RU2467682C1 - Diagnostic technique for elongation distraction rate correction of consequences of cold injury of finger stumps - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine. For the purpose of diagnosing elongation distraction rate correction of the consequences of a cold injury of finger stumps, calculated parameters of blood flow of proper digital artery of a finger phalanx stump to be elongated before and during distraction, as well as calculated parameters of blood flow of proper digital artery of an intact symmetrical finger. If observing no systolic linear blood velocity (Vas) increase of proper digital artery by more than 25% in relation to the pre-therapeutic values in a combination with negative final diastolic velocity (Vakd), or if observing systolic linear blood velocity gain (Vas) decrease by 50% in relation to the values for proper digital artery of the collateral phalanx in a combination with negative final diastolic velocity (Vakd), distraction rate is decreased. If observing systolic linear blood velocity (Vas) decrease below the pre-therapeutic values or decrease by more than 75% in proper digital artery from the values for the collateral intact phalanx, distraction is temporarily terminated for 4-5 days.

EFFECT: method enables diagnosing elongation distraction rate correction in the cold injury of finger stumps as shown by the quantitative criteria of adaptation control.

3 dwg, 3 ex

Description

The invention relates to the field of medicine, in particular to methods for diagnosing the correction of the rate of distraction of post-traumatic stumps of fingers of the hand during their surgical lengthening.

A known method for evaluating the capillary blood flow of the skin in patients with post-traumatic stumps of the fingers of the hand during their surgical lengthening (Grebenyuk L.A., Ismayilov GR, Danilkin M.Yu. Features of microcirculation in patients with post-traumatic stumps of the fingers of the hand during their surgical lengthening. works Methodology of flowmetry, Moscow, 2001, issue 5, p.53-62).

The method involves the use of laser flowmetry to determine the capillary blood flow of the skin in order to assess the blood supply to the soft tissues of the hand in the process of distraction lengthening of post-traumatic stumps of the phalanges of the fingers.

However, this method does not involve the correction of the rate of distraction depending on changes in the microcirculation indices of the skin of the hand.

Remains little studied changes in blood flow in the tissues of the hand exposed to the cold factor in the process of exposure to distraction efforts. The problem of an objective assessment of the biological state of the soft tissues of the hand in the process of exposure to distraction efforts remains poorly studied, while the need for an in-depth study of tissue and cell processes occurring in tissues under the influence of distraction in order to develop optimal, physiologically sound methods of treating stumps of the fingers of the hand remains relevant . Clinically, to adjust the rate of distraction, it becomes necessary 7-10 days after the start of lengthening, when in some cases the occurrence of pain and discoloration of the skin of the elongated segment are noted.

The objective of the invention is to develop quantitative criteria for monitoring the process of adaptation of tissues of the stumps of the fingers to distraction influences to reduce the number of ischemic complications in patients with the effects of cold hand injury.

The specified technical result is achieved by the fact that in the method for diagnosing the correction of the rate of distraction during lengthening with the consequences of a cold injury of the stumps of the fingers of the hand, including measuring the calculated parameters of the blood flow of the own digital artery of the elongated stump of the phalanx of the finger before and during distraction, as well as measuring the calculated parameters of the blood flow of its own digital artery symmetrical finger of an intact brush, the obtained data are compared with each other and in the absence of an increase of more than 25% of the systole linear linear blood flow velocity (Vas) of the own digital artery relative to the “pre-treatment” values in combination with negative values of the final diastolic velocity (Vakd) or a decrease in the systolic linear blood velocity (Vas) by 50% relative to the values of the own digital artery of the contralateral phalanx of the fingers in combination with negative values of the final diastolic velocity (Vakd) - the rate of distraction is reduced, and if the decrease in the systolic linear blood flow velocity (Vas) of the finger art Series below the values "before treatment" or a decrease of more than 75% in the index (Vas) of the own digital artery from the values of the contralateral phalanx of the fingers on the intact hand - distraction is temporarily stopped for 4-5 days.

The present invention is illustrated by a detailed description, clinical examples and illustrations, which depict:

Figa, b - blood flow measurement by ultrasonic dopplerography of your own digital artery of the elongated stump of the finger of the hand;

Figure 2 - Dopplerogram of the digital artery before treatment of a patient with a diagnosis of:

The consequences of a cold injury. Amputation stumps at the level of proximal phalanges of the II - V fingers, I metacarpal bone of the left hand. Amputation stumps of proximal phalanges of I - V fingers of the right hand;

Figure 3 - Dopplerogram of the digital artery during treatment of the patient.

The method is as follows.

