Urovsky O. Prognostication of Dupuytren's Contracture Progress and Treatment

The research is devoted to solving the issue, topical for orthopedics and traumatology - improving the results of Dupuytren's contracture treatment on the grounds of the disease's clinical progress prognostication, considering biochemical and histo-morphological changes in tissues of a hand, advancing the existing methods and tactics of treatment and development the new ones. The research is based on the results of examination and treatment of 299 patients (44 female and 255 male) suffering from Dupuytren's contracture of different severity. The retrospective analysis of treatment results created a fresh approach to Dupuytren's contracture formation, emphasizing the reasonable role of hand's own muscles in contracture formation. On the grounds of this approach, a new method of Dupuytren's disease surgical treatment has been proposed, mainly mobilization or tomy, if necessary, of hand's own muscles' tendons. Application of this new method decreased the level of recurrence in 2.8 % for patients with muscles mobilization and in 17.3% in control group (p=0,0031). Biochemical investigations, defining the character of changes in levels of collagenase, glycosaminoglycanes, hyaluronidase and oxyproline fractures in blood serum and those defining activity of hyaloridase and level of glycosaminoglicates in aponeurosis tissues and pathomorphological investigations of palm aponeurosis biopsy materials on different stages of disease shown the peculiarities of clinical progress of biochemical disorders of palm aponeurosis and pathomorphogenesis of Dupuytren's disease, laying in development of severity of pathological process as far as hand deformation develops. On the grounds of statistical analysis, the factors of influence on recurrence and post-surgery complications development have been defined. For prognostica-tion of Dupuytren's contracture recurrence the critical indications of recurrence development have been found, mainly: for the age under 43 years old (р=0,0002); indication of duration of the disease consists of ?9 years (р=0,008), for distribution of pathological process of ?3 fingers.(р=0,0002). On the grounds of the achieved results, the algorithm of differentiated approach to the choice of surgical treatment method was developed for prognostication of progress of the disease and choosing the optimal method of surgical treatment.