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Travma sonrası tekrarlayan anterior-inferior glenohumeral instabilitelerin selektif kapsüler kaydırma tekniği ile tamiri

Year 2005, Volume: 39 Issue: 2, 97 - 103, 11.09.2006

Abstract

Amaç: Travma sonrası tekrarlayan anterior-inferior glenohumeral instabilite tanısıyla selektif kapsül kaydırma ameliyatı yapılan hastaların fonksiyonel sonuçları değerlendirildi.
Çalışma planı: Çalışmada, travma sonrası tekrarlayan anterior-inferior glenohumeral instabilite nedeniyle selektif kapsül kaydırma tekniği uygulanan 16 hasta (15 erkek, 1 kadın; ort. yaş 30; dağılım 25-38 yıl) incelendi. Çıkıklar 14 hastada ciddi, ikisinde hafif travmadan sonra oluşmuştu. Ameliyattan önce ortalama çıkık sayısı 14 (dağılım 4-45) idi. Ameliyattan önce yapılan manyetik rezonans incelemelerinde tüm hastalarda Bankart lezyonu, %20’sinde ise Hill-Sachs lezyonu saptandı. Hastalar, Amerikan Omuz ve Dirsek Cerrahları standart omuz değerlendirme formuna (ASES) ve Rowe Bankart tamiri için skorlama tablosuna göre değerlendirildi. Ameliyattan önce ve sonra tüm hastalarda omzun ön-arka ve aksiller radyografileri çekildi. Eklem hareket açıklığı gonyometre ile, kas güçleri ise manuel olarak ölçüldü. Hastalar ortalama 41 ay (dağılım 21-74 ay) süreyle izlendi. İstatistiksel değerlendirmede t-testi kullanıldı.
Sonuçlar: Ameliyat öncesi ve sonrası ortalama ASES skorları anlamlı farklılık gösterdi (63.2 ve 95.8; p<0.05). Ameliyattan sonra ortalama Rowe skoru 92.5 (dağılım 70-100) bulundu. İnfraspinatus, supraspinatus ve subskapularis kas güçlerinde ameliyattan sonra anlamlı artış görüldü (p<0.05). Sonuçlar 12 hastada (%75) mükemmel, ikisinde (%12.5) iyi, ikisinde orta olarak değerlendirildi. On beş hasta (%93.8) yapılan ameliyattan memnun kaldığını belirtti.
Çıkarımlar: Bankart lezyonuna ek olarak kapsül yaralanması veya laksitesi bulunan anterior-inferior instabiliteli olgularda Bankart lezyonu tamiri ile birlikte uygulanan selektif kapsül kaydırma tekniği stabilite sağlamakta ve hareket açıklığını korumaktadır.





Anahtar sözcükler: Çıkık/cerrahi; eklem kapsülü/cerrahi; eklem instabilitesi/fizyopatoloji/cerrahi; hareket açıklığı, eklem; omuz eklemi/fizyopatoloji/cerrahi.


Yazışma adresi: Dr. Mehmet Uğur Özbaydar. İstanbul Okmeydanı Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji Kliniği, 34400 Şişli, İstanbul.
Tel: 0212 - 221 77 77 / 1308 Faks: 0212 - 221 78 00 e-posta: mehmetozbaydar@hotmail.com

Treatment of recurrent post-traumatic anterior-inferior glenohumeral instabilities with the selective capsular shift technique

