Akut Rockwood Tip 5 Akromioklaviküler Eklem Çıkıklarında Uygulanan Çift Düğme İmplantı Tekniğinin Fonksiyonel ve Radyolojik Sonuçları

Öz

Amaç: Akut tip 5 akromioklavikular eklem çıkıklarında çift düğme implantı tekniğinin orta dönemde klinik, fonksi-yonel ve radyolojik sonuçlarını ortaya koymayı hedefledik. Materyal ve metod: Kliniğimizde Ocak 2019- Haziran 2021 tarihleri arasında akromiyoklaviküler eklem çıkığı nedeniyle çift düğme implantı tekniği kullanılarak cerrahi tedavi edilmiş hastalar geriye dönük olarak tarandı. Son poliklinik kontrollerinde hastaların omuz radyografilerinden etkilenmemiş omuzda korakoklaviküler mesafeleri ile çift düğme implantı tekniği uygulanan omuzdaki korakoklaviküler mesafeleri ölçüldü. Aynı zamanda hastaların omuz radyografileri incelenerek redüksiyon kaliteleri ve akromioklaviküler eklemin Kellgren-Lawrence sınıflama-sına göre osteoartrit durumu not edildi. Hastaların son poliklinik kontrollerinde; ağrı durumları Visual Analog Score, fonksiyonel durumları Constant-Murley omuz skorlama sistemi kullanılarak değerlendirildi. Bulgular: Çalışmaya 15’i erkek, 1’i kadın olmak üzere toplam 16 hasta dâhil edildi. Dâhil edilen hastaların yaş orta-laması 42,1 (19-66) idi. Ortalama takip süresi 28.0 (15-44) ay idi. Son poliklinik kontrolünde, etkilenmemiş omuzda ölçülen korakoklaviküler mesafe ortalama 7,7±1.0 mm , düğme implantı tekniği uygulanan omuzda ortalama kora-koklaviküler mesafe 8,4± 2.0 mm olarak ölçüldü. Redüksiyon kalitesi dağılımı; 1 hastada tip 4, 2 hastada tip 2, 1 hastada tip 3, 12 hastada ise tip 1 olarak görüldü. Hastalardan 1’inde evre 2 ve 2’sinde ise evre 3 olmak üzere toplam 3 hastada akromioklaviküler eklem osteoartriti gelişimi gözlenirken 13 hastada osteoartrit gelişimi gözlen-medi. Ameliyat sonrası son poliklinik kontrollerinde ortalama Visual analog ağrı skoru 1,3 (0-4), ortalama modifiye Constant skoru ise 86,1 (73-93) olarak ölçüldü. Sonuç: Akut tip 5 akromioklaviküler eklem çıkıklarında uygulanan çift düğme implantı tekniğinin başarılı ve güvenli bir cerrahi prosedürdür.

Anahtar Kelimeler

• Akromioklaviküler eklem çıkığı
• Rockwood
• çift düğme implantı
• cerrahi tedavi
• korakoklaviküler mesafe

Functional and Radiologic Results of Tight Rope Technique in Acute Rockwood Type 5 Acromioclavicular Separations

Öz

Background We aimed to reveal clinical, functional and radiological mid-term results of double button implant technique in acute type 5 acromioclavicular joint separations. Materials and Methods Patients who were surgically treated in our clinic for acromioclavicular joint separation by using the double-button implant technique between January 2019 and June 2021 were retrospectively analyzed. Patients, with acute traumatic type 5 dislocations, over the age of 18, with at least 12 months follow-up period and patients without history of an injury in the affected upper extremity were included in the study. Patients with open injuries, accompanying acromion fractures, clavicle fractures or glenoid fractures, patients with a history of previous shoulder surgery, and chronic cases were excluded from the study. At the final outpatient follow-up, coracoclavicular distances of both the operated shoulder double button implant technique and the unaffected shoulder were measured from shoulder radiographs. Radiographs were simultaneously examined for the reduction quality and acromioclavicular joint osteoarthritis status. Also in the final follow-up, pain status, as well as functional status were evaluated by Visual Analog Score and Constant-Murley shoulder scoring system, respectively. Results A total of 16 patients, 15 male and 1 female, were included in the study. The mean age of the included patients was 42.1 (19-66). The mean follow-up period was 28.0 (15-44) months. Mean coracoclavicular distance of the unaffected and operated shoulders were 7.8 mm (5.7-9.8) and 8.4 mm (5.8-13.9), respectively. Reduction quality distribution was seen as type 4 in 1 patient, type 2 in 2 patients, type 3 in 1 patient, and type 1 in 12 patients. While acromioclavicular joint osteoarthritis developed in 3 patients, 1 of which was stage 2 and 2 of which was stage 3, rest of the patients had no osteoarthritis. The mean Visual analog pain score was 1.3 (0-4) and the mean modified Constant score was 86.1 (73-93) in the final follow-up. Conclusions Results of this study suggests that the double button implant technique can be considered in acute type 5 acromioclavicular joint separations as a reliable and a successful surgical procedure.

Anahtar Kelimeler

• Acromioclavicular joint dislocation
• Rockwood
• surgical treatment
• tightrope
• coracoclavicular distance

Kaynakça

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