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8/9/2019 Dupuytren Chir
http://slidepdf.com/reader/full/dupuytren-chir 1/129
DGLGNKH NH NXYX[^]HF
H.]@XL@^
^]GK^HDHF^BOK]X]EKBGL
KFR^K^X^ NH LG DGKFBLKFKWXH A@XZHFH^
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OKR^@L@EKH
•Bhllulhs juskj`rdhs
•Hnkjkbgtk`f nh b`llgehfh
J`rdgtk`fs f`nulgkrhs
Rtrubturhs lgdhllgkrhs
kfthrf`nulgkrhs
Yrëshfbh gf`rdglhnh b`llgeïfh nh typh
KKK
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]GYYHLRGFG^@DKWXHR
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L‛GY@FHZ]@RH YGLDGK]HD@[HFFH
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L‛GY@FHZ]@RH YGLDGK]H RXYH]JKBKHLLH
H_^H]FHKF^H]FH
D@[HFFH
8/9/2019 Dupuytren Chir
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L‛GY@FHZ]@RH YGLDGK]H D@[HFFH
Jkmrhstrgfsvhrsglhs
Jkmrhssgekttglhs
Jkmrhsl`fektunkfglhs
Gp`fhvr`sh pgldgkrh pr`j`fnh
8/9/2019 Dupuytren Chir
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JKM]HR L@FEK^XNKFGLHR
•pr`l`fehft lh l`fe pgldgkrh
•hf ëvhftgkl
•ëpgkssksshdhft hf gvgftnhs jlëboksshurs
mgfnhlhtths prëthfnkfhushs
8/9/2019 Dupuytren Chir
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MGFNHLH^^HR Y]Ë^HFNKFHXRHR
s'grráthft gu plk nhjlhxk`f pgldgkrh nkstgl
Okgtus poysk`l`ekquh
8/9/2019 Dupuytren Chir
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mgfnhlhtths prëthfnkfhushs
•kfshrtk`f s`us nhrdkquh
•b`ffhbtk`fs gvhb l‛gpfv pr`j`fnh
8/9/2019 Dupuytren Chir
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JKM]HR ̂ ]GFRZH]RGLHR
•Lket pgldgkrh trgfsvhrshsuphrjkbkhl(LY^R)
•Lket pgldgft kfthrnkektgl (LYK)
(lket pgldgft fgtgt`krh)•m`rn pr`xkdgl mkhf lkdktë
"rhb`uvrh Zx, fhrjs, thfn`fs
•hf nkstgl sh p`ursukt pgr lhsgpfv nkektglhs
•hf pr`j`fnhur rha`kft l‛gpfvpr`j`fnh
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JKM]HR ̂ ]GFRZH]RGLHR
•Lket pgldgkrh trgfsvhrshsuphrjkbkhl(LY^R)
•Lket pgldgft kfthrnkektgl (LYK)
(lket pgldgft fgtgt`krh)•m`rn pr`xkdgl mkhf lkdktë
"rhb`uvrh Zx, fhrjs, thfn`fs
•hf nkstgl sh p`ursukt pgr lhsgpfv nkektglhs
•hf pr`j`fnhur rha`kft l‛gpfvpr`j`fnh
8/9/2019 Dupuytren Chir
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JKM]HR ̂ ]GFRZH]RGLHR
•Lket pgldgkrh trgfsvhrshsuphrjkbkhl(LY^R)
•Lket pgldgft kfthrnkektgl (LYK)
(lket pgldgft fgtgt`krh)•m`rn pr`xkdgl mkhf lkdktë
"rhb`uvrh Zx, fhrjs, thfn`fs
•hf nkstgl sh p`ursukt pgr lhsgpfv nkektglhs
•hf pr`j`fnhur rha`kft l‛gpfvpr`j`fnh 1 bl`ks`f
8/9/2019 Dupuytren Chir
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8/9/2019 Dupuytren Chir
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BOKGRDG JKM]HX_• rëufk gu j`fn nhs b`ddkssurhs
•lhs hxpgfsk`fs prjnhs nu LYK
•l‛gpfv pr`j`fnh ht mgfnhlhtths rëtr`vgsbulgkrhs
•lhs hxpgfsk`fs nhs bl`ks`fs kfthrnkektglhs
•lhs hxpgfsk`fs pr`j`fnhs nhs jkmrhs l`fektunkfglhs
• gnoïrh gux bráths b`ddkssurglhs
8/9/2019 Dupuytren Chir
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L‛GY@FHZ]@RH YGLDGK]H
• G lg pgudh1•Jkmrhs l`fektunkfglhs
•Jkmrhs trgfsvhrsglhs
•Jkmrhs sgekttglhs
• Gux n`kets1
•jkmrhs bkrbulgkrhs 1
lkegdhft nh Blhlgfnlkegdhft nh Ergys`f
8/9/2019 Dupuytren Chir
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GY@FHZ]@RHRNKEK^GLHR
• jkmrhs bkrbulgkrhs
•gut`ur nhs pënkbulhs
!hf grrkïrh 4 lket Blhlgfn (7?5?)
