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8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 1/27
Sgoght bmvbhog
]rgbtaght kf oerkhlo gxtghskr tghmkhs dgslkhs kf teg flhjgrsPrlsg gh oebrjg sgokhmblrg mgs dìslkhs mg d“bppbrgld gxtghsgur mgs mkljts
P. CgddgaårgOdlhlqug
Igbhhg-m“Bro,
Lhstltut
mg
db
ablh
Hbhtgs
Btdbhtlqug,
32,
rug
mg
Abrtyrs,
==200
Hbhtgs,
Frbhog
Sgoglvgm
36
Ibhubry
3027> rgoglvgm lh rgvlsgm fkra
23
Bprld
3027> boogptgm 5 Aby 3027
Bvbldbcdg khdlhg 2= Iudy 3027
Bcstrbot
Oerkhlo flhjgr gxtghskr bppbrbtus lhiurlgs brg teg rgsudt kf teg lhltlbd boutg trgbtaght ebvlhj fbldgm kr cglhj ffibwgm. Cgobusg kf teglr oerkhlohbturg, tegsg lhiurlgs prgsght vbrlkus bakuhts kf tghmkh rgtrbotlkh, tghmkh obddus dghjteghlhj, pgrltghmlhkus sobr bmegslkhs, stbtlo bhm myhbalolacbdbhogs wlte teg ffigxkr bppbrbtus bhm lhtrlhslo ausodgs, bhm iklht okhtrboturgs. ]els brtlodg wldd rgvlgw teg bhbtkay kf teg gxtghskr agoebhlsabhm tegh wldd kutdlhg cy dkobtlkh, teg vbrlkus odlhlobd ploturgs tebt brg sgokhmbry tk oerkhlo tghmkh lhiury. ]eg odlhlobd prgsghtbtlkh kf tegsg lhiurlgsobh cg eljedy vbrlbcdg cut teglr syaptkabtkdkjy bhm trgbtaght brg vgry spgolflo. Kf teg pksslcdg tegrbpgutlo strbtgjlgs fkr oerkhlo abddgt flhjgr wltekr wltekut bsskolbtgm swbh-hgon mgfkralty, oerkhlo ckutkhhlgrg mgfkralty, oerkhlo sbjlttbd cbhm lhiurlgs, kdm rupturgs kh teg mkrsua kf teg wrlstbhm trbuabtlo mgfgots lh audtlpdg tlssugs, okhsgrvbtlvg trgbtaght ls kftgh teg ablh gdgaght. _gokhmbry surjlobd rgpblr ls hkt frgg kf okapdlobtlkhs,bhm teg rgsudts brg kftgh dbonlhj. Sgebcldltbtlkh bhm krtektlo crbolhj brg bh lhtgjrbd pbrt kf teg abhbjgaght kf tegsg lhiurlgs, hk abttgr weloetrgbtaght agtekm ls cglhj okhslmgrgm.# 3027 Gdsgvlgr Absskh _B_. Bdd rljets rgsgrvgm.
Ngywkrms9
Flhjgr
gxtghskr
tghmkh>
_gokhmbry
rgpblr>
Abddgt
flhjgr>
_wbh-hgon
mgfkralty>
Ckutkhhlgrg
mgfkralty>
]rbuabtlo
lhiury>
]ghmkh
dbogrbtlkh
Sìsuaì
Dgs dìslkhs bholghhgs mg d“bppbrgld gxtghsgur mgs mkljts rìsudtght mu mìfbut ku mg db fblddltg mg dgur trbltgaght lhltlbd bu stbmg blju. Dgsokhsìqughogs mg db oerkhloltì mgs dìslkhs ghtrbèhght à mgs mgjrìs mlvgrs mgs rìtrbotlkhs tghmlhgusgs, mgs bddkhjgaghts mg obds tghmlhgux, mgsbmeìrghogs
olobtrlolgddgs
pìrltghmlhgusgs,
mgs
mìsìquldlcrgs
stbtlqugs
gt
myhbalqugs
bvgo
d“bppbrgld
ffiìoelssgur
gt
dgs
ausodgs
lhtrlhsåqugs,
blhslqug
mgs
rblmgurs
brtloudblrgs.
Ogt
brtlodg
fblt
uh
rbppgd
mg
d“bhbtkalg
mg
d“bppbrgld
gxtghsgur
gt
mgs
mlffìrghts
tbcdgbux
odlhlqugs
okhsìoutlfs
à
uhgdìslkh tghmlhgusg bholghhg sgdkh dg slåjg mg db dìslkh. Dgs prìsghtbtlkhs odlhlqugs pguvght étrg trås vbrlìgs gt dgur sìalkdkjlg blhsl qug dgurtrbltgaght skht spìolflqugs 9 mkljt gh ablddgt oerkhlqug bvgo ku sbhs mìfkrabtlkh bsskolìg gh okd mg oyjhg, mìfkrabtlkh gh ckutkhhlårg oerkhlqug,dìslkh oerkhlqug mgs cbhmgdgttgs sbjlttbdgs, rupturgs bholghhgs bu mks mu pkljhgt blhsl qug dgs dìslkhs bvgo pgrtg mg sucstbhog pdurltlssudblrgrìpkhmght
à
mgs
strbtìjlgs
teìrbpgutlqugs
mbhs
dgsqugddgs
dg
trbltgaght
krtekpìmlqug
trkuvg
skuvght
uhg
dbrjg
pbrt.
Dgs
rìpbrbtlkhs
oelrurjlobdgssgokhmblrgs hg skht pbs mìhuìgs mg okapdlobtlkhs gt dgurs rìsudtbts skht dg pdus skuvght lhokapdgts. Db rììmuobtlkh gt d“bppbrglddbjg skhtlhmlsskolbcdgs mg db prlsg gh oebrjg mg ogs dìslkhs, qugddg qug sklt db aìtekmg teìrbpgutlqug ghvlsbjìg.#
3027 Gdsgvlgr Absskh _B_. ]kus mrklts rìsgrvìs.
Akts
odìs
9 ]ghmkh gxtghsgur mgs mkljts > Sìpbrbtlkh sgokhmblrg > Mkljt gh ablddgt > Mìfkrabtlkh gh okd mg oyjhg > Mìfkrabtlkh gh ckutkhhlårg > Dìslkh
trbuabtlqug > Supturg tghmlhgusg
Bvbldbcdg khdlhg bt
_olghogMlrgot
www.solghogmlrgot.oka
Oelrurjlg mg db ablh ?= (3027) 277‟252
G-abld
bmmrgss9 peldlppg.cgddgagrg@ag.oka.
ettp9//mx.mkl.krj/20.2026/i.ablh.3027.07.00223<:-?30?/ # 3027 Gdsgvlgr Absskh _B_. Bdd rljets rgsgrvgm.
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 2/27
2. Lhtrkmuotlkh
Oerkhlo lhiurlgs kf teg flhjgr gxtghskr bppbrbtus brg tegrgsudt kf bh kpgh (dbogrbtlkh, mgfgot) kr odksgm (rupturg,lhstbcldlty) lhltlbd lhiury tebt wbs gltegr hkt trgbtgm kr hkttrgbtgm prkpgrdy. ]els aby ebvg ebppghgm cgobusg teg lhiurywbs alssgm, teg lhltlbd trgbtaght wbs lhbpprkprlbtg, tegtrgbtaght murbtlkh wbs tkk sekrt kr tkk dkhj, kr cgobusg teglhltlbd trgbtaght fbldgm, mgspltg cglhj wgdd-okhmuotgm. Khogoerkhlo, teg tghmkh lhiury ls bsskolbtgm wlte vbrylhj bakuhts kf tghmkh rgtrbotlkh, tghmkh obddus dghjteghlhj, pgrltghmlhkus sobrbmegslkhs, stbtlo bhm myhbalo lacbdbhogs wlte teg ffigxkrbppbrbtus bhm lhtrlhslo ausodgs, bhm iklht okhtrboturgs.Abhlfgstbtlkh kf tegsg lhiurlgs, weloe ls odksgdy rgdbtgm tkteglr dkobtlkh bhm tegrgfkrg teg bhbtkay bhm peyslkdkjy kf teggxtghskr agoebhlsa, dgbms tk eljedy vbrlgm odlhlobd ploturgstebt ebvg gqubddy vbrlgm fuhotlkhbd okhsgqughogs. Cbsgm kh tegsljhlflobhog kf teg dbttgr, gboe odlhlobd ploturg wldd ebvg spgolflosyaptkabtkdkjy bhm rgspkhm tk spgolflo trgbtaght.
3. Bhbtkay kf gxtghskr agoebhlsa
3.2. Bhbtkay
bt
teg
fkrgbra
bhm
ebhm
3.2.2. _tbhmbrm
okhfljurbtlkh
]eg stbhmbrm okhfljurbtlkh kf teg flhjgr gxtghskr bppbrbtus(hkt lhodumlhj teg teuac) okhslsts kf b okaakh gxtghskrtghmkh fkr gboe flhjgr bhm lhmlvlmubd gxtghskr ausodgs fkr tegsgokhm bhm flfte flhjgr (Flj. 2). Lh teg fkrgbra, bckut = oa frkateg wrlst iklht, teg lhmlvlmubd gxtghskr tghmkhs fkr gboe flhjgrspdlt frka teg okaakh gxtghskr mljltkrua (GM) ausodg ckmy
(bdsk nhkwh
bs
teg
gxtghskr
mljltkrua
okaauhls).
Fkr
teg
flfteflhjgr, b slhjdg tghmkh brlsgs frka teg ausodg ckmy kf teggxtghskr mljltl alhlal (GMA), weloe ls bdsk nhkwh bs teggxtghskr mljltl qulhtl. Fkr teg sgokhm flhjgr, teg mggp gxtghskrlhmlols prkprlus (GLP) ebs ausodg flcgrs tebt rgboe teg wrlst iklhtlh :0% kf obsgs ^2Q.Kh teg mkrsua kf teg mlstbd rbmlus bhm teg rbmlkobrpbd iklht,
teg gxtghskr tghmkhs
‟ surrkuhmgm cy b syhkvlbd segbte
‟ ghtgr
lhtk b hbrrkw kstgkflcrkus obhbd tebt ls okapbrtaghtbdlzgm cysgptuasbhm ebs b rkkf fkragm cy teg gxtghskr rgtlhboudua. ]egtghmkh“s gxourslkh ls teg jrgbtgst bt tels pklht (up tk =2 aa).]eg 37-aa dkhj fkurte gxtghskr okapbrtaght okhtblhs teg GMbhmGLP. ]eg sdljetdy dkhjgr flfte okapbrtaght ls b flcrkus obhbd
tebt ruhs kvgr teg tkp kf teg mlstbd rbmlkudhbr iklht. Lt khdy ekdmsteg GMA. ]eg syhkvlbd segbte ebs b slhjdg prkxlabd rgogss,7 aa prkxlabd tk teg prkxlabd gmjg kf teg rgtlhboudua. Lttgralhbtgs cgykhm teg mlstbd gmjg kf teg rgtlhboudua cy b rgogssbrkuhm gboe tghmkh, wlte teg dkhjgst khg cglhj kh teg udhbrslmg. ]eg gxtghskr rgtlhboudua ekdms teg gxtghskr tghmkhsbjblhst teg sngdgtkh murlhj wrlst gxtghskr, prgvghtlhj tghmkhckw strlhjlhj.Kh teg mkrsua kf teg ebhm, teg tghmkhs mlvgrjg bhm brg hk
dkhjgr oydlhmrlobd> tegy cgokag ffibttgr bs tegy jgt odksgr tk tegagtbobrpkpebdbhjgbd (AOP) iklhts. ]eg gxtghskrs fkr tegalmmdg bhm rlhj flhjgrs ruh kvgr teg telrm bhm fkurte
agtbobrpbds. ]eksg
kf
teg
lhmgx
bhm
dlttdg
flhjgrs
ruh
kvgr
teg sgokhm bhm fkurte lhtgragtobrpbd spbogs. ]eg okaakh
gxtghskr tghmkhs
brg
egdm
tkjgtegr
cy
fbsolb,
weloe
obh
cgrglhfkrogm lh teg mlstbd agtbobrpbd rgjlkh cy kcdlqug krtrbhsvgrsg dlhns obddgm lhtgrtghmlhkus okhhgotlkhs. ]egmlstrlcutlkh kf tegsg lhtgrtghmlhkus okhhgotlkhs vbrlgs bs mkgsteglr okhstltutlkh (tghmkh, dljbaght, fbsolb). ]eg akst okaakh,akst mgflhgm bhm telongst iklh teg gxtghskr kf teg almmdg flhjgrtk tebt kf teg fkurte flhjgr lh :?% tk 50% kf obsgs ^3,?Q.Okhvgrsgdy, teg khg iklhlhj teg okaakh gxtghskr kf teg lhmgxtk tebt kf teg almmdg flhjgr ls rbrgr bhm telhhgr. ]eglhtgrtghmlhkus okhhgotlkh iklhlhj teg fkurte flhjgr“s gxtghskrtk tebt kf teg flfte flhjgr ls kftgh fkragm cy b mlvlslkh kf tegdbttgr“s okaakh gxtghskr tghmkh. ]eg GLP bhm GMA, weloe brgdkobtgm kh teg udhbr slmg kf teg okaakh gxtghskr kf teg
rgspgotlvg flhjgr, jghgrbddy mk hkt ebvg bhy lhtgrtghmlhkusokhhgotlkhs. Lhtgrtghmlhkus okhhgotlkhs egdp tk stbcldlzg teggxtghskr tghmkhs kh teg cbon kf teg agtbobrpbd egbms wegh tegAOPiklhts brg ffigxgm kr dbtgrbddy mgvlbtgm. ]egy obh pbrtlolpbtglh flhjgr gxtghslkh lh ogrtblh typgs kf bhbtkalobd vbrlbtlkhs.
3.2.3. Bhbtkalobd
vbrlbtlkhs
]eg jrgbtgst bhbtkalobd vbrlbtlkhs lh teg flhjgr gxtghskrbppbrbtus brg lh teg brgb cgtwggh teg fkrgbra bhm mkrsua kf tegebhm. ]egsg okhslst kf vbrlgm lhtgrtghmlhkus okhhgotlkhs,bcsghog kf teg flfte flhjgr“s okaakh gxtghskr tghmkh, tghmkhspdlttlhj, kr prgsghog kf gxtrb ausodgs kr tghmkhs suoe bs teg
gxtghskr agmll
prkprlus,
gxtghskr
lhmlols
bhm
agmll,
gxtghskr
Flj. 2. Mlbjrba kf teg flhjgr gxtghskr bppbrbtus kh teg mkrsua kf teg wrlst bhmebhm. Sgprkmuogm
wlte
pgralsslkh
kf Abètrlsg Krtekpìmlqug.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟252276
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 3/27
mljltkrua crgvls abhus (obddgm teg ――ausodg abhlgux““ lhFrghoe), gxtghskr lhmlols rbmlbdls, bhm gxtghskr okaauhlspkddlols bhm lhmlols ^2,3,=,7Q.
3.3.
Bhbtkay
bt
teg
flhjgrs
]eg bhbtkay kf teg gxtghskr agoebhlsa ls odgbrdy akrgokapdlobtgm bt teg mljlts (Flj. 3). Kh khg ebhm, teg gxtghskragoebhlsa ls stbcldlzgm cy Ybhokddl“s bssgacdbjg huodgus,wegrg vkdbr bhm mkrsbd obpsudg, dljbaght bhm tghmkh struoturgsokhvgrjg bt teg AOP bhm prkxlabd lhtgrpebdbhjgbd (PLP) iklhts.Kh teg ktegr ebhm, teg okaakh gxtghskr tghmkh ls hk dkhjgrlhmlvlmubdlzgm cgobusg lt ls lhtgrokhhgotgm wlte teg lhtrlhsloausodg‟tghmkh systga. Lhtgrdbolhj kf teg tghmkh flcgrs bhmDbhmsaggr“s rgtlhboudbr dljbaght (trbhsvgrsg bhm kcdlqugcbhms) bdkhj wlte teg supgrlapksltlkh kf teg gxtghskr ekkmrgsudts lh teg fkrabtlkh kf bh gxtghskr bpkhgurksls tebt lslhgdbstlo cut vbrlgs lh sebpg murlhj flhjgr ffigxlkh bhm gxtghslkh
^6Q. ]els bhbtkalobd okapdgxlty ls mlffloudt tk rgprkmuogsgokhmbrldy lh teg prgsghog kf kdm tghmkh lhiurlgs.
3.3.2. Agtbobrpkpebdbhjgbd iklht
]eg gxtghskr tghmkh jlvgs rlsg kh lts mggp surfbog tk b dkksgflcrkus cbhm tebt bttboegs tk teg mkrsbd AOP obpsudg bhm tegcbsg kf teg prkxlabd pebdbhx (P2), cut mkgs hkt okhtrlcutg tkprkxlabd pebdbhx gxtghslkh. ]rbhsvgrsg sbjlttbd cbhms (_C)frka ckte slmgs kf teg tghmkh dlhn teg gxtghskr agoebhlsa wlteteg vkdbr pdbtg, teg lhtgragtbobrpbd dljbaght (gxogpt fkr tegrbmlbd slmg kf teg lhmgx bhm teg udhbr slmg kf teg flfte flhjgr) bhmteg ffigxkr agoebhlsa bhm lhtrlhslo ausodg‟tghmkh systga cyagbhs kf teg agtbobrpkpebdbhjgbd flcrkus huodgus mgsorlcgm cyYbhokddl ^:Q. ]eg _C ebs twk seggts9 teg supgrflolbd khg okvgrstegmkrsbd pdbhg kf teg tghmkh bhm teg mggpgr, telongr khg okagsfrka teg mggp slmg kf teg tghmkh ^5Q.]eg _C kh teg rbmlbd slmg lstelhhgr bhm dkhjgr tebh teg khg kh teg udhbr slmg, pbrtloudbrdyfkr teg almmdg flhjgr ^<Q, weloe ls wey lt rupturgs akrg kftgh._lhog tegy ebvg hk flra bttboeaghts, teg _Cs brg akcldgstruoturgs. ]eg sbjlttbd cbhm“s flcgr krlghtbtlkh bhm tghslkh vbrymurlhj ffigxlkh-gxtghslkh. ]eg flcgrs brg pgrpghmloudbr tk teggxtghskr tghmkh wegh teg AOP ls lh hgutrbd pksltlkh. ]eg _C ls
uhmgr teg dgbst tghslkh wegh teg AOP ls ffigxgm =7 mgjrggs ^<Q.]eg _C nggps teg gxtghskr tghmkh pgrabhghtdy oghtgrgm kh tegmkrsua kf teg AOP, lhmgpghmght kf teg iklht“s ffigxlkh krmgvlbtlkh, dlalts lts prkxlabd gxourslkh bhm okhtrlcutgs tk tegprkxlabd pebdbhx“s gxtghslkh bhm eypgrgxtghslkh cy botlhj bs brgdby cgtwggh teg vkdbr pdbtg bhm gxtghskr tghmkh. Lts mggpbspgot ls lh odksg okhtbot wlte teg okddbtgrbd dljbaght, kvgrweloe lt sdlmgs murlhj ffigxlkh. Lts supgrflolbd bspgot ls okvgrgmmlstbddy cy trbhsvgrsg flcgrs frka teg gxtghskr ekkm. ]egyagrjg mkrsbddy bhm okhtrlcutg tk botlvg tghmkh stbcldlzbtlkh lhbmmltlkh tk teg pbsslvg stbcldlzbtlkh prkvlmgm cy teg _Cs.
3.3.3. Almmdg
pbrt
kf
prkxlabd
pebdbhx]eg okaakh gxtghskr tghmkh mlvlmgs lhtk tergg sdlps, boghtrbd sdlp (O_) bhm twk dbtgrbd khgs. ]egsg tergg sdlps agrjgwlte teg agmlbd bhm dbtgrbd sdlps frka teg lhtgrkssgl tghmkhs khgltegr slmg kf teg pebdbhx, bhm teg duacrlobd tghmkh kh tegrbmlbd slmg. ]eg O_ agrjgs wlte teg tghmlhkus flcgrs kf teg twklhtrlhslo agmlbd sdlps tk fkra b okaclhgm oghtrbd tghmkh, weloelhsgrts kh teg cbsg kf teg almmdg pebdbhx (P3) bhm gxtghms lt.Gboe dbtgrbd gxtghskr tghmkh sdlp fusgs wlte teg dbtgrbd sdlp kf teg lhtrlhslo tghmkhs tk fkra b okhiklhgm dbtgrbd cbhm, weloeorkssgs teg mkrskdbtgrbd slmg kf teg PLP iklht. ]eg gxtghskrekkm“s trbhsvgrsg bhm kcdlqug flcgrs iklh teg lhtrlhslo agmlbdbhm dbtgrbd sdlps wlte teg okaakh gxtghskr tghmkh. ]els
okapdgx tghmlhkus dbygr okvgrs bckut :7% kf teg olrouafgr-ghog kf teg prkxlabd pebdbhx.Kh gltegr slmg kf teg PLP iklht, teg trbhsvgrsg rgtlhboudbr
dljbaght (]SD), weloe brlsgs frka teg vkdbr pdbtg bhmoruolfkra O2 puddgy, bttboegs tk teg dbtgrbd gmjg kf tegokhiklhgm dbtgrbd cbhm. Dlng teg sbjlttbd cbhm, teg ]SD pudds tegokhiklhgm dbtgrbd cbhm tkwbrms teg mkrsua kf teg dbtgrbd slmg kf teg PLP murlhj ffigxlkh bhm dlalts lts mkrsbd mlspdbogaght murlhjgxtghslkh.
3.3.?. Almmdg pebdbhx
]eg twk okhiklhgm dbtgrbd cbhms cgokag mkrsbdlzgm bhm brg
iklhgm kvgr teg
cbsg
kf
teg
pebdbhx cy
b
trlbhjudbr
dljbaght
tebt
Flj. 3. Mlbjrba kf teg gxtghskr agoebhlsa lh b flhjgr. Mkrsbd (B) bhm dbtgrbdudhbr
(C)
vlgws
kf
29
tgralhbd
tghmkh,
39
trlbhjudbr
dljbaght,
?9
kcdlqugrgtlhboudbr dljbaght, =9 okhiklhgm dbtgrbd cbhm, 79 trbhsvgrsg rgtlhboudbr dljb-aght,
69
oghtrbd
sdlp,
:9
gxtghskr
ekkm
(kcdlqug
flcgrs),
59
lhtgrkssgkus
tghmkh,
<9gxtghskr ekkm (trbhsvgrsg flcgrs), 209 sbjlttbd cbhm, 229 mggp trbhsvgrsg agtb-obrpbd
dljbaght,
239
duacrlobd
ausodg,
2?9
okaakh
gxtghskr
tghmkh,
2=9
mkrsbdlhtgrkssgkus ausodg.
