Anatomy Dupuytren

8/19/2019 Anatomy Dupuytren

1/26

Aeatkly kg gasnca

kg tom pail aehHupuytrme–s

hcsmasm (mxniuhceb tom toulf)

N. Hulketcmr

^mrvcnm hm nocrurbcm Ziastcqum,

Vmnkestruntrcnm mt Mstoãtcqum,

Ecnm


2/26

Ekrlai aeatkly

Xormm gasnca

Xomear (kvmr tomear lusnims)

Oypktomear (kvmr oypktomear lusnims)

Zailar apkemurkscs ce tom lch pail


3/26

Xom pailar apkemurkscs

Krcbceatms hcstai tk tom rmtceanuiar icbalmet

Ce nketceucty (fut hcstcent) wcto tom pailarcs ikebus


4/26


Mxtmehs hcstaiiy ce twk iaymrs

^upmrfincai iaymr prmsmets

ikebctuhceai rmcegkrnmlmets

naiimh tom prm-tmehcekus faeh


5/26


Xom hmmp iaymr kg tom pailarapkemurkscs cs vmry toce mxnmpt at

tom imvmi kg tom lmtanarpai omahs

womrm ct gkrls tom hmmp traesvmrsm

icbalmet (^dkkb–s)

W

1

A

E

@

y

1

A

k

l

h

u

k

k

p

l

a

k

s

p

m

2

G

b

1

A

K

v

m

w

k

o

l

a

k

s

o

w

e

o

i

k

u

e

a

a

v

l

p

s

F

E

m

t

o

a

a

l

k

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i

l

v

g

f

X

V

h

k

t

o

i

k

u

e

m

m

l

s

I

K

k


6/26

Xom traesvmrsm fifmrs kg tom pailar apkemurkscs (^dkkb–s

icbalmet)

1 nl wchto (6,3 tk 6:,1 ll)

Zrkxclai mhbm 0 1-> ll hcstai tk tom fmbceeceb kg tomsomato

Hcstai mhbm0 ?-1: ll grkl tom prkxclai mhbm kg A1 puiimy

Hkyim @V. Aeatkly aeh guentcke kg tom pailar apkemurkscs puiimy. @O^ 133:4 1=A0 2?-?6


7/26

Xom traesvmrsm fifmrs kg tom pailar apkemurkscs (^dkkb–s

icbalmet)

Aenokrmh ke cts hmmp part, ke mano schm, fy tom smpta tktom hmmp traesvmrsm lmtanarpai icbalmet

Hkyim @V. Aeatkly aeh guentcke kg tom pailar apkemurkscs puiimy. @O^ 133:4 1=A0 2?-?6

Xom @kureai

kg

O E

^]VBMVS

Xraes. cfmr

Zail.

Apke.

k

st s hmpcntcke tk sokw tom

rmiaickesocp

kg tom pailar apkemurkscs puiimy tk tom

Wki. 1=A, Ek. C

@aeuary

133:

Aeatkly aehguentcke

kg

pailar


8/26

^urbcnai nkesmqumenms

Xocs icbalmet cs ekt cevkivmh fy tom

hcsmasm mxnmpt ce tom 1st wmf aeh ke

tom uiear schmCt cs fmttmr toat tom traesvmrsm fifmrs

sokuih fm rmtacemh sk as tk lacetace

tomcr puiimy guentcke (A:) aeh/kr tk fix tom

sdce kvmr ct tk avkch/iclct hmah spanmsaeh/kr tk prktmnt tom pmhcnims hurceb

smnkehary surbmry


9/26

Xom hmmp surganm kg tom pailar

apkemurkscs

Imbumu aeh @uvarahmsnrcfmh smpta fmtwmme tom

hmmp part kg tom apkemurkscs

aeh tom skgt-tcssums kvmr tom

cetmrkssmkus lusnims


10/26

Xom smpta kg Imbumu aeh @uvara

^mpta emvmr fmbae lkrm prkxclaiiy

toae tom supmrfincai pailar artmrcai

arno kr tom tmehcekus krcbces kg tom

iulfrcnai lusnims (Bkssmt)

Mehs at tom imvmi kg A1 puiimy.


11/26

^mpta kg Imbumu aeh @uvara

?, rahcai aeh uiear -Vahcai ikebmr

toae uiear

Attanomh tk tom traesvmrsmicbalmet kg pailar apkemurkscs

(supmrfincaiiy) aeh skgt-tcssum

(hmmpiy)

2 nklpartlmets (stmxkr tmehkesaeh wmf spanm)

Xocndmr aeh krbaeczmh nkiiabme

Fcihmrfand. @O^ 6::8463A0838-833

Gasnca cetmrkssmux pailacrm

Xueemi iklfrcnai

Xueemi tmehcemux


12/26

^mpta kg Imbumu aeh @uvara

Ek cevkivmlmet kg tom smpta kg Imbumu aeh @uvara ce

Hupuytrme–s hcsmasm

Ce smvmrm gkrls, tom hmmp cesmrtcke kg tom prmtmehcekus

faeh lcx wcto tom hcstai fifmrs kg tom smpta +/- tom

cetmrpailar piatm icbalmet (Fcihmrfand. @O^ 6::6462A0>88->87)


13/26

Hcstai mhbm kg tom pailar apkemurkscs

Zrmtmehcekus faeh spicts cetk > iaymrs

^upmrfincai iaymr attanoms tk tom sdce at tom pailarhcbctai nrmasm.

