Akromiyoklaviküler Eklem Çıkığı Tedavisinde Klavikula Hook Plak Tekniği ve Fonksiyonel Sonuçları

Year 2019, Volume: 3 Issue: 3, 226 - 230, 26.10.2019

İbrahim Etli , Ömer Faruk Kılıçaslan

https://doi.org/10.30565/medalanya.569893

Abstract

Amaç: Bu çalışmada, akromiyoklaviküler eklem (AKE) çıkığı olan ve Kanca plak (HP) ile cerrahi olarak tedavi edilen hastaların fonksiyonel sonuçlarının değerlendirilmesi amaçlanmıştır. 

Hastalar ve Yöntem: Çalışmaya 2016-2018 yılları arasında AKE çıkığı olan ve cerrahi olarak klavikula KP tekniği ile tedavi edilen hastalar çalışmaya alındı. 19 hastadan 17’si erkek ve 2’si kadındı. Hastaların 13’ünde Rockwood Tip IV, 6’sında Rockwood Tip V eklem çıkığı vardı.Fonksiyonel sonuçlar Modifiye Constant-Murley omuz skoru ve standart test protokolü ile değerlendirildi. Veri analizinde, tanımlayıcı istatistikler kullanıldı. 

Bulgular: Hastaların 1’inde şiddetli ağrı ve hareket kısıtlılığı nedeni ile ameliyat sonrası 10. ayda plak çıkartıldı. Hastaların 2’sinde plak çıkığı oluştu. Diğer hastalarda herhangi bir șikayet olmadı. Hastaların 2’sinde radyografide dejeneratif değişiklikler saptandı. Hastaların ortalama Modifiye Constant-Murley Omuz Skoru 65 (min: 26, max:84) bulundu. Ağrı skoru ortalaması 7’ idi. Olguların 4’ünde 8 şiddetinde, 4’ünde 10 şiddetinde, 2’sinde 12 şiddetinde olmak üzere toplam 10 (%53) hastada orta ve üzeri şiddette ağrı vardı. Hastaların günlük yaşam aktivite puan toplamı ortalama 12 (min:6-max:20) idi. Hastaların fleksiyon ve abduksiyon puanı eksternal rotasyon ve internal rotasyon hareketine göre daha düşük idi. Hastaların toplam hareket puanı ise 27 (min:8-max:36) bulundu. 

Sonuç: AKE çıkığı cerrahi tedavisinde KP yöntemi;erken hareket ve yük verilebilen, cerrahi süresi kısa olan ve uygulanması kolay olan bir yöntemdir. Bununla birlikte orta ve şiddetli düzeyde ağrıya neden olmaktadır. Bu durum fonksiyonel sonuçları etkilemektedir. 

Keywords

Akromiyoklavikuler eklem, çıkık, kanca plak, modifiye Constant-Murley omuz skoru

Clavicle Hook Plate Technique and Functional Results in the Treatment of Acromioclavicular Joint Dislocation

Abstract

Aim: The aim of this study was to evaluate the functional results of patients with acromioclavicular joint (ACJ) dislocation and who were treated surgically with Hook plate (HP) .

Patients and Methods:Patients with ACE dislocation between the years of 2016- 2018 and treated surgically with clavicle KP technique were included in the study. Of the 19 patients, 17 were male and 2 were female. 13 patients had Rockwood Type IV joint dislocation and 6 patients had Rockwood Type V joint dislocation. Functional results were evaluated with modified Constant-Murley shoulder score and standard test protocol. Descriptive statistics were used for data analysis.

Results: The plate was removed at 10 months after the operation due to severe pain and limitation of movement in 1 patient. Two of the patients had plate dislocation. Other patients had no complaints. Degenerative changes were detected in direct radiography in 2 patients. The mean Modified Constant-Murley Shoulder Score of the patients was 65 (min: 26, max: 84). The mean pain score of the patients was 7. Ten (53%) patients had moderate and severe pain. Four of the patients had pain at the severity of 8, 4 of the patients had pain at the severity of 10, and 2 of the patients had pain at the severity of 12. The mean daily life activity score of the patients was 12 (min: 6-max: 20). The flexion and abduction score of the patients were lower than the external rotation and internal rotation. The mean total motion score of the patients was calculated as 27 (min: 8-max: 36).

