Öz
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.
Kaynakça
- Suresh SS, Abraham R, Ravi P. Isolated symmetrical brachymetacarpia of the thumb-case report. Hand (NY) 2009; 4:424-26.
- Davidson RS. Metatarsal lengthening. Foot Ankle Clin 2001; 6:499-518.
- Wood VE. Brachymetacarpia. In Gren DP, ed. Green’s operative hand surgery. 4th ed. New York: Churchill Livingstone; 1999:390-96.
- Houshian S, Ipsen T. Metacarpal and phalangeal lengthening by callus distraction. J Hand Surg Br 2001;26:13-16.
- Almasi S, Solgaard S. Polyphalangism-a rare anomaly. Ugeskr Laeger 2006;168:2472-73.
- Günal I, Durak T, Öztuna V, Seber S. Various manifestation of hyperphalangism. J Hand Surg Br 1996;21B:405-407.
- Bozan ME, Alt›nel L, Kuru I, Maralcan G, Acar M, Durmaz H. Factors that affect the healing index of metacarpal lengthening: a retrospective study. J Orthop Surg 2006;14:167-71. Ogino T, Kato H, Ishii S, Usui M. Digital lengthening in congenital hand deformities. J Hand Surg Br 1994;19:120-29.
- Kato H, Minami A, Suenaga N, Iwasaki M, Kimura T. Callotasis lengthening in patients with brachymetacarpia. J Pediatr Orthop 2002; 22:497-500.
- Arslan H. Metacarpal lengthening by distraction osteogenesis in childhood brachydactyly. Acta Orthop Belg 2001;67: 242Minguella J, Cabrera M, Escola J. Techniques for smollbone lengthening in congenital anomalies of the hand and foot. J Pediatr Orthop Part B 2001;10:355-59.
- Belusa M. Distraction legthening in brachymetacarpia. Case report. Handchir Microchir Plast Chir 1994;26:298-301.
- Smith RJ, Gumley GJ. Metacarpal distraction lengthening. Hand Clin 1985;1:417-29.
- Bell J. On brachydactyly and symphalangism. In: Penrose LS, ed. Treasury of human inheritance. Vol 5. London: Cambridge University Press, 1951:1-31.
- Ayd›nl›o¤lu A, Akp›nar F, Tosun N. Mathematical relations between the lengths of the metacarpal bones and phalanges: surgical significance. Tohoku J Exp Med 1998:185;209-16.
- Messina A. Surgical treatment of congenital brachymetacarpus by dynamic elongation osteosynthesis. Report of a clinical case. Ann Chir Main 1991;10:54-58.
- fien C, Kocao¤lu M, Eralp L, Ç›nar M. Bone Lengthening of congenitally short metacarpus and metatarsus by the callus distraction technique. Acta Orthop Traumatol Turc 2003;37:154-61.
- Pensler JM, Carroll NC, Cheng LF. Distraction osteogenesis in the hand. Plast Reconstr Surg 1998;102:92-95.
- Tanaka J. Lengthening middle hand and finger segment stumps by external distraction devices following traumatic amputations and in congenital abnormalities. Handchir Microchir Plast Chir 1988;20:198-203.
- Masada K, Fujita S, Fuji T, Ohono H. Complications following metatarsal lengthening by callus distraction for brachymetatarsia. J Pediatr Orthop1999;19:394-7.
- Takakura Y, Tanaka Y, Fujii T, Tamai S. Lengthening of short great toes by callus distraction. J Bone Boint Surg Br 1997;79:955-8.
- Foucher G, Hultgren T, Merle M, Braun JM. Matev’s digit lengthening technic. A propos of 20 cases. Ann Chir Main 1988;7:210-16.
- Miyawaki T, Masuzawa G, Hirakawa M, Kurihara K. Bonelengthening for symbrachydactyly of the hand with the technique of callus distraction. J Bone Joint Surg Am 2002;84:986-91.
- Matev IB. Thumb reconstruction through metacarpal bone lengthening. J Hand Surg Am 1980;5:482-87.
Öz
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.
