Rockwood Tip III Akromiyoklaviküler Eklem Çıkıklarının Cerrahi Tedavisinde Modifiye Bosworth ve Endobutton Tekniklerinin Karşılaştırılması

Year 2020, Volume: 25 Issue: 1, 33 - 38, 15.01.2020

Zekeriya Okan Karaduman Zafer Orhan Yalçın Turhan Mehmet Arıcan Erdem Değirmenci Ozan Turhal

https://doi.org/10.21673/anadoluklin.636164

Abstract

Amaç:
Bu çalışmada tip III akromiyoklaviküler çıkıkların
cerrahi tedavisinde modifiye Bosworth tekniğinin ve Endobutton tekniğinin uzun dönem
klinik ve radyolojik sonuçlarını retrospektif olarak karşılaştırmak
amaçlanmıştır.

Gereç ve Yöntemler:
Otuz iki hasta (26 erkek, 6 kadın) (ortalama yaş 37,
dağılım 15–78 yıl) akromiyoklaviküler eklem (AKE) çıkığı nedeniyle cerrahi yolla
tedavi edildi. Tüm
hastalarda tip III çıkık vardı. Yirmi
iki hastada sağ AKE çıkığı, 10 hastada sol AKE çıkığı mevcuttu. Çıkıkların 18’i
düşme, 9’u spor yaralanması, 5’i trafik kazası sonucunda meydana gelmişti.
Hastaların 18’i Endobutton tekniği, 14’ü ise modifiye Bosworth tekniği ile
opere edildi. Hastalar ameliyat sonrası fonksiyonel Constant, DASH ve VAS skorları üzerinden ve radyolojik
olarak da KKM (korakoklaviküler mesafe) ölçümü ile değerlendirildi. Ortalama
takip süresi 52 (37–66) ay idi.

Bulgular: Tüm hastalarda akromiyoklaviküler eklem dizilimi
normaldi. Hiçbir
hastada eklem dejenerasyonu görülmedi. Tüm
hastalarda omuz hareketleri ağrısız ve tamdı. Endobutton grubunun ortalama postoperatif 3., 12. ve
24. ay Constant skorları modifiye Bosworth grubununkilerden istatistiksel
olarak anlamlı şekilde yüksek bulundu (p=0,001). Endobutton grubunun ortalama postoperatif
3., 12. ve 24. ay DASH skorları modifiye
Bosworth grubununkilerden istatistiksel
olarak anlamlı şekilde düşüktü (p=0,003). Endobutton grubunun ortalama postoperatif
3. 12. ve 24. ay VAS skorları modifiye Bosworth grubununkilerden istatistiksel
olarak anlamlı şekilde düşüktü (p=0,001). İki grubun preoperatif ve postoperatif
KKM ortalamaları arasında ise istatistiksel olarak anlamlı fark gözlenmedi
(p=0,104).

Tartışma ve Sonuç:
Endobutton tekniği akromiyoklaviküler çıkıkların
cerrahi tedavisinde modifiye Bosworth tekniğine karşı iyi bir alternatiftir. 

Keywords

Akromiyoklaviküler çıkık, Endobutton tekniği, modifiye Bosworth tekniği

A Comparison of the Modified Bosworth and Endobutton Techniques in the Surgical Treatment of Rockwood Type III Acromioclavicular Joint Dislocations

Abstract

Aim: In this study, we aimed to retrospectively compare the long-term clinical and radiological outcomes obtained with the modified Bosworth technique
and Endobutton technique in surgical treatment of type III acromioclavicular
dislocations.

Materials and Methods: Thirty-two patients (26 males, 6 females) (mean age 37,
range 15–78 years) were treated surgically for acromioclavicular joint (ACJ)
dislocation. All patients had type III dislocation. Twenty-two patients had
right ACJ dislocation and 10 patients had left ACJ dislocation. Of the dislocations,
18 occurred due to falls; 9, sports injuries; and 5, traffic accidents. Of the
patients, 18 were operated on with the Endobutton technique and 14 with the
modified Endobutton technique. Patients were evaluated postoperatively in terms
of functional Constant, DASH, and VAS scores and radiologically with coracoclavicular distance (CCD) assessment. The mean follow-up was 52 (37–66)
months.

Results: The alignment of the acromioclavicular joint was normal in all
patients. No joint degeneration was observed in any patient. Shoulder movements
were painless and complete in all patients. The mean postoperative 3^rd,
12^th, and 24^th month Constant scores were found significantly higher
for the Endobutton group than for the modified Bosworth group (p=0.001). The
mean postoperative 3^rd, 12^th, and 24^th month DASH scores
were significantly lower for the Endobutton Group than for the modified
Bosworth group (p=0.003). The mean postoperative
3^rd, 12^th, and 24^th month VAS scores were significantly lower for the Endobutton group than for the modified Bosworth group (p=0.001).
However, no statistically significant difference was found between the mean preoperative
and postoperative CCD values of the two groups (p=0.104).

