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TRİANGULAR FİBROKARTİLAJ KOMPLEKS HASARLANMALARI TANI VE TEDAVİSİ; ÖN KLİNİK ÇALIŞMA

Yıl 2011, Cilt: 19 Sayı: 2, 64 - 69, 01.08.2011

Öz

Amaç: Triangular fibrokartilaj kompleks (TFK) hasarlanması el bileği ulnar taraf ağrılarının başlıca nedenlerindendir. Bu çalışmada, TFK hasarlanması nedeni ile tedavi edilen hastaların erken dönem sonuçları değerlendirildi. Hastlar ve Metod: Kliniğimizde 2007-2009 yılları arasında 32 adet TFK hasarlanması tedavi edildi. Tüm hastalar direk röntgenogram ve MRG (magnetik rezonans görüntüleme) ile değerlendirildi. Hastaların ortalama şikayet başlama zamanları ile başvuru zamanları arası 14 ay (4-42 ay) idi. Tüm hastalara el bileği artroskopisi uygulandı. TFK hasarlanmaları, Palmer sınıflamasına göre sınıflandırıldı. En sık görülen lezyon tip 1A olup olgu sayısı 19 idi. Olgulardan 1 tanesi tip 1B, 3 tanesi tip 1C, 4 tanesi tip 1D, 5 tanesi tip 2C lezyona sahipti. TFK debridmanı her hastaya uygulandı. Periferik yırtığı olan 1 hastaya dışarıdan içeriye teknik ile sütür atıldı. Distal radioulnar eklem (DRUE) instabilitesi saptanan 7 hasta, artikuler disk debridmanı ve Fulkerson-Watson ekstraartikuler stabilizasyon yöntemi ile tedavi edildi. Ulnar stiloid fraktürü saptanan 2 hastaya artroskopik debridman sonrası açık redüksiyon ve K teli ile fiksasyon uygulandı. Skafolunat (SL) ligaman parsiyel yaralanması saptanan 4 hasta debridman ile tedavi edildi. SL ligaman total hasarlanması saptanan 2 hastaya artroskopik TFK debridmanını takiben 3 ay sonra modifiye Brunelli suturasyon yöntemi ile ligaman rekonstruksiyonu uygulandı. Hastaların ortalama takip süresi 11,6 ay (6-21 ay) idi. Bulgular: Ameliyat öncesi Quick-DASH-T (Disabilities of the Arm, Shoulder and Hand-Türkçe) semptom skorlaması ortalama 24,12 (9,09-52,27 aralığı) iken ameliyat sonrası 6,99 (2,27-25,00 aralığı) saptandı. Ameliyat öncesi visual analog skorlaması (VAS) ortalama 7,24 (4,5 -9,2 aralığı) iken ameliyat sonrası 2,12 ( 0,3 – 5,4 aralığı ) saptandı. Sonuç: TFK hasarlanmalarının distal radioulnar eklem (DRUE) ile birlikte değerlendirilerek tedavi buna göre planlanmalıdır. El bileğinde uygulanan artrokopik tedavi girişimleri ile etkin sonuçlar elde edilebilebilmektedir.

