Proksimal humerus kırıklarında hemiartroplasti sonuçlarını etkileyen faktörler

Amaç: Proksimal humerus kırıklarında uygulanan hemartroplastilerin sonuçlarını etkileyen faktörleri incelemek. Hastalar ve yöntem: Ortalama 34 ay (8-80 ay) takibi bulunan 38 hasta (20 kadın, 18 erkek; ortalama yaş 60; dağılım 37-83) retrospektif olarak değerlendirildi. Olguların 18’inde Neer tip IV, 16’sında kırıklı çıkık, üçünde tip III, birinde tip II kırık nedeniyle girişim uygulandı. Ameliyat öncesi geçen süre primer olgularda ortalama 12 gün (2 gün-3 ay), dört sekonder olguda 135 gündü (90-180 gün). Klinik sonuçlar, Neer kriterleri, Constant skoru ve elevasyon derecesi ile değerlendirildi. Radyolojik incelemede özellikle tüberkulum majus kaynama durumu ve kemik stoğu dikkate alındı. Humeral offset, lateral glenohumeral offset, protez ile akromion arası mesafe, tuberkulum majusun akromiona ve protez başına uzaklığı gibi mesafelerin ağrı, başarı durumu ve elevasyon derecesi ile ilişkileri incelendi. Sonuçlar: Neer kriterlerine göre 12 olguda çok iyi (%31.5), 12’sinde iyi (%31.5), 13’ünde kötü (%34) ve bir olguda (%2.6) sınırlı fonksiyona göre kötü sonuç alındı. Sekonder olguların hepsinde sonuçlar kötü idi. Constant skoru ortalaması 64 (dağılım 10-98), elevasyon ortalaması 107° (dağılım 30-180°) bulundu. Otuz iki olgu (%84) ağrısız veya hafif ağrılı grupta yer aldı. Yaralanmadan sonra ilk 14 gün içinde ameliyat edilen hastalarda fonksiyonel sonuçlar daha iyi (p=0.001), ağrı yakınmaları daha az (p=0.018) bulundu. Yaş ve kırık tipi ile klinik başarı ve ağrı durumu arasında ilişki saptanmadı. Radyolojik mesafelerden humeral offset’in artışına paralel olarak elevasyon derecesinin arttığı görüldü (p=0.002). En sık komplikasyon olan tüberkulum majus problemlerinin (%52) başarı durumunu olumsuz etkilediği saptandı (p=0.001). Primer olgularda cerrahi tekniğe bağlı komplikasyon oranı %24 idi. Bir sekonder olguda derin enfeksiyon ve bir diğerinde tüberkulum majus lizisi nedeniyle protezin çıkarılması gerekti. Çıkarımlar: Çalışma, ameliyat öncesi geçen süre, daha önce uygulanmış cerrahi girişimler, tüberkulum majusa ait problemler ve humeral offset’in, proksimal humerus kırıklarında hemiartroplasti sonuçlarını etkileyen parametreler olduğunu gösterdi.

Anahtar Kelimeler:

Protezler ve implantlar, Humerus, Artroplasti, Çıkıklar, Omuz kırıkları, Humerus kırıkları

Factors affecting the results of hemiarthroplasty for proximal humerus fractures

Objectives: To investigate the factors influencing the results of prosthetic replacement operations for proximal humerus fractures. Methods: Thirty-eight patients (20 females, 18 males; mean age 60 years; range 37-83 years) were retrospectively evaluated. Fractures were classified as Neer type IV (n=18), fracture-dislocation (n=16), type III (n=3), and type II (n=1). Mean delay for surgery was 12 days (range 2-90 days) for primary cases and 135 days (range 90-180 days) for secondary operations (n=4). Clinical outcomes were evaluated using the Neer criteria, Constant scores and elevation degrees. Radiological parameters were union of the greater tubercle and bone stock. Humeral offset, lateral humeral offset, the prosthesis-acromion distance and the position of the greater tubercle relative to the acromion and the head of the implant were measured and evaluated with respect to pain, general outcome, and elevation degree. Mean follow-up was 34 months (range 8-80 months). Results: According to the Neer criteria, the results were excellent in 12 patients (31.5%), good in 12 (31.5%), poor in 13 (34%) and poor related to limited function in one patient (%2.6). All secondary cases had poor results. Mean Constant score was 64 (range 10-98) and mean elevation was 107¡ (range 30-180¡). Thirty-two patients (84%) had no or mild pain. Patients undergoing surgery within 14 days following injury had better functional results (p=0.001) and less pain (p=0.018). No correlations were found between age, fracture type and clinical success and pain status. A significant positive correlation was found between the humeral offset and the elevation degree (p=0.002). The most common complications were those associated with the greater tubercle (52%), adversely affecting the clinical success (p=0.001). Complications related to surgical technique were observed in %24 of the primary cases. Two secondary cases required removal of the prosthesis for deep infection and lysis of the greater tubercle, respectively. Conclusion: The study showed that preoperative delay, previous surgeries, problems of the greater tubercle and the humeral offset were the parameters affecting the clinical outcome following prosthetic replacement in proximal humeral fractures.

Keywords:

Prostheses and Implants, Humerus, Arthroplasty, Dislocations, Shoulder Fractures, Humeral Fractures,

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