Akut tip III akromiyoklaviküler eklem çıkıklarında perkütan çift düğme tespit yöntemi ile tedavisi

Year 2015, Volume: 49 Issue: 3, 241 - 248, 17.07.2015

Mehmet Acar , Ali Güleç Ömer Erkoçak Güney Yılmaz Fatih Durgut Mehmet Elmadağ

https://doi.org/10.3944/AOTT.2015.14.0230

Abstract

Amaç: Akut akromiyoklaviküler (AC) eklem çıkıklarında perkütan çift düğme tekniği kullanılarak tedavi edilen hastaların fonksiyonel ve radyolojik sonuçlarını değerlendirdik.

Çalışma planı: Akut tip III AC eklem çıkığı tanısı ile peruktan çift-düğme tespit yöntemi ile ameliyat edilen 13 hasta retrospektif olarak incelendi. Hastaların radyolojik değerlendirilmesinde son kontrolde çekilen ön arka grafide etkilen taraftaki korakoklavikular (KK) mesafe ile sağlam taraf arasındaki mesafeler karşılaştırıldı. Fonksiyonel değerlendirmede Constant, Disability of Arm, ShoulderandHand (DASH)ve visual analog scale(VAS) skorları kullanıldı.

Bulgular: Çalışmaya alınan on üç hastanın 12’si erkek, biri kadın ve ortalama yaşları 43.4 yıldı (aralık: 22–60 yıl). Hastaların ortalama takip süreleri 13.61 aydı (aralık: 9–24 ay). Ameliyat edilen taraftaki KK mesafe ortalama 9.23 (aralık 8–15) karşı tarafla karşılaştırıldığında istatiksel olarak fark yoktu. Preoperatif Constant skorları ortalama 30.3’ten (aralık 18–42) son kontrolde 84.4’e (aralık 70–90) yükseldi. Preoperatif DASH skorları ortalama 14.1’den (aralık: 11–28) son kontrolde 0.4’e (aralık 0–3) indi (p<0.001). Preoperatif VAS skorları ortalama 6.0’dan (aralık 5–8) son kontrolde 0.6’ya (aralık 0–3) indi (p<0.001).

Çıkarımlar: Akut tip III AC eklem çıkıklarında perkütan çift düğme tespit yöntemi artroskopik ve açık yöntemlere alternatif olabilecek güvenli, pratik ve etkili bir tespit yöntemidir.

 

 

DOI: 10.3944/AOTT.2015.14.0230

Bu özet, makalenin henüz redaksiyonu tamamlanmamış haline aittir ve bilgi verme amaçlıdır. Yayın aşamasında değişiklik gösterebilir.

Keywords

Akromiyoklaviküler eklem; çift düğmeli fiksasyon; perkütan.

Percutaneous double-button fixation method for treatment of acute type III acromioclavicular joint dislocation

Abstract

Objective: The aim of this study was to evaluate the functional and radiological results of patients treated with the percutaneous double-button technique for acute acromioclavicular (AC) joint dislocation.
Methods: A retrospective evaluation was performed of 13 patients surgically treated for acute Type III AC joint dislocation with the percutaneous double-button fixation method. The coracoclavicular (CC) distance of the affected side was compared with that of the healthy side on anterior-posterior radiographs obtained at the final follow-up. In the functional evaluation, Disabilities of the Arm, Shoulder and Hand (DASH), Constant, and visual analog scale (VAS) scores were used.
Results: The 13 patients in the study included 12 males and 1 female with a mean age of 43.4 years (range: 22–60 years). The mean follow-up period was 13.61 months (range: 9–24 months). The mean CC distance on the operated side was 9.23 mm (range: 8–15 mm), and when compared with the healthy side, no statistically significant difference was observed. Preoperative Constant scores of a mean of 30.3 (range: 18–42) increased to 84.4 (range: 70–90) at the final follow-up. Preoperative DASH scores had a mean of 14.1 (range: 11–28) and decreased to 0.4 (range: 0–3) at the final followup (p<0.001). Mean preoperative VAS score was 6.0 (range: 5–8), which decreased to 0.6 (range: 0–3) at the final follow-up (p<0.001).
Conclusion: The percutaneous double-button fixation technique is a safe, practical, and effective fixation method that can be used as an alternative to arthroscopic and open methods for acute Type III AC joint dislocations.