Kaynakça

  • 1. Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist-anatomy and function. J Hand Surg. 1981;6:153-62.
  • 2. Nakamura T, Takayama S, Horiuchi Y, Yabe Y. Origins an insertions of the triangular fibrocartilage complex: A histological study. J Hand Surg. 2001;26:446-54.
  • 3. Linscheid RL. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res. 1992;275:46-55.
  • 4. Rozental TD, Beredjiklian PK, Bozentka DJ. Instability of the distal radioulnar joint: current diagnostic and treatment methods. Curr Opin Orthop. 2003;14:245-51.
  • 5. Adams B. Anatomic reconstruction of the distal radioulnar ligaments for DRUJ instability. Tech Hand Up Extrem Surg. 2000;4:154-60.
  • 6. Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res. 1984;187:26-35.
  • 7. Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg. 2008;33:1669-79.
  • 8. Lee DH, Dickson KF, Bradley EL. The incidence of wrist interosseous ligament and triangular fibrocartilage articular disc disruptions: a cadaveric study. J Hand Surg Am. 2004;29:676-84.
  • 9. Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am. 1989;14:594-606.
  • 10. Kalainov DM, Culp RW. Arthroscopic treatment of TFCC tears. Tech Hand Up Extrem Surg. 1997;1:l75-182.
  • 11. Palmer AK. Triangular fibrocartilage disorders: injury patterns and treatment. Arthroscopy. 1990;6:125-32.
  • 12. Lee AT, Yao J. An update on the triangular fibrocartilage complex. Current Orthopaedic Practice. 2008;19,509-14
  • 13. Shih JT, Lee HM, Tan CM. Early isolated triangular fibrocartilage complex tears: management by arthroscopic repair. J Trauma. 2002;53:922-7.
  • 14. Tay SC, Tomita K, Berger RA. The “ulnar fovea sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity. J Hand Surg. 2007;32:438-44.
  • 15. Park MJ, Lee JS. The relationship between stress position and pain intensity in the triangular fibrocartilage lesions. J Hand Surg Eur Vol. 2010;35:735-9.
  • 16. Friedman SL, Palmer AK. The ulnar impaction syndrome. Hand Clin. 1991;7:295-310.
  • 17. Lawler E, Adams BD. Reconstruction for DRUJ instability. Hand (NY). 2007;2:123-6.
  • 18. Braun RM. The distal joint of the radius and ulna. Diagnostic studies and treatment rationale. Clin Orthop Relat Res. 1992;275:74-8.
  • 19. Albastaki U, Sophocleous D, Göthlin J, Pierre-Jerome C. Magnetıc resonance imaging of the triangular fibrocartilage complex lesions: a comprehensive clinicoradiologic approach and review of the literature. J Manipulative Physiol Ther. 2007;30:522-6.
  • 20. Sahin G, Dogan BE, Demirtaş M. Virtual MR arthroscopy of the wrist joint: a new intraarticular perspective. Skeletal Radiol. 2004;33:9-14.
  • 21. Potter HG, Asnis-Ernberg L, Weiland AJ, Hotchkiss RN, Peterson MG, McCormack Jr RR. The utility of high-resolution magnetic resonance imaging in the evaluation of the triangular fibrocartilage complex of the wrist. J Bone Joint Surg Am. 1997;79: 1675-84.
  • 22. Joshy S, Ghosh S, Lee K, Deshmukh SC. Accuracy of direct magnetic resonance arthrography in the diagnosis of triangular fibrocartilage complex tears of the wrist. Int Orthop. 2008;32:251-3.
  • 23. Scheer JH, Hammerby S, Adolfsson LE. Radioulnar ratio in detection of distal radioulnar joint instability associated with acute distal radius fractures. The Journal of Hand Surgery Eur Vol 2010;35:730-4.
  • 24. Adams BD. Partial excision of the triangular fibrocartilage complex articular disk: a biomechanical study. J Hand Surg Am. 1993;18:334-40.
  • 25. Bednar JM, Osterman AL. The role of arthroscopy in the treatment of traumatic triangular fibrocartilage injuries. Hand Clin. 1994;10:605-14.
  • 26. Osterman AL. Arthroscopic debridement of triangular fibrocartilage complex tears. Arthroscopy. 1990;6:120-4.
  • 27. Durmaz H. Elbileği artroskopisi: Triangular fibrokartilaj lezyonlarının tedavisi. Acta Orthop Traumatol Turc. 2000;34:379- 83.
  • 28. Ozkan M, Yaldiz K, Bacakoglu AK, Ekin A, Ozcan C. Radius distal uç eklem içi kırıklarında yumuşak doku yaralanmaları ve bunların el bileği fonksiyonlarına etkileri. Acta Orthop Traumatol Turc 2001;35:21-7.
  • 29. Bombaci H, Polat A, Deniz G, Akinci O. The value of plain X-rays in predicting TFCC injury after distal radial fractures. J Hand Surg Eur Vol 2008;33:322-6.
  • 30. Anderson ML, Larson AN, Moran SL, Cooney WP, Amrami KK, Berger RA. Clinical comparison of arthroscopic versus open repair of triangular fibrocartilage complex tears. J Hand Surg Am 2008;33:675-82.
  • 31. Hauck R. M. Ulnar styloid fractures: a review. Curr Opin Orthop 2005,16:227-230.

