RU2246913C1 - Method for removing thumb's adducting contracture - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: the present innovation deals with treating aftereffects of wrist's defects. One should cross muscular tendon of thumb's short extensor at the border with muscular part. Tendon of long thumb-abducting muscle should be resected for 5-6 cm being proximally against fixation level. One should conduct tenodesis in position of thumb's contrasting, suture up the distal tendinous end of long thumb-abducting muscle to tendon of wrist's radial extensor. Distal tendinous end of thumb's short extensor should be applied through carpal canal to be sutured with proximal tendinous end of long thumb-abducting muscle. The present method enables to increase grasping function, thumb's stability in opposition position and decrease traumaticity.

EFFECT: shortened duration of postoperational treatment.

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Description

The invention relates to medicine, in particular to traumatology and orthopedics in the treatment of the effects of injuries of the hand, and is intended to restore the opposition (opposition) of the I finger of the hand with irreversible changes in the muscles after damage to the median and ulnar nerves, as well as with cicatricial changes in flexor tendons.

Several methods of treating this pathology are known [1]. Some of them suggested the transplantation of tendons of superficial flexors of other fingers on the 1st finger of the hand, others, when it is impossible to apply methods of restoring active movements of the thumb, stabilizing operations (synostosis between the 1st and 2nd metacarpal bones). The most effective, according to the author [1], are the operations proposed by A. Steindler and M. Makin, and its modifications.

The first is to dissect the tendon of the long flexor of the thumb into two parts, starting from the level of the interphalangeal joint to the base of the 1st metacarpal bone, the radial part is cut off from the attachment site, carried out in the subcutaneous fat and sutured subperiosteally, on the dorsal-ulnar side to the base the main phalanx of the 1st finger. In the long-term results of postoperative treatment, the strength and range of the tendon excursions of the long flexor of the thumb are not always sufficient to ensure the opposition of the 1st finger and grasping hand function.

The second method consists in oblique osteotomy of the main phalanx of the 1st finger in the frontal plane, passing through the gap between the tendon fragments of the long flexor of the thumb to the back of the distal phalanx. The place of attachment of the tendon is maintained, the distal phalanx takes a flexion position, bone fragments are fixed with a Kirschner spoke. The disadvantage is the loss of active movements of the nail phalanx, the invasiveness of the operation, and there may also be a long nonunion of fragments after an osteotomy of the main phalanx of the 1st finger.

The closest, in essence, to the proposed one, is a method of restoring the motor function of the 1st finger of the hand, which we adopted as a prototype [2]. The method (prototype) consists in crossing the tendon of the short extensor of the I-th finger on the border with the muscle part, cutting off the tendon of the long abducent I-th finger of the muscle from the place of its attachment, forming channels in the tenor muscles, passing tendons through them under the carpal ligament and connecting them proximal to it, additionally, capsulodesis of the 1st metacarpal carpal joint is performed in the position of opposition of the 1st finger. Capsulodesis of the 1st metacarpal carpal joint in the opposition position of the 1st finger, based on our experience, does not provide sufficient stability of the thumb in the opposition position and relapse often occurs (leading contracture).

Thus, the previously proposed methods are characterized by trauma, the duration of postoperative treatment, and, in addition, lack of effectiveness.

The technical result consists in eliminating the leading contracture of the 1st finger, increasing the grip function and stability of the 1st finger in the opposition position, and as a result, reducing trauma, the duration of postoperative treatment, increasing its effectiveness, improving long-term results.

The technical result of the invention is achieved by the fact that the tendon of the long abducent I-th muscle finger is cut off 5-6 cm proximal to the attachment level, tenodesis is performed in the position of opposition of the I-th finger of the hand, by suturing the distal end of the tendon with the long abduction I-th muscle finger to the tendon radial flexor of the hand; the distal end of the tendon of the short extensor of the 1st finger is passed through the carpal canal, after which its end is sutured with the proximal end of the tendon of the long decaying 1st finger of the muscle using one of the known methods.

The method is as follows: a shaped section along the dorso-radial surface of the I-th metacarpal bone with a transition to the forearm, a tendon of the long abducting I-th muscle finger (1) is isolated (drawing) and a muscle tendon of the short extensor of the I-th finger (4). The first one is cut off, departing from the attachment site by 5-6 cm, the second - at the level of transition to the muscle part (3), the latter is sutured to the long muscle that takes away the 1st finger (2). The distal end of the tendon of the short extensor of the 1st finger is passed through the carpal canal, after which its end is sutured with the proximal end of the tendon of the long decaying 1st finger of the muscle (5) using one of the known methods, with moderate tension. Using the distal end of the tendon of the long abducent I-th finger of the muscle, tenodesis (7) is performed with suturing to the tendon of the radial flexor of the hand (6), in the opposition position of the I-th finger. Hemostasis. Layered suture of the wound. The first finger is fixed with a plaster cast in the abduction and opposing positions. Immobilization is stopped after 3 weeks.

Clinical example

Patient DB, 35 years old, with a diagnosis of Post-traumatic adrenal contracture of the 1st finger of the right hand, after chronic injuries of the median and ulnar nerves. The operation was performed according to the method described above “eliminating the leading contracture of the 1st finger of the brush”. The postoperative period was uneventful, after removing the plaster cast (3 weeks later), the first finger of the right hand was actively developed. A long-term result in a year is the grasping function of the I-th finger in full, the I-th finger is stable in the opposition position.

Sources of information

1. Raye R.E. Reconstructive surgery for violation of the opposition of the thumb of the hand. Abstract. M., 1970.

2. Voskresensky E.V. Alexandrov N.M. A method of restoring the motor function of the I-th finger of the brush. Description of the invention to ed. SU 1560161 A1, M., 1988.

Claims (1)

A method of eliminating the leading contracture of the I-th finger of the hand by crossing the tendon of the muscle of the short extensor of the I-th finger at the border with the muscle part, characterized in that the tendon of the long retracting I-th finger of the muscle is cut off 5-6 cm proximal to the attachment level, tenodesis is performed the position of the opposition of the I-th finger of the hand, by suturing the distal end of the tendon with the long abducent I-th muscle finger to the tendon of the radial flexor of the hand, the distal end of the tendon of the short extensor of the I-th finger is passed through the carp the canal, after which its end is sutured to the proximal end of the tendon of the long muscle I retracting the first finger.