Skafoid distal pol rezeksiyonu ile skafotrapezial trapezoidal artroz tedavisi

Abstract

Amaç: Bu çalışmanın amacı skafoidin distal çeyreğinin rezeksiyonunda kullanılan cerrahi tekniği tanımlamak ve rezeksiyon sonrası pirokarbon implant ile tedavi edilen hastalarla sadece rezeksiyon ile tedavi edilen hastaların sonuçlarını karşılaştırmaktı.

Çalışma planı: Çalışmada sadece rezeksiyon ile tedavi edilen 9 ve rezeksiyon sonrası implant uygulaması gerçekleştirilen 8 bilek yer aldı. Ortalama takip süresi 77 (dağılım: 24-130) ay idi. Hastaların bilek hareketleri ve kavrama güçleri ölçüldü; ağrıları görsel analog skala (GAS) ile değerlendirildi. Radyografik sınıflandırma Crosby sınıflandırma sistemine göre gerçekleştirilirken, hastaların ameliyat öncesi ve sonrası radyolunat (RL) açıları kaydedildi.

Bulgular: Ameliyat sonrası GAS ağrı skorları sadece rezeksiyon ve implant gruplarında, sırasıyla, 2.1 ve 2.6 olarak bulundu. Ağrı skorlarının her iki grupta anlamlı şekilde azaldığı saptandı (sırasıyla, p=0.007 ve p=0.01). Ortalama RL açısı sadece rezeksiyon uygulanan grupta 14°’den 30°’ye yükseldi (p=0.008. İmplant grubundaki ortalama RL açısı 21°’den 23°’ye yükselmiş bulunsa da, bu farkın anlamlı olmadığı görüldü (p=0.75).

Çıkarımlar: Pirokarbon implant uygulaması ağrı tedavisi için yararlı bir teknik olarak gözükmektedir. Uygulama, skafotrapezial trapezoidal artrit tedavisinde sekonder deformitelerin önlenmesine katkı sağlayabilir.

Keywords

• DISI; skafotrapezial trapezoidal artroz; STPI protezi; skafoid distal pol rezeksiyonu.

Treatment of scaphotrapezial trapezoidal osteoarthritis with resection of the distal pole of the scaphoid

Abstract

Objective: The aim of this study was to describe the surgical technique for resection of the distal quarter of the scaphoid and compare the results of patients treated by resection with patients treated by resection with insertion of a pyrocarbon implant.

Methods: The study included 9 wrists treated by resection-only and 8 wrists treated by resection with implant. Average follow-up period was 77 (range: 24 to 130) months. Wrist motion and pinch strength were measured and pain was evaluated using the visual analog scale (VAS). Radiographic classification was performed according to Crosby’s classification system and the radiolunate (RL) angle was measured pre- and postoperatively.

Results: Postoperative VAS pain scores were 2.1 and 2.6 in the in the resection-only and implant group, respectively. Pain scores decreased significantly in both groups (p=0.007 and p=0.01, respectively). The mean RL angle increased from 14º to 30º in the resection-only group (p=0.008). In the STPI implant group, there was an increase in the mean RL angle from 21º to 23º; however, this difference was not significant (p=0.75).

Conclusion: Application of a pyrocarbon implant appears to be useful for pain relief and may help prevent secondary deformities in the treatment of scaphotrapezial trapezoidal arthritis.

Keywords

• DISI
• resection of the distal pole of the scaphoid
• scaphotrapezial trapezoidal arthrosis
• STPI prosthesis

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