RU-2861708-C1 - METHOD FOR SURGICAL CORRECTION OF HAND DEFORMITY IN PARALYSIS OF LUMBRICAL AND INTEROSSEOUS MUSCLES, INCLUDING PERFORMING TENODESIS OF METACARPOPHALANGEAL JOINTS USING AUTO- OR ALLOGRAFTS

RU2861708C1RU 2861708 C1RU2861708 C1RU 2861708C1RU-2861708-C1

Abstract

FIELD: medicine. SUBSTANCE: invention relates to orthopaedics, neurosurgery, reconstructive surgery, and can be used to correct the consequences of paresis and paralysis of the upper limb with damage to the lumbrical and interosseous muscles of the hand. A method for surgical correction of hand deformity in paralysis of the lumbrical and interosseous muscles includes performing tenodesis of the metacarpophalangeal joints using auto- and allografts with their fixation to the carpal ligament in the proximal part, subcutaneous passage along the palmar surface of the hand and fixation in the distal part to the extensor tendons in the region of the proximal phalanges of the fingers. EFFECT: elimination of claw hand deformity while reducing the invasiveness of the performed operation by achieving a neutral position of the proximal phalanx of the three-phalangeal finger in the MCP joint, absence of hyperextension of the fingers in the MCP joint. 2 cl, 4 dwg, 1 ex

Inventors

Lazarev Mikhail Petrovich
Kisel Dmitrij Aleksandrovich
Kozlova Regina Maksimovna
Akimov Ruslan Nurlanovich
VLASOV ALEKSEJ PETROVICH

Dates

Publication Date: 20260508
Application Date: 20250803

Claims (2)

1. A method for surgical correction of hand deformity in paralysis of the lumbrical and interosseous muscles, including tenodesis of the metacarpophalangeal joints (MCPJs) using auto- or allografts with their fixation to the carpal ligament in the proximal region, subcutaneous passage along the palmar surface of the hand and fixation in the distal region to the extensor tendons in the area of the proximal phalanges of the fingers, characterized in that tenodesis of the MCPJs includes longitudinal dissection of the carpal ligament, the formation of subcutaneous tunnels over the tendon canals of the flexor muscles of the fingers along the palmar surface of the hand to the level of the annular ligaments A1, the formation of tunnels along the canals of the flexor tendons of the fingers along the MCPJs of the fingers with a transition to the lateral surface from the radial side at the 2nd, 3rd fingers of the hand and/or from the ulnar side at the 4th, 5th fingers of the hand, and further transition to the dorsal surface tenodesis is performed using the following methods: tenodesis of the proximal phalanges of the fingers to the extensor tendons of the fingers, with a tunnel formed under the neurovascular bundles of the fingers; fixation of the proximal part of the tendon graft to the carpal ligament with interrupted sutures from the side of the thenar and hypothenar muscles, followed by longitudinal division of the graft into 2 or 4 parts distal to the point of fixation on the carpal ligament, depending on the number of fingers where tenodesis will be performed; subcutaneous passage of tendon grafts in the formed tunnels and fixation in the distal part to the extensor tendons with interrupted sutures from the radial and ulnar surfaces of the extensor tendon in the area of the proximal phalanges of the fingers in a position of hyperextension in the MTP joint from 190 to 200°.
2. The method according to paragraph 1, characterized in that a tendon auto- or allograft with a width of 2.0 to 4.0 cm is used.