Sgprkmuogm
wlte
pgralsslkh
kf
Abètrlsg
Krtekpìmlqug.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟252
27:
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 4/27
ebs trbhsvgrsg flcgrs. Lh teg mlstbd pkrtlkh kf teg almmdg pebdbhx,teg twk okhiklhgm dbtgrbd cbhms agrjg lhtk b slhjdg tgralhbdgxtghskr tghmkh tebt agrjgs wlte teg mkrsbd obpsudg kf teg mlstbdlhtgrpebdbhjgbd (MLP) iklht bhm lhsgrts kh teg cbsg kf teg mlstbdpebdbhx (P?), 2.= aa frka teg hbld abtrlx ^20Q. ]eg prgobrlkustghmkh bhm snlh vbsoudbrlty lh tels mlstbd bttboeaght brgb obhgxpdblh lts elje frgqughoy kf spkhtbhgkus rupturg bhm egbdlhjprkcdgas ^22Q.]eg kcdlqug rgtlhboudbr dljbaght (KSD) mgsorlcgm cy
Dbhmsaggr brlsgs frka teg dbtgrbd gmjg kf teg mlstbd agtbpeyslskfteg prkxlabd pebdbhx bhm teg ffigxkr tghmkh segbte. Lt tbngs bhkcdlqug trbigotkry bhm orkssgs teg PLP dbtgrbddy lh frkht kf ltsffigxlkh-gxtghslkh bxls, tk iklh teg vkdbr slmg kf teg okhiklhgmdbtgrbd cbhm bhm agrjgs wlte lt bt teg almmdg pebdbhx“s hgonbrgb, okhtrlcutlhj tk teg fkrabtlkh kf teg tgralhbd tghmkh kf tegmljltbd gxtghskr agoebhlsa. Ekwgvgr, tels dljbaght obh cggxtrgagdy telh, gvgh alsslhj ^23Q bhm lts prgolsg rkdg lsokhtrkvgrslbd ^2?Q. Cgobusg lts trbigotkry pdbogs lt uhmgr tghslkhmurlhj PLP gxtghslkh, lt ls prgsuagm tk prkvlmg bh botlvg
tghkmgsls gffgot tebt bddkws MLP gxtghslkh cut dlalts lts ffigxlkhwegh teg PLP ls gxtghmgm.
3.?. ]kpkjrbpelo zkhgs
]eg wlmgdy bmkptgm tkpkjrbpelo odbsslflobtlkh fkr gxtghskragoebhlsa lhiury mgvgdkpgm cy Vgrmbh bhm Ndglhgrt ebs gljetzkhgs ^2=Q (Flj. ?). ]eg gvgh-huacgr zkhgs (3, =, 6, 5)okrrgspkhm tk teg rgjlkhs dkobtgm kvgr b ckhg“s mlbpeysls. ]egkmm-huacgr zkhgs (2, ?, 7, :) brg dkobtgm kvgr teg MLP, PLP,AOP bhm wrlst iklhts, rgspgotlvgdy. ]eg tktbd gxtghskr tghmkhgxourslkh vbrlgs hgbrdy dlhgbrdy rgdbtlvg tk teg akvgaght
bapdltumg bt teg wrlst, AOP bhm PLP iklhts. Lt ls dbrjgst fkr tegalmmdg flhjgr (70 aa) bhm sabddgst fkr teg flfte flhjgr (?7 aa)^27Q.Lh gboe zkhg, sgokhmbry lhiurlgs tk teg gxtghskr agoebhlsa
ebvg vgry pbrtloudbr bhbtkalobd, pbtekdkjlobd, odlhlobd bhmtegrbpgutlo fgbturgs.
?. Oerkhlo lhiurlgs lh zkhg 29 abddgt flhjgr
?.2. Mgflhltlkhs
Abddgt flhjgr okrrgspkhms tk b ffigxlkh mgfkralty kf teg
mlstbd pebdbhx mug tk dkss kf botlvg gxtghslkh (Flj. =). ]elsvbrlbcdg ffigxlkh mgfkralty rgffigots dbon kf okhtlhulty lh tegtgralhbd gxtghskr agoebhlsa, gltegr mug tk sucoutbhgkusrupturg, kr pbrtlbd kr okapdgtg tghmkh dbogrbtlkh (tghmlhkusabddgt flhjgr), kr mug tk ckhg bvudslkh bt lts lhsgrtlkh kh tegP? cbsg (ckhy abddgt flhjgr). Lh akst obsgs, lt ls teg sgqugdbkf odksgm alhkr trbuab tebt akstdy koours murlhj fkrogm P?eypgrffigxlkh, cut koours lh skag obsgs bftgr b eypgrgxtgh-slkh lhiury, pbrtloudbrdy fkr ckhy abddgt flhjgr. ]eg flfteflhjgr, almmdg flhjgr bhm rlhj flhjgr brg bffgotgm teg akst^26Q.Abddgt flhjgr ls dbcgdgm oerkhlo = wggns bftgr teg lhltlbd
lhiury gvght
^2:Q.
B
hkh-pblhfud
lhltlbd
lhiury
aby
ebvg
cggh
alssgm lhltlbddy bhm dgft uhtrgbtgm kr hkt trgbtgm prkpgrdy(uhsultbcdg spdlht tebt ls hkt wgdd tkdgrbtgm kr wkrhlhtgralttghtdy, kvgrdy sekrt laakcldlzbtlkh pgrlkm). Oerkhloabddgt flhjgr aby bdsk rgffigot b fbldurg kf wgdd-okhmuotgm lhltlbdtrgbtaght tebt rgsudtgm lh b dghjteghgm, lhgffgotlvg tghmkhobddus.
Flj. ?. ]kpkjrbpelo zkhgs fkr gxtghskr tghmkhs. Sgprkmuogm
wlte
pgralsslkh
kf Abètrlsg Krtekpìmlqug.
Flj.
=.
Abddgt
flhjgr
mgfkralty
kf
teg
flfte
flhjgr.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟252275
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
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?.3. Odlhlobd prgsghtbtlkh bhm fuhotlkhbd lapblraght
]eg lhokhvghlghog rgdbtgm tk abddgt flhjgr aby khdy cg mugtk gstegtlos. Khog teg gxtghskr dbj rgboegs ?0 tk 70 mgjrggs, trugfuhotlkhbd lapblraght aby lhtgrfgrg wlte ^25Q pgrfkralhjmgdlobtg abhubd wkrn, pdbylhj bh lhstruaght, typlhj kh bngyckbrm kr cuaplhj murlhj lhhkoukus akvgaghts.Prgssurg-sghsltlvg swgddlhj aby cg prgsght kvgr teg MLP
iklht kr teg almmdg pebdbhx tebt okrrgspkhms tk teg obddus bt tegprkxlabd tghmkh ghm> lts rgtrbotlkh mgtgralhgs teg gxtght kf tegabddgt flhjgr. _oegltzgr bhm Sbybh ebvg sekwh tebt 2 aa kf tghmkh dghjteghlhj trljjgrs b 37-mgjrgg MLP gxtghskr dbj bhmtebt = aa kf dghjteghlhj dgbms tk akrg tebh 60 mgjrggs dbj^2<Q.Bsskolbtgm swbh-hgon mgfkralty9 b swbh-hgon mgfkralty
mug tk PLP eypgrgxtghslkh obh koour slaudtbhgkusdy wlteoerkhlo abddgt flhjgr (Flj. 7), pbrtloudbrdy lh eypgrakcldgpbtlghts. Lt ls gxpksgm murlhj fudd botlvg flhjgr gxtghslkh bhmobh crlhj bckut shbpplhj sghsbtlkhs upkh teg stbrt kf PLP
ffigxlkh.]els mgfkralty ls teg rgsudt kf lacbdbhog lh teg botlkh kf teg
gxtghskr agoebhlsa kh teg mljlts, dbxlty kf teg PLP vkdbr pdbtgbhm prkjrgsslvg ]SD wgbnghlhj. Cgobusg teg tgralhbd tghmkhkf teg gxtghskr agoebhlsa ls rupturgm, teg oghtrbd sdlp lssucigotgm tk teg fudd cruht kf teg gxtghslkh fkrogs. Lh obsgs kf vkdbr pdbtg dbxlty kr wgbnhgss, tels dgbms tk PLP eypgrgxtghslkh,mkrsbdlzbtlkh bhm agmlbdlzbtlkh kf teg dbtgrbd sdlps wlteprkjrgsslvg ]SD dkksghlhj (Flj. 6). _hbpplhj bt teg stbrt kf PLP ffigxlkh ls rgdbtgm tk summgh vghtrbd selftlhj kf teg dbtgrbdsdlps rgdbtlvg tk teg P2 okhmydgs. ]eg ffigxlkh botlkh kf teg mggpffigxkr tghmkh kh teg MLP ls rglhfkrogm cy PLP eypgrgxtghslkh,
prkjrgsslvgdy abnlhj
teg
mgfkralty
wkrsg.
]els
bdsk
rgmuogsokkrmlhbtlkh murlhj kvgrbdd flhjgr ffigxlkh cgobusg teg MLPffigxgs cgfkrg teg PLP.
?.?. Odlhlobd bssgssaght
]eg odlhlobd gxbalhbtlkh aust9
agbsurg teg mgjrgg kf gxtghskr dbj bhm pktghtlbddy bsskolbtgmPLP eypgrgxtghslkh>
bssgss teg bakuht kf botlvg MLP ffigxlkh wegh teg PLP ls egdmlh gxtghslkh, bhm teg bakuht kf botlvg MLP gxtghslkh> telsrgffigots kh teg dbxlty lh teg tghmkh obddus bt teg tgralhbd
gxtghskr agoebhlsa> mgtgralhg lf teg mgfkralty obh cg pbsslvgdy rgmuogm wlte tegflhjgr iklhts lh vbrlkus pksltlkhs>
bssgss teg snlh okhmltlkh kvgr teg MLP> bssgss teg bakuht kf iklht dbxlty.
Bmmltlkhbd gxbalhbtlkhs9 stbhmbrm rbmlkjrbpes wlte B/P bhmstrlot dbtgrbd vlgws brg gssghtlbd. ]egsg brg hggmgm fkr tegmlbjhksls kf ckhy abddgt flhjgr, bhm tk mgtgralhg tegsljhlflobhog bhm bakuht kf ckhg frbjaght rgtrbotlkh, bdkhjwlte teg sgvgrlty kf kstgkbrterltls. Vkdbr sucduxbtlkh kf tegmlstbd pebdbhx ls pksslcdg lf teg frbjaght ls dbrjgr tebh khg-telrm
kf teg
brtloudbr
surfbog. Wdtrbskhkjrbpey
bhm
ASL
obh
egdp
tkbssgss teg rgtrbotlkh kf teg prkxlabd tghmkh stuap, bdtekuje tegdbttgr ls rbrgdy lhmlobtgm.
?.=. ]rgbtaght
]rgbtaght ls obddgm fkr wegh teg pbtlght gxpgrlghogs trugfuhotlkhbd lapblraght. Abhy oerkhlo abddgt flhjgrs brg wgddtkdgrbtgm frka b fuhotlkhbd pklht kf vlgw bhm mk hkt iustlfybmmltlkhbd trgbtaght. Okhsgrvbtlvg trgbtaght aust pdby b vgrydbrjg rkdg egrg cgobusg surjlobd okrrgotlkh kf abddgt flhjgr lskftgh lhokapdgtg bhm hkt frgg kf okapdlobtlkhs.
?.=.2. Okhsgrvbtlvg trgbtaght Laakcldlzbtlkh kf teg MLP lh gxtghslkh cy bh krtektlo crbog
aust cg pgrfkragm systgabtlobddy fkr bhy obsg kf oerkhloabddgt flhjgr, hk abttgr lts murbtlkh ^2:,30,32Q. Gvgh lf telstrgbtaght wbs mkhg prgvlkusdy, pgrslstghog kf sljhlflobhtrgslmubd gxtghskr dbj ls qultg kftgh rgdbtgm tk trgbtaght hkh-okapdlbhog lh b pbtlght wek wbs hkt wgdd lhfkragm kr hktaktlvbtgm. ]eg pbtlght aust cg odgbrdy lhfkragm kf tegtrgbtaght“s jkbd, lts murbtlkh bhm ekw tk abhbjg teg pgrlkm kf iklht laakcldlzbtlkh.
?.=.2.2.
Jkbd
bhm
prlholpdgs. ]eg jkbd ls tk rgmuog teg
rgslmubd MLP
gxtghskr
dbj
tk
teg
pklht
wegrg
lt mkgs
hkt
lapblrFlj.
7.
_wbh-hgon
mgfkralty
bsskolbtgm
wlte
abddgt
flhjgr
lh
teg
lhmgx.
Flj.
6.
Mlbjrba
kf
teg
agoebhlsa
kf
swbh-hgon
mgfkralty
sgokhmbry
tk
abddgtflhjgr.Frka
^60Q. Sgprkmuogm
wlte
pgralsslkh
kf Abètrlsg Krtekpìmlqug.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
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27<
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
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fuhotlkh (20 tk 27 mgjrggs), kr gvgh cgttgr, ls hkh-gxlstght. ]elsls pksslcdg mug tk jrbmubd okhtrbotlkh kf teg tghmkh obddusmurlhj tghmkh sobr abturbtlkh, weloe tbngs bt dgbst ? akhtes._trlot MLP laakcldlzbtlkh lh gxtghslkh ls hgogssbry murlhj telspgrlkm> teg pbtlght aust okhtlhukusdy wgbr bh krtektlo crbogtebt laakcldlzgs teg iklht fkr bt dgbst 5 wggns. ]eg akrg tegstbrt kf trgbtaght ls mgdbygm, teg dkhjgr tels laakcldlzbtlkhpgrlkm aust cg, bhm lt obh skagtlags cg = akhtes dkhj ^30Q.]eg krtektlo crbog obh tegh cg wkrh khdy bt hljet fkr bhktegr 2‟?akhtes. ]eg laakcldlzbtlkh pgrlkm obh cg sekrtghgm fkr obsgskf ckhy abddgt flhjgr cgobusg teg pgrlkstgbd okhtlhulty kf tegfrbjaght okhtrlcutgs tk bppgbrbhog kf b ckhg obddus.
?.=.2.3. ]ypgs
kf
krtektlo
crbogs. ]egrg brg sgvgrbd typgs kf
krtektlo crbogs9 bdualhua strlps wlte fkba ruccgr-cbonlhj,prgakdmgm pdbstlo spdlhts kr oustka-akdmgm tegrakpdbstlospdlht. Lh tgras kf okafkrt bhm stlffhgss, skdlm tegrakpdbstlospdlhts tebt brg oustkalzgm tk teg pbtlght bhm wbtgr-rgslstbht brg
prgfgrbcdg ^32Q. ]eg huagrkus vkdbr kr mkrsbd crbogs bvbldbcdglh stkrgs brg kftgh hkt wgdd tkdgrbtgm lh teg dkhj tgra, bhm mk hktbdwbys prkvlmg strlot MLP laakcldlzbtlkh. Akrgkvgr, ogrtblhspdlhts bdsk laakcldlzg teg PLP iklht, weloe ls uhhgogssbrycgobusg teg PLP“s aktlkh mkgs hkt bffgot teg tgralhbd tghmkh“smlstbd rgtrbotlkh> lh bmmltlkh, tegy brg uhokafkrtbcdg bhm obhpktghtlbddy dgbm tk stlffhgss.Lh kur prbotlog, wg abng b mkrsbd tegrakpdbstlo spdlht tebt ls
jdugm skdlmdy tk teg hbld bhm bttboegm tk P3 cy b rgakvbcdgVgdork strbp (Flj. :). ]els dgbvgs teg flhjgrtlp frgg, bdtekuje ltobh cg suppkrtgm murlhj lhtghsg abhubd botlvltlgs wlte bhbmmltlkhbd Vgdork strbp tebt prktgots teg jdugm pkrtlkh kh teg
hbld. ]eg
MLP
aust
cg
laakcldlzgm
lh
b
okapdgtgdy
strbljetpksltlkh, kr gvgh up tk 20 mgjrggs eypgrgxtghslkh. Cgykhm tels,teg MLP“s mkrsbd snlh vbsoudbrlzbtlkh ls okaprkalsgm cgobusgteg mkrsbd okddbtgrbd brtgrlbd crbhoegs brg strgtoegm. Zegh bsljhlflobht, uhokafkrtbcdg swbh-hgon mgfkralty ls bdsk prgsght,wg dlalt PLP gxtghslkh gltegr wlte b PLP-stkp typg mkrsbd spdlhtgxtghslkh kr wlte b Cgbsdgy rlhj (Flj. 5).
?.=.2.?. Sgsudts. Lh b sgrlgs kf 20 obsgs, Pbtgd gt bd. fkuhm hkrgslmubd gxtghskr dbj lh flvg obsgs, b 20-mgjrgg dbj lh fkur obsgsbhm b 20- tk 30-mgjrgg dbj lh khg obsg ^30Q. ]eg mgfkraltyrgkoourrgm lh twk pbtlghts wltelh b wggn kf teg trgbtaght“s ghm,cut tegy udtlabtgdy ebm jkkm rgsudts wlte bh bmmltlkhbd 5-wggnlaakcldlzbtlkh pgrlkm. Jbrcgrabh gt bd. fkuhm hk mlffgrghogslh teg kutokags kf boutg bhm oerkhlo abddgt flhjgrs trgbtgm wlteokhtlhukus crbolhj fkr 6‟20 wggns, bhm tegh bh bmmltlkhbd =wggns bt hljet ^2:Q> teg agbh rgslmubd gxtghskr dbj wbs dgsstebh 20 mgjrggs lh ckte jrkups.Ogrtblh okapdlobtlkhs ebvg cggh rgpkrtgm wlte krtektlo
crbog trgbtaght9 snlh lhtkdgrbhog, abogrbtlkh, prgssurg skrgs,trbhslght hbld mystrkpey, okdm-lhmuogm pblh ^33Q. ]egsg obh cgprgvghtgm cy rgjudbr odlhlobd oegon-ups murlhj teg trgbtaghtpgrlkm.
?.=.3. _urjlobd trgbtaght
Flvg typgs kf prkogmurgs obh cg pgrfkragm fkr abddgt flhjgr9tghmkh obddus sekrtghlhj, tghmkh jrbftlhj, rgcbdbholhj kf tegflhjgr gxtghskr agoebhlsa, splrbd kcdlqug rgtlhboudbr dljbaght(_KSD) rgokhstruotlkh bhm MLP fuslkh. ]egsg agtekms ebvgcggh mgsorlcgm lh pucdlsegm rgtrkspgotlvg stumlgs tebt typlobddylhodumg khdy b sabdd huacgr kf obsgs bhm brg mlffloudt tk
okapbrg tk
gboe
ktegr.
Hk
agtekm
ebs
trudy
cggh
sekwh
tk
cg
Flj. :. Mkrsbd tegrakpdbstlo crbog jdugm tk teg hbld, dgbvlhj teg flhjgr pbm frgg.
Bh
bmmltlkhbd
Vgdork
strbp
obh
cg
bmmgm
tk
prktgot
teg
pkrtlkh
jdugm
kh
teg
hbld.
Flj. 5. Cgbsdgy-typg rlhj tk rgstrlots PLP eypgrgxtghslkh. Bppgbrbhog wlte teg iklht
ffigxgm
(b)
bhm
gxtghmgm
(c).
P.
Cgddgaårg
/
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?=
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8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
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supgrlkr rgdbtlvgtk bhktegr, kr rgdbtlvgtk okhsgrvbtlvg trgbtaght.Bs b okhsgqughog, teg lhmlobtlkh fkr surjlobd trgbtaght ls dlaltgmtk fbldurg kf wgdd-okhmuotgm okhsgrvbtlvg trgbtaght.
?.=.3.2. ]ghmkh obddus sekrtghlhj. Gxolslkh kf teg tghmkhobddus fkddkwgm cy mlrgot suturg ls teg kdmgst tgoehlqug stlddcglhj usgm fkr trgbtlhj oerkhlo abddgt flhjgr. _lapdy outtlhj tegtghmkh obddus bhm tegh suturlhj lt dgbms tk alxgm rgsudts (60%jkkm bhm vgry jkkm) ^3?Q. B tghmkh obddus sekrtghlhj‟suturlhjprkogmurg bppgbrs tk cg akrg bpprkprlbtg.Wslhj b cbykhgt-typg mkrsbd lholslkh, 3‟? aa kf teg tghmkh
obddus ls gxolsgm bhm teg tghmkh suturgm wlte b ruhhlhj =-0akhkfldbaght. Lt ls prktgotgm cy plhhlhj teg iklht lh sdljeteypgrgxtghslkh fkr 6 wggns. Dgvbhtg gt bd. rgpkrtgm kh sgrlgs kf 66 obsgs wlte bt dgbst ?0 mgjrggs gxtghskr dbj trgbtgm wlte telstgoehlqug bftgr b agbh mgdby kf 2= wggns ^3=Q. ]els wbs teg flrsttrgbtaght bttgaptgm lh akrg tebh ebdf kf teg obsgs. Zlteb agbhfkddkw-up kf 36 akhtes, teg agbh rgslmubd gxtghskr dbj wbs =.7mgjrggs, bhm wbs hgvgr jrgbtgr tebh 37 mgjrggs. ]eg agbh MLP
ffigxlkh wbs 70 mgjrggs. ]egrg wgrg twk fbldurgs mug tkgxtghslkh okhtrboturg, khg kf weloe wbs dbtgr trgbtgm wlte MLPfuslkh. ]eg cgst rgsudts wgrg lh teg ykuhjgr pbtlghts> teg wkrsgrgsudts wgrg lh teksg wlte ckhy abddgt flhjgr, dlngdy cgobusg kf jrgbtgr tghmkh sekrtghlhj bftgr rgsgotlkh kf teg ckhg frbjaght._oewgltzgr bhm Sbybh“s gxpgrlaghtbd wkrn ebs sekwh tebt lt lsvgry mlffloudt tk rglhsgrt teg tgralhbd gxtghskr tghmkh lf lt lsakrg tebh 2 aa rgtrbotgm ^2<Q. _laldbr rgsudts wgrg kctblhgmcy Wdnôr gt bd. wek rglhsgrtgm teg tgralhbd tghmkh kh teg P?cbsg wlte b ckhg bhoekr ^37Q bhm wlte pudd-kut bhm pudd-lhsuturg tgoehlqugs ^36,3:Q.]ghkmgrakmgsls kr teg Crkkns-Jrbhgr tgoehlqug ls b
vbrlbtlkh tebt
bvklms
teg
pktghtlbd
mgvbsoudbrlzbtlkh
rgdbtgmtk snlh mgtboeaght bhm gxpksurg kf tghmkh frbjaghts tebt tegprgvlkus tgoehlqug ebs cggh orltlolzgm fkr. B 3‟? aa cdkon kf snlh bhm tghmkh kvgr teg MLP ls gxolsgm bhm teg rgsudtlhj mgfgotsuturgm, fkddkwgm cy laakcldlzbtlkh wlte bxlbd plhhlhj kf tegfuddy gxtghmgm MLP (Flj. <). Lh kur prbotlog, teg lholslkh lsodksgm uslhj ?-0 kr =-0 hkh-rgskrcbcdg suturg lh b vgrtlobdabttrgss pbttgrh, wlte teg nhkt dkobtgm kh teg prkxlabd slmg.]eg suturg ls prktgotgm wlte bh bxlbd trbhs-MLP 2.0 aa N-wlrgterkuje teg pudp fkr bt dgbst 5 wggns> b rgakvbcdg prktgotlvgspdlht ls wkrh tk prgvght teg N-wlrg frka crgbnlhj. _uturgrgakvbd ls mgdbygm bs auoe bs pksslcdg, mgpghmlhj kh snlhtkdgrbhog. ]eg pucdlsegm rgsudts wlte tels tgoehlqug ^35‟?0Q
bppgbr gqulvbdght tk teg khgs wlte teg sekrtghlhj‟suturlhjtgoehlqug mgsorlcgm cy Dgvbhtg ^3=Q, wlte b rgslmubd gxtghskrdbj kf 20 mgjrggs kr dgss, bhm prgsgrvgm MLP ffigxlkh.]eg tgoehlqug rgoghtdy mgsorlcgm cy Jgkrjgsou dgbms tk
slaldbr rgsudts ^?2Q. Lt abngs usg kf b mg-gpltegdlbdlzgm pgmlodgmsnlh ffibp tk rglhfkrog teg gxtghskr tghmkh, weloe ls mlstbddyrgbttboegm uslhj teg pudd-kut tgoehlqug.
