RU2021775C1 - Method for restoring motor function of hand first finger - Google Patents

Abstract

FIELD: medicine, in particular, surgery. SUBSTANCE: this method prescribes isolating tendons of second finger short extensor and long abductor muscle of first finger, passing these under palmar carpal ligament, suturing together cut-off ends, carrying out capsulodesis of carpal-metacarpal joint, additionally cutting out aponeurotic graft from aponeurosis palmaris, suturing graft on pedicle to stump of tendon of long abductor muscle of first finger, incising tendon of surface extensor of fourth hand finger at level of main phalanx, passing it under muscles of eminence of first finger and through drilled lateral osseous passage in first metacarpal bone, and then fixing it in position by osseous transplant wedges. EFFECT: prevention of contraposition of first finger of hand.

Description

 The invention relates to medicine, namely to hand surgery, and is intended to restore the motor function of the first finger of the hand with the necessary changes in the muscles of the hand after damage to the median and ulnar nerves.

 To restore the violation of the active opposition of the first finger of the hand, many different operations have been proposed that are complex, time-consuming, but most importantly, are built on the wrong positions - the use of tendons and muscles innervated by a damaged nerve (median and ulnar) for plastic surgery.

 As a prototype, a method of restoring the motor function of the first finger of the hand can be used, in which the active conduct of the first finger is restored if it is impossible to restore conduction along previously injured median and ulnar nerves.

 To implement the method, tendons of the long muscle leading to the first finger and the short extensor of the first finger are used, which are carried out in the carpal canal and sutured after being cut off with moderate tension. In addition, capsulodesis of the first carpal-metacarpal joint is performed.

 The proposed method provides restoration of the absent reduction of the first finger to the lateral surface of the second (lateral coverage) or strengthens it with its partial safety before surgery.

 However, the method does not provide opposition to the first finger, which makes it possible to restore the end (hook) grip of the first finger with 2, 3, 4 fingers, significantly improving the functionality of the hand as a whole and dramatically increasing the operability of the operated person.

 The aim of the invention is to restore the opposition of the first finger of the brush while providing sufficient power to match it with the rest of the fingers.

 The method is as follows.

 The tendon of the long muscle leading to the first finger is cut off from the attachment point, the tendon of the short extensor of the first finger is crossed at the border with the muscle abdomen, performed in the formed subcutaneous muscle channel and under the carpal ligament, capsulodesis of the 1st carpal-metacarpal joint is performed, the tendon is long of the leading finger the muscles are carried in the subcutaneous canal to the carpal ligament and the proximal carpal canal is sutured in moderate tension with the end of the tendon of the short extensor of the first finger, and its muscle second part sutured to the long first finger abductor muscle. Additionally, from the transverse incision at the base of the 4 fingers, the tendon of the superficial flexor 4 fingers is crossed, a metacarpal bone is drilled in the frontal plane 1 above the head, the cut tendon of the superficial flexor 4 fingers is held under the tenar muscles, then it is carried out in the channel of the first metacarpal bone, stretched and wedged with two bone transplant wedges at the opening in the metacarpal bone. A flap is cut out of the palmar apeneurosis, which is freely moved to the base of the first metacarpal bone, fixing with a suture to the stump of the previously cut tendon of the long muscle leading to the first finger.

 From the fourth day after the operation, taking the lancet for a while, they begin to take active, passive light movements with the first finger in the direction of its reduction, rounding and increase in the achieved opposition.

 From 6-8 days, electrostimulation of the mixed muscles begins with small current values. Longet removed in 20-22 days. Light physical labor is allowed 30-45 days after surgery.

 The application of the proposed method allows to obtain the following positive effect.

 Provides reliable opposition of the first finger and at the same time its reduction. All this makes it possible to end (pinch) grip 1-2, 1-3, 1-4 fingers and provides movements previously not available to the patient. The function of the bone as a whole is significantly improved, which is based both on the basis of objective data and the subjective opinions of patients.

 Ensuring the sliding of the displaced tendons in the natural canals (carpal) promotes a large amplitude of flexion and matching of the first finger.

 The method is applicable in the complete absence of stem conduction along the median and ulnar nerves at a low intersection (level of the palm, carpal ligament 5-6 cm above it).

 The proposed method has been successfully applied in three patients.

Claims (1)

 METHOD OF RESTORING MOTOR FUNCTION OF THE FIRST FINGER OF THE BRUSH, including stitching the dissected tendons of the short extensor of the first finger and the long abducting first finger of the muscle passed through the formed subcutaneous canals, proximal to the carpal ligament with capsulodesis of the first metacarpal joint, which is different, by ensuring the contrast of the first finger, a flap on the leg, which is sutured to the cool, is additionally cut from the palmar aponeurosis those tendon long finger abductor muscles I and severed tendon of the flexor surface IY finger carried by the thenar muscles and then placed in the bone transverse channel base I metacarpal bone with fixation tapered grafts.