РОЛЬ ФУНКЦИОНАЛЬНОЙ ПЕРЕГРУЗКИ КИСТИ В РАЗВИТИИ КОНТРАКТУРЫ ДЮПЮИТРЕНА И БИОМЕХАНИЧЕСКИЙ МОНИТОРИНГ ТКАНЕЙ ПРИ ТЯЖЕЛЫХ ФОРМАХ ЗАБОЛЕВАНИЯ
Ключевые слова:
кисть, анизотропия, альпинисты, контрактура Дюпюитрена, кожа, биомеханические свойства, оперативное лечение, аппарат Илизарова
Аннотация
Цель: оценка биомеханического состояния покровных тканей кисти на основе их биомеханического мониторинга у здоровых людей и при оперативном лечении пациентов с тяжелыми формами контрактуры Дюпюитрена. Материалы и методы. На основании обследования здоровых людей (n = 8) и пациентов с тяжелыми формами заболевания в возрасте 59,6 ± 1,59 года (n = 22) с использованием высокочувствительной методики регистрации механоакустических свойств кожи кисти изучали ее анизотропные свойства. Результаты. При лечении контрактуры Дюпюитрена отмечается необходимость сочетания дермофасциотомии с постепенным растяжением мягких тканей пораженной кисти. Прослежена динамика биомеханических свойств кожи и определены критерии растяжения ткани в условиях использования метода Илизарова. Превышение изучаемых параметров тестирования в два раза и выше относительно исходных величин указывает на необходимость прекращения дозированной тракции и снижения её темпов. Заключение. Игнорирование установленных критериев реакции кожи на дистракцию приводит к развитию микротравматизации кожи, микроциркуляторным нарушениям и снижению вероятности благоприятного исхода лечения.
Литература
1. Гребенюк Л.А. Анализ влияния повышенных физических нагрузок на микроциркуляцию и механоакустические свойства кожи конечностей человека // Физиология человека. 2014. Т. 40, № 4. С. 470–476. [Grebenyuk L.A. [Analyzing the Impact of Increased Loads on the Microcirculation and Mechanical-Acoustic Properties if Human Limb Skin]. Fiziologiya cheloveka [Human Physiology], 2014, vol. 40, no. 4, pp. 470–476. (in Russ.)] DOI: 10.1134/S0362119714040082
2. Мартель И.И., Гребенюк Л.А. Замещение дефекта мягких тканей опорной поверхности стопы по методике Илизарова под контролем механо-биологического состояния кожи // Политравма. 2018. № 1. С. 39–46. [Martel I.I., Grebenyuk L.A. [Soft Tissue Defects of the Foot Supporting Surface Repaired with the Ilizarov Method Under Control of Mechanical and Biological Condition of the Skin]. Politravma [Polytrauma], 2018, no. 1, pp. 39–46. (in Russ.)]
3. Müller-Seubert W., Cai A., Arkudas A. et al. A Personalized Approach to Treat Advanced Stage Severely Contracted Joints in Dupuytren's Disease with a Unique Skeletal Distraction Device-Utilizing Modern Imaging Tools to Enhance Safety for the Patient. Journal of Personalized Medicine, 2022, vol. 12 (3), art. 378. DOI: 10.3390/jpm12030378
4. Logan A.J., Mason G., Dias J., Makwana N. Can Rock Climbing Lead to Dupuytren's Disease? British Journal of Sports Medicine, 2005, vol. 39 (9), pp. 639–644. DOI: 10.1136/bjsm.2004.015792
5. Karkampouna S., Kreulen M., Obdeijn M.C. et al. Connective Tissue Degeneration: Mechanisms of Palmar Fascia Degeneration (Dupuytren's Disease). Current Molecular Biology Reports, 2016, vol. 2 (3), pp. 133–140. DOI: 10.1007/s40610-016-0045-3
6. Ruettermann M., Hermann R.M., Khatib-Chahidi K., Werker P.M.N. Dupuytren's Disease-Etiology and Treatment. Deutsches Ärzteblatt International, 2021, vol. 118 (46), pp. 781–788. DOI: 10.3238/arztebl.m2021.0325