?.=.3.3.
]ghmkh
jrbftlhj. ]ghmkh jrbftlhj tgoehlqugs bftgrobddus gxolslkh ebvg cggh mgsorlcgm akrg rgoghtdy. ]eglhmlobtlkh sggas pbrtloudbrdy rgdgvbht bftgr dkss kf tghmkhsucstbhog fkddkwlhj bh kpgh gxtghskr agoebhlsa lhiury ^?3Q.
]eg jrbft
obh
cg
tbngh
frka
teg
pbdabrls
dkhjus,
lhsgrtgm
lhtk
b
ckhg tuhhgd kh P? bhm tegh suturgm bt teg prkxlabd ghm bsmgsorlcgm cy Ju bhm Yeu ^?3Q. B prktgotlvg spdlht ls wkrh fkr =wggns. Zbhj gt bd. ebrvgstgm b ckhg-tghmkh jrbft frka teggxtghskr obrpl rbmlbdls crgvls (GOSC)
‟ lhodumlhj lts mlstbd ckhg
bttboeaght ‟ bhm sgourgm lt tk teg P? cbsg ^??Q. ]eg MLP iklhtwbs plhhgm lh 20‟27 mgjrggs eypgrgxtghslkh fkr = wggns.]egsg twk tgoehlqugs sgga tk jlvg okapbrbcdg rgsudts tk teksgkf teg bckvg-mgsorlcgm tgoehlqugs. Lh b sgrlgs kf =0 oerkhlo
obsgs, Ju
bhm
Yeu
rgpkrtgm
rgstkrlhj
<:.6%
kf
teg
rbhjg
kf aktlkh kf teg okhtrbdbtgrbd MLP iklht bhm ebvlhj <5.7% jkkm krgxogddght rgsudts ^?3Q. Lh teg 35 pbtlght sgrlgs mgsorlcgm cyZbhj gt bd., teg agbh rgslmubd pkstkpgrbtlvg MLP gxtghskr dbjwbs = mgjrggs> 3= pbtlghts ebm bh gxogddght kutokag bhm tegktegr fkur ebm b jkkm kutokag ^??Q.
?.=.3.?.
Gxtghskr
agoebhlsa
rgcbdbholhj. Gxtghskr agoebh-
lsa rgcbdbholhj okhslsts kf oghtrbd sdlp tghktkay (Fkwdgr“stgoehlqug) bhm rgdbtgm prkogmurgs. ]eg prlholpdg cgelhm telstgoehlqug ls tk rgmuog teg gxtghslkh fkrogs pdbogm kh teg PLP cyrgdgbslhj teg O_ lhsgrtlkh. ]eg rgsudt ls tebt teg dbtgrbd sdlpstrbhsalt gxtghslkh fkrogs tk teg tgralhbd tghmkh bhm tk lts
dghjteghlhj obddus, tegrgcy bddkwlhj P? gxtghslkh (Flj. 20).]eg trlbhjudbr dljbaght aust cg prgsgrvgm tk bvklm orgbtlhj bckutkhhlgrg mgfkralty. ]eg tgoehlqug mgsorlcgm cy Fkwdgr obhcg pgrfkragm wlte dkobd bhgstegslb uslhj b mkrskdbtgrbdbpprkboe. Cy outtlhj teg ]SD, teg gxtghskr agoebhlsa obhcg dlftgm bhm rgffigotgm. Frka teg mggp slmg kf teg gxtghskragoebhlsa, teg O_ lhsgrtlkh ls tegh jrbmubddy mgtboegmprkxlabddy tk mlstbddy. Botlvg MLP gxtghslkh obh cg bssgssgmlhtrbkpgrbtlvgdy lf teg prkogmurg ls pgrfkragm wlte b sghskryhgrvg cdkon ^?=Q.B mlrgot mkrsbd lholslkh obh bdsk cg abmg, bhm teg O_
rgdgbsgm kvgr teg PLP iklht ^?7Q. ]erkuje b trbhsvgrsg bpprkboe,
Skzabryh rgokaaghmgm
gxolslkh
kf
70%
kf
teg
oghtrbd
sdlp“s
Flj. <. Mlbjrba kf teg tghkmgrakmgsls tgoehlqug. Sgprkmuogm
wlte
pgralsslkh
kf
Abètrlsg
Krtekpìmlqug.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟252
262
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 8/27
wlmte (? kf 6 aa), bckut 7 aa prkxlabd tk teg iklht dlhg tkbvklm teg dbtgrbd cbhms bhm trlbhjudbr dljbaght ^?6Q. Bookrmlhj
tk Skzabryh, tels jghulhg O_ tghgotkay ls iustlflgm cbsgm khteg okhoduslkhs kf Elwbtbrl“s clkagoebhlobd stumy sekwlhjtebt teg rgslmubd MLP gxtghskr dbj ls dgss wegh akrg kf teg O_wbs gxolsgm kh teg mkrsbd slmg kf P2 ^?:Q.Pkstkpgrbtlvg PLP spdlht laakcldlzbtlkh lh gxtghslkh fkr 3
wggns ls rgokaaghmgm tk bvklmkr prgvght PLP gxtghslkh mgflolt^?7,?6Q. ]eg MLP iklht aust cg laagmlbtgdy akcldlzgm.Fkwdgr“s tgoehlqug okrrgots abddgt flhjgr wlte b agbh
rgslmubd pkstkpgrbtlvg gxtghskr dbj kf 20 mgjrggs kr dgss ^?7‟=0Q (Flj. 22). Lt ls hkt uhegbrm kf tk kcsgrvg jrbmubdlaprkvgaght lh teg MLP gxtghskr dbj lh teg akhtes fkddkwlhjteg prkogmurg (up tk 2 ygbr), bdkhj wlte okrrgotlkh kf bhy
rgsudtlhj PLP
gxtghslkh
mgflolt ^?=,?7Q.
]eg
koourrghog
kf sgokhmbry ckutkhhlgrg mgfkralty ls rbrg, bhm ebs cggh rgpkrtgmlh =.7% kf pucdlsegm obsgs ^?7‟=0Q. ]els obh cg prgvghtgm cyprgsgrvlhj teg trlbhjudbr dljbaght bhm dbtgrbd cbhms murlhj tegtghktkay, bhm trbhslght pkstkpgrbtlvg PLP laakcldlzbtlkh lhgxtghslkh. Fkwdgr“s tgoehlqug obh cg okaclhgm wlte bprkogmurg kh teg tgralhbd tghmkh kvgr teg MLP iklht, bsrgokaaghmgm cy Skzabryh wegh teg abddgt flhjgr“s gxtghskrdbj ls sljhlflobht ^?6Q. Clkagoebhlobd stumlgs, pgrfkragm cyOebk bhm tegh Elwbtbrl, ebvg sekwh tebt Fkwdgr“s tgoehlqug lshkt tktbddy gffgotlvg wegh teg MLP gxtghskr dbj ls jrgbtgr tebh ?6mgjrggs ^?:,=2Q. Lh suoe obsgs, Skzabryh bdsk sekrtghs tegtghmkh obddus cy pdlobturg (wltekut gxolslkh) wlte twk alork-
ckhg bhoekrs pdbogm bt teg P? cbsg, lh okaclhbtlkh wlte MLPplhhlhj lh gxtghslkh fkr = wggns ^?6Q. Cbrbtz gt bd. ebvg stbtgmtebt Fkwdgr“s prkogmurg sekudm hkt cg pgrfkragm wegh teg MLPgxtghskr dbj ls jrgbtgr tebh =7 mgjrggs kr wegh tegrg ls hkokhtlhulty cgtwggh teg tgralhbd gxtghskr tghmkh bhm teg mlstbdpebdbhx ^?=Q. ]egsg okhtrblhmlobtlkhs ebvg dgm tega tk usg teg_KSD tgoehlqug lhstgbm (mgsorlcgm dbtgr kh).Zegh b swbh-hgon mgfkralty gxlsts wlte teg abddgt flhjgr,
Fkwdgr“s tgoehlqug bddkws fkr pbrtlbd kr gvgh fudd okrrgotlkh kf tels mgfkralty, mgpghmlhj kh teg bakuht kf PLP eypgrgxtghslkh.Lh Skzabryh“s ?<-obsg sgrlgs, teg agbh prg-kpgrbtlvg PLPeypgrgxtghslkh kf 25 mgjrggs (0 tk :0 mgjrggs) wbs rgmuogm tk
=.5 mgjrggs
(0
tk
?0
mgjrggs)
uslhj
Fkwdgr“s
tgoehlqug
^?6Q.
Hgvgrtegdgss, tels tgoehlqug ls hkt rgokaaghmgm wegh PLP
eypgrgxtghslkh gxoggms
37
mgjrggs
^?6,?5,=3Q. ]els
ls
bhlhmlobtlkh fkr teg _KSD tgoehlqug.
?.=.3.=.
_plrbd
kcdlqug
rgtlhboudbr
dljbaght
rgokhstruotlkh
(_KSD) tgoehlqug. ]els eljedy lhjghlkus tgoehlqug ls cbsgm
kh Dbhmsaggr“s bhbtkalobd wkrn kh teg KSD. Flrst mgsorlcgmcy ]ekapskh bhm Dlttdgr, lt ls mgrlvgm frka Dlttdgr“s krljlhbdtgoehlqug kf lskdbtgm KSD rgokhstruotlkh uslhj b sdlp kf tegdbtgrbd cbhm. Ekwgvgr, teg krljlhbd tgoehlqug ls mlffloudt tk obrrykut lf teg tgralhbd tghmkh ls mlsokhtlhukus, suoe bs lh oerkhloabddgt flhjgr ^=3,=?Q. _KSD bots bs b myhbalo tghkmgsls. Khkhg ebhm, lt okrrgots teg mgfkralty kf teg oerkhlo abddgt flhjgr
wlte swbh-hgon mgfkralty, bhm kh teg ktegr ebhm, lt rgstkrgs tegsyhgrjy kf PLP bhm MLP ffigxlkh murlhj flhjgr ourdlhj (Flj. 23).Lh jghgrbd, b ebdf-strlp kf frgg pbdabrls dkhjus tghmkh ls usgm bsteg jrbft, cut wg bdsk usg syhtegtlo abtgrlbds suoe bs JKSG-]GU2 OV-0 suturg. ]eg jrbft tbngs b splrbd okursg brkuhm tegmkrsbd slmg kf P?, fkddkwlhj teg KSD“s trbigotkry, tegh orkssgsteg PLP vghtrbddy cgtwggh teg ffigxkr segbte bhm teg okddbtgrbdpgmlodgs tk rgboe teg kppksltg dbtgrbd slmg kf teg cbsg kf P2.]rbhskssgkus flxbtlkh kf teg jrbft prkxlabddy bhm mlstbddy lspgrfkragm terkuje b mkrskpbdabr tuhhgd bt teg P? cbsg bhmbhktegr trbhsvgrsg tuhhgd bt teg P2 cbsg> teg suturgs brgtyplobddy suppkrtgm kh b pudd-kut cuttkh, cut ckhg bhoekrs ^=3Q
bhm prkxlabd
skft
tlssug
flxbtlkh
obh
bdsk
cg
usgm
^==Q.
Flj. 22. ]rgbtaght kf oerkhlo abddgt flhjgr wlte swbh-hgon mgfkralty uslhjFkwdgr“s tgoehlqug. Prgkpgrbtlvg bppgbrbhog (b). Pkstkpgrbtlvg rgsudt (c).
Flj. 20. Mlbjrba kf teg prlholpdg cgelhm Fkwdgr“s tgoehlqug usgm tk trgbtoerkhlo
abddgt
flhjgr. Sgprkmuogm
wlte
pgralsslkh
kf Abètrlsg Krtekpìmlqug.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟252263
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 9/27
]eg prlabry oebddghjg rgslmgs lh sgttlhj teg okrrgot tghslkhkh teg jrbftgm tghmkh. Lhsufflolght tghslkh wldd hkt okrrgot tegmgfkralty. Okhvgrsgdy, tkk auoe tghslkh wldd obusg MLPeypgrgxtghslkh bhm PLP ffigxlkh wlte b ckutkhhlgrg mgfkralty.Bdtekuje ]ekapskh mlm hkt plh teg rgokhstruotlkh, NdglhabhbhmPgtgrsgh rgokaaghm plhhlhj teg MLP lh hgutrbd pksltlkh fkr=.7 wggns bhm teg PLP lh 27 mgjrggs ffigxlkh fkr ? wggns ^==Q.Nbhbyb gt bd. rgokaaghm pdbolhj teg PLP lh hgutrbd pksltlkhbhm ffigxlhj teg MLP 27 mgjrggs, weldg abnlhj surg tebt ckte tegPLP bhm MLP obh cg slaudtbhgkusdy ffigxgm fuddy pbsslvgdy, bhmtegh plhhlhj teg MLP khdy fkr 7 wggns ^=7Q.Wslhj teg JKSG-]GU2 OV-0 suturg bddkws us tk orgbtg b
mkucdg _KSD rgokhstruotlkh. ]eg suturg ls pbssgm terkuje bekrlzkhtbd trbhskssgkus tuhhgd lh teg P2 cbsg> gboe strbhmfkddkwgm teg _KSD trbigotkry kh gltegr slmg kf teg flhjgr> khg kf teg strbhms rgturhs tk teg P? cbsg lh teg tgralhbd gxtghskrtghmkh, kr lf lt ls alsslhj, lh b ekrlzkhtbd trbhskssgkus tuhhgd>teg twk strbhms brg tegh tlgm dbtgrbddy bt teg hgon kf teg almmdgpebdbhx (Flj. 2?). Hk plhhlhj ls pgrfkragm> teg flhjgr ls ffigxgm
gbrdy kh wlte b Cgbsdgy rlhj fkr 3‟? wggns. ]eg tghslkh obh cgsgt gbsldy wlte tels tgoehlqug, bhm tegrg ls hk rlsn kf obuslhjodlhkmbotydy. Cy uslhj b syhtegtlo suturg, b tghmkh jrbft mkgshkt hggm tk cg ebrvgstgm> tels abtgrlbd ls dgss cudny tebh tegjrbft, iust bs skdlm bhm iust bs wgdd tkdgrbtgm.
Flj. 23. Mlbjrba kf teg _KSD tgoehlqug wlte teg ghms kf teg tghmkh trbhspdbhtsgourgm wlte ckhg bhoekrs. Sgprkmuogm
wlte
pgralsslkh
kf Abètrlsg Krtekpìmlqug.
Flj. 2?. Lhtrbkpgrbtlvg vlgw kf teg trgbtaght kf b swbh-hgon mgfkralty sgokhmbry tk oerkhlo abddgt flhjgr uslhj teg mkucdg _KSD tgoehlqug wlte b JKSG-]GU2OV-
0
suturg.
Pbdabr
vlgw
(b).
Peyslkdkjlobd
ffigxlkh
(c)
bhm
gxtghslkh
(o)
bftgr
bmiustlhj
teg
_KSD
tghslkh.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟252
26?
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 10/27
Lh teg sabdd obsg sgrlgs tebt ebvg cggh pucdlsegm up tk hkw,teg_KSD tgoehlqug okrrgots teg swbh-hgon mgfkralty, rgmuogs tegMLPgxtghskrdbj tkcgtwggh 0 bhm 20 mgjrggs, wltekutlhtgrfgrlhjwlte fudd PLP bhm MLP ffigxlkh. Ekwgvgr, MLP eypgrgxtghslkh kf 20 tk 37 mgjrggs ebs cggh kcsgrvgm lh ? kf teg 23 obsgs lh tegNdglhabh bhm Pgtgrsgh stumy, bdkhj wlte khg obsg kf iklhtokhtrboturg> tegsg okapdlobtlkhs dgm tk twk rg-kpgrbtlkhs ^==Q.]els tgoehlqug mkgs hkt rgokhstruot teg tgralhbd tghmkh kf teggxtghskr agoebhlsa cut obh cg usgm suoogssfuddy wegh lt lsbcsght (mug tk bvudslkh kr trbuab-lhmuogm mgfgot) kr bftgr fbldgmsgokhmbry rgpblr kf tels tghmkh ^?=,=7Q.
?.=.3.7. Fuslkh. MLP fuslkh ls lhmlobtgm wegh teg ktegrsurjlobd skdutlkhs brg okhtrblhmlobtgm (prgobrlkus snlh okhml-tlkh, pgrslstght iklht stlffhgss, kstgkbrterltls pblh) kr ebvg fbldgm.]eg fuslkh bhjdg ls sgt cgtwggh 0 bhm 37 mgjrggs kf ffigxlkhmgpghmlhj kh teg flhjgr lhvkdvgm bhm teg pbtlght“s fuhotlkhbdmgabhms. Zg rgokaaghm ghsurlhj okhtlhulty kf teg tgralhbdgxtghskr tghmkh cy tghkmgrakmgsls suturg, sk bs tk rgmuog teg
rlsn kf sgokhmbry swbh-hgon mgfkralty. Zegh teg dbttgr lsprgsght, b Fkwdgr-typg tghktkay prkogmurg kh teg oghtrbd sdlpobh cg pgrfkragm lh okaclhbtlkh wlte teg fuslkh.
?.7. ]rgbtaght bdjkrltea fkr oerkhlo abddgt flhjgr
Flj. 2= suaabrlzgs teg trgbtaght lhmlobtlkh kptlkhs tebt obhcg put fkrwbrm lh obsgs kf oerkhlo abddgt flhjgr tebt brg hkt wgdd
tkdgrbtgm fuhotlkhbddy. ]wk gdgaghts aust cg tbngh lhtkokhslmgrbtlkh9 teg bakuht kf MLP gxtghskr dbj bhm teg prgsghogkf swbh-hgon mgfkralty. Lhmgpghmght kf teg oeksgh tegrbpgutloagtekm, bh 5‟23 wggn trgbtaght pgrlkm ls rgqulrgm.Hk agtekm ebs cggh sekwh tk cg supgrlkr tk bhktegr. Hkhg
obh ghsurg okapdgtg okrrgotlkh kf teg mgfkralty, bhm rgslmubdMLP gxtghskr dbj kf bpprkxlabtgdy 20 mgjrggs ls vgry okaakh^=6Q.]eg bmvbhtbjgs bhm mlsbmvbhtbjgs kf gboe trgbtaght agtekm
aust cg wgdd uhmgrstkkm, pbrtloudbrdy fkr bhy surjlobdtrgbtaghts cgobusg kf teglr pktghtlbd okapdlobtlkhs9 lhfgotlkh,N-wlrgaljrbtlkh kr crgbnbjg, wkuhm egbdlhj prkcdga, pblhfudsobr-lhmuogm swgddlhj kh mkrsua kf P? bhm teg MLP iklht, hbldmgfkralty mug tk abtrlx dgslkh, MLP kr PLP iklht okhtrboturg,pgrslstght rgslmubd mgfkralty kr rgourrght mgfkralty.
=. Oerkhlo lhiurlgs lh zkhg 3
Oerkhlo zkhg 3 lhiurlgs brg teg okhsgqughog kf bh lhltlbddy
kpgh tghmkh lhiury tebt rgsudts lh MLP okhtrboturg mug tkpgrltghmlhkus bmegslkhs kr MLP gxtghskr dbj (abddgt flhjgr) mugtk sgokhmbry rupturg kr tghmkh mgfgot.
=.2. Okhtrboturg obusgm cy bmegslkhs
]egsg brg bmegslkhs brkuhm khg kr ckte dbtgrbd cbhms bs bokhsgqughog kf bh lhltlbd pbrtlbd kr tktbd tghmkh dbogrbtlkh tebt
Okhsgrvbtlvg trgbtaght
Fbldurg
Hk swbh hgon
]ghmkh mgfgot
Jrbft kr
MLP fuslkh_gokhmbry rgpblr kr
]ghkmgrakmgsls
_wbh hgon +
PLP eypgrgxtghslkh ≭ 37°
MLP gxtghskr dbj ≭ ?7°
Fkwdgr“s tgoehlqug
PLP eypgrgxtghslkh 8 37°
_KSD
Flj. 2=. ]rgbtaght bdjkrltea fkr oerkhlo abddgt flhjgr.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟25226=
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 11/27
wbs laakcldlzgm fkr tkk dkhj bftgr cglhj rgpblrgm, kr wegrg tegagoebhlsa kf lhiury dgm tk bsskolbtgm ckhg kr snlh mbabjg, krlh obsgs kf tghmkh sekrtghlhj mug tk mlrgot suturlhj kf b mgfgot.Wpkh gxbalhbtlkh, teg botlvg bhm pbsslvg ffigxlkh bhm/krgxtghslkh kf teg MLP iklht ls dlaltgm kr gvgh hkh-gxlstght.]rgbtaghtaust lhltlbddy okhslst kf abhubddy crgbnlhj up teg
sobr tlssug lh okaclhbtlkh wlte rgebcldltbtlkh bhm peyslktegr-bpy, bhm lhtgralttght wgbr kf b MLP ffigxlkh kr gxtghslkh crbog lf hggmgm. Lf teg pbtlght gxpgrlghogs pgrslstght fuhotlkhbdlapblraght, lt ls lapkrtbht tk wblt fkr teg lhltlbd egbdlhjsgqughog tk cg okapdgtgm (bckut 6 akhtes) bhm fkr bhyfrboturgs tk cg egbdgm cgfkrg okhslmgrlhj b surjlobd trgbtaght.Lf teg snlh okhmltlkh bddkws, tghkdysls obh cg pgrfkragm cy
rgdgbslhj teg pgrltghmlhkus ckhg bhm snlh bmegslkhs. Mgcrlmg-aght kf teg tghmkh ghms cy pbrtlbd kr tktbd rgsgotlkh kf b sobrgm,hkh-okhtlhukus dbtgrbd cbhm aby cg rgqulrgm, bs dkhj bs tegktegr dbtgrbd cbhm ls okhtlhukus bhm frgg kf bmegslkhs. ]egMLP“s bcldlty tk ffigx bhm gxtghm wldd hkt cg elhmgrgm cy mklhjtels. Bhtl-bmegslkh prkmuots lh teg fkra kf jgds bhm rgskrcbcdg
agacrbhgs ebvg cggh mgsorlcgm, cut teglr cghgflts ebvg hkt ygtcggh mgakhstrbtgm. B snlh trbhspdbht kr dkobd ffibp prkogmurgaby cg hgogssbry lf teg snlh okhmltlkh ls prgobrlkus.Gxtghslvg pkstkpgrbtlvg rgebcldltbtlkh fkr PLP bhm MLP
ffigxlkh bhm gxtghslkh aust cg lhltlbtgm laagmlbtgdy. Pkst-tghkdysls okapdlobtlkhs lhodumg lhfgotlkh, rgourrght bmegslkhs,tghmkh rupturg bhm snlh wkuhm egbdlhj prkcdgas.