DIAGNOSIS AND TREATMENT OF TRIANGULAR FIBROCARTILAGE COMPLEX INJURY; A PRELIMINARY CLINICAL STUDY

Yıl 2011, Cilt: 19 Sayı: 2, 64 - 69, 01.08.2011

Öz

Objectives: Triangular fibrocartilage complex (TFCC) injury is one of the leading causes for localized persistant pain at the ulnar side of the wrist. Preliminary treatment results of the patients diagnosed with TFCC injury are assessed. Patients and materials: 32 patients with TFCC injury were treated in our department between 2007-2009. All patients were evaluated with direct rontgenogram and MR imaging. Mean time between the onset of symptoms and application to the clinic was noted as 14 (4-42) months. Wrist arthroscopy was performed for each patient. TFCC injury clasified with Palmer clasification. Most of the lesions were type 1A lesions, noted at 19 of the patients. One patient had type 1B lesion, 3 patients had type 1C lesions, 4 patients had type 1D lesions and 5 patients had type 2C lesions. TFCC debridement was used for each patient. One patient with peripheral rupture was treated with suturing in an outside to inside fashion. 7 patients with distal radioulnar joint (DRUJ) instability were treated with articular disc debridement and Fulkerson-Watson extraarticular stabilization method. Two patients with ulnar styloid fractures were treated with open reduction and Kischner wire fixation following arthroscopic debridement. Four patients with partial scapholunate ligament (SL) injury were treated with debridement. Two patients with total SL rupture were treated with arthroscopic TFCC debridement followed by ligament reconstruction with modified Brunelli suturing method three months later. Mean follow-up time was noted as 11,6 months (6-21 months). Results: Mean Quick-DASH-T (Disabilities of the Arm, Shoulder and Hand-Turkish) symptom score was noted as 24,12 (range from 9,09 to 52,17) preoperatively and 6,99 (range from 2,27 to 25) postoperatively. Mean Visual Analog Scoring (VAS) was notes as 7,24 (range from 4,5 to 9,2) and 2,12 (range from 0,3 to 5,4) at the preoperative and postoperative period respectively. Discussion: Injuries of the TFCC should be evaluated together with the distal radioulnar joint (DRUJ), and the treatment should be planned accordingly. Arthroscopic procedures in the wrist yield successful results

