Doğuştan metakarp kısalığında distraksiyon osteogenezi ile uzatma

Abstract

Amaç: Çalışmanın amacı distraksiyon osteogenezi ile uzatma yaptığımız doğuştan kısa metakarplı 7 olgunun sonuçlarını sunmak ve günlük uzatma miktarının ne kadar olması gerektiğini tartışmaktı. Çalışma planı: Kliniğimizde 2004-2007 yılları arasında, doğuştan metakarp kısalığı olan 4 hastanın (3 kadın, 1 erkek; yaş ortalaması: 14.9 yıl) 7 metakarpı distraksiyon osteogenezisi yöntemiyle uzatıldı. Uzatma için unilateral eksternal fiksatör kullanıldı. Her 2 elde 3. ve 4. parmaklarda tutulum olan olguda başlangıçta günlük 2¥0.5 mm hızında uzatma yapıldı. Uzatmanın onuncu gününde tüm parmaklarda ağrı ve kontraktür görülmesi üzerine uzatmaya ara verilip daha sonra 2¥0.25 mm/gün hızında devam edildi. Diğer tüm olgularda uzatma 0.5 mm/gün hızında yapıldı. Ameliyat öncesi ve sonrası eklem hareket açıklığı goniometre ile ölçüldü. Hasta memnuniyeti visual analog skala ile değerlendirildi. Bulgular: Ameliyat öncesi kısa metakarpların ortalama uzunluğu 34.6 (dağılım: 33-37) mm, ameliyat sonrası ise 49.7 (dağılım: 47-52) mm idi. Günlük ortalama distraksiyon uzunluğu 0.55 mm (dağılım: 0.48-0.63), sağlanan ortalama uzatma miktarı ise 15.1 (dağılım: 14-17) mm idi. Son kontrollerde parmaklarda fonksiyonel kısıtlılık olmadığı ve hastaların fonksiyonel ve kozmetik sonuçlardan memnun oldukları görüldü. Çıkarımlar: Distraksiyon osteogenezi doğuştan metakarp kısalığında kozmetik ve fonksiyonel açıdan tatminkar sonuçlar veren güvenli bir yöntemdir. Günlük uzatma miktarı belirlenirken metakarp boyu ve kas gerginliği dikkate alınmalıdır.

Keywords

• Metakarp kısalığı; distraksiyon osteogenezisi; eksternal fiksatör; uzatma.

Lengthening by distraction osteogenesis in congenital shortening of metacarpals

Abstract

Objective: The aim of this study was to present the results of seven cases of metacarpal lengthening by distraction osteogenesis and to discuss the ideal daily rate of distraction.
Methods: Metacarpal lengthening was performed by distraction osteogenesis in the seven metacarpals of four patients (3 females, 1 male; mean age: 14.9 years). A unilateral external fixator was used for lengthening. Lengthening was initiated with a distraction rate of 2×0.5 mm/day in the patient with bilateral involvement of the middle and ring metacarpals. On the tenth day of lengthening, distraction was discontinued due to pain and contracture. Then, distraction was continued with a rate of 2×0.25 mm/day. In all other cases, the distraction rate was 0.5 mm/day. Pre- and postoperative range of motion was measured with a goniometer. Patient satisfaction was evaluated with visual analog scale.
Results: The mean pre- and postoperative metacarpal lengths were 34.6 mm (range: 33 to 37) and 49.7 mm (range: 47 to 52), respectively. The mean lengthening achieved was 15.1 mm (range: 14 to 17), while the mean distraction rate was 0.55 mm/day (range: 0.48 to 0.63). No functional loss was observed in the fingers at the final check-up. The patients were happy with the functional and cosmetic results.
Conclusion: Distraction osteogenesis is a safe method providing acceptable cosmetic and functional results in patients with congenital metacarpal shortness. The length of metacarpals and muscles that will be affected from lengthening should be considered when determining the daily rate of distraction. 

Keywords

• Congenitally brachymetacarpia
• distraction osteogenesis
• external fixator
• lengthening

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