RU2306888C2 - Method for restoring 1-finger - Google Patents

Abstract

FIELD: traumatic surgery.

SUBSTANCE: object of invention is restoration of active superposition of 1-finger. Idea of invention resides in formation of subcutaneous canal to transpose hacked end of sinew of own extensor of 2-finger. In this situation, end of the sinew of own extensor of 2-finger is attached to distal site of the sinew of short extensor of 1-finger, while 1- and 2-middle metacarpal bones are fixed with transversal Kirschner pin, and 1-finger is positioned into superposition of 3- and 4-fingers.

EFFECT: reduced traumatism of surgical intervention and shortened time of restoring treatment.

2 dwg

Description

The invention relates to medicine, in particular to traumatology, and can be used in the treatment of the effects of damage to the motor branch of the median nerve.

Numerous methods are known for the operative restoration of the active opposition of 1 finger of the hand after damage to the motor branch of the median nerve and the resulting atrophy of the tenar muscles. All of them come down to the transposition of active muscles of the forearm to 1 finger. So known is the method of transposition of the ulnar flexor of the hand (Goldner J.L .: Tendon transfers for irreparable peripheral nerve injuries of the upper extremity, Orthop Clin North Am 2: 343, 1974) with the additional use of an auto- and allo-tendon graft. In some cases, it is proposed to immediately perform arthrodesis of the 1 metacarpophalangeal joint. Operation Burkhalter (Burkhalter W., Cristensen R.C., Brown P .: J. Bonej. Surgery. 55-A; 725, 1973), proposed in 1973, involves the transposition of one extensor extensor into 1 finger. Littler (Littler JW and Cooley SGE: Opposition of the thumb and its restoration by abductor digiti quinti transfer, J Bone Joint Surg 45-A: 1389, 1963) proposed in 1963 the operation of transposition of his own extensor of 5 fingers to 1 finger. In 1973, Magnus (Mangus DJ: Flexor pollicis longus tendon transfer for restoration of opposition of the thumb, Plast Reconstr Surg 52: 155, 1973) proposed to restore the opposition of 1 finger using the tendon of the long flexor of 1 finger, which led to a significant restriction of flexion 1 finger.

Known methods contribute to the restoration of function of the brush, including the active opposition of 1 finger, however, they have the following disadvantages. So the widely used operation during transposition of the ulnar flexor of the hand leads to a significant weakening of the strength of the flexors of the hand, the possibility of a gradual deviation of the hand in the radial direction. During surgery, Burkhalter does not always have the length of the tendon of its own extensor 2 fingers to fix it directly to the main phalanx of 1 finger. Immobilization is quite long, up to 5 weeks. With the transposition of one's extensor of the 5th finger (Littler's operation), due to insufficient muscle strength, a complete opposition of 1 finger was not always achieved. Thus, the known methods are characterized by excessive trauma, the possibility of cicatricial degeneration of free transplants and insufficient treatment efficiency.

The technical solution of the invention is to increase the effectiveness of treatment without a significant increase in its injuries. Burkhalter operation was taken as a prototype.

The claimed technical effect is achieved in that it makes it possible to restore the active opposition of 1 finger of the brush without causing significant damage to other functional structures of the brush.

The compliance of the technical solution with the criterion of "novelty" is determined by the absence in the prior art of an identical technical solution to achieve the claimed result.

Compliance with the criterion of "industrial applicability" is determined by the effectiveness of restoring the active opposition of 1 finger of the hand in case of damage to the motor branch of the median nerve and the willingness to proceed to the widespread implementation of the proposed method, for which it is advisable to obtain a patent protection of a new development.