Kaynakça

  • 1. Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist-anatomy and function. J Hand Surg. 1981;6:153-62.
  • 2. Nakamura T, Takayama S, Horiuchi Y, Yabe Y. Origins an insertions of the triangular fibrocartilage complex: A histological study. J Hand Surg. 2001;26:446-54.
  • 3. Linscheid RL. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res. 1992;275:46-55.
  • 4. Rozental TD, Beredjiklian PK, Bozentka DJ. Instability of the distal radioulnar joint: current diagnostic and treatment methods. Curr Opin Orthop. 2003;14:245-51.
  • 5. Adams B. Anatomic reconstruction of the distal radioulnar ligaments for DRUJ instability. Tech Hand Up Extrem Surg. 2000;4:154-60.
  • 6. Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res. 1984;187:26-35.
  • 7. Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg. 2008;33:1669-79.
  • 8. Lee DH, Dickson KF, Bradley EL. The incidence of wrist interosseous ligament and triangular fibrocartilage articular disc disruptions: a cadaveric study. J Hand Surg Am. 2004;29:676-84.
  • 9. Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am. 1989;14:594-606.
  • 10. Kalainov DM, Culp RW. Arthroscopic treatment of TFCC tears. Tech Hand Up Extrem Surg. 1997;1:l75-182.
  • 11. Palmer AK. Triangular fibrocartilage disorders: injury patterns and treatment. Arthroscopy. 1990;6:125-32.
  • 12. Lee AT, Yao J. An update on the triangular fibrocartilage complex. Current Orthopaedic Practice. 2008;19,509-14
  • 13. Shih JT, Lee HM, Tan CM. Early isolated triangular fibrocartilage complex tears: management by arthroscopic repair. J Trauma. 2002;53:922-7.
  • 14. Tay SC, Tomita K, Berger RA. The “ulnar fovea sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity. J Hand Surg. 2007;32:438-44.
  • 15. Park MJ, Lee JS. The relationship between stress position and pain intensity in the triangular fibrocartilage lesions. J Hand Surg Eur Vol. 2010;35:735-9.
  • 16. Friedman SL, Palmer AK. The ulnar impaction syndrome. Hand Clin. 1991;7:295-310.
  • 17. Lawler E, Adams BD. Reconstruction for DRUJ instability. Hand (NY). 2007;2:123-6.
  • 18. Braun RM. The distal joint of the radius and ulna. Diagnostic studies and treatment rationale. Clin Orthop Relat Res. 1992;275:74-8.
  • 19. Albastaki U, Sophocleous D, Göthlin J, Pierre-Jerome C. Magnetıc resonance imaging of the triangular fibrocartilage complex lesions: a comprehensive clinicoradiologic approach and review of the literature. J Manipulative Physiol Ther. 2007;30:522-6.
  • 20. Sahin G, Dogan BE, Demirtaş M. Virtual MR arthroscopy of the wrist joint: a new intraarticular perspective. Skeletal Radiol. 2004;33:9-14.
  • 21. Potter HG, Asnis-Ernberg L, Weiland AJ, Hotchkiss RN, Peterson MG, McCormack Jr RR. The utility of high-resolution magnetic resonance imaging in the evaluation of the triangular fibrocartilage complex of the wrist. J Bone Joint Surg Am. 1997;79: 1675-84.
  • 22. Joshy S, Ghosh S, Lee K, Deshmukh SC. Accuracy of direct magnetic resonance arthrography in the diagnosis of triangular fibrocartilage complex tears of the wrist. Int Orthop. 2008;32:251-3.
  • 23. Scheer JH, Hammerby S, Adolfsson LE. Radioulnar ratio in detection of distal radioulnar joint instability associated with acute distal radius fractures. The Journal of Hand Surgery Eur Vol 2010;35:730-4.
  • 24. Adams BD. Partial excision of the triangular fibrocartilage complex articular disk: a biomechanical study. J Hand Surg Am. 1993;18:334-40.
  • 25. Bednar JM, Osterman AL. The role of arthroscopy in the treatment of traumatic triangular fibrocartilage injuries. Hand Clin. 1994;10:605-14.
  • 26. Osterman AL. Arthroscopic debridement of triangular fibrocartilage complex tears. Arthroscopy. 1990;6:120-4.
  • 27. Durmaz H. Elbileği artroskopisi: Triangular fibrokartilaj lezyonlarının tedavisi. Acta Orthop Traumatol Turc. 2000;34:379- 83.
  • 28. Ozkan M, Yaldiz K, Bacakoglu AK, Ekin A, Ozcan C. Radius distal uç eklem içi kırıklarında yumuşak doku yaralanmaları ve bunların el bileği fonksiyonlarına etkileri. Acta Orthop Traumatol Turc 2001;35:21-7.
  • 29. Bombaci H, Polat A, Deniz G, Akinci O. The value of plain X-rays in predicting TFCC injury after distal radial fractures. J Hand Surg Eur Vol 2008;33:322-6.
  • 30. Anderson ML, Larson AN, Moran SL, Cooney WP, Amrami KK, Berger RA. Clinical comparison of arthroscopic versus open repair of triangular fibrocartilage complex tears. J Hand Surg Am 2008;33:675-82.
  • 31. Hauck R. M. Ulnar styloid fractures: a review. Curr Opin Orthop 2005,16:227-230.
Toplam 31 adet kaynakça vardır.