!hf gvgft 4 lket Ergys`f (7;>7)
• jhukllht suphrjkbkhl gnoïrh
•egkfhs nhs jlëboksshurs•gu nhrdh /b`rn`fs jkmrhux
8/9/2019 Dupuytren Chir
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JKM]@RH ]H^]GB^KLH
• F`nulhs
• @dmklkbgtk`fs
• Mrknhs
8/9/2019 Dupuytren Chir
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M]KNH YGLDGK]H
•Lg mrknh
•sh jkxh gu systïdh
b`ddkssurgl•sh thfn pr`erhsskvhdhft
•jlëbokt lg D.Y.
•suphrjkbkglksh lh pënkbulh
•Lh pënkbulh
•nhvkhft trgfsvhrsgl
8/9/2019 Dupuytren Chir
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M]KNHNKEK^GLH
g.Gxkglhm.Lgtërglh
b.Rpkrglh
8/9/2019 Dupuytren Chir
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]KRWXH ZGRBXL@-FH]ZHX_
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LH ]KRWXH ZGRBXL@-FH]ZHX_
G ufh kfjluhfbh sur lg strgtëekhdënkb`-bokrurekbglh nh lg prksh hfbogreh nh lg dglgnkh nh nupuytrhf
8/9/2019 Dupuytren Chir
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GY@FHZ]@^@DKH
•Kfjluhfbh lh rksquh bokrurekbgl
•Rurt`ut sk 1
!Dgfquh nh j`rdgtk`f!]ëpëtktkvh
!Gvhb shfsgtk`f nh nëbogreh ëlhbtrkquh
!Yhtkt tr`umlh shfsktkj thdp`rgkrh `u rësknuhl
!kft`lërgfbh gu jr`kn
!
J`rdh nkektglh
8/9/2019 Dupuytren Chir
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GY@FHZ]@^@DKH
• Fh n`kt pgs átrh p`ursukvkh sk rësultgt f`f pr`mgft
• Hst é nksbuthr sk kfthrvhftk`f prëvuh é b`urt thrdh
!ngfs lhs j`rdhs `û hllh rksquh n‛guedhfthr lh rksquhbokrurekbgl
• kfj`rdhr lh pgtkhft n‛ufh p`sskmlh lësk`f vgsbul`-fhrvhush é dkfkdg
! Rgfs b`fsëquhfbh phrbhptkmlh kddënkgth
!Dgks kfjluhfågft lh rksquh bokrurekbgl
8/9/2019 Dupuytren Chir
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N@KE^ F@F
ZKH]EH
•Lh pëboë `rkekfhl
•Lh roudgt`l`euh
0
8/9/2019 Dupuytren Chir
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LH ̂ ]GK^HDHF^ BOK]X]EKBGL
•G-t-kl uf kftërát 0•Hst kl gftge`fksth nh l‛gp`fëvr`t`dkh 0
•Wu‛hllh hst sg plgbh hxgbth 0
8/9/2019 Dupuytren Chir
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LH ̂ ]HYKHN NHBKRK@FFHL
• Lh typh nh
nupuytrhf• Lh typh nh pgtkhft
• Lhs trgkthdhfts
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NKJJH]HF^HR J@]DHR GFG^@DKWXHR
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LG BLGRRKJKBG^K@F HF R^GNH FH RXJJK^YGR !
•Wuh n`kt-`f brgkfnrh 0
!
