Publication: Estudio experimental anatómico y clínico de la tenosinovitis de los tendones flexores de la mano en la polea proximal
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2017-02-07
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Universidad Complutense de Madrid
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Abstract
La tenosinovitis estenosante de los flexores de los dedos es uno de los motivos más frecuentes de consulta en los especialistas de cirugía de la mano. Aunque la técnica convencional es efectiva, las complicaciones observadas han hecho que, en los últimos años, la técnica percutánea haya cobrado importancia. Sin embargo, la estrecha relación que mantienen el primer, segundo y quinto dedo con las estructuras neurovasculares adyacentes ha promovido la búsqueda de referencias anatómicas y ecográficas que permitan realizar esta técnica con seguridad. OBJETIVOS: Localizar las referencias anatómicas en el especimen para aplicar la técnica percutánea en la práctica clínica y comprobar las ventajas de la técnica percutánea frente a la tenolisis convencional en el tratamiento de la tenosinovitis estenosante. MATERIAL Y MÉTODO: Se realiza un estudio experimental en 16 manos de cadáver en el Departamento de Anatomía de la Universidad de Valladolid. Se realizan mediciones de las estructuras anatómicas, se establecen márgenes de seguridad entre el sistema flexor y las estructuras neurovasculares, se buscan referencias radiológicas y se valora la apertura de la polea A1 y las lesiones de las estructuras adyacentes al realizar la técnica percutánea con y sin ultrasonidos. Se complementa con un estudio clínico descriptivo retrospectivo de 116 pacientes intervenidos de dedo en resorte en el HCUV (2008- 2013), con seguimiento medio de 36 meses. Se realiza el análisis de datos con el 91% de la muestra (105 pacientes) con un total de 182 dedos afectos realizando comparación entre la técnica abierta y la percutánea...
Stenosing tenosynovitis of fingers is one of the most common conditions treated by hand surgeons. Although the traditional technique of open release is effective, complications derived from it in the past have led to an increasing interest in the use of the percutaneous technique. However, the close relationship existing between first, second and fifth fingers with near neurovascular structures have promoted the search for anatomic and ultrasound references to safely implement this technique effectively. OBJECTIVES: Location of anatomical landmarks to conduct the percutaneous technique in clinical practice and subsequent analysis of the eventual advantages of such percutaneous technique over conventional tenolisis in the treatment of the stenosing tenosinovitis. MATERIAL AND METHOD: An experimental study is performed in 16 cadaver hands in the Department of Anatomy in Valladolid University. Measurements of anatomical structures are made, safety margins are established between the flexor system and neurovascular structures, radiological references are searched. Opening the pulley A1 and injuries to adjacent structures are assessed when performing percutaneous technique with and without ultrasounds. The analysis is complemented by a descriptive retrospective clinical study of 116 patients undergoing surgery for trigger finger in HCUV (2008-2013), with an average follow up period of 36 months. Data analysis was performed in 91% of the sample (105 patients) with a total of 182 fingers, making comparing the open and the percutaneous technique...
Stenosing tenosynovitis of fingers is one of the most common conditions treated by hand surgeons. Although the traditional technique of open release is effective, complications derived from it in the past have led to an increasing interest in the use of the percutaneous technique. However, the close relationship existing between first, second and fifth fingers with near neurovascular structures have promoted the search for anatomic and ultrasound references to safely implement this technique effectively. OBJECTIVES: Location of anatomical landmarks to conduct the percutaneous technique in clinical practice and subsequent analysis of the eventual advantages of such percutaneous technique over conventional tenolisis in the treatment of the stenosing tenosinovitis. MATERIAL AND METHOD: An experimental study is performed in 16 cadaver hands in the Department of Anatomy in Valladolid University. Measurements of anatomical structures are made, safety margins are established between the flexor system and neurovascular structures, radiological references are searched. Opening the pulley A1 and injuries to adjacent structures are assessed when performing percutaneous technique with and without ultrasounds. The analysis is complemented by a descriptive retrospective clinical study of 116 patients undergoing surgery for trigger finger in HCUV (2008-2013), with an average follow up period of 36 months. Data analysis was performed in 91% of the sample (105 patients) with a total of 182 fingers, making comparing the open and the percutaneous technique...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 03/02/2016