Conclusion: The HP method in the treatment of ACJ dislocation is early movement and load can be given, surgery is short and easy to apply as a method. However, it causes moderate and severe pain. This may affect functional results. 

Keywords

Acromioclaviculary joint, dislocation, hook plate, modified Constant-Murley sholder score

References

• 1. van Bergen CJA, van Bemmel AF, Alta TDW, van Noort A. New insights in the treatment of acromioclavicular separation. World J Orthop. 2017;8(12):861-73. PMID: 29312844
• 2. North AS, Wilkinson T. Surgical reconstruction of the acromioclavicular joint: Can we identify the optimal approach? Strategies Trauma Limb Reconstr. 2018;13(2):69-74. PMID: 29978445
• 3. Özden R, Uruç V, Duman İG, Doğramacı Y, Kalacı A, Kömürcü E. Endobutton technique for the treatment of acute acromioclavicular joint dislocations. Dicle Medical Journal 2014;41(2):268-271. doi: 10.5798/diclemedj.0921.2014.02.0414
• 4. Baran MA, Dinçel YM,Beytemür O, Çağlar S, Adanır O, Alagöz E. Clavicle Hook Plate Technique and Its Functional Results in the Treatment of Acromioclavicular Joint Dislocation. Kafkas J Med Sci 2015; 5(1):13–17. doi: 10.5505/kjms.2015.02418  
• 5. Athar MS, Ashwood N, Arealis G, Hamlet M, Salt E. Acromioclavicular joint disruptions: A comparison of two surgical approaches 'hook' and 'rope'.J Orthop Surg.2018;26(1):2309499017749984.PMID: 29353523
• 6. Esenyel CZ, Öztürk K, Bülbül M, Ayanoğlu S, Ceylan HH, Öztürk K, Bülbül M, Ayanoğlu S. Akromiyoklaviküler eklem çıkıklarında korakoklaviküler bağ tamiri ve vida ile tespit. Acta Orthop Traumatol Turc 2010;44(3):194-198. PMID: 21088459
• 7. Kienast B, Thietje R, Queitsch C, Gille J, Schulz AP, Meiners J. Mid-term results after operative treatment of rockwood grade III-V acromioclavicular joint dislocations with an AC-hook-plate. Eur J Med Res 2011;16: 52-56. PMID: 21463981
• 8. Modi CS, Beazley J, Zywiel MG, Lawrence TM, Veillette CJ. Controversies relating to the management of acromioclavicular joint dislocations. Bone Joint J 2013; 95-B: 1595-1602. PMID: 24293587
• 9. Jensen G, Ellwein A, Voigt C, Katthagen JC, Lill H .Injuries of the acromioclavicular joint: Hook plate versus arthroscopy. Unfallchirurg. 2015;118(12):1041-53. PMID: 26601846
• 10. Arirachakaran A, Boonard M, Piyapittayanun P, Kanchanatawan W, Chaijenkij K, Prommahachai A, Kongtharvonskul J. Post-operative outcomes and complications of suspensory loop fixation device versus hook plate in acute unstable acromioclavicular joint dislocation: a systematic review and meta-analysis. J Orthop Traumatol 2017;18:293-304. PMID: 28236179
• 11. Canadian Orthopaedic Trauma Society. Multicenter Randomized Clinical Trial of Nonoperative Versus Operative Treatment of Acute Acromio-Clavicular Joint Dislocation. J Orthop Trauma 2015; 29: 479-487. PMID: 26489055
• 12. Aslan A. Systematic Reviews and Meta-Analyses Acta Med. Alanya 2018;2(2):62-63. [Turkish] DOI: 10.30565/medalanya.439541