Kienböck Hastalığının Tedavisinde Radial Kısaltma Osteotomisi

Öz

Amaç: Kienböck hastalığı, el bilek ekleminde ilerleyici ağrı, fonksiyon kaybı ve uzun dönemde karpal kemikler arasında yaygın artroz oluşumuna neden olan, lunatumun avasküler nekrozu ile karakterize bir klinik tablodur. Günümüzde halen kabul edilmiş standart bir tedavi protokolü mevcut değildir. Kienböck hastalığının tedavisinde birçok teknik tanımlanmıştır. Tedavinin planlanmasında hastanın yaşı, hastalığın evresi, distal radio-ulnar eklem ilişkisi, el bilek eklemindeki artrozun derecesi ve hastanın beklentileri önemlidir. Bu çalışmamızda, radial kısaltma yöntemi ile tedavi edilen hastalarımızın klinik sonuçlarını sunmayı amaçladık.Gereç ve Yöntemler: Mayıs 2008 ile Mart 2014 tarihleri arasında Kienböck hastalığı nedeniyle 16 olgu 7 kadın, 9 erkek volar yaklaşımla radial kısaltma osteotmisi yöntemi ile tedavi edildi. Hastaların ortalama yaşı 27,2 idi ve 6 hastada sol, 10 hastada sağ el bileği etkilenmişti. Hastaların ortalama takip süresi 31 aydı. Hastaların ameliyat öncesi ve sonrasındaki eklem hareket genişlikleri, kavrama gücü, görsel ağrı skalası ile ağrı düzeyleri ve radyolojik ilerlemesi değerlendirildi. Bulgular: Ameliyat öncesi ölçülen ortalama kavrama gücü 21,5 kg iken, son ölçümde ortalama 26,5 kg olduğu ve tüm hastalarda arttığı gözlendi. Ameliyat öncesi hareket genişliği 86,5 derece, ameliyat sonrası son değerlendirmede ise 125,5 derece olarak ölçüldü. Ameliyat öncesi ortalama 7,5 olan VAS skoru ameliyat sonrası dönemde ortalama 2,6 olarak bulundu. Sonuç: Radial kısaltma tekniği; ulnar varyansı negatif, Lichtman evre 2, 3A, 3B Kienböck hastalığı olan hastalarda etkin, morbiditesi düşük ve güvenilir bir yöntemdir

Anahtar Kelimeler

• Kienböck hastalığı, Lunatum, Avasküler nekroz

Radial Shortening Osteotomy in Kienböck Disease

Abstract

Objective: Kienböck disease is an avascular necrosis of the lunate which can lead to progressive wrist pain, loss of function of the wrist joint and intercarpal arthrosis. Treatment of Kienböck disease is still debated today. There are several treatment options, based on the patient’s age, stage of disease, distal radio-ulnar joint, presence or absence of arthritic changes and expectations of the patient. The aim of this study was to evaluate the clinical outcomes of the patients treated with radial shortening osteotomy. Material and Methods: Sixteen patients 7 women, 9 men with Kienböck disease who were treated with radial shortening osteotomy between May 2008 and March 2014 were reviewed. The average age of the patients was 27.2 years. The affected wrists were the left side in 6 cases and the right side in 10 cases. The mean follow-up period was 31 months. Patients’ preoperative and postoperative range of wrist motions, grip strength, pain level using visual analogue scale VAS and radiographic progression were evaluated.Results: At follow up, the mean grip strength of the patients was 26.5 kg, while it was 21.5 preoperatively. The mean range of wrist motion was 86.5 degrees preoperatively and 125.5 degrees at the last examination postoperatively. All patients showed improvement in grip strength and range of motion. The average VAS score was 2.6 postoperatively and 7.5 preoperatively. GIRIŞ ve AMAÇConclusion: Radial shortening osteotomy is an effective and reliable technique with less morbidity in the treatment of patients with Lichtman stage 2, 3A and 3B Kienböck disease and negative ulnar variance

Keywords

• Kienböck disease, Lunate, Avascular necrosis

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