The result of the invention is achieved due to the fact that the tendon of the extensor 2 of the finger is fixed not directly to the main phalanx of the 1st finger, but to the distal portion of the tendon of the short extensor of the 1st finger with fixation of the 1st and 2nd metacarpal bones by the Kirschner cross spoke, without making an additional incision on the ulnar surface of the hand that allows you to minimize the morbidity of surgical intervention and reduce the duration of rehabilitation treatment. The start of the operation follows Burkhalter’s technique From the incision on the rear of the hand in the region of the head 2 of the metacarpal bone, the tendon of the extensor 2 of the finger is distinguished. At this level, it intersects transversely. An additional transverse incision is made on the back surface of the wrist joint, where the tendon of the extensor 2 of the finger is removed (Fig. 1). Next, a half-moon incision is made along the radial surface of the hand in the projection of 1 proximal and middle thirds of the 1 metacarpal bone (figure 2), where the tendon of the short extensor 1 of the finger is highlighted. The tendon intersects transversely at the base of the 1st metacarpal bone. Subcutaneously on the rear of the hand and its palmar surface with the help of a bougie, a channel is formed that envelopes the pisiform bone. And with the help of a flexible conductor, the tendon of the extensor 2 of the finger is held subcutaneously along the formed channel into the incision on the radial surface of the hand. Unlike Burkhalter surgery, an additional incision on the ulnar surface in the wrist region is not performed. The proximal end of the tendon of the own extensor 2 of the finger (Fig.2-B) is lapped with the distal end of the tendon of the short extensor 1 of the finger (Fig.2-B) with 3-4 interrupted sutures. In this case, 1 finger is in the position of opposition to 3, 4 fingers. For this, 1 and 2 metacarpal bones are additionally fixed transversely to each other with a Kirschner spoke for 3 weeks (Fig. 2-A). With a sharp severity of atrophy of the short muscles of the hand for the prevention of hyperextension of 1 finger in the metacarpophalangeal joint, its arthrodesis is performed with fixation of the joint with 2 Kirschner spokes. Additional fixation with a plaster cast. Active movements begin 3 weeks after the operation.

The goal is achieved, since the method does not significantly increase the invasiveness and is highly effective.

The increase in the effectiveness of the operation is explained by the fact that an earlier start of movements is possible (after 3 weeks). The strength of the suture of the tendons with this method is significantly higher than when fixing the tendon to the joint capsule. Extension of 1 finger of the hand practically does not suffer when crossing the tendon of the short extensor of 1 finger. The effectiveness of the treatment according to the proposed method increases, since in a shorter time the function of the brush is restored and the patient returns to work.

Clinical example. Patient N., 32 years old, was admitted to the 16th department of RosNIIITO on an emergency basis with a diagnosis of damage to the median and ulnar nerves of the right forearm. In RosNIIITO them. R.R.Vreden by ambulance epineural suture of the median and ulnar nerves. After 6 months, the patient was hospitalized in a planned manner with a diagnosis of neurogenic contracture of the fingers of the right hand. The patient complained of a lack of active opposition of 1 finger, a decrease in the strength of the right hand. An operation was performed according to the described method with fixation of 1 and 2 metacarpal bones with needles and a plaster cast for up to 3 weeks. After a course of rehabilitation treatment, the active opposition of 1 finger without pain was almost completely restored, the grip force was restored. Extension of 1 finger practically does not suffer. Examined after 1 year: the effect of the operation is preserved in full.

Information sources

1. Brand PW: Tendon transfers for median and ulnar nerve paralysis, Orthop Clin North Am 2: 447, 1970.

2. Burkhalter W. Cristensen R. C., Brown P.: J. Bonej. Surgery 55-A; 725, 1973.

3. Bwkhalter W. Tendon transfers in median nerve palsy, Orthop Clin North Am 2: 271, 1974.

4. Curtis RM: Opposition of the thumb, Orthop Clin North Am 2: 305, 1974.

5. Kaplan I, Dinner M, and Chait L: Use of extensor pollicis longus tendon as a distal extension for an opponens transfer, Plast Reconstr Surg 57: 186, 1976.

6. Littler JW and Cooley SGE: Opposition of the thumb and its restoration by abductor digiti quinti transfer, J Bone Joint Surg 45-A: 1389, 1963.

8. Mangus DJ: Flexor pollicis longus tendon transfer for restoration of opposition of the thumb, Plast Reconstr Surg 52: 155, 1973.

Claims (1)

The method of operative restoration of the active opposition of 1 finger of the hand, which consists in the formation of a subcutaneous canal for transposition of the cut off end of the tendon of the extensor 2 of the finger, characterized in that the fixation of the end of the tendon of the extensor 2 of the finger is performed to the distal portion of the tendon of the short extensor of the 1st finger with fixation of 1 and 2 metacarpals bones transversely with a Kirschner needle, with 1 finger set in the position of opposition to 3 and 4 fingers.

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