Object: a pathological process in the palmar aponeurosis of patients with Dupuytren's contracture and chronic noninfectious pathological process in the liver. Objective: to improve treatment outcomes of patients with Dupuytren's contracture by studying the causes, mechanisms of formation, features of the course and development of a pathogenetically substantiated treatment and diagnostic scheme. Methods: clinical, laboratory (coagulorometr HUMACLOT DUO - HUMAN, Germany, 2006), biochemical (biochemical analyzer А-25, Spain, 2008), , immunological (haematological analyzer ВС 300 Plus, China; immunoenzyme analyzer Rider "LabLain-022", cytological, morphological (microscope OLYMPUS CX-41, Olympus Corp., Japan, 2004), tool (apparatus for ultrasonography HDI 3500, Phillips, США, 1999; Toshiba, NEMIO XG, Japan, 2009; Samsung Medison - Accuvix V10, South Korea, 2009 и MyLabTM ClassG, Italy, 2009), statistical. New data on the mechanisms of formation of connective tissue changes of patients with Dupuytren's contracture were obtained. The assumption of the pathological changes of Dupuytren's contracture as a marker of extrahepatic lesions of connective tissue was scientifically proved. New evidences of the influence of environmental factors on the course of destruction of connective tissue were obtained: from clinical manifestations of local forms (in particular, such clinical nosology as Dupuytren's contracture) to generalized forms. New data on the morphological changes of the connective tissue of various localization were obtained. The criteria of the further course of the pathological process in Dupuytren's contracture after surgery were justified and defined. The risk factors for recurrence of the pathological process in the palmar aponeurosis were verified. The features of the immune disorders and immune dysfunction were revealed. The immune link of the pathogenesis of Dupuytren's contracture depending on the pathological process activity in a liver was characterized. New data of the immunologic studies show that Dupuytren's contracture should be considered as progressive systemic inflammatory disease, which has immune dysfunction as one of the pathogenetic links. This supports the hypothesis of the systematic nature of Dupuytren's contracture. For the first time the synchronization of pathological changes in the locomotor system and pathological processes in the connective tissue of the liver was determined. For the first time the feasibility of surgical treatment of patients with Dupuytren's contracture, based on, first of all, not the degree of deformation of the hand, but the nature of pathological changes in the connective tissue of various localization and of pathological process activity was scientifically substantiated. On the basis of new data the optimal on volume methodology of surgical treatment of studied patients with Dupuytren's contracture was defined and implemented. For the first time, based on the study of pathogenic mechanisms of Dupuytren's contracture medical complex, used as a local conservative treatment, and the method of conservative treatment of patients (patents of Ukraine №70806, № 71645) founded, developed and introduced into medical practice. The use of the proposed complex treatment allows avoid the trauma of anatomical structures and pain, to ensure widespread adoption of minimally invasive surgical approach, to minimize the number of relapses, accelerate the dynamics of the wound healing process and reduce the number of complications in the early postoperative period. Developed diagnostic and therapeutic scheme which allows justify the choice of the method to optimize the timing and tactics of treatment of these patients. Results of the study were introduced into clinical practice Kyiv city clinical emergency hospital, City hospital №1 (Vinnitsa), University hospital (Ternopil), Scientific Center of Radiation Medicine SCRM AMS Ukraine, Irpen military hospital and in the educational process of profile departments of National Medical Academy of Postgraduate Education named P.L. Shupyk, Bogomolets National Medical University Ukrainian Ministry of Health. Traumatology and orthopaedics.
