Посттравматические деформации, как осложнение застарелых повреждений сухожилий разгибателей пальцев кистей

. У даній роботі розглянуті деформації пальців кисті при різних варіантах ушкодження розгинального апарату, проведено їх біомеханічний аналіз з подальшою оперативною корекцією. Представлено досвід лікування 39 хворих з ушкодженнями сухожилків розгиначів пальців кисті віком від 20 до 59 років. Показано ефективність реабілітаційних заходів в терміни від 6 місяців до 1 року і більше, яка виразилася в позитивних як коригуючих, так і функціональних результатах в 97% випадків. В данной работе рассмотрены деформации пальцев кисти при разных вариантах повреждения разгибательного аппарата, проведен их биомеханический анализ с последующей оперативной коррекцией. Представлен опыт лечения 39 больных с повреждениями сухожилий разгибателей пальцев кистей в возрасте от 20 до 59 лет. Показана эффективность реабилитационных мероприятий в сроки от 6 месяцев до 1 года и более, которая выразилась в позитивных как корригирующий, так и функциональный результатах в 97% случаев. Extensor apparatus of the fingers is characterized by complex interactions of many anatomical structures, which include both passive and active elements. Even minor damage to the tendon may disrupt the complex biomechanics of extensor mechanism, which eventually can cause toe deformities and functional failure. Existing for a considerable time deformation of fingers in most cases lead to the restriction of mobility of the joints, resulting in the formation and progress of contracture. Formation of contractures of the fingers is one of the major complications that significantly impairs the functional prognosis. Consider the deformation of fingers in different variants of damage extensor mechanism and biomechanically justify their correction was the purpose of the study. The observation group were 39 patients with deformities of the fingers on the background of chronic extensor tendons injuries, there were 29 men (74%), women – 10 (26%). Their ages ranged from 20 to 59 years. In 16 (41%) patients had mallet finger while the distal phalanx acquired flexion position, active extension of the distal interphalangeal joint was limited or absent. In the long term, due to the transfer of extension efforts in the central portion of the tendon on the middle phalanx only, appeared stable hyperextension of the proximal interphalangeal joint – finger acquired characteristic deformation type “swan neck”. In 23 (59%) patients had a finger-type strain and boutonnieres damage was caused extensor mechanism at the level of the proximal interphalangeal joint. To study the biomechanical characteristics and functioning of the fingers under typical tenogen strain was conducted a series of physical and computational studies on which options have been proposed reconstruction and deformity correction. All patients underwent surgical treatment Depends on the type of deformation. Functional state involved in the pathological process of the joints at the time of surgery is one of the determining factors of the final outcome of treatment. For this reason, surgery preceded by a complex physiological events functional treatment, which aimed to minimize the functional impairment of the finger joints. Effectiveness of rehabilitation measures tracked in the period from 6 months to 1 year or more. In 38 (97%) patients showed positive as flavoring, and functional outcome. In the early and late postoperative period marked by persistent correction of the original strain. In 35 (89%) patients injured finger flexion deficit does not exceed 1 cm, and the restriction of extension ranged from 0 ° to 20 °. In 3 (7%) when performed stabilizing surgery – resection of the proximal interphalangeal joint, finger flexion deficit was 2.5 – 3 cm, functionally advantageous position finger segments permits efficient implementation grabs. In 1 (3%) patients had recurrent strain, which was caused violation of the immobilization in the postoperative period. Thus, early restoration of extensor mechanism and correction of the deformity prevents the formation of secondary degenerative changes of articular structures. Affected with deformities of the fingers due to damage extensor tendons have high rehabilitation potential and need for reconstructive operations staged postoperative functional rehabilitation