In the supine position, the patient is measured by ultrasonic dopplerography of the blood flow of their own digital artery of the elongated stump of the phalanx of the finger before treatment. In the process of distraction on day 7-10, a blood flow measurement of the own digital artery of the extended stump (Figa, b) of the finger and blood flow measurement of the own digital artery of the symmetrical finger of the intact hand are carried out. The data obtained are compared with each other and in the absence of an increase of more than 25% in the systolic linear blood flow velocity (Vas) of the own digital artery relative to the “pre-treatment” values in combination with negative values of the final diastolic velocity (Vakd) or a decrease in the systolic linear blood flow velocity ( Vas) by 50% relative to the values of the own digital artery of the contralateral phalanx of the fingers on the intact hand, in combination with negative values of the final diastolic velocity ty (Vakd) - reduce the rate of distraction. Decrease in the indices of systolic linear blood flow velocity (Vas) of the finger arteries below the pre-treatment values or by more than 75% of the Vas indices of the own digital artery from the blood values of the own digital artery of the contralateral phalanx of the fingers on the intact hand - stop distraction for 4-5 days.

The practical implementation of the method is illustrated by the following clinical observations.

Example 1

Patient K., 62 years old, diagnosis: Consequences of cold injury. Amputation stumps of the hands at the level of the metacarpal bones. Surgery performed:

Double osteotomy of the I metacarpal bone of the right hand, osteosynthesis by Ilizarov apparatus. Elongation of 25 days. The achieved lengthening of the I metacarpal bone is 2.2 cm.

When examining before treatment with ultrasound dopplerography (Doppler ultrasound) the common finger artery of the first finger of the right hand, the maximum systolic (Vas, cm / s) and diastolic speed (Vakd, cm / s) were determined during the quantitative assessment of dopplerograms with post-processing signal, and the values obtained were: Vas - 1.14 cm / s, Vakd - 1.63 cm / s. After 7 days of distraction of the stump of the I metacarpal bone of the right hand with a rate of 90 ° × 3 times / day at two levels and when 1.2 cm of distraction regenerate was reached, it was clinically noted: the appearance of pain in the projection of the end face of the stump of the metacarpal bone, pallor of the skin. To correct patient management tactics, a study was conducted according to the proposed method. The ultrasound Doppler ultrasound method was used to study the blood flow of the common digital artery of the stump of the I metacarpal bone of the right hand, and the maximum systolic (Vas, cm / sec) and diastolic velocity (Vakd, cm / sec) were determined by quantitative assessment of dopplerograms with post-processing signal, and the values obtained were: Vas - 1, 37 cm / sec, Vakd - -0.41 cm / sec. Comparing the obtained values of USDG of the common digital artery of the stump of the I metacarpal bone of the right hand in the process of distraction with the values of USDG of the common digital artery of the stump of the I metacarpal bone of the right hand before treatment, we obtain: an increase of the Vas parameter relative to the values "before treatment" by 20% and registration of negative values of Vakd - diagnose a criterion for reducing the rate of distraction. It was decided to change the patient management tactics and reduce the rate of distraction to 90 ° × 2 times / day at two levels. After 10 days, we conduct a control examination using ultrasound dopplerography of the common digital artery of the stump of the I metacarpal bone of the right hand, and with a quantitative assessment of dopplerograms, we determine the maximum systolic (Vas, cm / sec) and diastolic speed (Vakd, cm / sec). The obtained values: Vas - 1.54 cm / s, Vakd - -1.08 cm / s. Comparing the obtained values of USDG of the common digital artery of the stump of the I metacarpal bone of the right hand during distraction with the values of USDG of the common digital artery of the stump of the I metacarpal bone of the right hand before treatment, we obtain: an increase of Vas by 35% and registration of positive Vakd values. It was decided to change the patient management tactics and restore the rate of distraction to 90 × 4 times / day. The total duration of the distraction period was 25 days, the lengthening of the I metacarpal bone was 2.2 cm.

Example 2

Patient D., 17 years old, diagnosis: Consequences of cold injury. Amputation stumps at the level of proximal phalanges of the II - V fingers, I metacarpal bone of the left hand. Amputation stumps of proximal phalanges of I - V fingers of the right hand. 02.17.01 operation: Osteotomy of the I metacarpal bone, stump of the proximal phalanx of the III, IV fingers of the left hand. Osteosynthesis by Ilizarov apparatuses of I, III, IV rays of the brush. Distraction started on the 7th day after the operation, the rate of 90 ° × 4 times / day.