Xom nmetrai iaymr lmrbms wcto tom hcbctai tcssums

Xom hmmpmst iaymr hcvms hkrsaiiy arkueh tom LNZ `kcet

aeh `kce tom smpta, tom cetmrlmtanarpai icbalmet,...


14/26

^upmrfincai iaymr cs

rmspkescfim gkr tom pcts


15/26


16/26

Xom hmmp fifmrs kg tom

pailar apkemurkscs meh

ke tom fifrkus eunimusaeh arm rmspkescfim gkr

LZ `kcet stmxcke


17/26

Hcstai part kg tom pail0 LZ imvmi

Paenkiic–s fifrkus eunimus cs

lahm kg fifmrs nklceb grkl

tom hmmp traesvmrsmcetmrlmtanarpai icbalmet, tom

sabcttai faeh, tom vkiar piatm

aeh tom A1 puiimy (+ tom

hcstai fifmrs kg tom smpta kgImbumu aeh @uvara)

Fahm O. Guentckeai lkrpokikby kg tom hmmp

traesvmrsm lmtanarpai icbalmet. Aee Aeat 13384

127088>-8=:


18/26


19/26

Xom eatatkry icbalmet

Xraesvmrsm strunturm, hcstai tk

tom A1 puiimy, lmrbceb wcto tom

hcbctai gasnca (Brayske–s, iatmrai

faeh, rmtrk-vasnuiar gasnca


20/26

Eatatkry icbalmet

Aetmrckr tk tom pmhcnims

^dce ahomscke (wmf soapm)


21/26

Hcstai supmrfincai traesvmrsm icbalmet

Ke tom uiear schm, ct mehs partiy

ke tom sdce, partiy ke tom gasnca

wocno cs a nkestumenm kg tom

gasnca kvmriyceb tom oypktomear

lusnims, fifrms kg tom tmehke

AFL aeh Brayske–s icbalmet

Roctm ^. Aeatkly kg Xom Zailar Gasnca ke Xom ]iear Fkrhmr kg Xom Oaeh. @O^

13?84 3F0 =:-=2

AEAXKLSKG XOM ZAILAV GA^NCA KE XOM ]IEAV FKV HMV KG XOM OAEH.

Brayske–s

icbalmets

hcbctai

faeh

*

Nimiaeh s

supmrgcncai traesvmrsm

icbalmets

pailar icbalmet

tmehke

prkxclai

poaiaex

emurkvasnuiar

fuehim

afhuntkr

lceclc

hcbctc

=to dmtanar ai

supmrgcncai traesvm

pailar icbalmet

afhuntkr hcbctc

Zmrspmntcvm hcabral kg afhuntkr hcbctc lceclc. Xom lace

gasncai mxtmesckes kg tom tmehke arm tk tom supmrgcncai

traesvmrsm paila r icbalmet, B rayske–s icbalmets, tom hcbctai

faeh aeh tom mxtmeskr mxpaescke.


22/26

AEAXKLSKG X OM ZAILAV GA^NCA KE X OM ]IEAV FKVHMV KG XOM OAEH.

Brayske–s

icbalmets

hcbctai

faeh

*

Nimiaeh s

supmrgcncai traesvmrsm

icbalmets

pailar icbalmet

tmehke

prkxclai

poaiaex

emurkvasnuiar

fuehim

afhuntkr

lceclc

hcbctc

Gcb. ?.

=to dmtanarpai

Zmrspmntcvm hcabral. ^mntcke 1 cs at tom hcstai pailar nrmasm.

^mntcke 6 cs at tom p ailar hcbctai nrmasm. ^mntcke > cs at tom

lchhim kg tom erkxclai koaiaeam. Xom tmehke kg afhuntkr

supmrgcncai traesvm

pailar icbalmet

Zmrspmntcvm hcabral kg afhuntk

gasncai mxtmesckes kg tom tmeh

traesvmrsm pailar icbalmet, Bra

faeh aeh tom mxtmeskr mxpaescke.

ehim

_


23/26

^urbcnai nkesmqumenms

Xom pmhcnims toat rues hkrsai aeh

iatmrai tk tom prmtmehcekus faehs attom pail

Rcii nrkss tom eatatkry icbalmet

(supmrfincai tk toml), tom hmmp fifmrs

(hkrsai tk toml) aeh pass lmhcai tktom hcbctai gasnca


24/26


25/26

Xom spcrai faeh hkms ekt mxcst

!

Ct cs keiy tom asskncatcke kg a prmtmehcekus faeh, tom

cevkivmlmet kg tom hmmp fifmrs, a iatmrai nkrh toat mehs

kvmr tom A8 puiimy (Brayske–s icbalmet cevkivmlmet)


26/26

Nkeniuscke

Dekwimhbm kg aeatkly cs laehatkry tk kftace a bkkh

rmsuits agtmr surbmry aeh tk prmvmet grkl surbcnai

nklpicnatckes

Kem lust dmmp ce lceh toat tom hcsmasm kg tom pail cs

hcggmrmet aeh ekt aiways asskncatmh wcto hcbctai

cevkivmlmet ce Hupuytrme–s hcsmasm

Xom twk patokikbcn aeatklcms lmrbm at tom fasm kg tom

fiebmr, tom galkus bcii kg tom hcbct

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Anatomy Dupuytren