalanges of the fingers on the dorsum and palmar, including marking points on the palmar surface along the distal edge of the interphalangeal and / or metacarpophalangeal fold in the projection of the edge of the flexor tendons of the fingers, and on the dorsum in the projection of the distal edge of the collateral metacarpal ligament phalangeal and / or interphalangeal joint along the lateral or medial edge of the extensor tendons of the fingers, after which the needle is injected in the distal direction at an acute angle, after puncturing the skin, the needle is inserted into the subcutaneous fat tissue parallel to the bone and the readings are taken from the manometer.

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