Xfh mrknh mkhf kfnkvknuglksëh sur uf n`ket gvhbufh rëtrgbtk`f kdp`rtgfth
!Xf hfvgoksshdhft hf dgssh nh lg dgkf gvhb ufh
jkmr`sh el`mglh phu rëtrgbtëh•Lh plus kdp`rtgft hst l‛gsphbt el`mgl nh lg
dgkf
8/9/2019 Dupuytren Chir
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LG M]KNH
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LG DGKF
•Lhs grtkbulgtk`fs
•Lg phgu•Lhs pgto`l`ekhs gss`bkëhs
8/9/2019 Dupuytren Chir
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LHR G]^KBXLG^K@FR
• Lg rgknhur grtkbulgkrh
!DY 1 agdgks rgknh
!KYY 1 lh prkfbkpgl pr`mlïdh!KYN 1
" jlëbokh pgrj`ks rgknh
" Oyphr-hxthfsk`f
• D`kfs eáfgfth bgr pgs n‛gbbr`bogeh
• Fëbhsskth uf gll`fehdhft thfnkfhux
• Yr`mlïdh nh lg m`ut`ffkïrh
8/9/2019 Dupuytren Chir
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M`ut`ffkïrhNksthfsk`f nh lg mgfnhlhtth dënkgfh nh l‛gppgrhkl hxthfshur
]ëtrgbtk`f nhs mgfnhlhtths lgtërglhs
8/9/2019 Dupuytren Chir
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LG YHGX
• Hpgkssh ht kfjkltrëh!Yrksh hf dgssh pgr lg dglgnkh
• F`dmrhushs `dmklkbgtk`fs
!F`f trgktëhs pgr l‛gp`fëvr`t`dkh
• Gnoërhfth
!Ygs nh rksquh n‛kfthrp`sktk`f vgsbul`-fhrvhush
!Nksshbtk`f plus nkjjkbklh
• Bkbgtrkbkhllh
!
Mrknh rëtrgbtklh p`st `përgt`krh
8/9/2019 Dupuytren Chir
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8/9/2019 Dupuytren Chir
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LHR YG^O@L@EKHR GRR@BKHHR
• Lg tëf`syf`vkth f`nulgkrh!Ykïeh nkgef`stkquh ht toërgphutkquh
!J`rdhs n`ul`urhushs
!Jgkmlh rëtrgbtk`f sguj qugfn ml`bgeh
!Gss`bkgtk`f jrëquhfth é ufh mrknh nh nupuytrhf
" ^rgkthr lhs nhux pr`mlïdhs hf dádh thdps
• Lhs dgkfs fhur`l`ekquhs
• Lg dgkf nkgmëtkquh 1 kfjkltrgtk`f0, rksquhs `p.
• Lhs dgkfs nh Agb`un
8/9/2019 Dupuytren Chir
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LH ̂ ]HYKHN NHBKRK@FFHL
• Lh typh nh
nupuytrhf• Lh typh nh pgtkhft
• Lhs trgkthdhfts
=/ l t n tk t
8/9/2019 Dupuytren Chir
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•Nkgtoïsh ht jgbthurs jgv`rksgft
•]ëbknkvksth
•Gfxkhux `u puskllgfkdh•Geh
•Nhdgfnh j`fbtk`ffhllh `u b`fj`rt
•Ëv`lutk`f b`ftr`-lgtërglh
•Gbtkvktë pr`jhssk`ffhllh ht thdps n‛grrát
=/ lh typh nh pgtkhft
8/9/2019 Dupuytren Chir
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NKG^OHRH
• B`usskfhts poglgfekhfs
• Lhnnhro`sh
• Lgphyr`fkh• Gtthkfth nhs n`ket rgnkgux
• Gtthkfths mklgtërglhs• Gtthkfths ëthfnuhs
• Gtthkfths jëdkfkfhs
8/9/2019 Dupuytren Chir
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JGB^HX]R JGZ@]KRGF^R
•Yrënksp`sktk`f jgdklkglh(=9%)
•Nkgmëtkquh ++++•Hpklhpskh (egrnhfgl)
•Glb``lkquhs +++++
•^rgudgtksdhs nëblhfbogfts!G.^.
