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II. ХИРУРГИЯ
MPHTM 76.29.41 ABOUT THE АUTHORS
Muradov M.I., PhD, head of the department of reconstructive-plastic microsurgery JSC NSCS A.N. Syzganov.
Mukhamedkerim K.B., microsurgeon of the department of reconstructive-plastic microsurgery of JSC NSCS A.N. Syzganov.
Sadykov T.A., third-year doctoral student Higher School of Public Health of the Ministry of Healthcare of the Republic of Kazakhstan.
Baiguzeva A.A., microsurgeon of the department of reconstructive-plastic microsurgery JSC NSCS A.N. Syzganov.
Kazantayev K.E., resident in the field of sports medicine 1 course of KazNMU.
e-mail: [email protected]
Koshkarbaev D.Zh., junior researcher of the department of reconstructive-plastic microsurgery of the JSC NSCS A.N. Syzganov
Keywords
trauma, wrist, flexor tendon, plastic, implant.
Кол саусактарыньщ 6ykk^ с^рлершщ жаракаттан кейшп салдарыньщ микрохирургиялык емшщ тэсiлiн жетiлдiру жолдары
Мурадов М.И., Садыков Т.А., Казантаев К.Е., Мухамедкерiм К.Б., Байгузева А.А., Кошкарбаев Д.Ж.
А.Н. Сызганов атында?ы Улттык, ?ылыми хирургия орталь™, Алматы, Казахстан
ЛЦДЭТПЭ
CsycsK; бYккiштepiнiц жаракаттан кeйiнгi cалдаpын cmликонды имnлантат жэнe алдын ал$т анаатомозы аркылы xиpypгиялык жoлмeн кайта квлпынв evpy тэалн жeтiлдipy жoлдаpы жэнe xиpypгиялык eм-шаpалаpдыц epeкшeлiктepi cиnатталFан, наyкаcтаpдыц отадан 3 айдан кeйiнгi eмдey нэтижeлepi талкылан€ан. CиатталFан оталык eм-шаpаcы œycsi ciцipлepiн кайта кßлnына ^vpy жолында€ы кoлданyFа колайлы жэнe тиiмдi эдicтepдiц 6ípí больт табылады.
Пути усовершенствования микрохирургической методики лечения при отдаленных последствиях травм кисти
Мурадов М.И., Садыков Т.А., Казантаев К.Е., Мухамедкерим К.Б., Байгузева А.А., Кошкарбаев Д.Ж.
Национальный научный центр хирургии им. А.Н. Сызганова, Алматы, Казахстан
Аннотация
Усовершенствован способ лечения повреждений сухожилий сгибателей пальцев кисти с использованием силиконового имплантата и наложения проксимального превентивного анастомоза.
Представлены особенности хирургической техники, проведен анализ лечения больных с отдаленными последствиями травм сухожилий сгибателей кисти. Контроль результатов проведен в сроки до 3 месяцев. Вышеуказанная методика является относительно простым, высокоэффективным методом хирургического лечения, которая позволяет обеспечить полное восстановление функции кисти.
WAYS OF IMPROVING THE MICROSURGICAL TECHNIQUE OF TREATMENT WITH LONG-TERM CONSEQUENCES INJURIES OF FLEXOR TENDONS OF THE HAND
Muradov M.I., Sadykov T.A., Kazantayev K.E., Mukhamedkerim K.B., Bayguzeva A.A., Koshkarbaev D.Zh.
National Scientific Center of Surgery named after A.N. Syzganov, Almaty, Kazakhstan Abstract
The peculiarities of surgical technique are presented, the analysis of treatment of patients with long-term consequences injuries of flexors tendons hand. The results were monitored within 3 months. The above procedure is a relatively simple, highly effective method of surgical treatment, which allows for a complete restoration of the function of the hand.
AВТОРЛAР ТУРAЛЫ
Мурэдйв М.И., мвдицина гылымдарынын кандидаты. A.H. Cuзганов атындагы улттык гылыми xMpypM орталыгынын pвкoнcгpyгивтi nлаcтикалык микpoxиpypгия бвл1м1н1н бае дэpiгвpi.