Discussion and Conclusion: The Endobutton technique is a good alternative to the modified
Bosworth technique in the surgical treatment of acromioclavicular dislocations.

Keywords

Acromioclavicular dislocation, Endobutton technique, modified Bosworth technique

References

• 1. Collins DN. Disorders of theacromioclavicularjoint. (2009), Theshoulder. Vol. 4, 4th ed. Philadelphia: SaundersElsevier.
• 2. Rockwood CA Jr, Williams GR, Young DC. Injuriestotheacromioclavicularjoint. (1996), RockwoodandGreen’sfractures in adults. Vol. 2, 4th ed. Philadelphia: JB Lippincott- Raven.
• 3.Lancaster S, Horowitz M, Alonso J. Complete acromioclavicularseparations. A comparison of operativemethods. ClinOrthopRelatRes. 1987;(216):80-8.
• 4.Salem KH, Schmelz A. Treatment of Tossy III acromioclavicularjointinjuriesusinghookplatesandligamentsuture. J OrthopTrauma. 2009;23:565-9.
• 5. Bargren JH, Erlanger S, Dick HM. Biomechanicsandcomparison of twooperativemethods of treatment of completeacromioclavicularseparation. ClinOrthopRelatRes. 1978;(130):267-72.
• 6. Fukuda K, Craig EV, An KN, Cofield RH, Chao EY. Biomechanicalstudyof theligamentoussystem of theacromioclavicularjoint. J Bone JointSurg . 1986;68:434-40.
• 7. Deshmukh AV, Wilson DR, Zilberfarb JL, Perlmutter GS. Stability of acromioclavicularjointreconstruction: biomechanicaltesting of varioussurgicaltechniques in a cadaveric model. Am JSportsMed. 2004;32:1492-8.
• 8. Grutter PW, Petersen SA. Anatomicalacromioclavicularligamentreconstruction: a biomechanicalcomparison of reconstructivetechniques of theacromioclavicularjoint. Am J Sports Med. 2005;33:1723-8.
• 9. Wei HF, Chen YF, Zeng BF. Tripleendobutttontechniqueforthetreatment of acutecompleteacromioclavicularjointdislocations: preliminary results. IntOrthop. 2011;35(4):555-559
• 10. Schlegel TF, Burks RT, Marcus RL, Dunn HK. A prospective evaluation of untreated acute grade III acromioclavicular separations. Am J Sports Med. 2001;29:699e703.
• 11. Smith TO, Chester R, Pearse EO, Hing CB. Operative versus non-operative management following Rockwood grade III cromioclavicular separation: a meta-analysis of the current evidence base. J Orthop Traumatol. 2011;12:19e27.
• 12. Press J, Zuckerman JD, Gallagher M, Cuomo F. Treatment of grade III acromioclavicular separations. Operative versus nonoperative management. Bull Hosp Jt Dis. 1997;56:77–83.
• 13. Tauber M. Management of acute acromioclavicular joint dislocations: current concepts. Arch Orthop Trauma Surg. 2013;133:985e995.
• 14. Takase K, Yamamoto K. Changes in surgical procedures for acromioclavicular joint dislocation over the past 30 years. Orthopedics. 2013;36:1277e1282.
• 15. Harris RI, Wallace AL, Harper GD, Goldberg JA, SonnabendDH, Walsh WR. Structuralproperties of theintactandthereconstructedcoracoclavicularligamentcomplex. Am J Sports Med. 2000;28:103-8.
• 16. Assaghir YM. Outcome of exact anatomic repair and coracoclavicular cortical lag screw in acute acromioclavicular dislocations. J Trauma Acute Care Surg. 2011;71:50e54.
• 17. Pavlik A, Csépai D, Hidas P. Surgicaltreatment of chronic acromioclavicular joint dislocation by modifiedWeaver- Dunnprocedure. KneeSurg Sports Traumatol Arthrosc. 2001;9:307-12.
• 18. Bektaşer B, Bozkurt M, Öçgüder A, Solak Ş, Oğuz T. Tip III akromiyoklaviküler eklem çıkıklarının modifiyeBosworthtekniği ile cerrahi tedavisi. Ulus Travma Acil Cerrahi Derg. 2004;10:245-9.
• 19. Bhattacharya R, Goodchild L, Rangan A. Acromioclavicularjointreconstructionusingthe Nottingham Surgilig: a preliminaryreport. ActaOrthopBelg. 2008;74:167-72.
• 20. Bannister GC, Wallace WA,Stableforth PG, Hutson MA. Themanagement of acuteacromioclaviculardislocation. A randomisedprospectivecontrolledtrial. J Bone JointSurg. 1989;71:848-50.