Akromiyoklaviküler çıkıklarda Ethibond sütür ve semitendinozus otogretfi ilerekonstrüksiyon sonuçlarının karşılaştırması

Yıl 2013, Cilt: 47 Sayı: 5, 307 - 310, 29.10.2013

Mohsen Mardani-kivi Ahmadreza Mirbolook Mostafa Salariyeh Keyvan Hashemi-motlagh Khashayar Saheb-ekhtiari

Öz

Amaç: Akromiyoklaviküler (AC) eklem çıkıklarında 5 numara Ethibond sütür ve semitendinozus otogretfi kullanılarak yapılan cerrahi rekonstrüksiyonların sonuçlarının karşılaştırması amaçlandı.
Çalışma planı: Bu analitik kesitsel çalışmada AC eklem çıkığı nedeniyle cerrahi tedavi uygulanmış olan 39 hastanın (35 erkek, 4 kadın; ortalama yaş: 32.6±11.8) kayıtları retrospektif olarak tarandı. Yirmi bir hastaya 5 numara Ethibond sütür (Grup A), 18 hastaya ise semtendinozus otogrefti (Grup B) kullanılarak rekonstrüksiyon uygulandı. Veritabanı taramasında ortalama 25.7 aylık bir takip dönemindeki radyografik bulgular, Constant ve VAS skorları ve enfeksiyon kayıtları değerlendirildi.
Bulgular: A ve B gruplarının ortalama Constant skoru sırasıyla 91±1 ve 92±2.1 olarak bulundu. Zanca grafisinde A grubunda 15, B grubunda ise 12 hastada AC eklemin redükte edilmiş olduğu görüldü. A grubunda 6, B grubunda ise 5 hastada AC eklemde %25’in altında subluksasyon saptandı. Redüksiyon başarısı, hasta tatmini ve ağrı açısından gruplar arasında anlamlı fark saptanmadı (p>0.05). Hiçbir hastada derin enfeksiyon görülmedi.
Çıkarımlar: Her iki teknik de başarılı sonuç verdiğinden semitendinozus otogreftindeki greft alma morbiditesinden kaçınmak için 5 numara Ethibond sütür kullanılması tercih edilebilir.

Anahtar Kelimeler

Akromiyoklaviler eklem çıkığı; Constant skoru; Ethibond, Görsel Ağrı Skalası; semitendinozus otogrefti.

The comparison of Ethibond sutures and semitendinosus autograft in the surgical treatment of acromioclavicular dislocation

Öz

Objective: The aim of this study was to compare the results of the surgical reconstruction of the acromioclavicular joint (ACJ) dislocations using No. 5 Ethibond suture or semitendinosus autograft.
Methods: This analytical cross-sectional study was conducted on the medical records of 39 patients (35 males and 4 females; mean age: 32.6±11.8 years), with complete ACJ joint dislocation (Type 3 to 6). Twenty one patients underwent reconstruction using No. 5 Ethibond suture (Group A) and 18 patients using semitendinosus tendon autograft (Group B). The patients’ database records were queried for the information regarding the evaluations during follow-up period (mean: 25.7 months) such as radiographic evaluations, Constant score, VAS score and infection.
Results: The mean Constant score was 91±1 and 92±2.1 in Groups A and B, respectively. There was a reduction of ACJ based on Zanca view in 15 patients in Group A and 12 patients in Group B. There was subluxation of ACJ by less than 25% in six patients in Group A and five in Group B, in that, the difference was not significant. Patients expressed acceptable satisfaction and equal pain severity in rest and daily activity in both groups. No deep infection has been observed.
Conclusion: Since both surgical techniques led to satisfactory results, reduction of ACJ, excellent functional score and acceptable patient satisfaction, No. 5 Ethibond suture technique could be recommended as the treatment of choice due to the absence of morbidity in removing semitendinosus autograft tendon.  

Anahtar Kelimeler

Acromioclavicular joint dislocation, Constant score, Ethibond suture, semitendinosus autograft, Visual analogue score

Kaynakça

• Pallis M, Cameron KL, Svoboda SJ, Owens BD. Epidemiology of acromioclavicular joint injury in young athletes. Am J Sports Med 2012; 40: 2072-7.
• Ponce BA, Millett PJ, Warner JJP. Acromioclavicular joint instability – Reconstruction indications and techniques. Op Tech Sports Med 2004; 12: 35-42.
• Baek SH, Oh CW, Wallace WA, Jeon IH. Anterior clavicle dislocation associated with acromioclavicular dislocation in a soccer player: a case report. Am J Sports Med 2007;35:1752-5. Simovitch R, Sanders B, Ozbaydar M, Lavery K, Warner JJP. Acromioclavicular joint injuries: diagnosis and management. J Am Acad Orthop Surg 2009;17:207-19.
• Dias JJ, Steingold RF, Richardson RA, Tesfayohannes B, Gregg PJ. The conservative treatment of acromioclavicular dislocation. Review after five years. J Bone Joint Surg Br 1987; 69:719-22.
• Roper BA, Levack B. The surgical treatment of acromioclavicular dislocations. J Bone Joint Surg Br 1982;64:597-9.
• Law KY, Yung SH, Ho PY, Chang HT, Chan KM. Coracoclavicular ligament reconstruction using a gracilis tendon graft for acute type-III acromioclavicular dislocation. J Orthop Surg (Hong Kong) 2007;15:315-8.
• Grutter PW, Petersen SA. Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med 2005;33:1723-8.
• Galpin RD, Hawkins RJ, Grainger RW. A comparative analysis of operative versus nonoperative treatment of grade III acromioclavicular separations. Clin Orthop Relat Res 1985; (193):150-5.
• Bhattacharya R, Goodchild L, Rangan A. Acromioclavicular joint reconstruction using the Nottingham Surgilig: a preliminary report. Acta Orthop Belg 2008;74:167-72.
• Bishop JY, Kaeding C. Treatment of the acute traumatic acromioclavicular separation. Sports Med Arthrosc 2006;14: 237Ryhänen J, Niemelä E, Kaarela O, Raatikainen T. Stabilization of acute, complete acromioclavicular joint dislocations with a new C hook implant. J Shoulder Elbow Surg 2003;12:442-5.
• Motamedi AR, Blevins FT, Willis MC, McNally TP, Shahinpoor M. Biomechanics of the coracoclavicular ligament complex and augmentations used in its repair and reconstruction. Am J Sports Med 2000;28:380-4.
• Ho WP, Chen JY, Shih CH. The surgical treatment of complete acromioclavicular joint dislocation. Orthop Rev 1988;17: 1116Leow HK, Hyzan Y, Gan EC, Hassan S. Surgical treatment of acromio-clavicular dislocation. Med J Malaysia 1998;53Suppl A:71Cooper ES. New method for treating longstanding dislocations of the scapuloclavicular articulation. Am J Med Sci 1861; 41:389-92.
• De Baets T, Truijen J, Driesen R, Pittevils T. The treatment of acromioclavicular joint dislocation Tossy grade III with a clavicle hook plate. Acta Orthop Belg 2004;70:515-9.
• Ejam S, Lind T, Falkenberg B. Surgical treatment of acute and chronic acromioclavicular dislocation Tossy type III and V using the Hook plate. Acta Orthop Belg 2008;74:441-5.