7. Horch R.E., Schmitz M., Kreuzer M. et al. External Screw-Threaded Traction Device Helps Optimize Finger Joint Mobility in Severe Stage III and IV Dupuytren Disease. Medical Science Monitor, 2021, vol. 27, art. e929814. DOI: 10.12659/MSM.929814
8. Zügel M., Maganaris C.N., Wilke J. et al. Fascial Tissue Research in Sports Medicine: from Molecules to Tissue Adaptation, Injury and Diagnostics: Consensus Statement. British Journal of Sports Medicine, 2018, vol. 52 (23), art. 1497. DOI: 10.1136/bjsports-2018-099308
9. Vránová H., Zeman J., Cech Z., Otáhal S. Identification of Viscoelastic Parameters of Skin with a Scar in Vivo, Influence of Soft Tissue Technique on Changes of Skin Parameters. Journal of Bodywork and Movement Therapies, 2009, vol. 13 (4), pp. 344–349. DOI: 10.1016/j.jbmt.2008.06.004
10. Major M., Freund M.K., Burch K.S. et al. Integrative Analysis of Dupuytren's Disease Identifies Novel Risk Locus and Reveals a Shared Genetic Etiology with BMI. Genetic Epidemiology, 2019, vol. 43 (6), pp. 629–645. DOI: 10.1002/gepi.22209
11. Qureshi F.I., Hornigold R., Spencer J.D., Hall S.M. Langerhans Cells in Dupuytren's Contracture. The Journal of Hand Surgery: British & European Volume, 2001, vol. 26 (4), pp. 362–367. DOI: 10.1054/jhsb.2000.0518
12. White J.W., Kang S.N., Nancoo T. et al. Management of Severe Dupuytren's Contracture of the Proximal Interphalangeal Joint with Use of a Central Slip Facilitation Device. Journal of Hand Surgery (European Volume), 2012, vol. 37(8), pp. 728–732. DOI: 10.1177/1753193412439673
13. Messina A, Messina J. The Continuous Elongation Treatment by the TEC Device for Severe Dupuytren's Contracture of the Fingers. Plastic and Reconstructive Surgery, 1993, vol. 92 (1), pp. 84–90. DOI: 10.1097/00006534-199307000-00012
14. Craft R.O., Smith A.A., Coakley B. et al. Preliminary Soft-Tissue Distraction Versus Checkrein Ligament Release After Fasciectomy in the Treatment of Dupuytren Proximal Interphalangeal Joint Contractures. Plastic and Reconstructive Surgery, 2011, Vol. 128 (5), pp. 1107–1113. DOI: 10.1097/ PRS.0b013e31822b67c9
15. Corain M., Zanotti F., Sartore R., Pozza P. Proposal for Treatment of Severe Dupuytren Disease in 2 Steps: Progressive Distraction With External Fixator and Collagenase – A Preliminary Case Series. Hand, 2020, vol. 15 (5), pp. 631–637. DOI: 10.1177/1558944718822086
16. Schleip R., Müller D.G. Training Principles for Fascial Connective Tissues: Scientific Foundation and Suggested Practical Applications. Journal of Bodywork and Movement Therapies, 2013, vol. 17 (1), pp. 103–115. DOI: 10.1016/j.jbmt.2012.06.007
17. Schöffl VR, Schöffl I. Finger Pain in Rock Climbers: Reaching the Fight Differential Diagnosis and Therapy. Journal of Sports Medicine and Physical Fitness, 2007, vol. 47 (1), pp. 70–78.
18. Wade R., Igali L., Figus A. Skin Involvement in Dupuytren's Disease. Journal of Hand Surgery (European Volume), 2016, vol. 41 (6), pp. 600–608. DOI: 10.1177/1753193415601353
2. Мартель И.И., Гребенюк Л.А. Замещение дефекта мягких тканей опорной поверхности стопы по методике Илизарова под контролем механо-биологического состояния кожи // Политравма. 2018. № 1. С. 39–46. [Martel I.I., Grebenyuk L.A. [Soft Tissue Defects of the Foot Supporting Surface Repaired with the Ilizarov Method Under Control of Mechanical and Biological Condition of the Skin]. Politravma [Polytrauma], 2018, no. 1, pp. 39–46. (in Russ.)]