=.3. Gxtghslkh
mgflolt
mug
tk
tghmkh
rupturg
kr
mgfgot
Pbsslvg rgmuotlkh kf teg abddgt flhjgr aust cg okhflragm. Bslh Ykhg 2, okhsgrvbtlvg trgbtaght wlte bh gxtghslkh crbog aust
cg stbrtgm
laagmlbtgdy.
Lf
tels
fblds,
bh
lhtgrobdbtgm
tghmkh
jrbftobh cg prkpksgm lf teg snlh okhmltlkhs bddkws ^??Q. ]egbdtgrhbtlvg skdutlkh ls b _KSD rgokhstruotlkh, gspgolbddy lh tegprgsghog kf bh bsskolbtgm swbh-hgon mgfkralty ^?=Q.
7. Oerkhlo
lhiurlgs
lh
zkhg
?9
ckutkhhlgrg
mgfkralty
]egsg lhiurlgs lhvkdvg teg oghtrbd sdlp kf teg gxtghskragoebhlsa. ]egy brg teg okhsgqughog kf gltegr mkrsbd PLPdbogrbtlkh kr odksgm trbuab (PLP vkdbr mlsdkobtlkh, fkrogmffigxlkh kf teg PLP lh gxtghslkh, mlrgot mkrsbd cdkw tk ffigxgm PLP iklht) dgbmlhj tk O_ rupturg kr bvudslkh kf lts mlstbd lhsgrtlkh,skagtlags wlte b alhlsoudg ckhg frbjaght. ]eg oerkhlo okursg
kf tegsg lhiurlgs rgsudts lh ckutkhhlgrg mgfkralty.
7.2. Mgflhltlkh bhm pbtekpeyslkdkjy
]els flhjgr mgfkralty ls typlobd kf bh kdm mlsruptlkh (bt dgbst3 kr ? wggns) ^?=Q lh teg oghtrbd sdlp (Flj. 27). Lt okaclhgs PLPffigxlkh bhm MLP eypgrgxtghslkh. Fudd botlvg PLP gxtghslkh lslapksslcdg. ]eg O_ mlsruptlkh lhmuogs b PLP ffigxlkh mgfkraltybhm prkjrgsslvg rgtrbotlkh kf teg gxtghskr agoebhlsa wltetrbhsfgr kf tghslkh tk teg dbtgrbd sdlps, weloe lh turhprkjrgsslvgdy strgtoegs teg trlbhjudbr dljbaght bhm lhmuogsMLP gxtghslkh (Flj. 26). Jrbmubddy, teg dbtgrbd sdlps aljrbtg lh
frkht kf
teg
PLP
ffigxlkh-gxtghslkh
bxls
cgobusg
tegy
brg
cglhj
puddgm cy teg ]SD> tels furtegr lhorgbsgs teg PLP ffigxlkh bhmMLP eypgrgxtghslkh. ]els mgfkralty jgts lts hbag frka teg fbot
tebt teg PLP sdlmgs cgtwggh teg twk dbtgrbd sdlps, dlng b cuttkh lhb cuttkh ekdg. Kvgr tlag, teg mgfkralty wkrsghs bhm cgokagshkh-rgmuolcdg wlte prkjrgsslvg okhtrboturg kf teg PLP bhm MLP iklhts (vkdbr pdbtg bhm dbtgrbd dljbaghts)> tels okhtrlcutgs tkKSD rgtrbotlkh tebt lh turh dlalts pbsslvg PLP gxtghslkh bhmbotlvg bhm pbsslvg MLP ffigxlkh.Oerkhlo ckutkhhlgrg mgfkralty ls mgflhgm cy Cbrbtz gt bd.
^?=Q bs b hkh-rgmuolcdg okhtrboturg kf teg PLP bhm MLP iklhts.Pkshgr bhm Jrggh ^=:Q cgdlgvg tebt teg murbtlkh kf teg mgfkralty(cgykhm 5 wggns) abngs lt oerkhlo lh hbturg.Hkt gvgry kdm lhiury tk teg gxtghskr agoebhlsa lh zkhg ?
wldd dgbm tk teg typlobd ckutkhhlgrg mgfkralty. MLP eypgrgxtgh-
slkh obh
cg
bcsght,
pbrtloudbrdy
wegh
teg
lhltlbd
lhiury
jkgscgykhm teg O_ bhm gxtghms dbtgrbddy tk teg dbtgrbd sdlps,prgvghtlhj tega frka gxtghmlhj teg MLP iklht. ]eg sbag telhjkoours wegh sobr bmegslkhs clhm teg dbtgrbd sdlps tk teg mkrsbdslmg kf teg PLP iklht.
Flj.
27.
Ckutkhhlgrg
mgfkralty.
Flj.
26.
Mlbjrba
kf
teg
agoebhlsa
kf
teg
ckutkhhlgrg
mgfkralty.
Sgprkmuogm
wlte
pgralsslkh
kf
Abètrlsg
Krtekpìmlqug.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟252
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7.3. Odlhlobd prgsghtbtlkh bhm fuhotlkhbd lapblraght
]eg lapblraght obh cg bppgbrbhog-rgdbtgm, cut lt ls ablhdyfuhotlkhbd9 lt ls mug tk bh botlvg PLP gxtghslkh mgflolt tebt obhobusg flhjgr ekknlhj boolmghts, bhm tk lhokapdgtgdy botlvg MLPffigxlkh, weloe dlalts bhm wgbnghs teg jrlp murlhj flhjgrourdlhj. ]eg MLP ffigxlkh dlaltbtlkh kftgh ls teg cljjgstokhtrlcutkr tk fuhotlkhbd lapblraght (Flj. 2:).]eg odlhlobd gxbalhbtlkh ls usgm tk9
agbsurg teg botlvg PLP bhm MLP rbhjg kf aktlkh murlhj flhjgrffigxlkh-gxtghslkh. Gbrdy lh teg mgvgdkpaght kf ckutkhhlgrgmgfkralty, Gdskh“s tgst ls pksltlvg9 PLP gxtghslkh bjblhstrgslstbhog ls wgbn kr dlaltgm bhm dgbms tk MLP gxtghslkh ^=5Q>
mgtgralhg lf teg PLP gxtghslkh mgflolt obh cg pbsslvgdyrgmuogm>
gvbdubtg teg pksslcldlty kf MLP botlvg bhm pbsslvg ffigxlkhwegh teg PLP ls pbsslvgdy egdm lh gxtghslkh. ]els abhguvgr(Eblhgs-Ybhokddl tgst kr Ckygs tgst) gvbdubtgs KSD tghslkh.
Zegh lt ls rgtrbotgm, teg tgst ls pksltlvg cgobusg botlvg bhmpbsslvg MLP ffigxlkh ls dlaltgm kr gvgh lapksslcdg, cut lt lspksslcdg wlte teg PLP ffigxgm (Flj. 25)>
agbsurg jrlp strghjte, weloe obh cg rgmuogm cgobusg kf tegmgflolt lh MLP botlvg ffigxlkh.
7.?. Bmmltlkhbd
gxbalhbtlkhs
_tbhmbrm rbmlkjrbpes wlte B/P bhm dbtgrbd vlgws kf teggxtghmgm flhjgr obh egdp rgvgbd bvudslkh kf teg O_ ckhylhsgrtlkh bhm gvbdubtg teg okhmltlkh kf teg iklht. _ljhs kf kstgkbrterltls aby cg prgsght lh oerkhlo hkh-rgmuolcdgckutkhhlgrg mgfkralty. ASL bhm udtrbskuhm labjlhj obh sekwteg O_ rgtrbotlkh bhm pksltlkh kf teg dbtgrbd sdlps.
7.=. ]rgbtaght
Lt aust cg stbtgm upfrkht tebt lt wldd cg mlffloudt tk boelgvgokapdgtgdy rgstkrgm fuhotlkh wlte trgbtaght. ]eg PLP gxtghslkhmgflolt aust hkt cg trbhsfkragm lhtk bh gxtghslkh okhtrboturgtebt ls gvgh dgss fuhotlkhbd. _ghslcdg kcigotlvgs brg tk rgokvgrfudd MLP botlvg ffigxlkh bhm dlalt teg PLP gxtghslkh mgflolt tk dgss
tebh ?0 mgjrggs. Bdtekuje abhy trgbtaght tgoehlqugs gxlst,tegy bdd sebrg teg sbag pkkr flhbd kutokags, rgqulrgaght tkwgbr b crbog fkr bh gxtghmgm pgrlkm kf tlag bhm hggm fkrmldljght rgebcldltbtlkh, pksslcldlty kf mgtgrlkrbtlkh kf tegkutokag lh teg dkhj-tgra bdkhj wlte teg koourrghog kf okapdlobtlkhs, suoe bs pgrslstghog kf teg mgfkralty bhmfuhotlkhbd lapblraght, iklht okhtrboturg, lhfgotlkh, pblhfudbhm sghsltlvg swgddlhj kvgr teg mkrsua kf teg PLP iklht.
7.=.2. Ltgas tk tbng lhtk okhslmgrbtlkh
_gvgrbd orltgrlb aust cg bhbdyzgm cgfkrgabnlhj b trgbtaghtmgolslkh9
mgjrgg kf fuhotlkhbd lapblraght bhm teg pbtlght“s hggms,pbrtloudbrdy bh lhbcldlty tk ffigx teg MLP iklht. _kag pbtlghtskhdy wbht cgttgr MLP ffigxlkh cgobusg teg PLP ffigxlkhmgfkralty mkgs hkt lhokhvghlghog tega. Botlvg PLP gxtghslkhmgflolt kf dgss tebh ?0 mgjrggs ls kftgh wgdd tkdgrbtgm>
mgjrgg kf PLP bhm MLP iklht mgfkralty bhm pksslcldlty tebttegsg mgfkraltlgs obh cg botlvgdy bhm pbsslvgdy rgmuogm>
Flj.
2:.
Dlaltgm
botlvg
MLP
ffigxlkh
mug
tk
oerkhlo
ckutkhhlgrg
mgfkralty.
Bppgbrbhog
lh
gxtghslkh
(b)
bhm
ffigxlkh
(c).
Flj.
25.
Mlbjrba
kf
teg
Eblhgs-Ybhokddl
kr
Ckygs
tgst
sekwlhj
KSD
rgtrbotlkh.
Sgprkmuogm
wlte
pgralsslkh
kf
Abètrlsg
Krtekpìmlqug.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
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8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
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snlh okhmltlkh, weloe obh cg b okhtrblhmlobtlkh fkr bhy dkobdprkogmurg kr iustlfy bsskolbtgm snlh rgokhstruotlkh prkog-murgs>
sljhs kf kstgkbrterltls lh teg PLP bhm/kr MLP iklht.
7.=.3. Odbsslflobtlkh
Zg prkpksg b odbsslflobtlkh lh ]bcdg 2 tebt ls mgrlvgm frkateg khg sgt kut cy Curtkh ^=<Q bhm dbtgr akmlflgm cy _trbuoe.]els odbsslflobtlkh tbngs lhtk bookuht teg rgmuolcldlty kf teg MLPbhm PLP mgfkralty, mgjrgg kf PLP gxtghslkh mgflolt (akrg kr dgsstebh ?0 mgjrggs), bhm teg prgsghog kf kstgkbrterltls lh teg dbststbjg.
7.=.?. Okhsgrvbtlvg
trgbtaght
B vgry dbrjg pkrtlkhs kf tegsg obsgs aust cg trgbtgmokhsgrvbtlvgdy, hbagdy bdd teksg lh stbjgs L tk LLL.]eg jkbds brg tk mkrsbdlzg teg dbtgrbd sdlps cy ekdmlhj teg PLP
lh gxtghslkh, tk bddkw teg MLP tk ffigx frggdy, bhm tk okrrgot teg
iklht okhtrboturg, pbrtloudbrdy lh teg PLP. ]els rgqulrgs usg kf bstbtlo bhm/kr myhbalo PLP gxtghslkh krtektlo crbog, wkrh mbybhmhljet (Flj. 2<). Cy hkt pdbolhj teg MLP lh teg spdlt, lt obh cgpbsslvgdy bhm botlvgdy ffigxgm. Lh bmmltlkh bhm lh pbrbddgd,pbsslvg bhm botlvg MLP ffigxlkh bhm PLP gxtghslkh akcldlzbtlkhls obrrlgm kut murlhj rgebcldltbtlkh bhm sgdf-mlrgotgm rgebcldltb-tlkh. ]eg trgbtaght wldd dbst 6 tk 23 wggns, uhtld teg sobr tlssugebs abturgm. Lt aby hggm tk cg dkhjgr lf bh kdm odksgm lhiury lscglhj trgbtgm.Lf fuhotlkhbd lapblraght pgrslsts mgspltg teg okhsgrvbtlvg
trgbtaght mug tk akrg tebh ?0 mgjrggs PLP gxtghslkh mgflolt kr
lhbmgqubtg MLP botlvg ffigxlkh, surjlobd trgbtaght obh tegh cgokhslmgrgm.
7.=.=. _urjlobd
trgbtaght
]eg rgsudts kf surjlobd trgbtaght brg kftgh lhokapdgtg.
_gvgrbd prkogmurgs obh cg obrrlgm kut, gltegr bdkhg kr lhokaclhbtlkh, murlhj teg sbag surjgry sgsslkh. ]eg jkbds brg tk9
dghjtegh teg tgralhbd gxtghskr tghmkh> rgdgbsg teg dbtgrbd sdlps bhm rgmuog teglr vkdbr mlsdkobtlkh> rgbttboe kr rgokhstruot teg oghtrbd sdlp> abng teg PLP iklht akrg ffigxlcdg.
7.=.=.2. Lskdbtgm tghktkay kf teg tgralhbd gxtghskr tgh-
mkh. ]els tghktkay tgoehlqug, weloe wbs mgsorlcgm cyFkwdgr tegh Mkdpelh ^70Q, rgmuogs teg gxtghslkh fkrogs kh
]bcdg 2Odbsslflobtlkh kf ckutkhhlgrg mgfkralty obsgs.
Mgfkralty PLP mgflolt
_tbjg L9 MLP bhm PLP rgmuolcdgLB
4
?05LC
8
?05_tbjg LL9 MLP stlffhgss bhm PLP rgmuolcdg
LLB 4 ?05LLC
8
?05_tbjg
LLL9
MLP
bhm
PLP
stlffhgssLLLB 4 ?05LLLC 8 ?05
_tbjg
LV9
PLP
kstgkbrterltls
Flj. 2<. Okhsgrvbtlvg trgbtaght kf b oerkhlo ckutkhhlgrg mgfkralty. PLP gxtghslkh spdlht tebt bddkws MLP ffigxlkh (b). Myhbalo gxtghslkh crbog usgm tk abng b stlff
ckutkhhlgrg
mgfkralty
akrg
ffigxlcdg
(c).
P. Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
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8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
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teg tgralhbd tghmkh bt P? bhm, cy sdlmlhj teg gxtghskragoebhlsa prkxlabddy, lhorgbsgs teksg pdbogm kh teg PLP iklht. B mkrsbd snlh lholslkh ls abmg kh teg mkrsua kf P3. ]eggxtghskr tghmkh obh gltegr cg out ekrlzkhtbddy, bt bh bhjdg ^?=Q,lh b cbykhgt okhfljurbtlkh kr lh b oegvrkh sebpg cgykhm tegtrlbhjudbr dljbaght stbrtlhj bt teg iuhotlkh kf teg almmdg telrmbhm prkxlabd telrm kf teg almmdg pebdbhx bhm prkxlabd tk tegmlstbd KSD lhsgrtlkh. Zg prgfgr obrrylhj kut b agse-dlngdghjteghlhj kf teg tgralhbd gxtghskr tghmkh cy abnlhj sgvgrbdtrbhsvgrsg, tlgrgm bhm lrrgjudbr sabdd tghktkalgs tebt prgsgrvgteg gxtghskr“s okhtlhulty> tels bddkws rgebcldltbtlkh tk stbrtlaagmlbtgdy (Flj. 30). ]eg prkogmurg ls pgrfkragm uhmgr dkobdbhgstegslb wlte b sghskry hgrvg cdkon> tels bddkws teg huacgrbhm slzg kf teg tghktkalgs tk cg bmiustgm bookrmlhj tk teglaprkvgaght lh ffigxlkh kctblhgm lhtrbkpgrbtlvgdy.Lskdbtgm Fkwdgr/Mkdpelh tghktkay ls lhmlobtgm fkr pbtlghts
wek brg khdy okhogrhgm wlte teg MLP ffigxlkh mgflolt kr wegh tegPLP mgflolt ls ?0 mgjrggs kr dgss ^72,73Q. Bh lhorgbsg kf bckut =0mgjrggs lh MLP ffigxlkh obh cg boelgvgm ^7?Q bhm b rgmuotlkh lh
teg PLP gxtghslkh mgflolt ebs cggh kcsgrvgm lh hgbrdy ebdf tegobsgs ^7?,7=Q. Bcsghog kf rgslmubd abddgt flhjgr bs bokhsgqughog kf teg tghktkay ls rgdbtgm tk teg prg-gxlstlhjokhtrboturg kf teg obpsudg bhm MLP okddbtgrbd dljbaghts ^?=Q.
7.=.=.3. Sgdgbsg
bhm
mkrsbdlzbtlkh
kf
dbtgrbd
sdlps. Bftgr
abnlhj b ourvgm mkrsbd lholslkh kf teg PLP, teg ]SDs brg
mlvlmgm bhm tegh teg dbtgrbd sdlps rgdgbsgm up tk teg P2 cbsg.Zegh pgrfkragm uhmgr mlstbd sghskry bhgstegslb, bhm lh obsgswlte alhkr ffigxlkh mgfkralty, tels prkogmurg obh cg sufflolght tkrgstkrg skag kf teg PLP gxtghslkh murlhj botlvg lhtrbkpgrbtlvggxtghslkh ^72Q. Cut lh abhy obsgs, teg trlbhjudbr dljbaght austbdsk cg rgokhstruotgm tk ablhtblh mkrsbdlzbtlkh kf teg dbtgrbdsdlps cy suturlhj tega tkjgtegr bhm abnlhj surg hkt tk gxtghmpbst teg PLP prkxlabddy”tels ghsurg lts ffigxlkh obpbolty ls hktrgmuogm. ]eg bcldlty tk pbsslvgdy ffigx teg MLP weldg nggplhj tegPLP gxtghmgm aust cg vgrlflgm. Bhy dlaltbtlkh aby rgqulrg bhbsskolbtgm tghktkay prkogmurg suoe bs teg Fkwdgr/Mkdpelhkhg. Sgdgbsg bhm mkrsbdlzbtlkh kf teg dbtgrbd sdlps jghgrbddyprgogmgs sgokhmbry rgpblr kf teg oghtrbd sdlp lh teg sbag surjgrysgsslkh. ^26,?=,=:,73,77Q.
7.=.=.?.
_gokhmbry
rgpblr
kf
oghtrbd
sdlp
_gvgrbdagtekms brg pksslcdg9 mlrgot rgpblr, dkobd pdbsty, jrbftkr tghmkh trbhsfgr.
7.=.=.?.2. Mlrgot rgpblr.
]els
okhslsts
kf
rgakvlhj
3‟? aa kf teg dghjteghgm obddus bhm suturlhj teg oghtrbd sdlp^73,77‟7:Q kr rgbttboelhj lt bt teg P3 cbsg uslhj ckhg bhoekrs krwlrg ogrodbjg lf bvudsgm ^75Q. Bs abhy ktegrs, wg rgokaaghmtels prkogmurg weghgvgr pksslcdg lh obsgs wlte sljhlflobht PLPgxtghslkh mgflolts ^?=,=:,73,77Q. Kcdlqug plhhlhj kf teg iklhtwlte b 2.0 kr 2.3 aa N-wlrg ls kftgh hgogssbry, wlte teg N-wlrgcglhj pdbogm vkdbr tk teg dbtgrbd sdlps. Lt ls dgft lh pdbog fkr bt
Flj. 30. Agse-dghjteghlhj kf tgralhbd gxtghskr tghmkh fkr trgbtlhj b ckutkhhlgrg mgfkralty. _bag pbtlght bs Flj. 2:. Lhtrbkpgrbtlvg vlgw kf teg stbjgm tghktkay
wltekut
mlsruptlkh
tk
teg
gxtghskr
tghmkh
(b).
Odlhlobd
kutokag
lh
gxtghslkh
(c)
bhm
ffigxlkh
(o).
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
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8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
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dgbst ? wggns bhm up tk 7 wggns ^77Q. Murlhj tels tlag, botlvgbhm pbsslvg MLP ffigxlkh aust cg pgrfkragm rgjudbrdy cy tegpbtlght audtlpdg tlags gboe mby.]eg okaclhbtlkh kf O_ rgpblr bhm dbtgrbd sdlp rgdgbsg dgbms tk
jkkm bhm gvgh vgry jkkm rgsudts lh 60% kf obsgs wlte ffigxlcdgckutkhhlgrg mgfkralty ^77‟7:Q (Flj. 32). ]eg bvgrbjg rgslmubdgxtghslkh mgflolt ls 20 mgjrggs wlte tels tgoehlqug ^72Q. Lh obsgskf stlff ckutkhhlgrg mgfkralty, teg kutokags brg auoe wkrsg9Dg Cgddgo gt bd. rgpkrtgm 70% pkkr rgsudts bhm hk jkkm kr vgryjkkm rgsudts lh teglr stumy ^77Q.7.=.=.?.3.
Sgokhstruotlkh
kf
teg
oghtrbd
sdlp
cy
dkobd
pdbsty,
jrbftlhj kr
tghmkh
trbhsfgr. Sgokhstruotlkh ls lhmlobtgm lf teg
O_ obhhkt cg mlrgotdy rgpblrgm cgobusg kf b tghmkh mgfgot krprgobrlkus egbdlhj okhmltlkh. Abhy tgoehlqugs ebvg cgghmgsorlcgm (Flj. 33). ]eglr prlholpdgs wldd cg rgvlgwgm wltekutjklhj lhtk teg mgtblds kf teg tgoehlobd akmlflobtlkhs abmg cyvbrlkus butekrs. ]egy lhvkdvg gltegr dkobd pdbsty, jrbftlhj krtghmkh trbhsfgr.