8/9/2019 Dupuytren Chir
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LHR ]HBKNKZKR^HR
•]ksquh `përgt`krh plus ergfn•Fëbhssktë n‛ufh kfthrvhftk`f plus rgnkbglh
!erhjjh nh phgu t`tglh
!Y`ur fh pgs gv`kr é lh rë`përhr
•^hfkr b`dpth nhs rësultgts prëbënhfts
!Dgkf b`ftr`-lgtërglh
8/9/2019 Dupuytren Chir
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^H]]GKF YR[BO@L@EKWXH
• Brktïrh nh bo`kx dgahur
!Gfxkhux" Gle`nystr`pokh
" Lg prhdkïrh bgush n‛ëbohb sëvïrh
!Yuskllgfkdh" Dguvgksh rëënubgtk`f
" Dëb`fthfthdhft ht pr`bënurh
8/9/2019 Dupuytren Chir
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L‛GEH
• D`kfs nh nhdgfnh j`fbtk`ffhllh• D`kfs nh thdps nh rëbknkvh
• D`kfs nh rksquh nh rëbknkvh
!Lh suaht ahufh g ufh j`rdh prëb`bh ht n`fb plus sëvïrh
• Ygrj`ks nhdgfnhur n‛uf trgkthdhft ufkquhrgnkbgl
!Bokrurekh hfvksgehgmlh p`ur ufh j`rdh skdplh
• Yr`boh nh lg rhtrgkth plutþt gp`fëvr`t`dkh
!Ygs n‛grrát ht gtthfnrh jkf n‛gbtkvktë
8/9/2019 Dupuytren Chir
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8/9/2019 Dupuytren Chir
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8/9/2019 Dupuytren Chir
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2/ LHR ̂ ]GK^HDHF^R
•Lg m`ffh b`ffgkssgfbh nhs
p`sskmklktës toërgphutkquhs!Dënkbglhs
!Bokrurekbglhs!Gmsthftk`ffksths
8/9/2019 Dupuytren Chir
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B@DDH Y@X] ^@X^HR LHR DGLGNKHR
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B@DDH Y@X] ̂ @X^HR LHR DGLGNKHRËZ@LX^KZHR
•L‛ënubgtk`f nu pgtkhft hst hsshftkhllh
•Lg b``rnkfgtk`f dënkb`-bokrurekbglh rgssurgfthp`ur luk
•Lg b`ffgkssgfbh n‛ufh ëv`lutk`f kdprëvkskmlhsur lh l`fe b`urs n`kt átrh n‛hdmlëh prëbksëh!gkfsk quh lh p`sskmlh rhb`urs é uf trgkthdhft bokrurekbgl
hf bgs n‛ëbohb nh lg prksh hf bogreh dënkbglh.
8/9/2019 Dupuytren Chir
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LH ]ÞLH NH LG Y]KRH HF BOG]EH
]OXDG^@L@EKWXH Y]HDKÏ]H
•Hst n`fb ëvknhft ht hsshftkhl•Hst lg dhkllhurh kftr`nubtk`f é lg prksh
hf bogreh bokrurekbglh qugfn hllhs‛kdp`sh
8/9/2019 Dupuytren Chir
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8/9/2019 Dupuytren Chir
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LG BOK]X]EKH F‛HR^ AGDGKR
GF@NKFH
•Dgks rhsth skdplh p`ur lhs j`rdhs skdplhs (o`rs
gle`)•Hllhs hst gstrhkefgfth ht b`dplkquëh p`ur lhs
j`rdhs sëvïrhs
•Hllhs nhvkhft ngfehrhush p`ur lhs j`rdhsrëbknkvgfths
8/9/2019 Dupuytren Chir
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LHR ̂ ]@KR E]GFNR Y]KFBKYHR J@FNG^HX]R NHL‛KFNKBG^K@F BOK]X]EKBGLH
•L‛hxërïsh nu dgxkdud nh tkssus pgto`l`ekquh
•Lg p`sskmklktë nh ehsths gss`bkës
•Lg shulh rhss`urbh hf bgs n‛ëbohb nu trgkthdhft
dënkbgl
8/9/2019 Dupuytren Chir
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GY@FHZ]HB^@DKH
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GY@FHZ]HB^@DKH
GY@FHZ]HB^@DKH
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GY@FHZ]HB^@DKH
]ëshbtk`f nh l‛hfshdmlh nu tkssus
pgto`l`ekquhR`us GL], gdmu
Ygfshdhfts 78 a. (2s, Dgb bgso)
]ëënubgtk`f l`feuh, `rtoïsh