3. Müller-Seubert W., Cai A., Arkudas A. et al. A Personalized Approach to Treat Advanced Stage Severely Contracted Joints in Dupuytren's Disease with a Unique Skeletal Distraction Device-Utilizing Modern Imaging Tools to Enhance Safety for the Patient. Journal of Personalized Medicine, 2022, vol. 12 (3), art. 378. DOI: 10.3390/jpm12030378
4. Logan A.J., Mason G., Dias J., Makwana N. Can Rock Climbing Lead to Dupuytren's Disease? British Journal of Sports Medicine, 2005, vol. 39 (9), pp. 639–644. DOI: 10.1136/bjsm.2004.015792
5. Karkampouna S., Kreulen M., Obdeijn M.C. et al. Connective Tissue Degeneration: Mechanisms of Palmar Fascia Degeneration (Dupuytren's Disease). Current Molecular Biology Reports, 2016, vol. 2 (3), pp. 133–140. DOI: 10.1007/s40610-016-0045-3
6. Ruettermann M., Hermann R.M., Khatib-Chahidi K., Werker P.M.N. Dupuytren's Disease-Etiology and Treatment. Deutsches Ärzteblatt International, 2021, vol. 118 (46), pp. 781–788. DOI: 10.3238/arztebl.m2021.0325
7. Horch R.E., Schmitz M., Kreuzer M. et al. External Screw-Threaded Traction Device Helps Optimize Finger Joint Mobility in Severe Stage III and IV Dupuytren Disease. Medical Science Monitor, 2021, vol. 27, art. e929814. DOI: 10.12659/MSM.929814
8. Zügel M., Maganaris C.N., Wilke J. et al. Fascial Tissue Research in Sports Medicine: from Molecules to Tissue Adaptation, Injury and Diagnostics: Consensus Statement. British Journal of Sports Medicine, 2018, vol. 52 (23), art. 1497. DOI: 10.1136/bjsports-2018-099308
9. Vránová H., Zeman J., Cech Z., Otáhal S. Identification of Viscoelastic Parameters of Skin with a Scar in Vivo, Influence of Soft Tissue Technique on Changes of Skin Parameters. Journal of Bodywork and Movement Therapies, 2009, vol. 13 (4), pp. 344–349. DOI: 10.1016/j.jbmt.2008.06.004
10. Major M., Freund M.K., Burch K.S. et al. Integrative Analysis of Dupuytren's Disease Identifies Novel Risk Locus and Reveals a Shared Genetic Etiology with BMI. Genetic Epidemiology, 2019, vol. 43 (6), pp. 629–645. DOI: 10.1002/gepi.22209
11. Qureshi F.I., Hornigold R., Spencer J.D., Hall S.M. Langerhans Cells in Dupuytren's Contracture. The Journal of Hand Surgery: British & European Volume, 2001, vol. 26 (4), pp. 362–367. DOI: 10.1054/jhsb.2000.0518
12. White J.W., Kang S.N., Nancoo T. et al. Management of Severe Dupuytren's Contracture of the Proximal Interphalangeal Joint with Use of a Central Slip Facilitation Device. Journal of Hand Surgery (European Volume), 2012, vol. 37(8), pp. 728–732. DOI: 10.1177/1753193412439673
13. Messina A, Messina J. The Continuous Elongation Treatment by the TEC Device for Severe Dupuytren's Contracture of the Fingers. Plastic and Reconstructive Surgery, 1993, vol. 92 (1), pp. 84–90. DOI: 10.1097/00006534-199307000-00012
14. Craft R.O., Smith A.A., Coakley B. et al. Preliminary Soft-Tissue Distraction Versus Checkrein Ligament Release After Fasciectomy in the Treatment of Dupuytren Proximal Interphalangeal Joint Contractures. Plastic and Reconstructive Surgery, 2011, Vol. 128 (5), pp. 1107–1113. DOI: 10.1097/ PRS.0b013e31822b67c9
15. Corain M., Zanotti F., Sartore R., Pozza P. Proposal for Treatment of Severe Dupuytren Disease in 2 Steps: Progressive Distraction With External Fixator and Collagenase – A Preliminary Case Series. Hand, 2020, vol. 15 (5), pp. 631–637. DOI: 10.1177/1558944718822086
16. Schleip R., Müller D.G. Training Principles for Fascial Connective Tissues: Scientific Foundation and Suggested Practical Applications. Journal of Bodywork and Movement Therapies, 2013, vol. 17 (1), pp. 103–115. DOI: 10.1016/j.jbmt.2012.06.007
17. Schöffl VR, Schöffl I. Finger Pain in Rock Climbers: Reaching the Fight Differential Diagnosis and Therapy. Journal of Sports Medicine and Physical Fitness, 2007, vol. 47 (1), pp. 70–78.
