Cirugía ultra-mínimamente invasiva guiada por ecografía para el dedo en resorte: desarrollo y aplicación de una nueva técnica
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2018
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09/04/2018
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Universidad Complutense de Madrid
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Abstract
El dedo en resorte (DR), también llamado tenosinovitis estenosante, es una lesión que produce engatillamiento, resalte o bloqueo que puede ser doloroso en cualquier dedo de la mano durante el movimiento de flexoextensión. El DR es una de las patologías más frecuentes del miembro superior con una incidencia a lo largo de la vida del 2,2% y un 10% en pacientes diabéticos. La cirugía abierta clásica (CAC) ha mostrado una alta eficacia (60-100%) si bien se ha asociado a tasas de insatisfacción de hasta un 26%. La liberación percutánea a ciegas, por su parte, ha mostrado similares tasas de eficacia (74-100%) y mejores resultados en términos de recuperación funcional si bien, existen dudas acerca del riesgo de lesión de estructuras neurovasculares adyacentes y la generalización de la técnica a todos los dedos. Recientemente, diferentes técnicas de liberación percutánea guiada por ecografía (LPGUE) han descrito excelentes tasas de éxito clínico (91-100%), aplicables a todos los dedos y sin complicaciones reseñables. Sin embargo, algunas de estas técnicas producen liberaciones incompletas en cadáver...
Trigger Finger (TF), also called stenosing tenosynovitis, is a condition that may produce catching, clicking or locking of the digit and that can be painful. It affects every finger in the hand (including the thumb). TF is one of the most frequent pathologic conditions in hand surgery, with incidence rates of 2.2% throughout life in the diabetic population older than 30 years and 10% in patients with diabetes mellitus.The classic open surgical approach (COS) has shown a high efficacy (60-100%) but it has been related to dissatisfaction rates of 26%. Percutaneous blind release has shown a similar success rate (74-100%) and better results in functional recovery; however, some concerns arise in terms of generalization to every digit and over the risk of injuring the surrounding neurovascular structures. Recently different ultrasound guided techniques (UGT) have shown excellent results, with success rates between 91-100%, applicability to every finger without mayor complications. Nevertheless, some of these techniques produce an incomplete release in cadavers...
Trigger Finger (TF), also called stenosing tenosynovitis, is a condition that may produce catching, clicking or locking of the digit and that can be painful. It affects every finger in the hand (including the thumb). TF is one of the most frequent pathologic conditions in hand surgery, with incidence rates of 2.2% throughout life in the diabetic population older than 30 years and 10% in patients with diabetes mellitus.The classic open surgical approach (COS) has shown a high efficacy (60-100%) but it has been related to dissatisfaction rates of 26%. Percutaneous blind release has shown a similar success rate (74-100%) and better results in functional recovery; however, some concerns arise in terms of generalization to every digit and over the risk of injuring the surrounding neurovascular structures. Recently different ultrasound guided techniques (UGT) have shown excellent results, with success rates between 91-100%, applicability to every finger without mayor complications. Nevertheless, some of these techniques produce an incomplete release in cadavers...
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Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 09-04-2018