Mustafa YEL, Aydın KARABACAKOĞLU, Serdar KARAKÖSE, Mehmet ARAZİ, Ömer AKÇALI

Glenohumeral instabilitelerde pnömoartro-bilgisayarlı tomografi

Amaç: Travmatik, tek yönlü glenohumeral (GH) instabilitelerdeki kemik ve yumuşak doku değişikliklerini radyografi, bilgisayarlı tomografi (BT) ve pnömoartro-BT (PA-BT) ile incelemek ve artroskopi veya artrotomi bulgularıyla karşılaştırarak doğruluk oranlarını belirlemek. Çalışma planı: Glenohumeral instabilite saptanan ve cerrahi olarak tedavi edilen 20 hastanın (19 erkek, 1 kadın; ort. yaş 23.4; dağılım 17-41) omuz radyografileri, BT ve PA-BT incelemeleri değerlendirildi. Radyografi, BT ve PA-BT ile belirlenen kemik lezyonları ve yumuşak doku değişiklikleri, omuz artroskopi veya artrotomi bulgularıyla karşılaştırıldı; bu yöntemlerin tanıdaki etkinlikleri ve doğruluk oranları belirlendi. Sonuçlar: Kemik lezyonlarında artroskopi bulguları ile radyografi, BT, PA-BT bulguları karşılaştırıldığında, doğruluk oranları glenoid köşe kırığında radyografide %11.1 1/9), BT'de %100 (9/9), PA-BT'de %100 (9/9); Hill-Sachs lezyonunda sırasıyla %42.9 (3/7), %71.4 (5/7) ve %71.4 5/7) bulundu. Yumuşak doku lezyonlarında artroskopi bulguları ile PA-BT bulguları karşılaştırıldığında PA-BT' nin doğruluk oranı Bankart lezyonunda %81.8 (9/11), anterior kapsüler bollaşmada %95 (19/20) olarak belirlendi. Çıkarımlar: invaziv bir yöntem olmasına rağmen, PABT incelemesinin GH instabilitelerdeki kemik ve yumuşak doku değişikliklerini belirlemede başarılı ve ucuz bir görüntüleme yöntemi olduğu sonucuna varıldı.

Anahtar Kelimeler:

Artrografi, Artroskopi, Humerus, Eklem instabilitesi, Omuz çıkığı, Omuz eklemi, Tomografi, x-ışınlı bilgisayarlı

The role of pneumoarthro-computed tomography in glenohumeral instabilities

Objectives: To determine the accuracy of x-ray, computed tomography (CT), and pneumoarthro-CT (PA-CT) in correlation with arthroscopy or arthrotomy findings in bone and soft tissue changes of traumatic anterior glenohumeral (GH) instabilities. Methods: The study included 20 patients (19 males, 1 female; mean age 23.4 years; range 17 to 41 years) who underwent surgery for recurrent shoulder dislocations. Shoulder x-ray, CT, and PA-CT examinations were performed in all patients. Bone lesions and soft tissue changes detected by these examinations were compared with arthroscopy or arthrotomy findings and the efficiency and accuracy of these methods were determined. Results: Findings from x-ray, CT, and PA-CT were compared with those of arthroscopy. In bone lesions, the accuracy rates for x-ray, CT, and PA-CT were 11.1% (1/9), 100% (9/9), and 100% (9/9) for glenoid rim fractures; 42.9% (3/7), 71.4% (5/7), and 71.4% (5/7) for Hill-Sachs lesion of the humeral head, respectively. In soft tissue lesions, the accuracy of PA-CT was found as 81.8% (9/11) for Bankart lesions, and 95% (19/20) for anterior capsular ballooning. Conclusion: Albeit invasive, PA-CT seems to be a reliable, accurate, and cheap diagnostic imaging modality in determining bone lesions and soft tissue changes in GH instabilities.

Keywords:

Arthrography, Arthroscopy, Humerus, Joint Instability, Shoulder Dislocation, Shoulder Joint, Tomography, X-Ray Computed,

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