18. Wade R., Igali L., Figus A. Skin Involvement in Dupuytren's Disease. Journal of Hand Surgery (European Volume), 2016, vol. 41 (6), pp. 600–608. DOI: 10.1177/1753193415601353
2. Мартель И.И., Гребенюк Л.А. Замещение дефекта мягких тканей опорной поверхности стопы по методике Илизарова под контролем механо-биологического состояния кожи // Политравма. 2018. № 1. С. 39–46. [Martel I.I., Grebenyuk L.A. [Soft Tissue Defects of the Foot Supporting Surface Repaired with the Ilizarov Method Under Control of Mechanical and Biological Condition of the Skin]. Politravma [Polytrauma], 2018, no. 1, pp. 39–46. (in Russ.)]
3. Müller-Seubert W., Cai A., Arkudas A. et al. A Personalized Approach to Treat Advanced Stage Severely Contracted Joints in Dupuytren's Disease with a Unique Skeletal Distraction Device-Utilizing Modern Imaging Tools to Enhance Safety for the Patient. Journal of Personalized Medicine, 2022, vol. 12 (3), art. 378. DOI: 10.3390/jpm12030378
4. Logan A.J., Mason G., Dias J., Makwana N. Can Rock Climbing Lead to Dupuytren's Disease? British Journal of Sports Medicine, 2005, vol. 39 (9), pp. 639–644. DOI: 10.1136/bjsm.2004.015792
5. Karkampouna S., Kreulen M., Obdeijn M.C. et al. Connective Tissue Degeneration: Mechanisms of Palmar Fascia Degeneration (Dupuytren's Disease). Current Molecular Biology Reports, 2016, vol. 2 (3), pp. 133–140. DOI: 10.1007/s40610-016-0045-3
6. Ruettermann M., Hermann R.M., Khatib-Chahidi K., Werker P.M.N. Dupuytren's Disease-Etiology and Treatment. Deutsches Ärzteblatt International, 2021, vol. 118 (46), pp. 781–788. DOI: 10.3238/arztebl.m2021.0325
7. Horch R.E., Schmitz M., Kreuzer M. et al. External Screw-Threaded Traction Device Helps Optimize Finger Joint Mobility in Severe Stage III and IV Dupuytren Disease. Medical Science Monitor, 2021, vol. 27, art. e929814. DOI: 10.12659/MSM.929814
8. Zügel M., Maganaris C.N., Wilke J. et al. Fascial Tissue Research in Sports Medicine: from Molecules to Tissue Adaptation, Injury and Diagnostics: Consensus Statement. British Journal of Sports Medicine, 2018, vol. 52 (23), art. 1497. DOI: 10.1136/bjsports-2018-099308
9. Vránová H., Zeman J., Cech Z., Otáhal S. Identification of Viscoelastic Parameters of Skin with a Scar in Vivo, Influence of Soft Tissue Technique on Changes of Skin Parameters. Journal of Bodywork and Movement Therapies, 2009, vol. 13 (4), pp. 344–349. DOI: 10.1016/j.jbmt.2008.06.004
10. Major M., Freund M.K., Burch K.S. et al. Integrative Analysis of Dupuytren's Disease Identifies Novel Risk Locus and Reveals a Shared Genetic Etiology with BMI. Genetic Epidemiology, 2019, vol. 43 (6), pp. 629–645. DOI: 10.1002/gepi.22209
11. Qureshi F.I., Hornigold R., Spencer J.D., Hall S.M. Langerhans Cells in Dupuytren's Contracture. The Journal of Hand Surgery: British & European Volume, 2001, vol. 26 (4), pp. 362–367. DOI: 10.1054/jhsb.2000.0518
12. White J.W., Kang S.N., Nancoo T. et al. Management of Severe Dupuytren's Contracture of the Proximal Interphalangeal Joint with Use of a Central Slip Facilitation Device. Journal of Hand Surgery (European Volume), 2012, vol. 37(8), pp. 728–732. DOI: 10.1177/1753193412439673
13. Messina A, Messina J. The Continuous Elongation Treatment by the TEC Device for Severe Dupuytren's Contracture of the Fingers. Plastic and Reconstructive Surgery, 1993, vol. 92 (1), pp. 84–90. DOI: 10.1097/00006534-199307000-00012