In the study of the treatment of the own digital artery of the proximal phalanx (PF) stump of the second finger of the left hand before the ultrasound treatment with ultrasound, the maximum systolic (Vas, cm / sec) and diastolic velocity (Vakd, cm / sec) were determined by quantifying dopplerograms with postprocessing signal processing, and values were obtained : on the left, Vas - 1.70 cm / s, Vakd - 0.76 cm / s. After 7 days of distraction of the stump of the proximal phalanx of the second finger of the left hand with a rate of 90 ° × 4 times / day and when 0.8 cm of distraction regenerate is reached, the appearance of an ischemic zone in the area of the butt stump of the PF II of the finger of the left hand is clinically noted (pallor of the skin, slowing of the capillary response, pain on palpation of the end face of an elongated stump). To correct patient management tactics, a study was conducted according to the proposed method. The ultrasound blood flow was used to study the blood flow of the PF II own finger artery of the II finger of the left hand; in the quantitative assessment of dopplerograms with postprocessing signal processing, the maximum systolic (Vas, cm / sec) and diastolic velocity (Vakd, cm / sec) were determined, the values were obtained: on the left, Vas - 2, 28 cm / s, Vakd - + 0.17 cm / s. Comparing the obtained values of ultrasound of the own digital artery of the stump of the PF II of the left finger finger during distraction with the values of ultrasound of the own digital artery of the stump of the PF II finger of the left hand before treatment, we obtain: an increase of Vas indicator of the left PF of the II finger of the left hand relative to the values "before treatment" by 34% - diagnose - continue distraction at the same pace (Figure 2, Figure 3). After 7 days, we carry out a control examination using the method of ultrasound dopplerography of our own digital artery of the stump of the PF II of the left finger of the left hand, while quantifying the dopplerograms, we determine the maximum systolic (Vas, cm / sec) and diastolic speed (Vakd, cm / sec). The values are obtained: on the left, Vas - 1.93 cm / s, Vakd - -1.05 cm / s. Comparing the obtained values of ultrasound of your own finger artery PF II finger of the left hand in the process of distraction with the values of ultrasound of your own finger artery PF II finger of the left hand before treatment we get: an increase in Vas PF II of the finger of the left hand relative to the values "before treatment" by 13% and registration of negative Vakd values - we diagnose a criterion for reducing the rate of distraction. It was decided to change the patient management tactics and reduce the rate of distraction to 90 ° × 2 times / day. After 7 days, we carry out a control examination using the ultrasound Dopplerography method of our own digital artery PF II of the left finger of the finger, with a quantitative assessment of dopplerograms we determine the maximum systolic (Vas, cm / sec) and diastolic speed (Vakd, cm / sec). The values obtained are: on the left, Vas - 1.53 cm / s, Vakd - -0.68 cm / s. Comparing the obtained values of ultrasound of the own finger artery PF II of the finger of the left hand during distraction with the values of ultrasound of the own finger artery PF II of the finger of the left hand before treatment, we obtain: a 10% decrease in Vas PF II of the finger of the left hand relative to the values “before treatment” and registration of negative Vakd values - we diagnose the criterion for stopping distraction. A decision was made to change the patient management tactics and stop distraction for 5 days. After 5 days, we carry out a control examination using ultrasound dopplerography of our own digital artery PF II of the left finger of the finger, while quantifying the dopplerograms we determine the maximum systolic (Vas, cm / sec) and diastolic speed (Vakd, cm / sec). The values obtained are: on the left, Vas - 2.30 cm / s, Vakd - -0.31 cm / s. Comparing the obtained values of ultrasound of the own finger artery PF II of the finger of the left hand during distraction with the values of ultrasound of the own finger artery PF II of the finger of the left hand before treatment, we obtain: an increase in Vas PF II of the finger of the left hand relative to the values "before treatment" by 35%. A decision was made to change the patient management tactics and resume distraction at a rate of 90 ° × 4 times / day.

The total duration of the distraction period was 24 days, the elongation was 1.7 cm. Clinically, the PF axis of the II finger of the left hand is correct, the skin of the stump of the PF is physiological in color, the capillary response is positive, the palpation of the end of the stump of the phalanx is painless.

Example 3

Patient J., 18 years old, diagnosis: Consequences of a cold injury to the right hand. Amputation stumps of proximal phalanges of I, II, IV fingers of the right hand. The operation was performed: Osteotomy of stumps of proximal phalanges of I, II, IV fingers, osteosynthesis with Ilizarov devices of I, II, IV rays of the right hand. Distraction to lengthen the stumps of the proximal phalanges of I, II, IV rays of the right hand began on the 5th day after the operation, at a rate of 90 ° × 4 times / day. The period of distraction is 27 days, fixation is 37 days 1.8 cm.