Dkobd
pdbsty
kf
oghtrbd
sdlp9
vbrlkus
typgs
gxlst9
trlbhjudbr ffibp kf dkobd tlssug lhodumlhj b pkrtlkh kf teg dbtgrbdsdlps ^7<Q>
O_ ffibp mlvlmgm kvgr teg P2 cbsg, fkdmgm kvgr ltsgdf teghsgourgm tk teg O_ lhsgrtlkh (_hkw)> bdtekuje tels tgoehlqug lskftgh usgm lh trbuabtkdkjy wlte b frgse lhiury, lt ls hkt vgrygffgotlvg fkr sgokhmbry rgokhstruotlkh ^60Q>
lhvgrtgm trbhspksltlkh kf dbtgrbd sdlps (Abtgv) ^62Q9 khg kf tegsdlps ls mlvlmgm kvgr teg mlstbd sgotlkh kf teg trlbhjudbrdljbaght bhm teg ktegr khg bt teg P3 cbsg> teg sekrtgst sdlp lstergbmgm terkuje teg prkxlabd pbrt kf teg O_ bhm suturgm,weldg teg dkhjgst sdlp ls suturgm tk teg mlstbd pbrt kf tegokhtrbdbtgrbd sdlp>
mlstbd mlvlslkh kf khg kr ckte dbtgrbd sdlps (Dlttdgr) bhmtrbhsdkobtlkh khtk teg O_ lhsgrtlkh ^63Q. Dkhjltumlhbdmlvlslkh kf dbtgrbd sdlps lhtk twk okhtlhukus ebdf-sdlps tebtbrg crkujet tk teg almdlhg> tegy brg suturgm tkjgtegr bhmsgourgs tk teg O_ lhsgrtlkh (Dlttdgr-Curnbdtgr-Blboeg)^6?,6=Q>
twk oghtrbd sdlps, weloe brg prgvlkusdy sgpbrbtgm frka tegduacrlobds bhm KSD, brg turhgm-kvgr mkrsbddy, mlvlmgmmlstbddy bhm tegh suturgm tk gboe ktegr bhm sgourgm tk tegP3 cbsg ^63Q (Dlttdgr-Gbtkh)>
]SD mlvlslkh iust bckvg wlte teg vkdbr pdbtg, weloe ls teghfkdmgm-kvgr mkrsbddy bhm suturgm tkjgtegr ^67Q.Bdd kf tegsg pdbsty prkogmurgs bdsk rgqulrg tgapkrbry PLP
plhhlhj, cut teg MLP obh cg ffigxgm rljet bwby. Lhmlobtlkhs fkrtegsg vbrlkus tgoehlqugs mgpghm kh teg mgfgot slzg bhmwegtegr lt khdy bffgots teg oghtrbd sdlp kr khg kr ckte kf tegdbtgrbd sdlps.
]ghmkh jrbftlhj kf oghtrbd sdlp9 tels okhslsts kf teg fkddkwlhj
tgoehlqugs9
Flj.
32.
]rgbtaght
kf
b
ffigxlcdg
oerkhlo
ckutkhhlgrg
mgfkralty
cy
sgokhmbry
O_
rgpblr,
rgdgbsg
kf
dbtgrbd
sdlps
bhm
PLP
plhhlhj.
Prgkpgrbtlvg
bppgbrbhog
(b).Lhtrbkpgrbtlvg vlgw (c) Odlhlobd kutokag (o,m).
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟252
26<
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 16/27
sekrt frgg pbdabrls dkhjus jrbft sgourgm tk teg P3 cbsg bhmsuturgm prkxlabddy tk teg dbtgrbd sdlps ^66‟65Q>
pgmlodgm ffigxkr supgrflobdls mljltkrua (F_M) jrbft ^6<Q tebt lsokapdgtgdy rgdgbsgm prkxlabddy> khg strlp ls tuhhgdgmsucoutbhgkusdy tk rgokhstruot teg gxtghskr agoebhlsa bhmteg ktegr strlp ls suturgm tk teg ffigxkr segbte tk prgvght PLPeypgrgxtghslkh. Babm rgoghtdy prkpksgm b vbrlbtlkh wegrg bprkxlabddy mlvlmgm F_M sdlp ls pbssgm mkrsbddy terkuje bckhg tuhhgd lh teg P3 cbsg tk skdlmdy rgokhstruot teg O_ bhmbddkw gbrdy PLP akcldlzbtlkh ^:0Q.
]eg pdbsty bhm tghmkh jrbftlhj tgoehlqugs usgm tkrgokhstruot teg O_ ebvg dgm tk kutokags tebt brg mlffloudttk lhtgrprgt cgobusg kf teg vbrlgty kf pbtekdkjlgs bhmtgoehlqugs usgm, weloe brg kftgh mgsorlcgm lh khdy b fgwobsgs, bdkhj wlte teg kutokag agbsurgs. Lh bhy obsg, tegy brghkt bhy cgttgr tebh teg khgs bsskolbtgm wlte mlrgot O_ rgpblr.
]ghmkh trbhsfgr
gxtghmgm
wlte
frgg
dkhj
jrbft
(cy-pbss
tgoehlqug)9 teg tgoehlqug prkpksgm cy Kcgrdlh gt bd. usgs b
trbhsfgr kf teg gxtghskr lhmlols prkprlus ausodg tebt ls gxtghmgmcy b frgg pbdabrls dkhjus jrbft lh b cy-pbss okhfljurbtlkh ^:2Q.]eg jrbft ls pbssgm sucoutbhgkusdy kh teg cbon kf teg flhjgr bhm
sgourgm tk
teg
O_
bt
teg
P3
cbsg
(Flj.
3?).
Zg
rgokaaghm
stbcldlzlhj teg jrbft kh teg mkrsua kf teg AOP iklht tk stkp ltfrka mlsdkobtlkhj cgtwggh teg agtbobrpbds bhm dkslhj ltstghslkh. Okhtrbry tk akst kf teg prgvlkus tgoehlqugs, weloergqulrg tgapkrbry plhhlhj, tels botlvg trbhsfgr tgoehlqug bddkwsfkr laagmlbtg rgebcldltbtlkh kf PLP bhm MLP ffigxlkh bhmgxtghslkh, prktgotgm cy spdlhtlhj kf teg wrlst lh gxtghslkh bhmAOP lh b hgutrbd pksltlkh fkr ? wggns. ]eg kutokags kf telstgoehlqug sgga prkalslhj cbsgm kh teg flvg obsgs mgsorlcgm cyKcgrdlh gt bd.9 twk gxogddght, twk jkkm bhm khg fblr rgsudt.
7.=.=.=. PLP
brterkdysls. Fudd PLP iklht ffigxlcldlty ls hggmgm
cgfkrg bhy prkogmurg ls pgrfkragm kh teg dbtgrbd sdlps bhm tegoghtrbd sdlp. Lf tels obhhkt cg boelgvgm wlte krtektlo crbolhj bhmpeyslktegrbpy, brterkdysls wldd cg hgogssbry. ]els obh cg tegflrst prkogmurg pgrfkragm murlhj surjlobd trgbtaght kf bckutkhhlgrgmgfkralty lf teg PLP ffigxlkh mgflolt ls hkt sljhlflobht(dgss tebh =0 mgjrggs). Okhvgrsgdy, lf teg ffigxlkh mgflolt ls akrgtebh =0 mgjrggs, lt ls cgst tk pgrfkra teg brterkdysls khdy>sgokhmbry rgpblr kf teg gxtghskr agoebhlsa obh cg okhslmgrgmkhog iklht ffigxlcldlty ebs cggh rgstkrgm bhm ablhtblhgmpbsslvgdy bftgr sgvgrbd akhtes kf rgebcldltbtlkh bhm krtektlo
crbolhj ^?=,72,77Q.
Flj.
33.
Mlbjrba
kf
oghtrbd
sdlp
rgokhstruotlkh
tgoehlqugs.
_hkw
tgoehlqug
(b)
Abtgv
tgoehlqug
(c)
Dlttdgr-Curnbdtgr-Blboeg
tgoehlqug
(o).
Dlttdgr-Gbtkh
tgoehlqug(m).
Sgprkmuogm
wlte
pgralsslkh
kf
Abètrlsg
Krtekpìmlqug.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟2522:0
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 17/27
7.=.=.7. Fuslkh bhm brterkpdbsty. PLP brterkpdbsty obh cglhmlobtgm lh oerkhlo ckutkhhlgrg mgfkralty tebt okgxlsts wlte bpblhfud, stlffghgm brterltlo iklht. ]eg bdtgrhbtlvg ls PLP fuslkh lhb fuhotlkhbd pksltlkh. ]egsg prkogmurgs kh teg iklht obh cg
okaclhgm wlte b Fkwdgr/Mkdpelh tghktkay, sk bs tk kctblh fuddbotlvg MLP ffigxlkh> tels prkvlmg mgflhltg fuhotlkhbd laprkvg-aght, pbrtloudbrdy lh obsgs kf PLP fuslkh. _gokhmbry O_ rgpblrobh cg pgrfkragm lh teg sbag surjlobd sgsslkh lf brterkpdbsty lspgrfkragm.
7.=.=.6.
]rgbtaght bdjkrltea. Abhy surjgkhs fkddkw teg
trgbtaght sgqughog prkpksgm cy Ourtls bookrmlhj tk tegmgfkralty okrrgotlkh kctblhgm murlhj teg surjgry> tegprkogmurgs brg pgrfkragm stgp-cy-stgp uhmgr b purg mljltbdhgrvg cdkon ^2,?7,=:,=<,72,73Q. ]eg trgbtaght bdjkrlteaprkpksgm lh Flj. 3= tbngs lhtk bookuht teg prgkpgrbtlvgodbsslflobtlkh (]bcdg 2) bhm teg vbrlbcdgs tebt ebvg b sljhlflobhtgffgot kh teg flhbd kutokag9 PLP rgmuolcldlty, abjhltumg kf PLPmgflolt, MLP ffigxlcldlty, brterltlo iklht.
6. Oerkhlo
lhiurlgs
lh
zkhg
=
_lhog teg gxtghskr agoebhlsa crkbmdy okvgrs P2, lt ls rbrg tk
sgg oerkhlo lhiurlgs lh tels zkhg wlte okapdgtg dkss kf tghmkhokhtlhulty. ]rgbtaght okhslsts kf sgokhmbry rgpblr bftgrrgsgotlkh kf teg tghmkh obddus.Pgrltghmlhkus bmegslkhs brg auoe akrg okaakh ekwgvgr,
bhm obh koour gvgh bftgr odksgm trbuab (P2 frboturg),pbrtloudbrdy lf teg lhltlbd trbuab lhodumgm b oruse okapkhght.]egsg bmegslkhs dgbm tk flhjgr stlffhgss, weloe aust cgboourbtgdy bhbdyzgm odlhlobddy. Nldjkrg“s tgst sekws teg
Flj.
3?.
Mlbjrba
kf
Kcgrdlh“s
cy-pbss
trbhsfgr
tgoehlqug. Sgprkmuogm
wlte
pgralsslkh
kf
Abètrlsg
Krtekpìmlqug.
Ckutkhhlgrg mgfkralty
Okhsgrvbtlvg trgbtaght
FbldurgPLP rgmuolcdg
Hk prkogmurg kr
O_ rgdgbsg kr
DC rgpblr
PLP hkt rgmuolcdg
MLP dgxlcdg MLP hkt dgxlcdg
Mkdpelh
tghktkay
DC rgdgbsg
O_ rgpblr
DC rgdgbsg
Brterkdysls
O_ rgpblr
PLP mglolt 8 ?0°
PLP mglolt 8 ?0°
Brterkdysls Fuslkh kr
Brterkpdbsty
L LL
LB LLB LLC
LLLC LV
PLP brterltls
LLL B
PLP mglolt 4 ?0°
PLP mglolt 4 ?0°
LC
LVLLL
LB LCLLB LLC
Flj. 3=. ]rgbtaght bdjkrltea fkr ckutkhhlgrg mgfkralty bookrmlhj tk stbjg (L tk LV). O_9 oghtrbd sdlp, DC9 dbtgrbd cbhm.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
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8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 18/27
prgsghog kf gxtghskr bmegslkhs ckte lh zkhg = bhm prkxlabd tk lt(zkhgs 7 kr 6) ^:3Q. Lh hkrabd obsgs, botlvg kr pbsslvg AOPffigxlkh mkgs hkt prgvght PLP kr MLP ffigxlkh. Lf tegrg brg gxtghskrbmegslkhs bt P2 kr prkxlabddy kvgr teg AOP kr agtbobrpbd,Nldjkrg“s tgst wldd cg pksltlvg9 teg PLP bhm MLP obhhkt cg ffigxgmwegh teg AOP ls ffigxgm cgobusg teg gxtghskr ls rgstrlotgm cybmegslkhs. Okhvgrsgdy, wegh teg AOP ls egdm lh gxtghslkh kreypgrgxtghslkh, teg PLP bhm MLP obh cg ffigxgm botlvgdy bhmpbsslvgdy (Flj. 37). ]els tgst ls mlffgrght tebh teg Flhkoelgttk-Cuhhgdd tgst tebt sekws tljethgss mug tk lhtrlhslo ausodgrgtrbotlkh. ]eg dbttgr tgst okhslsts kf gxbalhlhj pbsslvg PLPffigxlkhwlte teg AOP pbsslvgdy gxtghmgm bhm ffigxgm. Lh obsgs kf lhtrlhslo ausodg tljethgss, PLP ffigxlkh wldd cg jrgbtgr wegh tegAOP ls ffigxgm tebh gxtghmgm. Lh skag kdm lhiurlgs, teg twkskurogs kf flhjgr stlffhgss okgxlst bhm lt aby cg ebrm tkmlffgrghtlbtg cgtwggh tega.Lf teg stlffhgss pgrslsts mgspltg rgebcldltbtlkh bhm krtektlo
crbolhj, teg trgbtaght okhslsts kf tghkdysls kf teg gxtghskragoebhlsa cy rgdgbslhj bhy pgrlkstgbd bhm outbhgkus bmeg-
slkhs, weldg abnlhj surg teg sbjlttbd cbhms bhm gxtghskr ekkmrgablh lhtbot.]eg Nldjkrg tgst bhm teg Flhkoelgttk-Cuhhgdd tgst aust cg
rgprkmuogm lhtrbkpgrbtlvgdy khog tels prkogmurg ebs cggh
obrrlgm kut. Lf Nldjkrg“s tgst ls stldd pksltlvg, gxtghskr tghmkhrgtrbotlkh ls obusgm cy sobrlhj. Nldjkrg gt bd. prkpksgmdghjteghlhj teg gxtghskr tghmkh wlte b pbrtlbd tghktkay ^:3Q(Flj. 36)> bdtgrhbtlvgdy, Dlttdgr prkpksgm rgsgotlhj teg oghtrbdtghmkh bt teg cbsg kf P2 ^60Q. Lf teg Flhkoelgttk-Cuhhgdd tgst lspksltlvg, teg lhstrlhslo ausodgs brg rgtrbotgm bt P2. ]rgbtaghtokhslsts kf rgsgotlhj teg kcdlqug flcgrs kf teg gxtghskr ekkm> lhakrg sgvgrg obsgs, teg lhtrlhslos brg bdsk mlvlmgm.Lt ls lapkrtbht tk hktg tebt, mgspltg laagmlbtg bhm prkdkhjgm
pkstkpgrbtlvg rgebcldltbtlkh, surjlobd rgvlslkh kf oerkhlo zkhg =lhiurlgs vgry rbrgdy dgbms tk jkkm rgsudts.
:.
Oerkhlo
lhiurlgs
lh
zkhg
7
]egsg brg teg okhsgqughog kf kpgh kr odksgm trbuab tk teggxtghskr agoebhlsa kvgr teg AOP iklhts. _gvgrbd typgs kf lhiurlgs obh cg kcsgrvgm9 okapdgtg kr pbrtlbd dbogrbtlkh kf teggxtghskr tghmkh, sbjlttbd cbhm rupturg, dkhjltumlhbd sgpbrbtlkhkf teg prkprlus bhm okaakh gxtghskr tghmkh bt teg flfte flhjgr.
Ogrtblh typgs kf rgpgbtgm odksgm trbuab obh dgbm tk oerkhlomkrsbd tghmkh-obpsudg lhiurlgs (ckxgr“s nhuondg).
:.2.
Zkuhms
kh
teg
mkrsua
kf
teg
AOP
iklhts
Kpgh trbuab obh dgbm tk okapdgtg kr akrg kftgh, pbrtlbddbogrbtlkh kf teg gxtghskr tghmkh, kftgh bsskolbtgm wlte mbabjgtk teg uhmgrdylhj iklht. _gokhmbry sgptlo dgslkhs brg okaakh lf teg lhltlbd lhiury wbs hgjdgotgm, gspgolbddy fkddkwlhj b cltgwkuhm kh teg flst. _obr bmegslkhs kftgh dlalt teg fuhotlkh kf teggxtghskr agoebhlsa bhm teg AOP“s bcldlty tk ffigx. Bh kdm
Flj. 37. Mlbjrba kf teg Nldjkrg tgst. ]eg tgst ls pksltlvg wegh teg PLP obh cgffigxgm
wlte
teg
AOP
gxtghmgm,
cut
lt
obhhkt
cg
ffigxgm
wlte
teg
AOP
ffigxgm.
Sgprkmuogm
wlte
pgralsslkh
kf
Abètrlsg
Krtekpìmlqug.
Flj. 36. Mlbjrba kf Nldjkrg“s tgoehlqug.
Cbsgm
kh
^:3Q. Sgprkmuogm
wlte
pgralsslkh
kf
Abètrlsg
Krtekpìmlqug.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟2522:3
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 19/27
sbjlttbd cbhm dbogrbtlkh obh dgbm tk sucduxbtlkh kf teg gxtghskragoebhlsa kh teg mkrsua kf teg AOP iklht._gokhmbry trgbtaght kf tegsg lhiurlgs aust cg okhslmgrgm lf
teg fuhotlkhbd lapblraght crkujet kh cy flhjgr stlffhgss lsrgslstbht tk rgebcldltbtlkh bhm krtektlo crbolhj. _urjlobdtrgbtaght okhslsts kf bh lholslkh tk rgakvg teg prg-gxlstlhjsobr tlssug> teg lholslkh ls tegh wlmghgm prkxlabddy bhm mlstbddyuhtld lt ls ourvldlhgbr. _bapdgs fkr alorkclkdkjy brg okddgotgmsystgabtlobddy. ]eg prkogmurg stbrts cy tghkdysls weldgprgsgrvlhj teg sbjlttbd cbhms. Lf hggmgm, khg sbjlttbd cbhmobh cg mlvlmgm dkhjltumlhbddy odksg tk teg gxtghskr tghmkh tkboogss teg mggp slmg kf teg tghmkh bhm cbon slmg kf teg iklht.]els abngs lt pksslcdg tk flhlse teg tghkdysls bhm tegh tkpgrfkra mkrsbd brterkdysls kf teg AOP lf teg iklht ls stlff. Lf Nldjkrg“s tgst ls stldd pksltlvg, teg gxtghskr tghmkh ls tkk sekrt> ltobh cg dghjteghgm sucsgqughtdy wlte b pbrtlbd tghktkay ^:3Q.Lf teg gxtghskr tghmkh ls rupturgm, sgokhmbry rgpblr rgqulrgs
mlrgot suturlhj kf teg ghms bftgr rgakvlhj teg obddus weldgabnlhj surg hkt tk sekrtgh teg tghmkh tkk auoe. ]eg dbogrbtgm
sbjlttbd cbhm aust cg rgpblrgm bhm teg stbcldlty kf teg gxtghskragoebhlsa kh teg mkrsua kf teg AOP iklht aust cg vgrlflgm cypbsslvgdy ffigxlhj teg iklht.
:.3. _bjlttbd cbhm rupturg
:.3.2. Pbtekpeyslkdkjy bhm odlhlobd okhsgqughogs
Ktegr tebh lh obsgs kf lhffibaabtkry brterkpbtey, sbjlttbdcbhm rupturg koours akst kftgh fkddkwlhj rgslstgm flhjgrgxtghslkh kr b mlrgot mkrsbd cdkw tk b ffigxgm AOP iklht,skagtlags weldg slapdy dgbflhj terkuje ckkn kr oruapdlhj bseggt kf pbpgr. Lt obh koour spkhtbhgkusdy, pbrtloudbrdy lh kdmgr
pgrskhs,
lh
teg
okhtgxt
kf
mgjghgrbtlvg
brtloudbr
kr
pgrlbrtloudbrokhmltlkhs, skagtlags lh audtlpdg flhjgrs.Lh teg abikrlty kf obsgs, teg rupturg ls dkobtgm kh teg rbmlbd
slmg, prlabrldy lh teg almmdg flhjgr ^:?Q bhm sgokhmbrldy lh tegrlhj flhjgr. ]eg jrgbtgr koourrghog lh teg almmdg flhjgr obh cggxpdblhgm cy teg bhbtkay kf lts sbjlttbd cbhms, weloe gxtghmakrg mlstbddy lh tels flhjgr tebh lh teg ktegr flhjgrs ^:=Q, tegmlstlhot prktucgrbhog kf teg telrm agtbobrpbd egbm, teg gxtghskrtghmkh“s rkuhmgr orkss-sgotlkh, weloe abngs lt akrg uhstbcdgtebh lh teg hgljeckrlhj flhjgrs ^:7Q, bhm cy teg prgsghog kf cgttgr mgvgdkpgm lhtrbtghmlhkus okhhgotlkhs kh teg udhbr slzg^:6,::Q. ]eg odlhlobd ploturg bsskolbtgs pblh bhm pbdpbcdgswgddlhj kvgr teg sbjlttbd cbhm, bdkhj wlte gxtghskr tghmkh
lhstbcldlty kh teg mkrsua kf teg AOP iklht tebt obh cgrgspkhslcdg fkr b shbpplhj sghsbtlkh, kr gvgh dkonlhj murlhjbotlvg AOP gxtghslkh.]eg bakuht kf lhstbcldlty lh teg gxtghskr tghmkh mgpghms kh
teg gxtght kf teg sbjlttbd cbhm rupturg. Gxpgrlaghtbddy, khgcbhm aust cg dbogrbtgm prkxlabddy cy akrg tebh 70% tk obusgtghmkh lhstbcldlty. Prkxlabd pbrtlbd rupturgs mgstbcldlzg tegtghmkh akrg tebh mlstbd rupturgs ^<,:6Q. ]ghmkh lhstbcldlty lsrgvgbdgm murlhj teg odlhlobd gxbalhbtlkh cy rgslstgm flhjgrgxtghslkh,weloe obusgs mgvlbtlkh kf teg tghmkh“s okhtkur tk tegkppksltg kf slmg teg rupturg.Okapdgtg sbjlttbd cbhm rupturg dgbms tk sucduxbtlkh kr
mlsdkobtlkh kf
teg
gxtghskr
agoebhlsa
lhtk
teg
lhtgragtbobrpbd
vbddgy (typlobddy kh teg udhbr slmg) murlhj AOP ffigxlkh(Flj. 3:). Murlhj botlvg AOP gxtghslkh, teg mlsdkobtgm tghmkhsummghdy rgmuogs, obuslhj b shbpplhj sghsbtlkh tebt ls kcvlkusvlsubddy bhm upkh pbdpbtlkh. Zegh teg tghmkh ls odgbrdymlsdkobtgm lh teg lhtgragtbobrpbd vbddgy, botlvg AOP gxtghslkhobh cg lapksslcdg cgobusg teg tghmkh ls lh frkht kf teg ffigxlkh-gxtghslkh bxls. ]eg AOP aust cg gxtghmgm pbsslvgdy sk tebtbotlvg gxtghskr okhtrbotlkh obh rgmuog teg mlsdkobtgm tghmkhbhm ekdm teg AOP gxtghslkh. Lh teg flfte flhjgr, prkhkuhogmudhbr mgvlbtlkh kf teg prkxlabd pebdbhx bookapbhlgs mlsdkob-tlkh kh teg udhbr slmg kf teg AOP kf teg prkprlus bhm okaakhgxtghskr tghmkhs ^:5Q. Lh ogrtblh oerkhlo fkras, teg mlsdkobtlkhobh cgokag hkh-rgmuolcdg lf teg udhbr sbjlttbd cbhm rgtrbots,dgbmlhj tk ffigxlkh mgfkralty bhm udhbr mgvlbtlkh kf teg AOPegdpgm cy prkjrgsslvg lhtrlhslo ausodg rgtrbotlkh (Flj. 3:).Sbybh bhm Aurrby ebvg mgsorlcgm tergg typgs kf sbjlttbd
cbhm lhiurlgs ^:<Q. Lh typg 2, tegrg ls b okhtuslkh wltekut tgbr krtghmkh lhstbcldlty> lh typg 3, b tgbr wlte tghmkh sucduxbtlkh bhmshbpplhj> lh typg ?, teg tghmkh okapdgtgdy mlsdkobtgs lh teg
lhtgragtbobrpbd vbddgy.Cbsgm kh Lselsunl“s lhtrbkpgrbtlvg bhbtkalobd kcsgrvbtlkhs
^5Q, spkhtbhgkus tghmkh mlsdkobtlkhs brg mug tk bh lhiury tk tegsupgrflolbd cuhmdg kf teg sbjlttbd cbhm odksg tk teg gxtghskrtghmkh, wegrgbs trbuabtlo mlsdkobtlkh ls teg okhsgqughog kf rupturg kf ckte cuhmdgs kf teg sbjlttbd cbhm furtegr bwby frkateg tghmkh.Zegh shbpplhj ls prgsght, teg odbsslobd mlffgrghtlbd
mlbjhksls ls trljjgr flhjgr mug tk ffigxkr tghksyhkvltls> rbrgragoebhlsas lhvkdvlhj b okddbtgrbd AOP dljbaght, lhtrbtghml-hkus okhhgotlkhs kr dbtgrbd sdlp shbpplhj bt teg dgvgd kf teg PLPlh obsgs kf rgmuolcdg swbh-hgon mgfkralty ebvg bdsk cggh
mgsorlcgm. Obrgfud odlhlobd
gxbalhbtlkh
ls
gssghtlbd
fkr
Flj.