14. Craft R.O., Smith A.A., Coakley B. et al. Preliminary Soft-Tissue Distraction Versus Checkrein Ligament Release After Fasciectomy in the Treatment of Dupuytren Proximal Interphalangeal Joint Contractures. Plastic and Reconstructive Surgery, 2011, Vol. 128 (5), pp. 1107–1113. DOI: 10.1097/ PRS.0b013e31822b67c9
15. Corain M., Zanotti F., Sartore R., Pozza P. Proposal for Treatment of Severe Dupuytren Disease in 2 Steps: Progressive Distraction With External Fixator and Collagenase – A Preliminary Case Series. Hand, 2020, vol. 15 (5), pp. 631–637. DOI: 10.1177/1558944718822086
16. Schleip R., Müller D.G. Training Principles for Fascial Connective Tissues: Scientific Foundation and Suggested Practical Applications. Journal of Bodywork and Movement Therapies, 2013, vol. 17 (1), pp. 103–115. DOI: 10.1016/j.jbmt.2012.06.007
17. Schöffl VR, Schöffl I. Finger Pain in Rock Climbers: Reaching the Fight Differential Diagnosis and Therapy. Journal of Sports Medicine and Physical Fitness, 2007, vol. 47 (1), pp. 70–78.
18. Wade R., Igali L., Figus A. Skin Involvement in Dupuytren's Disease. Journal of Hand Surgery (European Volume), 2016, vol. 41 (6), pp. 600–608. DOI: 10.1177/1753193415601353
References
1. Гребенюк Л.А. Анализ влияния повышенных физических нагрузок на микроциркуляцию и механоакустические свойства кожи конечностей человека // Физиология человека. 2014. Т. 40, № 4. С. 470–476. [Grebenyuk L.A. [Analyzing the Impact of Increased Loads on the Microcirculation and Mechanical-Acoustic Properties if Human Limb Skin]. Fiziologiya cheloveka [Human Physiology], 2014, vol. 40, no. 4, pp. 470–476. (in Russ.)] DOI: 10.1134/S03621197140400822. Мартель И.И., Гребенюк Л.А. Замещение дефекта мягких тканей опорной поверхности стопы по методике Илизарова под контролем механо-биологического состояния кожи // Политравма. 2018. № 1. С. 39–46. [Martel I.I., Grebenyuk L.A. [Soft Tissue Defects of the Foot Supporting Surface Repaired with the Ilizarov Method Under Control of Mechanical and Biological Condition of the Skin]. Politravma [Polytrauma], 2018, no. 1, pp. 39–46. (in Russ.)]
3. Müller-Seubert W., Cai A., Arkudas A. et al. A Personalized Approach to Treat Advanced Stage Severely Contracted Joints in Dupuytren's Disease with a Unique Skeletal Distraction Device-Utilizing Modern Imaging Tools to Enhance Safety for the Patient. Journal of Personalized Medicine, 2022, vol. 12 (3), art. 378. DOI: 10.3390/jpm12030378
4. Logan A.J., Mason G., Dias J., Makwana N. Can Rock Climbing Lead to Dupuytren's Disease? British Journal of Sports Medicine, 2005, vol. 39 (9), pp. 639–644. DOI: 10.1136/bjsm.2004.015792
5. Karkampouna S., Kreulen M., Obdeijn M.C. et al. Connective Tissue Degeneration: Mechanisms of Palmar Fascia Degeneration (Dupuytren's Disease). Current Molecular Biology Reports, 2016, vol. 2 (3), pp. 133–140. DOI: 10.1007/s40610-016-0045-3
6. Ruettermann M., Hermann R.M., Khatib-Chahidi K., Werker P.M.N. Dupuytren's Disease-Etiology and Treatment. Deutsches Ärzteblatt International, 2021, vol. 118 (46), pp. 781–788. DOI: 10.3238/arztebl.m2021.0325
7. Horch R.E., Schmitz M., Kreuzer M. et al. External Screw-Threaded Traction Device Helps Optimize Finger Joint Mobility in Severe Stage III and IV Dupuytren Disease. Medical Science Monitor, 2021, vol. 27, art. e929814. DOI: 10.12659/MSM.929814