Anahtar Kelimeler
Congenitally brachymetacarpia distraction osteogenesis external fixator lengthening
Kaynakça
- Suresh SS, Abraham R, Ravi P. Isolated symmetrical brachymetacarpia of the thumb-case report. Hand (NY) 2009; 4:424-26.
- Davidson RS. Metatarsal lengthening. Foot Ankle Clin 2001; 6:499-518.
- Wood VE. Brachymetacarpia. In Gren DP, ed. Green’s operative hand surgery. 4th ed. New York: Churchill Livingstone; 1999:390-96.
- Houshian S, Ipsen T. Metacarpal and phalangeal lengthening by callus distraction. J Hand Surg Br 2001;26:13-16.
- Almasi S, Solgaard S. Polyphalangism-a rare anomaly. Ugeskr Laeger 2006;168:2472-73.
- Günal I, Durak T, Öztuna V, Seber S. Various manifestation of hyperphalangism. J Hand Surg Br 1996;21B:405-407.
- Bozan ME, Alt›nel L, Kuru I, Maralcan G, Acar M, Durmaz H. Factors that affect the healing index of metacarpal lengthening: a retrospective study. J Orthop Surg 2006;14:167-71. Ogino T, Kato H, Ishii S, Usui M. Digital lengthening in congenital hand deformities. J Hand Surg Br 1994;19:120-29.
- Kato H, Minami A, Suenaga N, Iwasaki M, Kimura T. Callotasis lengthening in patients with brachymetacarpia. J Pediatr Orthop 2002; 22:497-500.
- Arslan H. Metacarpal lengthening by distraction osteogenesis in childhood brachydactyly. Acta Orthop Belg 2001;67: 242Minguella J, Cabrera M, Escola J. Techniques for smollbone lengthening in congenital anomalies of the hand and foot. J Pediatr Orthop Part B 2001;10:355-59.
- Belusa M. Distraction legthening in brachymetacarpia. Case report. Handchir Microchir Plast Chir 1994;26:298-301.
- Smith RJ, Gumley GJ. Metacarpal distraction lengthening. Hand Clin 1985;1:417-29.
- Bell J. On brachydactyly and symphalangism. In: Penrose LS, ed. Treasury of human inheritance. Vol 5. London: Cambridge University Press, 1951:1-31.
- Ayd›nl›o¤lu A, Akp›nar F, Tosun N. Mathematical relations between the lengths of the metacarpal bones and phalanges: surgical significance. Tohoku J Exp Med 1998:185;209-16.
- Messina A. Surgical treatment of congenital brachymetacarpus by dynamic elongation osteosynthesis. Report of a clinical case. Ann Chir Main 1991;10:54-58.
- fien C, Kocao¤lu M, Eralp L, Ç›nar M. Bone Lengthening of congenitally short metacarpus and metatarsus by the callus distraction technique. Acta Orthop Traumatol Turc 2003;37:154-61.
- Pensler JM, Carroll NC, Cheng LF. Distraction osteogenesis in the hand. Plast Reconstr Surg 1998;102:92-95.
- Tanaka J. Lengthening middle hand and finger segment stumps by external distraction devices following traumatic amputations and in congenital abnormalities. Handchir Microchir Plast Chir 1988;20:198-203.
- Masada K, Fujita S, Fuji T, Ohono H. Complications following metatarsal lengthening by callus distraction for brachymetatarsia. J Pediatr Orthop1999;19:394-7.
- Takakura Y, Tanaka Y, Fujii T, Tamai S. Lengthening of short great toes by callus distraction. J Bone Boint Surg Br 1997;79:955-8.
- Foucher G, Hultgren T, Merle M, Braun JM. Matev’s digit lengthening technic. A propos of 20 cases. Ann Chir Main 1988;7:210-16.
- Miyawaki T, Masuzawa G, Hirakawa M, Kurihara K. Bonelengthening for symbrachydactyly of the hand with the technique of callus distraction. J Bone Joint Surg Am 2002;84:986-91.
- Matev IB. Thumb reconstruction through metacarpal bone lengthening. J Hand Surg Am 1980;5:482-87.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Orijinal Makale |
| Yazarlar | |
| Yayımlanma Tarihi | 26 Nisan 2013 |
| Yayımlandığı Sayı | Yıl 2013 Cilt: 47 Sayı: 2 |