Keywords

Acromioclavicular joint, dislocation, double-button fixation, percutaneous

References

• Mazzocca AD, Arciero RA, Bicos J. Evaluation and treat- ment of acromioclavicular joint injuries. Am J Sports Med 2007;35:316–29.
• Pauly S, Kraus N, Greiner S, Scheibel M. Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities. J Shoulder Elbow Surg 2013;22:760–6.
• Oki S, Matsumura N, Iwamoto W, Ikegami H, Kiriyama Y, Ta Olgu no 1 2 3 4 5 6 7 8 9 10 11 *12 13 Mean *A Nakamura T, et al. The function of the acromioclavicu- lar and coracoclavicular ligaments in shoulder motion: a whole-cadaver study. Am J Sports Med 2012;40:2617–26.
• Tischer T, Salzmann GM, El-Azab H, Vogt S, Imhoff AB. Incidence of associated injuries with acute acromioclavicu- lar joint dislocations types III through V. Am J Sports Med 2009;37:136–9.
• Rockwood CA Jr. Injuries to the acromioclavicular joint. In: Rockwood CA Jr, Green DP, editors. Fractures in adults. Vol. 1, 2nd ed. Philadelphia: JB Lippincott; 1984. p. 860–910, 974–82.
• Collins DN. Disorders of the acromioclavicular joint. In: Rockwood CA Jr, Matsen FA III, Wirth MA, Lippitt SB, Fehringer EV, Sperling JW, editors. The shoulder. Vol. 4, 4th ed. Philadelphia: Saunders Elsevier 2009. p. 453–526.
• Smith TO, Chester R, Pearse EO, Hing CB. Operative ver- sus non-operative management following Rockwood grade III acromioclavicular separation: a meta-analysis of the current evidence base. J Orthop Traumatol 2011;12:19– 27.
• Rawes ML, Dias JJ. Long-term results of conservative treatment for acromioclavicular dislocation. J Bone Joint Surg Br 1996;78:410–2.
• Wojtys EM, Nelson G. Conservative treatment of Grade III acromioclavicular dislocations. Clin Orthop Relat Res 1991;268:112–9.
• Schlegel TF, Burks RT, Marcus RL, Dunn HK. A prospec- tive evaluation of untreated acute grade III acromioclavicu- lar separations. Am J Sports Med 2001;29:699–703.
• Glick JM, Milburn LJ, Haggerty JF, Nishimoto D. Dislo- cated acromioclavicular joint: follow-up study of 35 unre- duced acromioclavicular dislocations. Am J Sports Med 1977;5:264–70.
• Gstettner C, Tauber M, Hitzl W, Resch H. Rockwood type III acromioclavicular dislocation: surgical versus conserva- tive treatment. J Shoulder Elbow Surg 2008;17:220–5.
• Nadarajah R, Mahaluxmivala J, Amin A, Goodier DW. Clavicular hook-plate: complications of retaining the im- plant. Injury 2005;36:681–3.
• Press J, Zuckerman JD, Gallagher M, Cuomo F. Treat- ment of grade III acromioclavicular separations. Opera- tive versus nonoperative management. Bull Hosp Jt Dis 1997;56:77–83.
• Bradley JP, Elkousy H. Decision making: operative versus nonoperative treatment of acromioclavicular joint injuries. Clin Sports Med 2003;22:277–90.
• Ceccarelli E, Bondì R, Alviti F, Garofalo R, Miulli F, Padua R. Treatment of acute grade III acromioclavicular disloca- tion: a lack of evidence. J Orthop Traumatol 2008;9:105–8.
• Larsen E, Bjerg-Nielsen A, Christensen P. Conservative or surgical treatment of acromioclavicular dislocation. A pro- spective, controlled, randomized study. J Bone Joint Surg Am 1986;68:552–5.
• Balke M, Schneider MM, Akoto R, Bäthis H, Bouillon B, Banerjee M. Acute acromioclavicular joint injuries : Changes in diagnosis and therapy over the last 10 years. [Article in German] Unfallchirurg 2014. [Epub ahead of print] [Abstract]
• Wellmann M, Zantop T, Petersen W. Minimally invasive coracoclavicular ligament augmentation with a flip button/ polydioxanone repair for treatment of total acromioclavic- ular joint dislocation. Arthroscopy 2007;23:1132.e1–5.
• Glanzmann MC, Buchmann S, Audigé L, Kolling C, Flury M. Clinical and radiographical results after double flip button stabilization of acute grade III and IV acromio- clavicular joint separations. Arch Orthop Trauma Surg 2013;133:1699–707.
• Beris A, Lykissas M, Kostas-Agnantis I, Vekris M, Mit- sionis G, Korompilias A. Management of acute acromio- clavicular joint dislocation with a double-button fixation system. Injury 2013;44:288–92.
• Defoort S, Verborgt O. Functional and radiological out- come after arthroscopic and open acromioclavicular stabi- lization using a double-button fixation system. Acta Or- thop Belg 2010;76:585–91.
• Murena L, Vulcano E, Ratti C, Cecconello L, Rolla PR, Surace MF. Arthroscopic treatment of acute acromiocla- vicular joint dislocation with double flip button. Knee Surg Sports Traumatol Arthrosc 2009;17:1511–5.
• Esenyel CZ, Oztürk K, Bülbül M, Ayanoğlu S, Ceylan HH. Coracoclavicular ligament repair and screw fixation in acromioclavicular dislocations. Acta Orthop Traumatol Turc 2010;44:194–8.
• Li BC, Zhang M, Shi D, Yang ZX, Zhu CM. Postopera- tive complications of acromioclavicular joint dislocation of Tossy III. [Article in Chinese] Zhongguo Gu Shang 2009;22:95–7. [Abstract]
• El Sallakh SA. Evaluation of arthroscopic stabilization of acute acromioclavicular joint dislocation using the Tight- Rope system. Orthopedics 2012;35:18–22.