Before treatment, the patient was not examined. In the course of treatment, on the 10th day of distraction, pallor of the skin, slowing down of the capillary response, pain on palpation of the end face of the elongated stump PF of the first finger of the right hand were clinically noted. When ultrasound examination of the own digital artery of the stump of the proximal phalanx of the first finger of the right hand, the maximum systolic (Vas, cm / sec) and diastolic velocity (Vakd, cm / sec) were determined by quantitative evaluation of dopplerograms using the signal processing, the values were obtained: right Vas - 2.17 cm / s, Vakd - 0.76 cm / s; to the left, Vas - 9.07 cm / sec, Vakd - 3.16 cm / sec. Comparing the obtained values of Doppler ultrasound of the own digital artery of the stump of the proximal phalanx of the second finger of the right hand and the own digital artery of the first finger of the left hand, we obtain: a decrease in Vas of the operated stump during distraction relative to the values of the symmetric intact finger by 77% and registration of negative values of Vakd - we diagnose the criterion for stopping distraction . A decision was made to change the patient management tactics and stop the distraction for 5 days. After 5 days, we performed a control examination using the ultrasound scan of the own digital artery of the stump of the PF of the first finger of the right hand of the own finger artery of the first finger of the left hand, while quantifying the dopplerograms, we determine the maximum systolic (Vas, cm / sec) and diastolic speed (Vakd, cm / sec). The values obtained are: on the right, Vas - 3.76 cm / s, Vakd - 2.05 cm / s; to the left, Vas - 9.18 cm / sec, Vakd - 3.47 cm / sec. Comparing the obtained values of the ultrasound of the own digital artery of the stump of the PF of the first finger of the right hand and the own digital artery of the first finger of the left hand, we obtain: a decrease in the Vas index of the operated stump during distraction, relative to the values of the ultrasound of the own digital artery of the symmetrical intact finger by 60% and registration of positive Vakd values. It was decided to change the patient management tactics and restore distraction at a rate of 90 ° × 4 times / day.

After 10 days, we carry out a control examination using ultrasound dopplerography of our own digital artery of the stump of the proximal phalanx of the first finger of the right hand; when quantifying the dopplerograms, we determine the maximum systolic (Vas, cm / sec) and diastolic speed (Vakd, cm / sec). The values obtained are: on the right, Vas - 4.52 cm / s, Vakd - 2.73 cm / s; to the left, Vas - 8.93 cm / sec, Vakd - 3.01 cm / sec. Comparing the obtained values of ultrasound of the own digital artery of the stump of the proximal phalanx of the first finger of the right hand and the own digital artery of the first finger of the left hand, we obtain: a decrease in the Vas index of the operated stump during distraction relative to the values of the ultrasound of the own digital artery of the symmetrical intact finger by 50% and registration of positive Vakd values. It was decided not to change the patient management tactics and maintain the rate of distraction 90 ° × 4 times / day.

The distraction period was 27 days, the fixation period was 37 days, the elongation was 1.8 cm. Clinically: the skin of the right hand is physiologically colored. Palpation of the ends of the stumps of the proximal phalanges of the I, II, IV rays of the right hand is painless.

Using the proposed method in the clinic FSBI RRC "WTO" them. Acad. G.A. Ilizarova showed that its use reduces the number of ischemic complications due to the ability to control the process of tissue adaptation to distraction influences.

Claims (1)

A method for diagnosing the correction of the rate of distraction during lengthening with the consequences of a cold injury of the stumps of the fingers of the hand, including measuring blood supply to tissues of the extended phalanx of the finger, characterized in that the calculated parameters of blood flow of the own digital artery of the extended stump of the phalanx of the finger before and during distraction, as well as the measurement of the calculated parameters of blood flow of the intact hand’s own digital artery of a symmetrical finger, the obtained data are compared with each other, and in the absence of an increase of more than by 25% of the systolic linear blood flow velocity (Vas) of the own digital artery relative to the “pre-treatment” values in combination with negative values of the final diastolic velocity (Vakd), or a 50% decrease in the systolic linear blood speed (Vas) of the digital finger artery arteries of the contralateral phalanx of the fingers in combination with negative values of the final diastolic velocity (Vakd) - the rate of distraction is reduced, and if the decrease in the systolic linear velocity cr of the blood flow (Vas) of the digital arteries below the values “before treatment” or a decrease of more than 75% in the index (Vas) of the own digital artery from the values of the contralateral phalanx of the fingers on the intact hand - distraction is temporarily stopped for 4-5 days.

Images