RU130830U1 - DEVICE FOR LOCATING THE TOP EXTREMITY OF A PATIENT WITH SURGICAL TREATMENT OF PALM FIBROMATOSIS, STENOSING BRUSHES AND BRUSHES - Google Patents

Abstract

A device for arranging the patient’s upper limb during surgical treatment of palmar fibromatosis, stenotic ligamentitis of the hand and forearm, which consists in the fact that it has successively stiff fragments of the support 15-20 cm wide: from the shoulder to the elbow, from the elbow to the wrist joints with a groove-groove from the extremity and from the wrist joint to the tips of the fingers, with all the supports having a telescopic design and interconnected by removable and detachable clamps, to ensure I, during the operation of fitting the limb to the fragments of the supports, while the distal end of the support, in the projection of the fingers, has a series of through holes through which disposable tissue finger clips pass.

Description

The proposed utility model relates to medicine, namely to surgery, and can be used in the treatment of palmar fibromatosis, stenosing ligamentitis of the 1st bone-fibrous canal (De Kerven's disease), stenosis of tendons of the flexors of the fingers in the ring-shaped ligaments (Nott's disease).

These diseases in their frequency prevail over all other diseases of the hand and, according to various authors, make up 10 to 13% of all diseases of the hand (A.I. Ashkenazi 1990, Yu.G. Shaposhnikov 1997, Arons, 1987, Mikkelson, 1973). As a rule, the treatment of these diseases is accompanied by the use of side tables or armrests, which do not provide the necessary operational space for this pathology of the hand and are characterized by the occurrence of more frequent iatrogenic damage to the skin and nerves, with the formation of rough skin scars. This compromises surgical intervention, reducing its effectiveness.

When performing operations on the hands for fixing and positioning the limbs, a framework consisting of soft porous material (medical latex) is used on a flat surface. (See, as the closest analogue: R. Preibler "Karl Storz-Endoscope",

Gilbert "Karl Storz- Endoscope", Orthopedice - Traumatology - I-stedition 1999, str. 1-9.)

Disadvantages: Lack of stable fixation of the arm and in this connection: the risk of damage to the nerve trunks, the development of painful neuroma, lengthening the rehabilitation period, inconvenience to the surgeon due to the displacement of the limb during the operation, caused by the unreliable and uncomfortable position of the hand for the surgeon.

Tasks:

- Individualization of the location and fixation of the brush during surgery,

- convenient location of the surgical instrument during surgery,

- reduction of trauma to integumentary tissues,

- reduction of rehabilitation periods,

- the exclusion of the use of gypsum immobilization and antibiotics in the postoperative period,

- reducing the risk of recurrence, vicious skin scars, soldering tendons, damage to nerve trunks, suppuration of a postoperative wound,

- reduction in the cost of treatment.

The technical result of the proposed device is that the support for the shoulder, forearm and hand, taking into account the individual length of the limb of the patient and rotation, is made with the ability to move the arm in all three planes, the optimal location of the limb during surgery. This creates the conditions for reducing the morbidity, the convenience of the surgeon, eliminates the formation of vicious skin scars, shortens the treatment time due to a reduction in the possible risk of damage to the nerve trunks, and facilitates the choice of the surgical incision of the required shape and length.

The essence of the design of the utility model is that it has successively arranged rigid fragments-supports with a width of 15-20 cm from the shoulder to the elbow, from the elbow to the wrist joint with a recess-groove on the side of the disposable limb and a fragment from the wrist joint to the tips of the fingers, moreover, all fragments have a telescopic design and are interconnected by removable-detachable clamps to ensure during the operation a stable fit of the limb to the fragments of the supports, while the distal EC support in the projection of the fingers has a number of through-holes through which the disposable tissue retainers.

The device is schematically shown in general form in figure 1, where 1 is the device lock to the operating table; 2,3,4 - removable and detachable latches; 5, 6, 7 - fragments of the supports of a limb; 8-hole; 9-fabric finger clips.

The device can be used in the surgical treatment of not only palmar fibromatosis, but also in the treatment of stenotic ligamentitis of the hand and forearm.

