Yusuf GÜRBÜZ, Murat KAYALAR, Emin BAL, Tulgar TOROS, LEVENT KÜÇÜK, Tahir Sadık SÜGÜN

Akut Tip B skafoid kırıklarında dorsal ve volar perkütan vida tespit yöntemlerinin karşılaştırılması

Amaç: Çal›flmam›zda dorsal ve volar perkütan tespit yöntemiyle tedavi edilen akut skafoid k›r›kl› has- talarda klinik ve fonksiyonel sonuçlar›n karfl›laflt›r›lmas› amaçlanm›flt›r. Çal›flma plan›: 2000-2009 y›llar› aras›nda perkütan vida tespiti tekni¤iyle ameliyat edilen 26 hastan›n (24 erkek, 2 kad›n; ortalama yafl: 33.1) 27 akut skafoid k›r›¤› geriye dönük olarak de¤erlendirildi. K›- r›klardan 13’ü dorsal giriflim grubunda, 14’ü ise volar giriflim grubunda yer ald›. Hastalar›n el bile¤i splinti ameliyattan 10 gün sonra ç›kart›larak el bile¤i egzersizlerine baflland›. Çimdikleme ve kavrama güçleri, eklem hareket genifllikleri ölçümleri karfl› bileklerle karfl›laflt›r›larak de¤erlendirildi. Fonksiyo- nel de¤erlendirme için hasta merkezli el bile¤i de¤erlendirmesi (HMED) ve Mayo el bile¤i skorlama sistemi kullan›ld›. Bulgular: Herbert ve Fisher s›n›fland›rmas›na göre dorsal yaklafl›m grubundaki hastalar›n 9’u B2, 3’ü B3, 1’i B1; volar yaklafl›m grubundaki hastalar›n 12’si B2 ve 2’si B1 tipi k›r›¤a sahipti. Çal›flma içinde de¤erlendirilen tüm k›r›klar kaynad›. Fonksiyonel ve klinik sonuçlar›n gruplar aras› karfl›laflt›rmas›nda istatistiksel olarak anlaml› bir farka rastlanmad› (p>0.05). Hastalar yaralanma öncesi ifllerine ortalama 4.2 hafta içinde döndüler ve bu sürelerin karfl›laflt›r›lmas›nda da iki grup aras›nda anlaml› bir fark yok- tu (p=0.437). Karfl› tarafla karfl›laflt›r›ld›¤›nda her iki grupta da bilek fleksiyon derecelerinde istatistik- sel olarak anlaml› fark saptand› (p=0.009). Bir hastada lokal a¤r› nedeniyle vida ç›kar›l›rken, bir hasta- da skafotrapezoid eklemde asemptomatik vida bafl› ç›k›m› vard›. Ç›kar›mlar: B tipi skafoid k›r›klar›n›n perkütan vida tespitinde cerrahi yaklafl›m metodundaki farkl›l›k klinik ve fonksiyonel sonuçlar› etkilememektedir. Perkütan tespit erken eklem hareketine izin veren ve hasta memnuniyeti sa¤layan, güvenle uygulanabilecek tedavi yöntemlerinden biridir.

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