GY@FHZ]HB^@DKH
8/9/2019 Dupuytren Chir
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GY@FHZ]HB^@DKH
]ëshbtk`f nh l‛hfshdmlh nu tkssus
pgto`l`ekquhR`us GL], gdmu
Ygfshdhfts 78 a. (2s, Dgb bgso)
]ëënubgtk`f l`feuh, `rtoïsh
GY@FHZ]HB^@DKH
8/9/2019 Dupuytren Chir
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GY@FHZ]HB^@DKH
]ëshbtk`f nh l‛hfshdmlh nu tkssus
pgto`l`ekquhR`us GL], gdmu
Ygfshdhfts 78 a. (2s, Dgb bgso)
]ëënubgtk`f l`feuh, `rtoïsh
GY@FHZ]HB^@DKH
8/9/2019 Dupuytren Chir
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GY@FHZ]HB^@DKH
]ëshbtk`f nh l‛hfshdmlh nu tkssus
pgto`l`ekquhR`us GL], gdmu
Ygfshdhfts 78 a. (2s, Dgb bgso)
]ëënubgtk`f l`feuh, `rtoïsh
GY@FHZ]HB^@DKH
8/9/2019 Dupuytren Chir
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GY@FHZ]HB^@DKH
]ëshbtk`f nh l‛hfshdmlh nu tkssus
pgto`l`ekquhR`us GL], gdmu
Ygfshdhfts 78 a. (2s, Dgb bgso)
]ëënubgtk`f l`feuh, `rtoïsh
GY@FHZ]HB^@DKH
8/9/2019 Dupuytren Chir
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GY@FHZ]HB^@DKH
]ëshbtk`f nh l‛hfshdmlh nu tkssus
pgto`l`ekquhR`us GL], gdmu
Ygfshdhfts 78 a. (2s, Dgb bgso)
]ëënubgtk`f l`feuh, `rtoïsh
GY@FHZ]HB^@DKH
8/9/2019 Dupuytren Chir
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GY@FHZ]HB^@DKH
]ëshbtk`f nh l‛hfshdmlh nu tkssus
pgto`l`ekquhR`us GL], gdmu
Ygfshdhfts 78 a. (2s, Dgb bgso)
]ëënubgtk`f l`feuh, `rtoïsh
GY@FHZ]HB^@DKH
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GY@FHZ]HB^@DKH
GY@FHZ]HB^@DKH
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GY@FHZ]HB^@DKH
DGB BGRO
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DGB BGRO
DGB BGRO
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DGB BGRO
DGB BGRO
8/9/2019 Dupuytren Chir
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DGB BGRO
•Egefh nh lg phgu
•Lkdkth lh rksquh n‛oëdgt`dhs
•F‛guedhfth pgs lh rksquh kfjhbtkhux
•Fh lkdkth pgs lh rksquh nh rëbknkvhs
•]gll`feh lh thdps nh bkbgtrksgtk`f
]HHNXBG^K@F Y@R^ @Y
8/9/2019 Dupuytren Chir
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]HHNXBG^K@F Y@R^-@Y
• Kfnksphfsgmlh
• Kddënkgth
•N`ubh ht kfn`l`rh•Ygrj`ks gss`bkëh é ufh `rtoïsh
nyfgdkquh
•Yr`l`feëh : shdgkfhs
•Yuks gut`-rëënubgtk`f (2 d`ks)
LHR B@DYLKBG^K@FR
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LHR B@DYLKBG^K@FR
•Fëbr`sh butgfëh
• Ksboëdkh nkektglh, gdputgtk`f•Mrknh bkbgtrkbkhllh
• Kfjhbtk`fs
•RGFN
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KRBOHDKH
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KRBOHDKH
KFJHB^K@F
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KFJHB^K@F
KFJHB^K@F
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KFJHB^K@F
KFJHB^K@F
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KFJHB^K@F
GY@FHZ]HB^@DKH
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GY@FHZ]HB^@DKH
•KFB@FZHFKHF^R!Mhgub`up plus l`urn
!B`dplkbgtk`fs plus jrëquhfths"RGFN
"Rkf`f j`fbtk`f nh lg sëvërktë ( phu nh surprkshs)
!Yhrskstgfbh nu jlhssud svt rgttgboëh é lg bokrurekh pgs élg Nupuytrhf («
bkbgtrkbh tëd`kf
³)
!Ygs nh s`lutk`fs nh rgttrgpgeh hf bgs n‛ëbohb (dgl vëbu)