The device operates as follows:

The position of the patient on the back. Departments of the limb are placed on the corresponding fragments of 5, 6, 7 supports and the fragments are set at a given angle and with the extension of the hand with the arms necessary for holding the hand using clamps 2, 3, 4. When performing surgery for palmar fibromatosis, Nott or de Kerven disease, in the allotted position, they rotate outwards (the arm is maximally bent at the elbow joint and unbent at the wrist joint). When performing an operation for De Kerven’s disease, the arm is also in the retracted position, the forearm and hand are in the average physiological position, while the arm is maximally bent in the elbow joint and unbent in the wrist joint. The fingers are fixed for the duration of the operation: a tissue (bandage) 9 is passed through the hole 8 and tied from the side of the outer surface of the corresponding finger, the whole structure is fixed with a latch 1 to the operating table, the latch is made as a bolt and nut with ears. The gutters in fragments of 5-6 supports give the convenience of hand position and additional fixation.

The device was tested for 2 years on 56 patients and showed good results. The delivered results are fully resolved.

Example 1. Patient K. - 52 years old, No. IB-1173-182 - was admitted with complaints of restriction of movement-extension of the 5th finger of the right hand, a cord-like seal on the palmar surface, was ill for 3 years, no conservative treatment was carried out . He was diagnosed with Palmar-finger fibromatosis of the 5th finger of the right hand of the 3rd degree (according to Brenner), the patient was offered surgical treatment, endoscopic minimally invasive excision of the pathological beam. The patient’s location on the back, conduction anesthesia was performed, a compression tourniquet was placed on the lower third of the right forearm, the surgical field was treated three times with an antiseptic, the design was fixed with a fixative 1 to the operating table, the right upper limb was taken to the shoulder joint at an angle of 90 degrees, the limb sections were located on the corresponding fragments 5 , 6, 7 supports and set fragments at a given angle, in the elbow joint, bending to 80-90 degrees with the necessary extension of the hand to 80-85 degrees and maximum supination, with p power clamps 2, 3, 4; fabric (bandage) 9 was passed through hole 8 over 1, 2, 3, 4 fingers of the right hand and tied from the outer surface. We performed excision of the pathological beam using fiber optic optics and tools, through two skin incisions along the palmar surface up to 1 cm, no sutures were made. Aseptic dressing. The patient was discharged for outpatient treatment the next day in satisfactory condition. Active development of finger movements is recommended. Long-term results are good.

Example 2. Patient M - 43 years old No. IB-2119-381, was admitted with complaints of pain during movement and restriction of flexion in the proximal and distal interphalangeal (VMS) joints of the 1st finger of the left hand, painful clicks. According to him, he has been ill for 3 months, underwent a course of physiotherapeutic treatment, there are no positive dynamics. He was diagnosed with Stenosing ligamentitis of the 1st finger of the left hand (Nott's disease), surgical treatment, a non-invasive dissection of the annular ligament of the first finger of the left hand under the control of an endoscope were proposed.

The patient’s location on the back, conduction anesthesia was performed, a compression tourniquet was applied to the lower third of the left forearm, the surgical field was treated three times with an antiseptic, the design was fixed with a fixative 1 to the operating table, the left upper limb was taken to the shoulder joint at an angle of 90 degrees, the limb sections were located on the corresponding fragments 5 , 6, 7 supports and set the fragments at a given angle, in the elbow joint, bending to 80-90 degrees with the necessary extension of the hand to 80-85 degrees and maximum supination, with oschyu clamps 2, 3, 4; fabric (bandage) 9 was passed through hole 8 over 2, 3, 4, 5 fingers of the left hand and tied from the outer surface. Dissection of the annular ligament was performed using fiber optic optics and tools, through two skin incisions on the palmar surface up to 1 cm, no sutures were made. Aseptic dressing. The patient was discharged for outpatient treatment the next day in satisfactory condition. Active development of finger movements is recommended. Long-term results are good.

Claims (1)

A device for arranging the patient’s upper limb during surgical treatment of palmar fibromatosis, stenotic ligamentitis of the hand and forearm, which consists in the fact that it has successively stiff fragments of the support 15-20 cm wide: from the shoulder to the elbow, from the elbow to the wrist joints with a groove-groove from the extremity and from the wrist joint to the tips of the fingers, with all the supports having a telescopic design and interconnected by removable and detachable clamps, to ensure I, during the operation of fitting the limb to the fragments of the supports, while the distal end of the support, in the projection of the fingers, has a series of through holes through which disposable tissue finger clips pass.

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