Description

Field of technology to which the invention relates The invention relates to medicine, namely to orthopedics, neurosurgery, reconstructive surgery, and can be used to correct the consequences of paresis and paralysis of the upper limb with damage to the lumbrical and interosseous muscles of the hand. State of the art Conditions associated with damage to the lumbrical and interosseous muscles of the hand develop with lesions of the nervous system at various levels. When the short muscles fail to function, a specific deformity of the hand occurs, manifested not only by a change in appearance associated with muscle atrophy but also by a disruption in the biomechanics of the hand, as this muscle group performs an organizing function. The interosseous and lumbrical muscles stabilize the metacarpophalangeal joints (MCPJs) and are involved in flexion and extension of the fingers. Isolated loss of function of these muscles occurs, for example, with lesions of the ulnar nerve or its motor branch. This deformity results in a lack of active extension of the interphalangeal joints of the fourth and fifth fingers (sometimes the second, third, fourth, and fifth fingers), and hyperextension of the metacarpophalangeal joints occurs when attempting to extend these fingers. Numerous surgical treatments are available for neurogenic contractures of the fingers following damage to the motor branch of the ulnar nerve. These surgical options can be divided into dynamic surgeries, in which the loss of function of the short muscles is compensated for by connecting other motor units to their tendons or to the proximal phalanges, and static surgeries, which involve creating a tenodesis of the MCP joint, limiting hyperextension of the MCP joint using various grafts and fixation techniques. Dynamic methods of surgical correction of hand deformities in paralysis of the lumbrical and interosseous muscles include the "Zancolli lasso" method [Zancolli E. Correccion de la ''garra'' digital por paralysis intrinseca. La operacion del'lazo'. Acta Ortop Latinoam. 1974; 1:65-71.], in which the legs of the superficial flexor are cut from the attachment to the middle phalanx and passed over the annular ligament of A2 in the proximal direction and sutured onto themselves, forming a loop around the palmar portion of the osteofibrous canal of the flexor tendons at the level of the proximal phalanx. However, when implementing this method, stretching of the ligament is possible, due to which the degree of correction is reduced. Also known is the Brand tendon-muscle transposition, performed to correct claw hand deformity [Diaz-Garcia RJ, Chung KC. A Comprehensive Guide on Restoring Grasp Using Tendon Transfer Procedures for Ulnar Nerve Palsy. Hand Clin. 2016 Aug;32(3):361-8. doi: 10.1016/j.hcl.2016.03.006. Epub 2016 May 2. PMID: 27387079], where the tendon grafts are the palmaris longus tendon and the tendons of the long extensors of the toes, creating a total of 4 "tails". The grafts are fixed to the lateral bundles of the extensor apparatus at the level of the proximal phalanges. The extensor carpi radialis brevis (ECRB) is used as a motor unit. However, tendon grafts pass close to the extensor tendons of the fingers, which can lead to the formation of a cicatricial block of the extensor tendons of the fingers, which limits the excursion of the tendons and ultimately leads to a limitation of the range of active and passive movements of the fingers. A known method for surgical correction of hand deformity due to paralysis of the lumbrical and interosseous muscles [Patent for Invention RU 2686001] involves accessing the fibrous-osseous canal of the flexor tendons along the neutral lateral line of the triphalangeal finger on its non-working surface at the level of the proximal phalanges of the II, III, IV, and V fingers on the lateral surfaces, opening the fibrous-osseous canal of the flexor tendons of the fingers, and creating a new attachment point for the superficial flexor tendon at the level of the middle third of the proximal phalanx. However, when implementing this method, the development of a cicatricial block of the flexor tendons of the fingers is possible, since the fibrous-osseous canal of the flexors is opened in the 2nd zone at the level of the hand, which also leads to a limitation of the excursion of the flexor tendons of the fingers and a decrease in the range of active and passive movements of the fingers. Static methods of tenodesis of the MTP joint include shortening capsulorrhaphy, proposed by Zancolli [Zancolli E.A. Claw hand caused by paralysis of the intrinsic muscles. A simple surgical procedure for its correction. J Bone Joint Surg. 1957;39a: 1076-1080], which shortens and refixes the palmar portion of the MTP joint capsule – capsulodesis. However, when implementing this method, in some cases, overstretching of the scar at the suture site of the joint capsule occurs, and relapse of extension contracture of the fingers occurs. In