Мухэмедкерим K.B., A.H. Caзганов атындагы улттык гылыми xMpypM орталыгынын pвкoнcгpyгивтi nлаcгикалык микpoxиpypгия бвл1м1н1н микpoxиpypгi Сэдыксв T.A., когамдык двнcаyлык Œ^y жогаргы мвктвбiнщ 3 ку,pc докторанты. Бвйгузевв A.A., A.H. Ctíзганов агындагы улттык гылыми xMpypM орталыгынын pвкoнcгpyгивтi nлаcтикалык микpoxиpypгия бвл1м1н1н микpoxиpypгi
Kaзaнтaев K.E., КазУМУcnopr мвдицина мамандыгы бойынша 1 куpc pвзидвнтi.
e-mail: [email protected]
Koшкaрбaев Д.Ж., A.H. Ctíзганов атындагы улттык гылыми xMpypM орталы-гынын pвкoнcтpyтивтi nлаcтикалык микро-xMpypM бвл1м1н1н юш1 гылыми маманы
Тужн сездер
жаракат, бушш ciнipлвp, плаcтикаl им^ата^
ОБ АВТОРАХ
Мурадов М.И., кандидат медицинских наук, заведующий отделения реконструктивно-пластической микрохирургии АО «ННЦХим. А.Н. Сызганова».
Мухамедкерим К.Б., микрохирург отделения реконструктивно-пластической микрохирургии АО «ННЦХим.
А.Н. Сызганова».
Садыков Т.А., докторант третьего года обучения «Высшая школа общественного здравоохранения РК»
Байгузева А.А., микрохирург отделения реконструктивно-пластической микрохирургии АО «ННЦХ им.
А.Н. Сызганова».
Казантаев К.Е., резидент по специальности спортивная медицина 1 курс КазНМУ. e-mail: [email protected]
Кошкарбаев Д.Ж., младший научный сотрудник отделения реконструктивно-пластической микрохирургии АО «ННЦХим.
А.Н. Сызганова».
Ключевые слова
травма, киагь, cyxoжилия cm-батвлвй, плаcтикаl им^ата^
Introduction
Damage to flexor tendons ranges from 1.9 to 18.8% of all brush injuries [1]. Of these, 32% are injuries to the flexor tendons of the fingers flexor [2].
Positive outcomes of operations with long-term consequences of traumatic damage of tendons of flexor flexors do not exceed 25-30% and in 12.1% of cases, the use of autoplastic material is required [3,4]. At the same time, the unsatisfactory functional results of these operations range from 7 to 30%. The main reason, according to the majority of authors, is the formation of adhesions of tendons with surrounding tissues in the I, II anatomical zones of the hand and development of cicatricial changes of the osteo-fibrous canal [5]
The aim of study
To improve the result of treatment of patients with posttraumatic defect of flexor tendons of the fingers flexors in the critical zone, by endoprosthet-ics of the tendon channel of the fingers and the formation of preventive proximal autosoonal anastomosis.
Materials and methods
On the basis of the NSCS A.N. Syzganov, in the department of reconstructive-plastic microsurgery the technique of two-stage plastic surgery for surgical treatment was improved, with the long-term consequences of injuries to the tendons of the finger flexors with the long-term consequences of brush injuries.
Indication for the operation of flexor tendon plastic surgery is the presence of diastasis between the tendons, the formation of tendon ligaments with the surrounding tissues in the I, II anatomical zones of the wrist and the development of cicatricial changes in the osteo-fibrous channel of the fingers. Contraindication to plastic surgery of the tendon should be considered the presence of patients with
skin diseases and purulent infection in the zone of the forthcoming operation due to the possibility of rejection of the prosthesis and development of purulent complications.
Taking into account that, with the classical technique of secondary tendon plasty, with the implantation of a silicone implant in the osteo-fibrous canal, tendon grafts detachments are found in 15.6%, in the first 2-3 weeks, swelling of the ends on the primary tendon joints, which contributes to its reduction strength [6,7,8]. At the first stage, we preferred to use preventive proximal anastomosis between the tendons of the superficial and deep flexors with primary prosthetics of the osteo-fibrous canal (Figure 1). The second stage after 2-3 months of "autoplasty": after removal of the endoprosthesis, the tendon of the superficial flexor of the finger is excised, respectively, in diastase, with the formation of the tendon canal in the proper formation and filing of the latter to the distal end of the tendon or to the nail phalanx
Preventive proximal anastomosis between tendons of superficial and deep flexors with prosthet-ics of the osteo-fibrous canal.
Clinical case
The patient S. 41 years old, entered the clinic of the NNTSH them. A.N. Syzganova in the department of plastic and reconstructive microsurgery with the diagnosis: The long-term consequences of traumatic damage of flexor tendons of the IV fingers of the right hand.
Complaints on admission to infringement of flexion movements of the fourth finger of the right hand.
At admission, the general condition is on admission of moderate severity. Skin and visible mucous membranes of normal color, clean. Peripheral lymph nodes are not enlarged. Patient normostenic constitution, moderate nutrition. In the lungs, the breath is vesicular, there is no wheezing. Heart tones are clear, the rhythm is the right pulse 89
Fig. 1
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35
beats. in minutes, AD = 120/70 mm Hg. Tongue moist, clean. The abdomen is soft, painless. The liver and spleen are not enlarged. Physiological functions are not violated.