Ayrıntılar

Diğer ID JA59KY26YB
Bölüm Makaleler
Yazarlar

İsmail Bülent Özçelik Bu kişi benim

Berkan Mersa Bu kişi benim

Atakan Aydın Bu kişi benim

Serdar Tunçer Bu kişi benim

Samet Vasfi Kuvat Bu kişi benim

Yayımlanma Tarihi 1 Ağustos 2011
Yayımlandığı Sayı Yıl 2011 Cilt: 19 Sayı: 2

Kaynak Göster

APA Özçelik, İ. B., Mersa, B., Aydın, A., Tunçer, S., vd. (2011). TRİANGULAR FİBROKARTİLAJ KOMPLEKS HASARLANMALARI TANI VE TEDAVİSİ; ÖN KLİNİK ÇALIŞMA. Türk Plastik Rekonstrüktif Ve Estetik Cerrahi Dergisi, 19(2), 64-69.
AMA Özçelik İB, Mersa B, Aydın A, Tunçer S, Kuvat SV. TRİANGULAR FİBROKARTİLAJ KOMPLEKS HASARLANMALARI TANI VE TEDAVİSİ; ÖN KLİNİK ÇALIŞMA. turkplastsurg. Ağustos 2011;19(2):64-69.
Chicago Özçelik, İsmail Bülent, Berkan Mersa, Atakan Aydın, Serdar Tunçer, ve Samet Vasfi Kuvat. “TRİANGULAR FİBROKARTİLAJ KOMPLEKS HASARLANMALARI TANI VE TEDAVİSİ; ÖN KLİNİK ÇALIŞMA”. Türk Plastik Rekonstrüktif Ve Estetik Cerrahi Dergisi 19, sy. 2 (Ağustos 2011): 64-69.
EndNote Özçelik İB, Mersa B, Aydın A, Tunçer S, Kuvat SV (01 Ağustos 2011) TRİANGULAR FİBROKARTİLAJ KOMPLEKS HASARLANMALARI TANI VE TEDAVİSİ; ÖN KLİNİK ÇALIŞMA. Türk Plastik Rekonstrüktif Ve Estetik Cerrahi Dergisi 19 2 64–69.
IEEE İ. B. Özçelik, B. Mersa, A. Aydın, S. Tunçer, ve S. V. Kuvat, “TRİANGULAR FİBROKARTİLAJ KOMPLEKS HASARLANMALARI TANI VE TEDAVİSİ; ÖN KLİNİK ÇALIŞMA”, turkplastsurg, c. 19, sy. 2, ss. 64–69, 2011.
ISNAD Özçelik, İsmail Bülent vd. “TRİANGULAR FİBROKARTİLAJ KOMPLEKS HASARLANMALARI TANI VE TEDAVİSİ; ÖN KLİNİK ÇALIŞMA”. Türk Plastik Rekonstrüktif Ve Estetik Cerrahi Dergisi 19/2 (Ağustos 2011), 64-69.
JAMA Özçelik İB, Mersa B, Aydın A, Tunçer S, Kuvat SV. TRİANGULAR FİBROKARTİLAJ KOMPLEKS HASARLANMALARI TANI VE TEDAVİSİ; ÖN KLİNİK ÇALIŞMA. turkplastsurg. 2011;19:64–69.
MLA Özçelik, İsmail Bülent vd. “TRİANGULAR FİBROKARTİLAJ KOMPLEKS HASARLANMALARI TANI VE TEDAVİSİ; ÖN KLİNİK ÇALIŞMA”. Türk Plastik Rekonstrüktif Ve Estetik Cerrahi Dergisi, c. 19, sy. 2, 2011, ss. 64-69.
Vancouver Özçelik İB, Mersa B, Aydın A, Tunçer S, Kuvat SV. TRİANGULAR FİBROKARTİLAJ KOMPLEKS HASARLANMALARI TANI VE TEDAVİSİ; ÖN KLİNİK ÇALIŞMA. turkplastsurg. 2011;19(2):64-9.