3:.
Supturg
kf
teg
rbmlbd
sbjlttbd
cbhm
kf
teg
gxtghskr
tghmkhs
kh
tegmkrsua kf teg AOP iklht dgbms tk teglr udhbr sucduxbtlkh lhtk teg lhtgragtb-
obrpbd
vbddgy.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
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8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 20/27
gstbcdlselhj b mlbjhksls. ASL kr udtrbskuhm labjlhj, pbrtlou-dbrdy myhbalo labjlhj, obh cg rgdgvbht lh obsgs wegrg tegmlbjhksls ls uhodgbr.Pbtlghts wldd kftgh mgdby sggnlhj agmlobd bttghtlkh cgobusg
tegsg lhiurlgs brg fuhotlkhbddy wgdd tkdgrbtgm bhm cgobusg kf alsmlbjhksls. Akst butekrs okhslmgr teg lhiury tk cg oerkhlowegh lt ls akrg tebh ? wggns kdm.
:.3.3. ]rgbtaght
Oerkhlo lhiurlgs (akrg tebh ? wggns kdm) kf teg sbjlttbd cbhmhk dkhjgr cghgflt frka okhsgrvbtlvg trgbtaght bhm aust cgkpgrbtgm kh tk stbcldlzg teg gxtghskr agoebhlsa kh teg mkrsuakf teg AOP iklht. Bftgr abnlhj b mkrskdbtgrbd kr mkrsbd ourvldlhgbrlholslkh kvgr teg AOP iklht, bhy sobr bmegslkhs kh teg rbmlbd _Cbrg rgdgbsgm. _lhog mkrsbdlzbtlkh kf teg gxtghskr agoebhlsa obhcg dlaltgm cgobusg kf udhbr sbjlttbd cbhm rgtrbotlkh, lt obh cgpbrtlbddy mlvlmgm (bs vkdbr bhmprkxlabdbspksslcdg) kr okapdgtgdymlvlmgm lf hggmgm. _gokhmbry rgpblr kf teg rbmlbd _C obh cgobrrlgm kut cy mlrgot suturlhj kr cy uslhj khg kf teg abhy
vbrlbtlkhs kf teg gxtghskr oghtrbdlzbtlkh tgoehlqugs (Flj. 35).
:.3.3.2. Mlrgot
sbjlttbd
cbhm
rgpblr
^:=Q
(Nggttgdnbap). Mlr-
got rgpblr ls fgbslcdg wegh teg tlssug qubdlty ls sufflolght. Lf tegcbhm ls okhtlhukus cut strgtoegm, pdlobturg wlte kvgrdbpplhjsuturgs obh cg obrrlgm kut. Lf tegrg brg audtlpdg kdm lhiurlgs,rgpblr kf teg rbmlbd _C kf teg akst udhbr flhjgr(s) obh cgpgrfkragm cy mlrgot suturg tk b mlvlmgm udhbr _C frka tegbmiboght rbmlbd flhjgr.
:.3.3.3. ]rbhspksltlkh kf mlstbddy cbsgm gxtghskr tghmkh
sdlp. B mlstbddy cbsgm gxtghskr tghmkh sdlp (khg-qubrtgr tk
khg-telrm kf
tghmkh
mlbagtgr)
ls
ebrvgstgm
prkxlabddy
kvgrbckut = oa frka teg rbmlbd slmg kr teg udhbr slmg (Obrkdd) ^50Q> lf teg dbttgr ls usgm, lt obh cg gxtghmgm wlte lhtrbtghmlhkusokhhgotlkhs ^::Q. ]eg sdlp ekdms teg oghtrbdlzgm tghmkh bftgrtwlstlhj lt brkuhm teg rbmlbd okddbtgrbd dljbaght ^50,52Q kr
lhtgragtbobrpbd dljbaght ^::,53,5?Q, kr dkkplhj lt brkuhm tegpbdabr lhtgrkssgkus ausodg (Aloekh) ^:5Q. Lt ls tegh suturgm tkltsgdf bhm tk teg gxtghskr tghmkh kr obpsudg (Aloekh). Bhktegrtgoehlqug okhslsts kf ebrvgstlhj b prkxlabddy cbsgm tghmkh sdlpkvgr P2 bhm tegh dkkplhj lt brkuhm teg duacrlobd tghmkhlhsgrtlkh (AoOky) ^5=Q. Lf bh gxtrb tghmkh suoe bs teg prkprlusgxtghskr tghmkh tk teg almmdg flhjgr gxlsts, lt obh cg usgm tkstbcldlzg teg rgokhstruotlkh ^57Q.
:.3.3.?.
Sgpblr
wlte
lhtrbtghmlhkus
okhhgotlkh. Bh lhtgrtgh-
mlhkus okhhgotlkh kh teg udhbr slmg ls rgdgbsgm bhm selftgm tk tegrbmlbd slmg (Zeggdmkh) ^:7Q bhm tegh suturgm tk teg rbmlbd bhmvkdbr stuap kf teg tkrh _C.
:.3.3.=. Duacrlobd tghmkh trbhsfgr ^56Q. ]eg duacrlobdtghmkh ls pbssgm terkuje teg gxtghskr tghmkh bhm suturgm tkltsgdf. ]eg udhbr _C mkgs hkt hggm tk cg mlvlmgm murlhj telsbotlvg trbhsfgr tgoehlqug, weloe prgvghts rbmlbd lhstbcldlty.
:.3.3.7. Pbdabrls
dkhjus
tghmkh
jrbft. B pbdabrls dkhjus
tghmkh jrbft ls gltegr twlstgm brkuhm teg gxtghskr tghmkh teghsgourgm kh ckte slmgs kf teg agtbobrpbd egbm wlte 3 ckhgbhoekrs ^5:Q, kr pbssgm terkuje b ckhg tuhhgd lh teg agtbobrpbdegbm bhm tegh cgelhm teg gxtghskr tghmkh (Nbhj) ^55Q.
Hk abttgr weloe tgoehlqug ls usgm, teg surjgkh aust vgrlfylhtrbkpgrbtlvgdy tebt9
teg gxtghskr tghmkh ls pgrfgotdy oghtgrgm murlhj pbsslvg AOPffigxlkh bhm gxtghslkh>
sufflolght tghslkh ls pdbogm kh teg rgpblr9 tels aust cg
gvbdubtgm wlte
teg
AOP
iklht
ffigxgm
bckut
70
mgjrggs,
weldgabnlhj surg teg AOP obh cg ffigxgm okapdgtgdy pbsslvgdy>
teg stbcldlzlhj trbhsfgr kh teg gxtghskr tghmkh ls dkobtgm lh tegakst lskagtrlo dkobtlkh pksslcdg, lmgbddy bt teg sbag egljet bsteg agtbobrpbd hgon-egbm iuhotlkh ^5:,55Q. Akrg mlstbd
Flj.
35.
Mlbjrbas
kf
sgokhmbry
rgpblr
tgoehlqugs
bftgr
sbjlttbd
cbhm
rupturg.
Nggtgdnbap“s
tgoehlqug
(b).
Obrkdd“s
tgoehlqug
(c).
AoOky“s
tgoehlqug
(o).
Zeggdmkh“stgoehlqug (m).
Sgprkmuogm
wlte
pgralsslkh
kf
Abètrlsg
Krtekpìmlqug.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
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(3027)
277‟2522:=
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 21/27
flxbtlkh wldd elhmgr gxtghslkh, weldg akrg prkxlabd flxbtlkhwlte elhmgr AOP ffigxlkh>
teg rgpblr ls strkhj ghkuje tk bddkw gbrdy akcldlzbtlkh.
Pkstkpgrbtlvg obrg mgpghms kh teg tgoehlqug usgm bhm tegstrghjte kf teg rgpblr. ]eg AOP iklht obh cg laakcldlzgm lhbckut 30 mgjrggs ffigxlkh fkr ?‟= wggns wlte PLP ffigxlkhbddkwgm. ]eg AOP iklht obh tegh cg akvgm wlte teg bmiboghtflhjgrs weldg cglhj prktgotgm cy b crbog tebt prgvghts lt frkaffigxlhj okapdgtgdy fkr bhktegr ?‟= wggns (Flj. 3<).
:.?. Dkhjltumlhbd sgpbrbtlkh kf teg gxtghskr tghmkh bt teg
flfte flhjgr
]els rbrg lhiury rgsudts frka b mlrgot bxlbd cdkw lh b typlobddyykuhj pbtlght dgbmlhj tk sucduxbtlkh kf teg twk gxtghskrtghmkhs (prkprlus bhm okaakh) tk gltegr slmg kf teg iklht,obuslhj b psgumk-ckutkhhlgrg mgfkralty bt teg AOP iklht ^:5Q.]eg mkrsbd obpsudg aby bdsk cg tkrh ^5<‟<2Q. ]eg odlhlobd
ploturg sekws bh botlvg P2 gxtghslkh mgflolt wltekut abrngmudhbr mgvlbtlkh, weloe mlffgrs frka teg odlhlobd ploturg kf slaudtbhgkus mlsdkobtlkh kf teg twk gxtghskr tghmkh tk teg udhbrslmg mug tk rbmlbd _C rupturg ^:5Q.Zegh tels sgpbrbtlkh ls trgbtgm sgokhmbrldy, surjlobd
trgbtaght okhslsts kf rgakvlhj bhy flcrktlo brgbs lh tegtghmkhs, bcuttlhj teg twk gxtghskr tghmkh bhm suturlhj tegaslmg-tk-slmg ^:5,<0Q. Dg Vlgt gt bd. okaclhgm tels prkogmurg wlteudhbr _C mlvlslkh> lf teg rbmlbd _C ls rgtrbotgm, lt ls sobrlflgm tkwgbngh bhm dghjtegh lt ^:5Q.Pkstkpgrbtlvg laakcldlzbtlkh wlte b spdlht bt ?0 tk =0
mgjrggsAOP ffigxlkh ls usgm fkr 3‟=wggns, tegh okhtlhugm wlte
b prktgotlvg
crbog
tebt
prgvghts
fudd
AOP
ffigxlkh
(Flj.
3<).
]egrgsudts rgpkrtgm lh sabdd obsg sgrlgs brg jkkm, wlte hkrgourrghog kf teg pbtekdkjy.
:.=. Ckxgr“s nhuondg
]els obtoey hbag ls usgm fkr lhiurlgs tk teg mkrsbd obpsudg kf teg AOP iklht kf teg dkhj flhjgrs (prlabrldy teg almmdg flhjgr,cut bdsk teg lhmgx). ]egy brg typlobddy oerkhlo bhm lhmuogm cyrgpgtltlvg lapbots murlhj puhoelhj akvgaghts pgrfkragm fkr
ogrtblh okacbt spkrts, pbrtloudbrdy ckxlhj. ]eg prlabry lhiuryls b mkrsbd obpsudg tgbr tebt obh cg bsskolbtgm wlte okapdgtg krpbrtlbd _C rupturg, kr gvgh dkhjltumlhbd sgpbrbtlkh kf teggxtghskr tghmkhs lh teg flfte flhjgr ^<0,<2Q. ]egsg lhiurlgs obusgpblh bhm mkrsbd swgddlhj murlhj bhm laagmlbtgdy bftgr puhoelhjakvgaghts brg pgrfkragm. Gxtghskr agoebhlsa lhstbcldltyaby bdsk cg prgsght lf b sbjlttbd cbhm ls okapdgtgdy rupturgm.Khog oerkhlo, teg iklht obpsudg cgokags telonghgm wlte hkh-
gdbstlo flcrktlo sobr tlssug. Mlrgotdy suturg rgpblr kf teg tgbr obhcg obrrlgm kut lh hgwgr lhiurlgs ^<3Q, cut aby hk dkhjgr cgpksslcdg lh oerkhlo obsgs cgobusg kf teg rlsn kf lhtgrfgrlhj wltefudd AOP ffigxlkh. Lh suoe obsgs, Hbjbknb gt bd. ^<?Q rgokaaghmgxolslkh kf bh kvbd-sebpgm plgog kf sobr tlssug brkuhm tegrupturgm obpsudg bhm teg _C, lf lt ls bdsk rupturgm. ]eg slzg kf teg rgsudtlhj tlssug mgfgot ls agbsurgm wlte teg AOP fuddyffigxgm, bhm tegh rgpblrgm wlte bh gxtghskr rgtlhboudua jrbft.]egrg brg hk rgpkrts kf _C pdbsty fkr teg trgbtaght kf ckxgr“snhuondg.Pkstkpgrbtlvg laakcldlzbtlkh kf teg AOP lh 60 mgjrggs
ffigxlkh ls usgm fkr ? wggns. ]eg pbtlght obh rgstbrt puhoelhjbotlvltlgs ?‟6 akhtes bftgr teg surjlobd prkogmurg. ]eg rgsudtsrgpkrtgm lh vbrlkus sgrlgs brg jkkm, wlte hk rgourrghog kf tegpbtekdkjy.
5. Oerkhlo lhiurlgs lh zkhg 6, :, 5
5.2. Ykhg
6
Kh teg mkrsua kf teg agtbobrpbds, vbrlkus oerkhlo gxtghskragoebhlsa lhiurlgs ebvg cggh mgsorlcgm9 dkss kf okhtlhulty mug
tk slapdg
cut
hgjdgotgm
dbogrbtlkhs,
pgrltghmlhkus
bmegslkhsbftgr agtbobrpbd flxbtlkh kr tghmkh rgpblr, kr sgqugdbg kf audtlpdg tlssug lhiurlgs (snlh, tghmkh, ckhg) tebt obh rgqulrgckte ckhg bhm snlh rgokhstruotlkh.Lh obsgs wegrg tghmkh okhtlhulty ls dkst, teg AOP iklht ebs b
pgrabhght ffigxlkh mgfkralty tebt obhhkt cg botlvgdy rgmuogm.Ekwgvgr, tels ffigxlkh mgfkralty obh cg dlaltgm lf teg lhiury lsdkobtgm prkxlabd tk bh lhtgrtghmlhkus okhhgotlkh, weloe tbngskvgr murlhj gxtghslkh. Prkxlabd sgokhmbry tghmkh rgtrbotlkh lshkt sljhlflobht lf teg lhiury ls dkobtgm mlstbd tk bh lhtgrtghmlhkus
Flj.
3<.
Crbog
usgm
tk
prktgot
b
zkhg
7
gxtghskr
agoebhlsa
rgpblr
cy
dlaltlhj
fudd
AOP
ffigxlkh.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟252
2:7
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 22/27
okhhgotlkh, weloe rgablhs bttboegm bhm ekdms teg prkxlabdtghmkh ghm._gokhmbry rgpblr cy tghmkh suturlhj ls pksslcdg bftgr
gxolslkh kf teg tghmkh obddus. Zegh hkt pksslcdg (gxogsslvgrgtrbotlkh, dkss kf tghmkh sucstbhog, pkkr tghmkh qubdlty),suturgkf teg mlstbd tghmkh ghm cy bcuttlhj lt bjblhst teg bmiboghtflhjgr“s tghmkh obh cg okhslmgrgm lf lt mkgs hkt lhtgrfgrg wltefudd AOP ffigxlkh. Ekwgvgr, tegrg ls b rlsn kf obuslhj bhgxtrlhslo gxtghslkh okhtrboturg. B sabdd mgfgot obh bdsk cgtrgbtgm cy b turhgm-kvgr tghmkh trbhspksltlkh ^60Q.]eg gxtghskr obh bdsk cg rgculdt cy trbhsfgrrlhj b mgmlobtgm
flhjgr gxtghskr tghmkh> teg GLP obh cg usgm tk rgokhstruot tegalmmdg flhjgr“s gxtghskr tghmkh> teg GMA obh cg usgm tkrgokhstruot teg rlhj flhjgr“s gxtghskr, mgpghmlhj kh bhbtkalobdvbrlbtlkhs lh teg gxtghskr agoebhlsa lh teg flfte flhjgr.]rbhspksltlkh kf b tghmkh sdlp frka teg fkurte flhjgr ebs cgghprkpksgm bs b abhhgr tk rgokhstruot teg flfte flhjgr“s gxtghskr^<=Q.Bh bdtgrhbtlvg tk tghmkh trbhsfgr ls bh lhtgrobdbtgm tghmkh
jrbft uslhj teg pbdabrls dkhjus tghmkh, kr lf hkt bvbldbcdg, b tkggxtghskr tghmkh. ]eg prkxlabd ausodg ckmy aust stldd ebvg tegbcldlty tk okhtrbot, bhm obhhkt cg kvgrdy rgtrbotgm, weloe koourswegh teg lhiury ls vgry kdm. ]els akrg bhbtkalobd tgoehlqug lslhmlobtgm lf iustlflgm cy teg pbtlght“s fuhotlkhbd hggms (mgxtgrlty,lhmgpghmght flhjgr gxtghslkh). Prkxlabd bhm mlstbd suturlhj kf teg tghmkh jrbft aust cg obrrlgm kut fbr bwby frka teg gxtghskrrgtlhboudua, sk bs tk hkt laplhjg wlte lt. ]eg suturgs aust cgskdlm ghkuje tk bddkw fkr laagmlbtg rgebcldltbtlkh. Zgrgokaaghm uslhj b Pudvgrtbft wgbvg kh teg mlstbd ghm. ]egprkxlabd ghm ls suturgm lh zkhg :. Bpprkprlbtg tghslkh ls pdbogmkh teg rgpblr sk tebt flhjgr gxtghslkh obh cg kctblhgm wlte teg
wrlst lh
hgutrbd
pksltlkh
^60Q.
Bt
dgbst
=
wggns
kf
pkstkpgrbtlvglaakcldlzbtlkh bhm up tk 6 wggns ls hggmgm wlte b stbtlo krmyhbalo gxtghslkh crbog. ]els ekdms teg wrlst lh ?0 mgjrggsgxtghslkh bhm AOP lh hgutrbd kr 27 mgjrggs ffigxlkh, wlte tegPLP bhm MLP iklhts frgg.Lf teg sucoutbhgkus tlssug wldd hkt bddkw gffgotlvg tghmkh
jdlmlhj, tels jrbftlhj prkogmurg obh cg pgrfkragm lh twk stbjgs>b sldlokhg rkm ls usgm lhltlbddy bhm ls rgpdbogm b alhlaua kf 3‟?akhtes dbtgr wlte teg tghmkh jrbft. Lh skag obsgs, snlhrgokhstruotlkh wlte b ffibp tebt prkvlmgs telon sucoutbhgkustlssug aby cg hgogssbry> tels ls pgrfkragm cgfkrg kr murlhjsgokhmbry rgpblr kf teg gxtghskr agoebhlsa ^<7Q.Nldjkrg“s tgst wldd cg pksltlvg lf sobr bmegslkhs brg prgsght.
Sgebcldltbtlkh bhm stbtlo krtektlo crbolhj, tk prgvght gxtghslkhokhtrboturg bhm egdp tk skftgh teg snlh, aust cg obrrlgm kut uhtldteg lhffibaabtkry sobr prkogssgs ebvg sucslmgm, jghgrbddy 6akhtes bftgr teg lhltlbd lhiury gvght. Lh obsg kf fbldurg krlhokapdgtg rgstkrbtlkh, tghkdysls ls obrrlgm kut tk rgdgbsgbmegslkhs bhm gxolsg pgrltghmlhkus flcrkus sobr tlssug.Mgpghmlhj kh teg prgsghtbtlkh, tels obh cg okaclhgm wlteebrmwbrg rgakvbd (pdbtg, sorgw kr N-wlrg) bftgr teg agtbobrpbdckhg ebs egbdgm. ]els aust cg fkddkwgm cy laagmlbtgpkstkpgrbtlvg rgebcldltbtlkh bhm krtektlo crbolhj bs hggmgm.Pgrltghmlhkus bcskrcbcdg bmegslkh cbrrlgrs (jgds, agacrbhgs)obh cg usgm wlte teg tghkdysls prkogmurg, cut up tk hkw tegrg ls
hk prkkf
kf
teglr
gffgotlvghgss
lh
odlhlobd
prbotlog.