Locally: III, IV fingers of the right hand in the extension position. On the palmar surface at the level of middle phalanxes III, IV fingers there are oblique transverse scars on the width of the phalanges, which are welded to the underlying tissues. Active flexion of the third, fourth fingers of the right hand is absent.
After the patient's consent, the operation was performed in the first stage - prosthetics of the os-teo-fibrous canal, preventive proximal anastomosis of the tendons of the superficial and deep flexors of the fourth finger of the right hand.
The protocol of the operation: Conduction anesthesia. The position of the patient on his back. Treatment of the right upper limb with Povidone 3-D solution. III, IV fingers of the right hand in the extension position. On the palmar surface at the level of the middle phalanx of III, IV fingers, there are oblique transverse scars on the width of the phalanx, soldered to the underlying tissues, Z is the image of the skin exposed to the tissue. When the audit revealed: pronounced cicatrical and adhesive process, complete anatomical break of tendons of flexors III, IV fingers. The diastase between the ends of the tendons was 8 cm. Under 2.5x magnification: preventive proximal anastomosis was applied between the sinews of the superficial and deep flexors with primary prosthesis of the fibular canal IV of the right hand. Hemostasis during the operation. Stitches on the wound, drainages, aseptic bandage.
In the postoperative period the patient received antibacterial anti-inflammatory therapy. Postoperative wound healed by primary tension. It is discharged in a satisfactory condition with recommendations.
The patient was examined 2 months after the first operation.
References
1. Usoltseva E.V., Mashkara K.I. Surgery of diseases and bruises of the hand. - 3rd edition -L .: Medicine - 1986 - 352p.
2. Grishin I.G., Kodin A.V. Complex treatment of combined injuries of the flexor tendons of the fingers flexor // Topical issues of surgery, traumatology and orthopedics: Collection of scientific papers. - Vladimir, 1999. - P. 120-123.
3. Miguleva I.Y., Okhotskiy V.P. To the question of the timing of the execution of the plastic tendons of the flexor fingers of the hand // Annals of traumatology and orthopedics .- 1997.- No. 3-4.- P. 50-53.
4. Yuldashev A.A., Yuldashev M.Zh. Necessity of exercise of repeated skin-plastic operations in traumatic defects of brush and fingers. TR. Minaev, O.N. Nizov, Institute of First
"Autoplasty" is performed: after removal of the endoprosthesis, the tendon of the superficial flexor of the finger is excised correspondingly to diastase, with the formation in the properly formed tendon duct and filing of the latter to the distal end of the tendon. The length of the tendon graft was determined in the same way as for the primary tendon plasty.
The operation resulted in the application of a back gypsum longus to the injured limb, in the position of flexion of the fingers, in which there is no tension of the tendon joints. The period of immobilization was 3 weeks with the subsequent functional rehabilitation of the patient.
Results
The results of treatment according to the method of evaluation of the restoration of the function of the fingers after repair operations on the tendons after 2-3 months by the method of J.N. Boyes - an average of 1 inch - well, according to the method of VI. Rozova - 4 points.
The parameters of restoration of the function of the fingers of the hand after the application of the developed method were mostly excellent (75%) and good (25%), which indicates the expediency of its application and the continuation of a detailed study of this technique in the treatment of patients with damage to the flexor tendons of the fingers.
Conclusion
Advantage of the method is the technical prostate, which can be proposed for wide use for the surgical treatment of patients with long-term consequences of flexor tendon injuries. The main advantage of the method is: the formation of anastomosis of superficial and deep flexors at the level of the proximal end of the tendons. So, as a preventive stitching of tendons by the developed method helps to improve the slip of the restored tendon in the osteo-fibrous canal (in the I, II anatomical zones of the hand), and the formation of adhesions.
Aid to them. N.V. Sklifosovsky 2012 Moscow- P. 58-88.
5. Volkova A.M. Hand Surgery: 2 t. / A.M. Volkova. - Ekaterinburg: Middle Urals Book Publishing House, 1991. -T 1. - P. 133-138. 3.
6. Belousov A.E. Plastic, reconstructive and aesthetic surgery. - St. Petersburg: Hippocrates, 1998.- 744 p.
7. Beidik O.V., Zaretskov A.V., Shcerbakov M.A. Surgical treatment of patients with multitrauma of fingers. - Saratov Journal of Medical Scientific Research. 2009. Vol.5. No. 3. - 407r.
8. Kirillov V.F., Older injuries to the flexor tendons of the fingers flexors. In and. Arkhangel'skii,. Source: http://medbe. ru/materials/rekonstruktivnaya-khirurgiya/zastarelye-povrezhdeniya-sukhozhiliy-sgibateley-paltsev-kisti/.
