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Aeatkly kg gasnca
kg tom pail aehHupuytrme–s
hcsmasm (mxniuhceb tom toulf)
N. Hulketcmr
^mrvcnm hm nocrurbcm Ziastcqum,
Vmnkestruntrcnm mt Mstoãtcqum,
Ecnm
8/19/2019 Anatomy Dupuytren
2/26
Ekrlai aeatkly
Xormm gasnca
Xomear (kvmr tomear lusnims)
Oypktomear (kvmr oypktomear lusnims)
Zailar apkemurkscs ce tom lch pail
8/19/2019 Anatomy Dupuytren
3/26
Xom pailar apkemurkscs
Krcbceatms hcstai tk tom rmtceanuiar icbalmet
Ce nketceucty (fut hcstcent) wcto tom pailarcs ikebus
8/19/2019 Anatomy Dupuytren
4/26
Xom pailar apkemurkscs
Mxtmehs hcstaiiy ce twk iaymrs
^upmrfincai iaymr prmsmets
ikebctuhceai rmcegkrnmlmets
naiimh tom prm-tmehcekus faeh
8/19/2019 Anatomy Dupuytren
5/26
Xom pailar apkemurkscs
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
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1
A
k
l
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u
k
k
p
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a
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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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l
v
g
f
X
V
h
k
t
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i
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m
m
l
s
I
K
k
8/19/2019 Anatomy Dupuytren
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
8/19/2019 Anatomy Dupuytren
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
8/19/2019 Anatomy Dupuytren
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
8/19/2019 Anatomy Dupuytren
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
8/19/2019 Anatomy Dupuytren
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.
8/19/2019 Anatomy Dupuytren
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
8/19/2019 Anatomy Dupuytren
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)
8/19/2019 Anatomy Dupuytren
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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,...
8/19/2019 Anatomy Dupuytren
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^upmrfincai iaymr cs
rmspkescfim gkr tom pcts
8/19/2019 Anatomy Dupuytren
15/26
8/19/2019 Anatomy Dupuytren
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Xom hmmp fifmrs kg tom
pailar apkemurkscs meh
ke tom fifrkus eunimusaeh arm rmspkescfim gkr
LZ `kcet stmxcke
8/19/2019 Anatomy Dupuytren
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=:
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8/19/2019 Anatomy Dupuytren
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Xom eatatkry icbalmet
Xraesvmrsm strunturm, hcstai tk
tom A1 puiimy, lmrbceb wcto tom
hcbctai gasnca (Brayske–s, iatmrai
faeh, rmtrk-vasnuiar gasnca
8/19/2019 Anatomy Dupuytren
20/26
Eatatkry icbalmet
Aetmrckr tk tom pmhcnims
^dce ahomscke (wmf soapm)
8/19/2019 Anatomy Dupuytren
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.
8/19/2019 Anatomy Dupuytren
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
_
8/19/2019 Anatomy Dupuytren
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
8/19/2019 Anatomy Dupuytren
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8/19/2019 Anatomy Dupuytren
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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)
8/19/2019 Anatomy Dupuytren
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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