GY@FHZ]HB^@DKH
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GY@FHZ]HB^@DKH
•]hsth fëgfd`kfs prëbkhush!Rhul rhb`urs ngfs lhs j`rdhs
b`dplhxhs
!^rgkthdhft nhs pgto`l`ekhs gss`bkëhs
!Dhkllhurh prëvhftk`f nhs j`rdhssëvïrhs
GY@FHZ]HB^@DKH
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GY@FHZ]HB^@DKH
• DHKLLHX]H Y]HZHF^K@F NH LG ]HBKNKZH
!Ngfs lhs j`rdhs sëvïrhs
!Rurt`ut hf bgs nh erhjjh nh phgu
!Y`sskmklktë nh rëhllh euërks`fs
GY@FHZ]HB^@DKH
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GY@FHZ]HB^@DKH
•Rhul rhb`urs ngfs lhs
j`rdhs b`dplhxhs" ]gknhurs grtkbulgkrhs
" Gf`dglkhs butgfëhs
• Mrknhs bkbgtrkbkhllhs
• @dmklkbgtk`fs" ]ëtrgbtk`fs thfnkfhushs
8/9/2019 Dupuytren Chir
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EHR^HR GRR@BKHR
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EHR^HR GRR@BKHR
•Grtor`lysh
•Grtor`nïsh
•Erhjjh nh phgu
•Gll`fehdhft thfnkfhux
8/9/2019 Dupuytren Chir
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E]HJJH NH YHGX
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E]HJJH NH YHGX
E]HJJH NH YHGX
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E]HJJH NH YHGX
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GY@FHZ]HB^@DKH
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GY@FHZ]HB^@DKH
•Rhul rhb`urs hf bgs
n‛ëbohb nhl‛gp`fëvr`t`dkh!]ëbknkvhs
!B`dplkbgtk`fs
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B@DYLKBG^K@FR NH L‛GY@FHZ]@^@DKH
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B@DYLKBG^K@FR NH L GY@FHZ]@^@DKH
•]grhs
!Lësk`fs vgsbul`-fhrvhushs
" Zgsbulgkrhs phu pgrlgfths (sguj sk kfthrvhftk`f)
" Fhur`l`ekquhs 1 nyshstoëskh, oyp`hstoëskh
! Kfjhbtkhushs
• Ygrj`ks sëvïrhs1
! rupturh thfnkfhush1 ^rïs b`dplhxhs é trgkthr
• Rkdplhs dgks bokrurekbglhs
!Cysth ëpknhrdkquh1 F`f hxbhptk`ffhl
]XY^X]H JLHBOKRRHX]
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]XY^X]H JLHBOKRRHX]
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]XY^X]H JLHBOKRRHX]
]XY^X]H JLHBOKRRHX]
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]XY^X]H JLHBOKRRHX]
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]XY^X]H JLHBOKRRHX]
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]XY^X]H JLHBOKRRHX]
]XY^X]H JLHBOKRRHX]
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]XY^X]H JLHBOKRRHX]
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KFNKBG^K@F BOK]X]EKBGLH
LG ]Ë^]GB^K@F NKEK^GLH
8/9/2019 Dupuytren Chir
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• ]hsth lh shul ëlëdhft pr`f`stkquh
! Kl jgut gpprëohfnhr s`f nhvhfkr gu l`fe b`urs
! Kl hst kll`ekquh nh b`ftkfuhr é gdëlk`rhr ufhrëtrgbtk`f pgldgkrh gu prkx n‛ufh geergvgtk`f nh lgrëtrgbtk`f nkektglh ++++++++++
" Dádh sk lh pgtkhft g uf egkf el`mgl n‛hxthfsk`f
" Bhlg dïfh gu pkrh pr`f`stkb!^`uth rëtrgbtk`f nkektglh ëv`lutkvh s`us trgkthdhft pgr
gp`fëvr`t`dkh nhvkhft ufh kfnkbgtk`f bokrurekbglh
LG ]H^]GB^K@F NKEK^GLH
8/9/2019 Dupuytren Chir
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• Lh jlhssud nkektgl s‛hfrgknkt pr`erhsskvhdhft