8. Zügel M., Maganaris C.N., Wilke J. et al. Fascial Tissue Research in Sports Medicine: from Molecules to Tissue Adaptation, Injury and Diagnostics: Consensus Statement. British Journal of Sports Medicine, 2018, vol. 52 (23), art. 1497. DOI: 10.1136/bjsports-2018-099308
9. Vránová H., Zeman J., Cech Z., Otáhal S. Identification of Viscoelastic Parameters of Skin with a Scar in Vivo, Influence of Soft Tissue Technique on Changes of Skin Parameters. Journal of Bodywork and Movement Therapies, 2009, vol. 13 (4), pp. 344–349. DOI: 10.1016/j.jbmt.2008.06.004
10. Major M., Freund M.K., Burch K.S. et al. Integrative Analysis of Dupuytren's Disease Identifies Novel Risk Locus and Reveals a Shared Genetic Etiology with BMI. Genetic Epidemiology, 2019, vol. 43 (6), pp. 629–645. DOI: 10.1002/gepi.22209
11. Qureshi F.I., Hornigold R., Spencer J.D., Hall S.M. Langerhans Cells in Dupuytren's Contracture. The Journal of Hand Surgery: British & European Volume, 2001, vol. 26 (4), pp. 362–367. DOI: 10.1054/jhsb.2000.0518
12. White J.W., Kang S.N., Nancoo T. et al. Management of Severe Dupuytren's Contracture of the Proximal Interphalangeal Joint with Use of a Central Slip Facilitation Device. Journal of Hand Surgery (European Volume), 2012, vol. 37(8), pp. 728–732. DOI: 10.1177/1753193412439673
13. Messina A, Messina J. The Continuous Elongation Treatment by the TEC Device for Severe Dupuytren's Contracture of the Fingers. Plastic and Reconstructive Surgery, 1993, vol. 92 (1), pp. 84–90. DOI: 10.1097/00006534-199307000-00012
14. Craft R.O., Smith A.A., Coakley B. et al. Preliminary Soft-Tissue Distraction Versus Checkrein Ligament Release After Fasciectomy in the Treatment of Dupuytren Proximal Interphalangeal Joint Contractures. Plastic and Reconstructive Surgery, 2011, Vol. 128 (5), pp. 1107–1113. DOI: 10.1097/ PRS.0b013e31822b67c9
15. Corain M., Zanotti F., Sartore R., Pozza P. Proposal for Treatment of Severe Dupuytren Disease in 2 Steps: Progressive Distraction With External Fixator and Collagenase – A Preliminary Case Series. Hand, 2020, vol. 15 (5), pp. 631–637. DOI: 10.1177/1558944718822086
16. Schleip R., Müller D.G. Training Principles for Fascial Connective Tissues: Scientific Foundation and Suggested Practical Applications. Journal of Bodywork and Movement Therapies, 2013, vol. 17 (1), pp. 103–115. DOI: 10.1016/j.jbmt.2012.06.007
17. Schöffl VR, Schöffl I. Finger Pain in Rock Climbers: Reaching the Fight Differential Diagnosis and Therapy. Journal of Sports Medicine and Physical Fitness, 2007, vol. 47 (1), pp. 70–78.
18. Wade R., Igali L., Figus A. Skin Involvement in Dupuytren's Disease. Journal of Hand Surgery (European Volume), 2016, vol. 41 (6), pp. 600–608. DOI: 10.1177/1753193415601353
Опубликован
2023-06-23
Как цитировать
Гребенюк, Л., Грязных, А., Шабалин, Д., & Останина, Д. (2023). РОЛЬ ФУНКЦИОНАЛЬНОЙ ПЕРЕГРУЗКИ КИСТИ В РАЗВИТИИ КОНТРАКТУРЫ ДЮПЮИТРЕНА И БИОМЕХАНИЧЕСКИЙ МОНИТОРИНГ ТКАНЕЙ ПРИ ТЯЖЕЛЫХ ФОРМАХ ЗАБОЛЕВАНИЯ. Человек. Спорт. Медицина, 23(S1), 119-126. https://doi.org/10.14529/hsm23s117
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Восстановительная и спортивная медицина
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