5.3. Ykhg :
Lf teg tghmkh lhiury ls hk dkhjgr boutg, tegrg ls b sljhlflobhtrlsn kf pgrltghmlhkus sobr bmegslkhs bhm/kr laplhjgaght kf bdbrjg tghmkh obddus wlte teg gxtghskr rgtlhboudua cgobusg telszkhg ls hbrrkw, okapbrtaghtbdlzgm bhm okvgrgm wlte b syhkvlbdagacrbhg.Odlhlobd gxbalhbtlkh wldd rgvgbd bhy tghmkh jdlmlhj mgfgots9
wegh b flst ls abmg, teg wrlst obhhkt cg ffigxgm kr gxtghmgm.Akrgkvgr, flhjgr gxtghslkh okhtrboturg ls gvlmght murlhj wrlstffigxlkh bhm teg flhjgrs obhhkt cg okapdgtgdy gxtghmgm wegh tegwrlst ls gxtghmgm.]ghkdysls ls obrrlgm kut tk rgdgbsg bmegslkhs bhm laplhjg-
aghts. ]eg gxtghskr rgtlhboudua aust cg kpghgm bhm ogrtblhsgptuas aust cg out tk prkvlmg akrg rkka fkr jdlmlhj. Ltsrgokhstruotlkh bt teg ghm kf teg prkogmurg aust cg skdlm ghkujetk bddkw laagmlbtg bhm skagtlags prkdkhjgm rgebcldltbtlkh,pktghtlbddy suppdgaghtgm cy prktgotlvg hljet crbolhj kr b stbtlobhm/kr myhbalo crbog.
Ykhg : ls bdsk b okaakh dkobtlkh fkr tghmkh rupturgs tebtbrg mlbjhksgm bhm gvbdubtgm sgokhmbrldy. Ktegr tebh lhffiba-abtkry brterkpbtey, tegsg obh ebvg twk obusgs9
lbtrkjghlo, mug tk rucclhj bjblhst b N-wlrg, sebrp gmjg kf bsorgw kr pdbtg, kr kh teg prkxlabd ghm kf teg udhb bftgr teg_buvì-Nbpbhmil kr Mbrrboe prkogmurg, kr bftgr okrtlskhglhigotlkh kr wrlst brterksokpy>
mgjghgrbtlvg, bftgr rupturg mugtk agoebhlobd bhmlhffibaabtkryobusgs kvgr bh brterltlo bhm uhstbcdg mlstbd rbmlkudhbr iklht. Lhtegsg obsgs, tghmkh rupturgs stbrt wlte teg flhjgrs kh teg udhbrslmg bhm jrbmubddy gxtghm tk teg rbmlbd flhjgrs. ]egy brg
skagtlags prgogmgm
cy
sljhlflobht
tghksyhkvlbd lhffibaabtlkh.]ghmkh rupturg ls mlbjhksgm odlhlobddy9 botlvg AOP
gxtghslkh ls lapksslcdg bhm pbsslvg gxtghslkh cy teg tghkmgslsgffgot kf wrlst ffigxlkh ls hk dkhjgr prgsght. Jlvgh teg dkhjgxourslkh kf teg gxtghskr tghmkh lh tels zkhg bhm teg mgdbygmtrgbtaght, teg tghmkh ghms obh cg sljhlflobhtdy rgtrbotgm bhmserlvgdgm, abnlhj mlrgot suturg rgpblr lapksslcdg. _gvgrbdkptlkhs brg bvbldbcdg lh tegsg obsgs9 lhtgrobdbtgm jrbft, bcutaghttk bh bmiboght flhjgr, lhtgrobdbry jrbft, tghmkh trbhsfgr. ]egsgprkogmurgs obh cg okaclhgm tkjgtegr mgpghmlhj kh ekw abhygxtghskr tghmkhs brg rupturgm, ekw kdm tegsg rupturgs brg bhmekw auoe teg prkxlabd tghmkh ls rgtrbotgm. ]eg trgbtaght pdbh
ls fblrdy slaldbr tk teg khg fkr rupturgs sgokhmbry tk reguabtklmbrterltls. Lt okhslsts kf9
kpghlhj teg gxtghskr rgtlhboudua kh lts udhbr slmg, abrnlhjteg ckuhmbry fkr b rgotbhjudbr ffibp wlte rbmlbd elhjg>
gxtghskr tghksyhkvgotkay> bh bpprkprlbtg prkogmurg kh teg mlstbd rbmlkudhbr iklht,mgpghmlhj kh teg gtlkdkjy kf teg tghmkh rupturg>
sgokhmbry tghmkh rgpblr9 teg odbsslobd pdbh wegh teg gxtghskrtghmkhs kf teg fkurte bhm flfte flhjgrs brg rupturgm ls tktrbhsfgr teg GLP tk teg okaakh gxtghskr kf teg flfte flhjgr bhmpdbog teg almmdg flhjgr“s okaakh gxtghskr bjblhst tebt kf teg
lhmgx flhjgr
kh
teg
mkrsua
kf
teg
ebhm
(Flj.
?0).
Lf
teg
GLP
ls
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟2522:6
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 23/27
hkt bvbldbcdg, bh lhtgrobdbtgm tghmkh jrbft ls b pksslcldlty>ekwgvgr tegrg ls b rlsn kf pkstkpgrbtlvg bmegslkhs. Zeghgxtghskr tghmkhs brg rupturgm lh tergg flhjgrs, trbhsfgr kf tegsupgrflolbd ffigxkr tghmkh kf teg almmdg kr rlhj flhjgr obh cgprkpksgm. ]eg tghmkh ls pbssgm terkuje teg lhtgrkssgkusagacrbhg kr brkuhm teg wrlst. Lt ls sgourgm wlte b Pudvgrtbftwgbvg bt teg mlstbd ghms kf teg tkrh tghmkhs lh teg fkurte bhmflfte flhjgrs> teg almmdg flhjgr obh cg rgvlvgm wlte bh GLPtrbhsfgr. Zegh fkur flhjgr gxtghskr tghmkhs brg rupturgm, tegsupgrflolbd ffigxkr tghmkhs kf ckte teg almmdg bhm rlhj flhjgrsbrg usgm tk rgvlvg twk okaakh gxtghskr tghmkhs gboe. ]egtghslkh pdbogm kh teg rgpblrgm tghmkh ls teg sbag bs teg khgmgsorlcgm lh zkhg 6>
odkslhj teg gxtghskr rgtlhboudua skdlmdy weldg abnlhj surgtegrg ls hk laplhjgaght tebt okudm lapgmg tghmkh jdlmlhj. Bhgxtghskr rgtlhboudua pdbsty prkogmurg ls skagtlags hggmgm tklskdbtg teg tghmkh rgpblr frka teg mlstbd rbmlkudhbr iklht>
laakcldlzbtlkh bhm pkstkpgrbtlvg akhltkrlhj ls teg sbag bsfkr zkhg 6 tghmkh rupturgs (Flj. ?2).
Flj.
?0.
Mlbjrbas
kf
rgpblr
tgoehlqugs
fkr
rupturgm
gxtghskr
tghmkhs
lh
zkhg
:.GLP trbhsfgr bhm tghmkh bcutaght fkr rupturgm gxtghskr tghmkhs lh teg fkurtebhm
flfte
flhjgrs
(b).
]rbhsfgr
kf
teg
twk
supgrflolbd
ffigxkr
tghmkhs
lh
b
obsgwegrg bdd teg flhjgr gxtghskr tghmkhs brg rupturgm (c). Sgprkmuogm
wlte
pgralsslkh
kf
Abètrlsg
Krtekpìmlqug.
Flj. ?2. Sgpblr kf zkhg : gxtghskr tghmkh rupturgs lh teg telrm, fkurte bhm flfte flhjgrs cy GLP bhm supgrflolbd ffigxkr tghmkh trbhsfgrs. Lhtrbkpgrbtlvg vlgw (b)>
pkstkpgrbtlvg laakcldlzbtlkh tebt bddkws gbrdy ffigxlkh (c) bhm gxtghslkh (o) akvgaghts. Odlhlobd kutokag lh gxtghslkh (m) bhm ffigxlkh (g).
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟252
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8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
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5.?. Ykhg 5
_gokhmbry rgpblrs lh teg ausodg‟tghmkh iuhotlkh rgjlkh brgmlffloudt tk obrry kut cgobusg kf ausodg rgtrbotlkh bhm frgqughtausodg bhm tghmkh mgfgots. Mlstbd suturlhj lh zkhg : kf khg krtwk rupturgm tghmkhs bjblhst bh bmiboght egbdtey tghmkh obh cgpgrfkragm. Zegh audtlpdg tghmkhs brg rupturgm, khg kr akrgsupgrflolbd ffigxkr tghmkhs obh cg trbhsfgrrgm, bdkhj wlte tegffigxkrobrpl udhbrls tghmkh, weloe ls dkhj ghkuje tk rgboe zkhg 5.
<. Oerkhlo
tghmkh
lhiurlgs
wlte
mgfgots
lh
audtlpdg
tlssugs
Lt ls gssghtlbd tebt rgdlbcdg snlh okvgrbjg cg rg-gstbcdlsegm lhtegsg pbrtloudbr obsgs. _gokhmbry tghmkh rgpblr mgpghms kh tegzkhg bffgotgm bhm lf ckhg bhm iklht struoturgs bdsk hggm tk cgrgpblrgm. ]eg elje rlsn kf sgpsls aust cg ngpt lh alhm bhmbpprkprlbtg prg-kpgrbtlvg bhm pkstkpgrbtlvg prgvghtbtlvgagbsurgs tbngh.
<.2. Ykhgs
2
bhm
3
MLP fuslkh lh bsskolbtgm wlte wkuhm okvgrbjg uslhj b dkobdffibp kr b rgjlkhbd ffibp (rgvgrsgm mg-gpltegdlbdlzgm orkss flhjgr
ffibp) ls
teg
akst
okaakh
skdutlkh
usgm.
<.3. Ykhgs ?, =, 7
Dkobd bhm rgjlkhbd snlh ffibps obh cg usgm. Bs prgvlkusdystbtgm, sgokhmbry tghmkh rgpblr obh cg pgrfkragm bt teg sbagtlag lf teg ckhg bhm iklht struoturgs mk hkt hggm tk cg rgpblrgm.Ktegrwlsg, kr lf sobr tlssug ls prgsght tebt okudm dgbm tk tegmgvgdkpaght kf gbrdy pgrltghmlhkus bmegslkhs, wg rgokaaghmb twk-stbjg rgpblr uslhj b sldlokhg rkm (Flj. ?3).
<.?. Ykhgs 6, :, 5
Ykhgs 6, : bhm 5 obh cg teg sltg kf audtlpdg tlssug lhiurlgs(rkddkvgr ebhm) dgbmlhj tk gxtghslvg snlh, tghmkh, ckhg bhm iklht(agtbobrpbd bhm/kr obrpbd) mgfgots bdkhj wlte lhiurlgs tk teg
lhtgrkssgkus ausodgs (mgfgots, rgtrbotlkh). ]eg lmgbd strbtgjy lstk pgrfkra b slhjdg-stbjg rgokhstruotlkh bdd kf teg lhiurgmtlssugs ^<=,<7Q. ]els obh cg crkngh up mgpghmlhj kh teg gxtghtkf teg mgfgots, bakuht kf wkuhm okhtbalhbtlkh bhm tegpbtlght“s okhmltlkh (pkdytrbuab). ]eg prgsghog kf ckhg bhm iklht lhiurlgs bt teg wrlst kr AOP iklhts rgqulrgs tebt gxtghskrrgokhstruotlkh cg mgfgrrgm uhtld teg ckhg lhiurlgs bhm snlhwkuhms ebvg egbdgm, teg rlsn kf sgpsls ls okhtblhgm bhmabxlaua wrlst bhm AOP rbhjg kf aktlkh ebs cggh rgokvgrgm^<6Q.Lt ls gssghtlbd fkr teg snlh okvgrbjg tk prkvlmg bh gffgotlvg
sucoutbhgkus jdlmlhj dbygr. ]els obh cg boelgvgm terkuje b
rgjlkhbd pgmlodgm
ffibp
(rbmlbd,
pkstgrlkr
lhtgrkssgkus,
udhbr),
Flj. ?3. ]wk-stbjg rgpblr kf audtlpdg tlssug mgfgots lh zkhgs ?, = bhm 7 wlte lhltlbd ckhg lhiury. Lhtrbkpgrbtlvg vlgw kf teg flrst stbjg wlte lapdbhtbtlkh kf sldlokhg rkm.Hktg teg bsskolbtgm sbjlttbd cbhm rgokhstruotlkh (b). _gokhm stbjg wlte pbdabrls dkhjus jrbftlhj pgrfkragm tergg akhtes dbtgr (c). Pkstkpgrbtlvg rgsudt lh ffigxlkh (o)bhm
gxtghslkh
(m).
P. Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟2522:5
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
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mlstbht ffibp (lhjulhbd) kr frgg ffibp (gxtgrhbd crboelbd, tgapkrbdlsfbsolb). _gokhmbry tghmkh rgokhstruotlkh wldd rgqulrg jrbftlhj.Lf sufflolghtdy jkkm snlh okvgrbjg ebs cggh boelgvgm wlte tegffibp, b sldlokhg rkm mkgs hkt hggm tk cg usgm ^<6,<:Q. Lf teg ffibp lsbdrgbmy lh pdbog, wg rgokaaghm pdbolhj teg tghmkh jrbftcgtwggh teg fbsolb bhm sucoutbhgkus fbt tk boelgvg cgttgrjdlmlhj furtegr bwby frka teg mggp sobr tlssug. _lhjdg-stbjgtghmkh jrbftlhj wkudm sgga tk cg okhtrblhmlobtgm wegh ltwkudm okhtbot b ckhg rgpblr cgobusg kf teg sljhlflobht rlsn kf sgokhmbry bmegslkhs. Zegh dbrjg tghmkh mgfgots gxlst (jrgbtgrtebh 7 oa) ^<6Q, F_M tghmkh trbhsfgr wldd prkvlmgm ghkujetghmkh abtgrlbd fkr teg trbhspdbht. Mgpghmlhj kh teg typg kf ffibp, okapksltg vbsoudbrlzgm ffibps obh crlhj sufflolght snlhtlssug, jdlmlhj tlssug bhm tghmkh tlssug tk teg sltg ^<7‟<:Q. Bokapksltg ffibp pgmlodgm kh teg udhbr brtgry lhodumgs tegpbdabrls dkhjus tghmkh bhm b sdlp frka teg ffigxkr obrpl udhbrls(Julacgrtgbu). B ffibp pgmlodgm tk teg rbmlbd brtgry lhodumgs tegpbdabrls dkhjus tghmkh, b strlp kf crboelkrbmlbdls bhm b strlpfrka teg ffigxkr obrpl rbmlbdls (Sglm bhm Akss). B frgg okapksltg
ffibp kf mkrsbdls pgmls prkvlmgs fkur sufflolghtdy dkhj tghmkhs(Bmbhl). ]eg wkuhm egbdlhj sgqugdbg bftgr ebrvgstlhj tegsgffibps obh cg altljbtgm cy uslhj fbsolb wltekut snlh tlssug,pbrtloudbrdy fkr teg rbmlbd (Bmbhl) bhm udhbr ffibps, kr cy pdbolhjbrtlflolbd mgrals kh teg mkhkr sltg ^<:Q.]eg rgsudts kf tegsg sgokhmbry audtlpdg tlssug rgpblrs sgga
pksltlvg ^<6‟<5Q wegh teg pbsslvg rbhjg kf aktlkh kf teg AOPbhm wrlst iklht brg prgsgrvgm. Sgslmubd AOP gxtghslkh mgfloltsggas tk cg teg rudg ^<6,<5Q. Pkkr kutokags brg dlngdy wltegxtghslvg ckhg kr iklht mgfgots> mbabjg tk teg lhtgrkssglausodgs wldd bmm sljhlflobht sobr-rgdbtgm stlffghlhj tebt wldddlalt flhjgr ffigxlkh lh pbrtloudbr ^<6Q. _gokhmbry tghmkh
rgokhstruotlkh
ls
hkt iustlflgm
lh
tegsg
obsgs,
gspgolbddy
slhogagoebhlzbtlkh kf teg snlh okvgrbjg prkvlmgm cy teg ffibp mug tksobr bmegslkhs kftgh dlalts teg rgslmubd AOP gxtghslkh mgflolt.
Mlsodksurg kf
lhtgrgst
]eg butekr mgodbrgs tebt eg ebs hk okhffilots kf lhtgrgstokhogrhlhj tels brtlodg.
Sgfgrghogs
^2Q Fkhtblhg O, Zbvrglddg J, Oebhtgdkt O, Prkmekaag J. Bhbtkalg oelr-
urjlobdg
mg
db
fbog
mkrsbdg
mg
db
ablh
gt
mu
pkljhgt.
Oelr
Ablh300=>3=96=‟:5.^3Q
Vkh
_oerkgmgr
EP,
Ckttg
AI.
Bhbtkay
kf
teg
gxtghskr
tghmkhs
kf
tegflhjgrs9 vbrlbtlkhs bhm audtlpdlolty. I Ebhm _urj Ba 2<<7>3093:‟?=.
^?Q Zgecg AB. Iuhoturb bhbtkay. I Ebhm _urj Ba 2<<3>2:9223=‟<.^=Q
_tbuoe
SI.
Gxtghskr
tghmkh
lhiury.
Lh9
Zkdfg
_Z,
Ektoenlss
SH,Pgmgrskh
ZO,
gt
bd.,
gmltkrs.
Jrggh“s
kpgrbtlvg
ebhm
surjgry.
6te
gmltlkh,Peldbmgdpelb9 Gdsgvlgr9 Oeuroeldd Dlvlhjstkh> 3022. p. 27<.
^7Q
Yldcgr
_,
Kcgrdlh
O.
Bhbtkalobd
vbrlbtlkhs
kf
teg
gxtghskr
tghmkhs
tk
tegflhjgrs
kvgr
teg
mkrsua
kf
teg
ebhm9
b
stumy
kf
70
ebhms
bhm
rgvlgw
kf
tegdltgrbturg.
Pdbst
Sgokhstr
_urj
300=>22?932=‟32.^6Q Jbrolb-Gdlbs A, Bh NH, Cgrjduhm D, Dlhsoeglm SD, Okkhgy ?rm ZP,
Oebk
G\.
Gxtghskr
agoebhlsa
kf
teg
flhjgrs.
L.
B
qubhtltbtlvg
jgkagtrlostumy. I Ebhm _urj Ba 2<<2>26922?0‟6.
^:Q
Ybhokddl
GB.
_truoturbd
bhm
myhbalo
cbsgs
kf
ebhm
surjgry,
3hm
Gm.,
Peldbmgdpelb9
IC
Dlpplhoktt>
2<:<9 ?‟?6.
^5Q Lselzunl A. ]rbuabtlo bhm spkhtbhgkus mlsdkobtlkh kf gxtghskr tghmkh kf teg dkhj flhjgr. I Ebhm _urj Ba 2<<0>279<6:‟:3.
^<Q
\kuhj
OA,
Sbybh
JA.
]eg
sbjlttbd
cbhm9
bhbtkalo
bhm
clkagoebhlobdstumy. I Ebhm _urj Ba 3000>379220:‟2?.
^20Q
_eua
O,
Cruhk
SI,
Slstlo
_,
Sksghwbssgr
AP,
_trbuoe
SI.
Gxbalhbtlkh
kf teg bhbtkalo rgdbtlkhselp kf teg prkxlabd jgralhbd hbld abtrlx tk teggxtghskr
tghmkh
lhsgrtlkh.
I
Ebhm
_urj
Ba
3000>379222=‟:.^22Q Zbrrgh SB, Nby HSA, Hkrrls _E. ]eg alorkvbsoudbr bhbtkay kf teg
mlstbd mljltbd gxtghskr tghmkh. I Ebhm _urj Cr 2<55>2?9262‟?.^23Q _oewgltzgr ]P, Sbybh JA. ]eg tgralhbd tghmkh kf teg mljltbd
gxtghskr
agoebhlsa9
Pbrt
L,
Bhbtkalo
stumy. I
Ebhm _urj Ba300=>3<95<5‟<03.
^2?Q Bmnlhskh IA, Ikehskh _P, Oeuhj NO. ]eg odlhlobd lapdlobtlkhs kf tegkcdlqug rgtlhboudbr dljbaght. I Ebhm _urj Ba 302=>?<97?7‟=2.
^2=Q
Ndglhgrt
EG,
Vgrmbh
O.
Sgpkrt
kf
teg
Okaalttgg
kh
]ghmkh
Lhiurlgs(Lhtgrhbtlkhbd Fgmgrbtlkh kf _kolgtlgs fkr _urjgry kf teg Ebhm). I Ebhm_urj Ba 2<5?>59:<=‟5.
^27Q Gddlkt M, AoJrkutegr MB. ]eg gxourslkhs kf teg dkhj gxtghskrs kf tegebhm.
I
Ebhm
_urj
Cr
2<56>229::‟50.^26Q Dlh IM, _trbuoe SI. Odksgm skft tlssug gxtghskr agoebhlsa lhiurlgs
(abddgt, ckutkhhlgrg, bhm sbjlttbd cbhm). I Ebhm _urj Ba302=>?<92007‟22.
^2:Q
Jbrcgrabh
_F,
Mlbk
G,
Pglagr
OB.
Abddgt
flhjgr9
rgsudts
kf
gbrdy
vgrsus
mgdbygm odksgm trgbtaght. I Ebhm _urj Ba 2<<=>2<9570‟3.^25Q Akss IJ, _tglhjkdm SF. ]eg dkhj tgra rgsudts kf abddgt flhjgr lhiury9 b
rgtrkspgotlvg
stumy
kf
khg
euhmrgm
obsgs.
Ebhm
2<5?>279272‟=.^2<Q _oewgltzgr ]P, Sbybh JA. ]eg tgralhbd tghmkh kf teg mljltbd gxtghskr
agoebhlsa9
Pbrt
LL,
Nlhgabtlo
stumy.
I
Ebhm
_urj
Ba
300=>3<9<0?‟5.^30Q Pbtgd AS, Mgsbl __, Cbsslhl-Dlpskh D. Okhsgrvbtlvg abhbjgaght kf
oerkhlo
abddgt
flhjgr.
I
Ebhm
_urj
Ba
2<56>2297:0‟?.^32Q Fboob _, Hkhhghaboegr I, Dlvgrhgbux P. ]rbltgaght mu mkljt gh ablddgt
bvgo
uhg
krteåsg
mkrsbdg
okddìg.
À
prkpks
m“uhg
sìrlg
rìtrkspgotlvg
mg
3:0obs. Sgv Oelr Krtekp Sgpbrbtrlog Bppbr Akt 300:><?9653‟<.
^33Q
Zbrrgh
SB,
Nby
HSA,
Fgrjuskh
MJ.
Abddgt
flhjgr9
okapbrlskh
cgtwgghkpgrbtlvg bhm okhsgrvbtlvg abhbjgaght lh teksg obsgs fbldlhj tk cg ourgmcy
spdlhtbjg.
I
Ebhm
_urj
Cr
2<55>2?927<‟60.^3?Q Dlhm I, Ebhsgh C. Bccrgvbtlk9 b hgw kpgrbtlkh fkr oerkhlo abddgt flhjgr. I
Ebhm
_urj
Cr
2<5<>2=9?=:‟<.