• Lg rgknhur grtkbulgkrh hst lg prhdkïrh bgush n‛ëbohbnëjkfktkj nu trgkthdhft
!Hllh gl`urnkt lhs sukths `përgt`krhs
" N`ulhur
" Nurëh n‛ëv`lutk`f
" Nkjjkbultë nh rëënubgtk`f
!Hllh nkdkfuh b`fsknërgmlhdhft lh rësultgt sur l‛hxthfsk`f
• Ylus `f gtthfn plus `f b`dpr`dht l‛gvhfkr ++++
HF BGR NH JLHRRXD NKEK^GL HZ@LX^KJ
8/9/2019 Dupuytren Chir
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•Kfnkbgtk`f bokrurekbglh
!Rk ëbohb nh lg bokrurekh 1
"
nh t`uth jgå`f bhluk-bk hst kfëlubtgmlh" @f gftkbkph skdplhdhft bh b`fstgt
!@f `mtkhft uf egkf kdp`rtgft
"
Xfkquhdhft p`ur lhs j`rdhs• Jgv`rgmlhs
• prëb`bhs
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LHR BK NH L‛GY@FHZ]HB^@DKH
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• Kl f‛y hf g pgs vrgkdhft 1
! r̂gkthdhft gftkb`geulgft hjjkbgbh
• Dgks 1!Ëvkthr lhs pgtkhfts é er`s rksquh n‛ëbohb
" Ëf`lksdh
" Gle`nystr`pokh
" Ëbohbs `u geergvgtk`f prëbënhfth p`st-`p
" L‛kfb`dprëohfsk`f nu trgkthdhft ht nh lg pgto`l`ekh
L‛KFJ@]DG^K@F
8/9/2019 Dupuytren Chir
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• Rur lhs ngfehrs
• Rur lhs rksquhs nh rëbknkvhs
• Rur lh rksquh nh rësultgts kfb`dplhts
• Rur l‛gmshfbh nh s`lutk`fs nh rgttrgpgeh hf
bgs n‛ëbohb!nhrfkhr rhb`urs
LG R^]G^HEKH
8/9/2019 Dupuytren Chir
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• Gp`fëvr`t`dkh systëdgtkquh!Y`ur lhs j`rdhs pgldgkrhs skdplhs
!Wuhlquh s`kt l‛gfeulgtk`f
!Hfvksgehgmlh p`ur lhs j`rdhs nkektglhs
" Rk hllh fh lgkssh pgs ëv`luhr lh jlhssud
• Gp`fëvrhbt`dkh
!Nh shb`fnh kfthftk`f hf bgs n‛ëbohb
!Nh prhdkïrh kfthftk`f sk BK é l‛gp`fëvr`t`dkh• Gp`fëvr`t`dkh
nh rhtgrnhdhft hf bgs nh BK bokrurekbglh (pgllkgtkj)
8/9/2019 Dupuytren Chir
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8/9/2019 Dupuytren Chir
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B@FBLXRK@F
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•Lg bokrurekh rhsth skdplh p`ur lhs j`rdhsskdplhs!
(o`rs gle`)!Kl f‛hst pgs lëektkdh nh b`dpgrhr lhs ëbohbs nh
lg bokrurekh ngfs lhs j`rdhs sëvïrhs gvhb lhs m`fs
rësultgts `mthfus quhlquh s`kt lh trgkthdhft ngfslhs j`rdhs pgldgkrhs skdplhs
8/9/2019 Dupuytren Chir
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•Lg bokrurekh hst uf ëlëdhft hsshftkhl ht
s`uvhft kfb`ft`urfgmlh nh l‛grshfgltoërgphutkquh
!R`f kftr`nubtk`f rëp`fn é nhs rïelhs n‟kfnkbgtk`fsht nh tkdkfe rke`urhux
8/9/2019 Dupuytren Chir
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• Lg bokrurekh n`ffh lhs dhkllhurs dgks gussk lhs pkrhsrësultgts 1
!Lhs kfnkbgtk`fs n`kvhft n`fb átrh prunhfths ht austkjkëhs
!Kl jgut n`ffhr lg prk`rktë é l‛gp`fëvr`t`dkh" nïs qu‛hllh hst p`sskmlh
" Wugfn hllh phut gpp`rthr ufh gdëlk`rgtk`f pr`mgfth
8/9/2019 Dupuytren Chir
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• L‛gp`fëvr`t`dkh fh n`kt pgs rhtgrnhr lg dksh hfr`uth nu trgkthdhft bokrurekbgl hf bgs nh rëtrgbtk`f
nkektglh ëv`lutkvh• Dádh hf bgs n‛gdëlk`rgtk`fs kdp`rtgfths nh lg
rëtrgbtk`f pgldgkrh `u el`mglh
L‛GY@FHZ]@^@DKH
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