Year 2005, Volume: 39 Issue: 2, 97 - 103, 11.09.2006

Abstract

Objectives: We evaluated the functional results of treatment with the selective capsular shift technique in patients with recurrent post-traumatic anterior-inferior glenohumeral instability.
Methods: The study included 16 patients (15 males, 1 female; mean age 30 years; range 25 to 38 years) who underwent selective capsular shift operation for recurrent post-traumatic anterior inferior glenohumeral instability. Dislocations occurred following severe (n=14) or mild (n=2) trauma. Preoperatively, the mean number of dislocations was 14 (range 4 to 45) and magnetic resonance imaging showed a Bankart lesion in all the patients and a Hill-Sachs lesion in 20%. The patients were evaluated according to the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and Rowe’s scoring for Bankart repair. Preoperative and postoperative anteroposterior and axillary x-rays were obtained from all the patients. Range of motion was measured with a goniometer and manual muscle strength tests were performed. The mean follow-up was 41 months (range 21 to 74 months). Statistical analysis was made using the t-test.
Results: The mean preoperative and postoperative ASES scores differed significantly (63.2 vs 95.8; p<0.05). The mean Rowe score was 92.5 (range 70 to 100). Strength of the infraspinatus, supraspinatus, and subscapularis muscles increased significantly (p<0.05). The results were excellent in 12 patients (75%), good in two patients (12.5%), and fair in two patients. Fifteen patients (93.8%) expressed satisfaction with the operation and results.
Conclusion: Addition of the selective capsular shift technique to the Bankart repair procedure improves stability and preserves the range of motion of the glenohumeral joint in patients with anterior-inferior glenohumeral instability accompanied by a Bankart lesion and capsular injury or laxity.

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Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Mehmet Ozbaydar This is me

Murat Tonbul This is me

Mehmet Altun This is me

Okan Yalaman This is me

Publication Date September 11, 2006
Published in Issue Year 2005 Volume: 39 Issue: 2

Cite

APA Ozbaydar, M., Tonbul, M., Altun, M., Yalaman, O. (2006). Treatment of recurrent post-traumatic anterior-inferior glenohumeral instabilities with the selective capsular shift technique. Acta Orthopaedica Et Traumatologica Turcica, 39(2), 97-103.
AMA Ozbaydar M, Tonbul M, Altun M, Yalaman O. Treatment of recurrent post-traumatic anterior-inferior glenohumeral instabilities with the selective capsular shift technique. Acta Orthopaedica et Traumatologica Turcica. September 2006;39(2):97-103.
Chicago Ozbaydar, Mehmet, Murat Tonbul, Mehmet Altun, and Okan Yalaman. “Treatment of Recurrent Post-Traumatic Anterior-Inferior Glenohumeral Instabilities With the Selective Capsular Shift Technique”. Acta Orthopaedica Et Traumatologica Turcica 39, no. 2 (September 2006): 97-103.
EndNote Ozbaydar M, Tonbul M, Altun M, Yalaman O (September 1, 2006) Treatment of recurrent post-traumatic anterior-inferior glenohumeral instabilities with the selective capsular shift technique. Acta Orthopaedica et Traumatologica Turcica 39 2 97–103.
IEEE M. Ozbaydar, M. Tonbul, M. Altun, and O. Yalaman, “Treatment of recurrent post-traumatic anterior-inferior glenohumeral instabilities with the selective capsular shift technique”, Acta Orthopaedica et Traumatologica Turcica, vol. 39, no. 2, pp. 97–103, 2006.
ISNAD Ozbaydar, Mehmet et al. “Treatment of Recurrent Post-Traumatic Anterior-Inferior Glenohumeral Instabilities With the Selective Capsular Shift Technique”. Acta Orthopaedica et Traumatologica Turcica 39/2 (September 2006), 97-103.
JAMA Ozbaydar M, Tonbul M, Altun M, Yalaman O. Treatment of recurrent post-traumatic anterior-inferior glenohumeral instabilities with the selective capsular shift technique. Acta Orthopaedica et Traumatologica Turcica. 2006;39:97–103.
MLA Ozbaydar, Mehmet et al. “Treatment of Recurrent Post-Traumatic Anterior-Inferior Glenohumeral Instabilities With the Selective Capsular Shift Technique”. Acta Orthopaedica Et Traumatologica Turcica, vol. 39, no. 2, 2006, pp. 97-103.
Vancouver Ozbaydar M, Tonbul M, Altun M, Yalaman O. Treatment of recurrent post-traumatic anterior-inferior glenohumeral instabilities with the selective capsular shift technique. Acta Orthopaedica et Traumatologica Turcica. 2006;39(2):97-103.