^3=Q Dgvbhtg _, Cgdnbml B, Gcgdlh A. ]rbltgaght oelrurjlobd mu mkljt gh ablddgtlhvìtìrì
pbr
bookurolssgaght‟suturg
mu
obd
tghmlhgux.
À
prkpks
mg
66
obs.Oelr Ablh 300?>3392?‟5.
^37Q
Wdnôr
G,
Bêlngd
O,
Grjuh
K,
Ogdlnöz
C.
Sgpblr
kf
oerkhlo
abddgt
flhjgrmgfkralty
uslhj
Altgn
alork
bro
ckhg
bhoekr.
Bhh
Pdbst
_urj3007>7=9?<?‟6.
^36Q Dgg _N, Nla EI, Dgg NZ, Nla NI, Oeky Z_. Akmlflgm pudd-kut wlrgsuturg
tgoehlqug
fkr
teg
trgbtaght
kf
oerkhlo
ckhy
abddgt
flhjgr.
Bhh
Pdbst_urj
3020>679=66‟:0.^3:Q Du I, Ilbhj I, Uu D, Uu Z, Uu I. Akmlflobtlkh kf teg pudd-lh suturg
tgoehlqug fkr abddgt flhjgr. Bhh Pdbst _urj 302?>:09?0‟?.^35Q
Lsgdlh
F, Dgvbag
I,
Jkmky
I.
_lapdlflgm
tgoehlqug
fkr
trgbtlhj
abddgtflhjgr9
tghkmgrakmgsls.
I
Ebhm
_urj
Ba
2<::>39225‟32.^3<Q Bdcgrtkhl ZA. ]eg Crkkns bhm Jrbhgr prkogmurg fkr okrrgotlkh kf abddgt
flhjgr. Lh9 ]uclbhb S, gmltkr. ]eg Ebhm, Vkd. ?. Peldbmgdpelb9 ZC
_buhmgrs> 2<55. p. <:‟200.
^?0Q
Nkh
A,
Cdkga
II.
]rgbtaght
kf
abddgt
flhjgrs
cy
tghkmgrakmgsls.
Ebhm2<53>2=92:=‟7.
^?2Q
Jgkrjgsou
BV, Obpktb
LA,
Abtgl
LS.
B
hgw
surjlobd
trgbtaght
fkr
abddgtflhjgr mgfkralty9 mggpltegdlbdlsgm pgmlodgm snlh ffibp tgoehlqug. Lhiury302?>==9?72‟7.
^?3Q Ju \P, Yeu _A. B hgw tgoehlqug fkr rgpblr kf boutg kr oerkhlo gxtghskrtghmkh
lhiurlgs
lh
zkhg
2.
I
Ckhg
Iklht
_urj
Cr
3023><=9665‟:0.^??Q Zbhj D, Yebhj U, Dlu Y, Eubhj U, Yeu E, \u \. ]ghmkh-ckhg jrbft fkr
tghmlhkus
abddgt
flhjgrs
fkddkwlhj
fbldgm
spdlhtlhj.
I
Ebhm
_urj
Ba302?>?593?7?‟<.
^?=Q Cbrbtz AG, _oealmt OO, Eujegs ]C. Gxtghskr tghmkh lhiurlgs. Lh9 JrgghMP, Ektoenlss SH, Pgmgrskh ZO, gmltkrs. 7te Gm., Jrggh“s kpgrbtlvg ebhmsurjgry,
Vkd.
3,
7te
Gm.
Hgw
\krn,
H\9
Oeuroeldd
Dlvlhjstkh>
3007.
p.
25:‟
325.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟252
2:<
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
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^?7Q Jruhmcgrj BC, Sgbjbh M_. Oghtrbd sdlp tghktkay fkr oerkhlo abddgtflhjgr mgfkralty. I Ebhm _urj Ba 2<5:>2397=7‟:.
^?6Q
Skzabryh
DA.
Oghtrbd
_dlp
]ghktkay
wlte
mlstbd
rgpblr
lh
teg
trgbtaghtkf sgvgrg oerkhlo abddgt flhjgrs. I Ebhm _urj Ba 302=>?<9::?‟5.
^?:Q
Elwbtbrl
S,
Nuhlykse
N,
Bknl
A,
Ebselaktk
N,
_uzunl
],
]bnbebsel
N.Frbotlkhbd Fkwdgr tghkhkay fkr oerkhlo abddgt flhjgr9 b obmbvgrlo clk-agoebhlobd
stumy.
I
Ebhm
_urj
Ba
3023>?:9336?‟5.^?5Q Duobs JD. Fkwdgr oghtrbd sdlp tghktkay fkr kdm abddgt mgfkralty. Pdbst
Sgokhstr _urj 2<5:>509<3‟=.^?<Q Ekupt P, Mlinstrb S, _tkra vbh Dgguwgh IC. Fkwdgr“s tghktkay fkr abddgt
mgfkralty.
I
Ebhm
_urj
Cr
2<<?>259=<<‟700.^=0Q Ckwgrs ZE, Eurst DO. Oerkhlo abddgt flhjgr9 teg usg kf Fkwdgr“s oghtrbd
sdlp rgdgbsg. I Ebhm _urj Ba 2<:5>?9?:?‟6.^=2Q Oebk IM, _brwbel V, Mb _ldvb \_, Sksghwbssgr AP, _trbuoe SI. Oghtrbd
sdlp
tghktkay
fkr
teg
trgbtaght
kf
oerkhlo
abddgt
flhjgr9
bh
bhbtkalostumy. I Ebhm _urj Ba 300=>3<9326‟<.
^=3Q ]ekapskh I_, Dlttdgr IZ, Wptkh I. ]eg splrbd kcdlqug rgtlhboudbr dljbaght(_KSD). I Ebhm _urj Ba 2<:5>?9=53‟:.
^=?Q
Ke
I\,
Nla
I_,
Dgg
MO,
\bhj
IZ,
Nl
_E,
Igkh
CI,
gt
bd.
Okapbrbtlvg
stumykf splrbd kcdlqug rgtlhboudbr dljbaght rgokhstruotlkh tgoehlqugs uslhjgltegr b dbtgrbd cbhm kr b tghmkh jrbft. Broe Pdbst _urj 302?>=09::?‟5.
^==Q
Ndglhabh
ZC,
Pgtgrsgh
MP.
Kcdlqug
rgtlhboudbr
dljbaght
rgokhstruotlkhfkr
oerkhlo
abddgt
flhjgr
mgfkralty.
I
Ebhm
_urj
Ba
2<5=><9?<<‟=0=.
^=7Q Nbhbyb N, Zbmb ], \babseltb ]. ]eg ]ekapskh prkogmurg fkr oerkhloabddgt flhjgr mgfkralty. I Ebhm _urj Ba 302?>?5923<7‟?00.
^=6Q
_ue
H,
Zkdfg
_Z.
_kft
tlssug
abddgt
flhjgr
lhiurlgs
wlte
mgdbygm
trgbtaght.I Ebhm _urj Ba 302?>?59250?‟7.
^=:Q
Pkshgr
AB,
Jrggh
_A.
Mlbjhksls
bhm
trgbtaght
kf
flhjgr
mgfkraltlgsfkddkwlhj lhiurlgs tk teg gxtghskr tghmkh agoebhlsa. Ebhm Odlh302?>3<936<‟52.
^=5Q Gdskh SB. Supturg kf teg oghtrbd sdlp kf teg gxtghskr ekkm kf teg flhjgr. ICkhg
Iklht
_urj
Cr
2<56>65933<‟?2.^=<Q Curtkh SL. Gxtghskr tghmkh‟Dbtg rgokhstruotlkh., Lh9 Jrggh MP, gmltkr.
3hm
gm,
Jrggh“s
Kpgrbtlvg
Ebhm
_urjgry,
Vkd.
?,
3hm
gm
Hgw
\krn,
H\9Oeuroeldd Dlvlhjstkh> 3003. p. 30:?‟226.
^70Q
Mkdpelh
IB.
Gxtghskr
tghktkay
fkr
oerkhlo
ckutkhhlårg
mgfkralty
kf
tegflhjgr> rgpkrt kf twk obsgs. I Ckhg Iklht _urj Ba 2<67>=:9262‟=.
^72Q
Ourtls
SA,
Sglm
SD,
Prkvkst
IA.
B
stbjgm
tgoehlqug
fkr
teg
rgpblr
kf
teg
trbuabtlo ckutkhhlgrg mgfkralty. I Ebhm _urj 2<5?>5926:‟:2.^73Q
]k
P,
Zbtskh
I].
Ckutkhhlgrg
mgfkralty.
I
Ebhm
_urj
Ba
3022>?692?<‟=3.
^7?Q
Agbmkws
_G,
_oehglmgr
DE,
_egrwyh
IE.
]rgbtaght
kf
teg
oerkhlockutkhhlårg
mgfkralty
cy
gxtghskr
tghktkay.
Ebhm
Odlh
2<<7>229==2‟:.^7=Q _tgrh PI. Gxtghskr tghktkay9 b tgoehlqug fkr okrrgotlkh kf pksttrbuabtlo
mlstbd lhtgrpebdbhjgbd iklht eypgrgxtghslkh mgfkralty. I Ebhm _urj Ba2<5<>2=97=6‟<.
^77Q
Dg
Cgddgo
\, Dky
_,
]kuba
O,
Bdhkt
I\, Absagigbh
G.
]rbltgaghtoelrurjlobd mg db mìfkrabtlkh gh ckutkhhlårg mgs mkljts dkhjs. Ìtumgm“uhg sìrlg rìtrkspgotlvg mg =: pbtlghts. Oelr Ablh 3002>309?63‟:.
^76Q
Jruhmcgrj
BC.
Bhbtkalo
rgpblr
kf
ckutkhhlgrg
mgfkralty.
Odlh
KrtekpSgdbt
Sgs
2<50>27?9336‟<.^7:Q Obrkdl B, Ybhbsl _, _qubrzlhb PC, Jugrrb A, Pbhobdml J. Kpgrbtlvg
trgbtaght kf teg pkst-trbuabtlo ckutkhhlgrg mgfkralty. B akmlflobtlkh kf
teg mlrgot bhbtkalobd rgpblr tgoehlqug. I Ebhm _urj Cr 2<<0>279=20‟7.^75Q
Yebhj
U,
\bhj
D,
_ebk
U,
Zgh
_,
Yeu
E,
Yebhj
Y.
]rgbtaght
kf
ckhyckutkhhlgrg mgfkralty wlte b dkkp wlrg. I Ebhm _urj Ba 3022>?692050‟7.
^7<Q
Wrcbhlbn
IS,
Ebygs
AJ.
Oerkhlo
ckutkhhlårg
mgfkralty‟bh
bhbtkalorgokhstruotlkh. I Ebhm _urj Ba 2<52>69?:<‟5?.
^60Q
Vblghtl
D,
Agrdg
A.
Oelrurjlg
sgokhmblrg
mg
d“bppbrgld
gxtghsgur
mgsmkljts. Lh9 Agrdg A, Mbutgd J, gmltkrs. Db Ablh ]rbuabtlqug 3, Oelrurjlgsgokhmblrg.
Pbrls9
Absskh>
2<<7. p.
<?‟22?.^62Q Abtgv L. ]rbhspksltlkh kf teg dbtgrbd sdlps kf teg bpkhgurksls lh trgbtaght
kf
dkhj-stbhmlhj
――Ckutkhhlårg
mgfkralty““
kf
teg
flhjgrs.
Cr
I
Pdbst
_urj2<6=>2:9352‟6.
^63Q Dlttdgr IZ, Gbtkh SJ. Sgmlstrlcutlkh kf fkrogs lh teg okrrgotlkh kf tegckutkhhlgrg mgfkralty. I Ckhg Iklht _urj Ba 2<6:>=<9236:‟:=.
^6?Q
Blboeg
B,
Cbrsny
BI,
Zglhgr
MD.
Prgvghtlkh
kf
ckutkhhlgrg
mgfkralty.Pdbst Sgokhstr _urj 2<:0>=6926=‟:.
^6=Q _dgsbrghnk \B, Eurst DO, Abl N. _uturg bhoekr tgoehlqug fkr bhbtkalorgokhstruotlkh lh oerkhlo ckutkhhlgrg mgfkralty. ]goe Ebhm Wp Gxtrga_urj
3007><92:3‟=.^67Q Keselk L, Kjlhk ], Alhbal B, Nbtk E. Sgokhstruotlkh kf teg oghtrbd sdlp
cy
teg
trbhsvgrsg
rgtlhboudbr
dljbaght
fkr
ckutkhhlårg
mgfkralty.
I
Ebhm_urj Cr 2<<0>279=0:‟<.
^66Q
Hloekds
EA.
Sgpblr
kf
teg
gxtghskr
tghmkh
lhsgrtlkhs
kf
teg
flhjgrs.
ICkhg Iklht _urj Ba 2<72>??95?6‟=2.
^6:Q Fkwdgr _C. ]eg abhbjgaght kf tghmkh lhiurlgs. I Ckhg Iklht _urj Ba2<7<>=297:<‟50.
^65Q
]uclbhb
S,
Vbdghtlh
P.
Dgs
mìfkrabtlkhs
gh
ckutkhhlårg
mgs
mkljts.
SgvOelr Krtekp Sgpbrbtrlog Bppbr Akt 2<6<>779222‟3=.
^6<Q _tbon EJ. Cuttkh-ekdg mgfkralty. Ebhm 2<:2>?9273‟=.^:0Q Beabm F, Plonfkrm A. Sgokhstruotlkh kf teg gxtghskr oghtrbd sdlp uslhj b
mlstbddy
cbsgm
ffigxkr
mljltkrua
supgrflolbdls
sdlp.
I
Ebhm
_urj
Ba300<>?=9<?0‟3.
^:2Q Kcgrd lh O, Btoebcbybh B, _bdkh B, Cebtlb B, Kvlåvg IA. ]eg cy-pbss gxtghskr tghmkh trbhsfgr. B sbdvbjg tgoehlqug fkr dkss kf suc-stbhog kf
teg gxtghskr bppbrbtus lh dkhj flhjgrs. I
Ebhm _urj Cr2<<7>309?<3‟:.
^:3Q Nldjkrg Ir G_, Jrbeba ?rm ZP, Hgwagygr ZD,Crkwh DJ. ]eg gxtghskrpdus
flhjgr.
Ebhm
2<:7>:927<‟67.^:?Q
Lhkug
J,
]baurb
\.
Mlsdkobtlkh
kf
teg
gxtghskr
tghmkhs
kvgr
teg
agtb-
obrpkpebdbhjgbd iklhts. I Ebhm _urj Ba 2<<6>329=6=‟<.^:=Q Ngttgdnbap MC, Fdbtt BG, Akudms S. ]rbuabtlo mlsdkobtlkh kf teg dkhj-
flhjgr
gxtghskr
tghmkh.
B
odlhlobd,
bhbtkalobd,
bhm
clkagoebhlobd
stumy.
ICkhg Iklht _urj Ba 2<:2>7?933<‟=0.
^:7Q
Zeggdmkh
F].
Sgourrght
mlsdkobtlkh
kf
gxtghskr
tghmkhs
lh
teg
ebhm.
ICkhg Iklht _urj Cr 2<7=>?69623‟:.
^:6Q
Sbybh
JA,
Aurrby
M,
Oeuhj
NZ,
Skergr
A.
]eg
gxtghskr
rgtlhboudbrsystga bt teg agtbobrpkpebdbhjgbd iklht. Bhbtkalobd bhm elstkdkjlobdstumy.
I
Ebhm
_urj
Cr
2<<:>339757‟<0.^::Q Gd Abrbjey BZ, Pghhlhjs B. Agtbobrpkpebdbhjgbd iklht gxtghskr tghmkh
sucduxbtlkh9
b
rgokhstruotlvg
stbcldlzbtlkh
tgoehlqug.
I
Ebhm
_urj
Ba302?>?597:5‟53.
^:5Q
Dg
Vlgt
M,
Gcgdlh
A,
Dky
_.
Duxbtlkh
trbuabtlqug
mg
d“bppbrgld
gxtghsgurbu mks mg d“brtloudbtlkh aìtbobrpkpebdbhjlghhg mg d“burloudblrg. À prkpksmg
slx
obs.
Bhh
Oelr
Ablh
Agac
_upgr
2<<2>2093:?‟<.
^:<Q Sbybh JA, Aurrby M. Odbsslflobtlkh bhm trgbtaght kf odksgm sbjlttbd cbhmlhiurlgs.
I
Ebhm
_urj
Ba
2<<=>2<97<0‟=.^50Q Obrrkdd O, =te, Akkrg IS, Zgldbhm BI. Pksttrbuabtlo udhbr sucduxbtlkh kf
teg
gxtghskr
tghmkhs9
b
rgokhstruotlvg
tgoehlqug.
I
Ebhm
_urj2<5:>23933:‟?2.
^52Q Nldjkrg G_, Jrbeba ZP, Hgwagygr ZP, Crkwh DJ. Okrrgotlkh kf udhbrsucduxbtlkh kf teg gxtghskr okaauhls. Ebhm 2<:7>:93:3‟=.
^53Q
Gdskh
SB.
Mlsdkobtlkh
kf
teg
gxtghskr
tghmkhs
kf
teg
ebhm.
I
Ckhg
Iklht_urj
Cr
2<6:>=<9?3=‟6.^5?Q Zbtskh EN, Zglhzwglj I, Julmgrb PA. _bjlttbd cbhm rgokhstruotlkh. I
Ebhm _urj Ba 2<<:>339=73‟6.^5=Q
AoOky
FI,
Zlhsny
BI.
Duacrlobd
dkkp
kpgrbtlkh
fkr
teg
duxbtlkh
kf
teggxtghskr
tghmkhs
kf
teg
ebhm.
Pdbstlo
Sgokhstr
_urj
2<6<>==92=3‟6.^57Q Cgon IM, Slged I], Ndghb IO. Bhkabdkus tghmkh tk teg almmdg flhjgr fkr
sbjlttbd cbhm rgokhstruotlkh9 rgpkrt kf 3 obsgs. I Ebhm _urj Ba
3023>?:926=6‟<.^56Q
_gjbdabh
NB.
Myhbalo
duacrlobd
ausodg
trbhsfgr
fkr
okrrgotlkh
kf pksttrbuabtlo gxtghskr tghmkh sucduxbtlkh. ]goe Ebhm Wp Gxtrga _urj3006>20920:‟2?.
^5:Q Skzabryh DA. ]ghmkh jrbft rgokhstruotlkh kf gxtghskr ekkm mgflolts wltesucduxbtlkh.
I
Ebhm
_urj
Ba
2<<7>3095=2‟?.^55Q Nbhj D, Obrdskh AJ. Gxtghskr tghmkh oghtrbdlzbtlkh bt teg agtbobr-
pkpebdbhjgbd
iklht9
surjlobd
tgoehlqug. I
Ebhm
_urj
Ba
3020>?7922<=‟:.
^5<Q
Vbh
Aglrebgjeg
I,
Vgrobutgrgh
A.
]rbuabtlo
mlsdkobtlkh
kf
teg
gxtghskrtghmkhs kvgr teg flfte agtbobrpkpebdbhjgbd iklht. I Ebhm _urj Cr2<5<>2=9?70‟2.
^<0Q Brbl N, ]ke _, Hbnbebrb N, Hlselnbwb _, Ebrbtb _. ]rgbtaght kf skfttlssug
lhiurlgs
tk
teg
mkrsua
kf
teg
agtbobrpkpebdbhjgbd
iklht
(ckxgr“snhuondg). I Ebhm _urj Cr 3003>3:9<0‟7.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟252250
8/20/2019 Treatment of Chronic Extensor Tendons Lesions of the Fingers 2015 Chirurgie de La Main
http://slidepdf.com/reader/full/treatment-of-chronic-extensor-tendons-lesions-of-the-fingers-2015-chirurgie 27/27
^<2Q Akhtgld AO, Cbdbjugr ], Oeljhkh-_lobrm C, Dgcrgtkh G. Psgumkckutkh-hlårg trbuabtlqug mg d“brtloudbtlkh aìtbobrpkpebdbhjlghhg mu olhqulåagmkljt
9
à
prkpks
m“uh
obs
gt
rgvug
mg
db
dlttìrbturg.
Oelr
Ablh
3006>379<3‟7.
^<3Q
Pkshgr
AB,
Bacrksg
D.
Ckxgr“s
nhuondg‟mkrsbd
obpsudbr
rupturg
kf
tegagtbobrpkpebdbhjgbd iklht kf b flhjgr. I Ebhm _urj Ba 2<5<>2=933<‟?6.
^<?Q
Hbjbknb
A,
_btke
],
Hbjbk
_,
Abtsuzbnl
E.
Gxtghskr
rgtlhboudua
jrbftfkr oerkhlo ckxgr“s nhuondg. I Ebhm _urj Ba 3006>?29<=:‟72.
^<=Q Jbcd A, Dutz A, Ylaagrabhh S, Bhjgrabhh P, Brkrb S. Mlffloudtprkcdgas lh gxtghskr tghmkh lhiurlgs. Lh9 Mucgrt ], gmltkr. Prlabry obrgkf
okapdgx
lhiurlgs
kf
teg
ebhm
bhm
wrlst.
Bteghs9
Nkhstbhtbrbs
agmlobdPucdlobtlkhs> 3020. p. 3?:‟=?.
^<7Q Bmbhl S, Abrokoolk L, ]brbddk D. Fdbp okvgrbjg kf mkrsua kf ebhmbsskolbtgm wlte gxtghskr tghmkhs lhiurlgs9 b okapdgtgdy vbsoudbrlzgmslhjdg-stbjg
rgokhstruotlkh.
Alorksurjgry
300?>3?9?3‟<.^<6Q Okudgt C, Ckrgttk IJ, Dbzgrjgs O, Ogsbr A, Abrgs K, Oebaabs A.
«
Ablh
mg
pkrtlårg
¾
9
odbsslflobtlkh
dìslkhhgddg
gt
strbtìjlg
teìrbpgutlqug.Oelr Ablh 3022>?093=6‟7=.
^<:Q
Bmbhl
S,
]brbddk
D,
Okrblh
A,
Julacgrtgbu
IO.
Vbsoudbrlzgm
tghmkh
jrbftfkr gxtghskr tghmkh rgokhstruotlkh. Lh9 ]bhj IC, gmltkr. ]ghmkh _urjgry kf
teg Ebhm. 2st Gm, Peldbmgdpelb9 Gdsgvlgr _buhmgrs> 3023. p. ?<=‟=03.^<5Q Bd-Rbttbh AA. ]wk-stbjgm gxtghskr tghmkh rgokhstruotlkh fkr zkhg 6
gxtghskr
tghmkh
dkss
kf
teg
flhjgrs9
lhmlobtlkhs,
tgoehlqug,
bhm
rgsudts.
IEbhm _urj Gur 3027>=093:6‟50.
P.
Cgddgaårg
/
Oelrurjlg
mg
db
ablh
?=
(3027)
277‟252
252
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