Mehmet Uğur ÖZBAYDAR, İlker KERİŞ, MEHMET ALTUN, Okan YALAMAN

Semptomatik mezo-akromiyon cerrahi tedavisinin sonuçları

Amaç: Bulgu veren mezo os akromiyale nedeniyle tedavi edilen hastaların fonksiyonel sonuçları geriye dönük olarak değerlendirildi. Çalışma planı: Konservatif tedaviye yanıt vermeyen, semptomatik os akromiyale tanısıyla ameliyat edilen altı hasta (5 kadın, 1 erkek; ort. yaş 58.5; dağılım 51-64) değerlendirildi. Tüm hastalara internal tespit ve kemik grefti uygulaması yapıldı. Değerlendirmede fizik muayene ve radyografi bulguları ve UCLA (University of California at Los Angeles) skoru göz önüne alındı. Hastaların tümünde subakromiyal sıkışma bulguları vardı ve çeşitli derecelerde rotator manşet yırtığı bulunuyordu. Semptomatik os akromiyale tanısı görüntüleme yöntemleri ve akromiyon üzerinde palpasyonla hassasiyet saptanmasıyla kondu. Akromiyon stabilitesinden şüphe edilen olgularda akromiyon hareketi artroskopiyle incelendi. Tespit materyali olarak, kanüllü vidalar (n=4) veya K-telleri (n=2), serkilaj teli veya erimeyen dikişler kullanıldı. Kemik grefti lokal olarak sağlandı. Ameliyat sonrasında ortalama takip süresi 29 aydı (dağılım 18-35 ay). Sonuçlar: Ameliyat öncesinde 11.8 olarak ölçülen UCLA omuz skoru, ameliyat sonrasında 28.2’ye yükseldi. Dört hastada kaynama elde edildi. Bu hastaların tümünde kanüllü vidalar kullanılmıştı. K-telleri kullanılarak tespit edilen diğer iki hastada ise kaynama elde edilemedi. Çıkarımlar: Semptomatik os akromiyale tedavisinde daha sıkı tespit sağlayan kanüllü vidalar kullanılarak başarılı sonuç alınabilir. Os akromiyalenin semptomatik olup olmadığına karar vermede artroskopik değerlendirme yararlı olabilir.

Anahtar Kelimeler:

Akromiyon, Fonksiyon iyileşmesi, Ağrı ölçümü, Kemik vidaları, Geriyedönük çalışma, Kemik telleri, İnternal fiksatörler, Tedavi sonucu, Omuz sıkışma sendromu

Results of the surgical treatment for symptomatic mesoacromion

Objectives: Functional results of patients who were operated on for symptomatic meso os acromiale were retrospectively evaluated. Methods: The study included six patients (5 females, 1 male; mean age 58.5 years; range 51 to 64 years) who underwent surgical treatment for symptomatic os acromiale following unsuccessful conservative treatment. Internal fixation and bone grafting were performed in all the patients. Evaluations were based on physical assessment, radiographic examination, and the UCLA (University of California at Los Angeles) score. All the patients had symptoms of subacromial impingement accompanied by various degrees of rotator cuff tears. Symptomatic os acromiale was diagnosed by imaging studies and tenderness over the acromion during palpation. In case of suspected stability of the acromion, arthroscopy was performed. Fixation was performed with cannulated screws (n=4) or K-wires (n=2) and a cerclage wire or nonabsorbable sutures. Bone graft was harvested locally. The mean follow-up period was 29 months (range 18 to 35 months). Results: The mean UCLA score increased from a preoperative 11.8 to postoperative 28.2. Union was achieved in four patients in whom cannulated screws were used. Two patients who were fixed with K-wires remained ununited. Conclusion: It is possible to obtain satisfactory results with cannulated screws which probably enable a more rigid fixation in symptomatic os acromiale. Arthroscopic evaluation may be helpful in deciding whether or not os acromiale is symptomatic.

Keywords:

Acromion, Recovery of Function, Pain Measurement, Bone Screws, Retrospective Studies, Bone Wires, Internal Fixators, Treatment Outcome, Shoulder Impingement Syndrome,

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1. Edelson JG, Zuckerman J, Hershkovitz I. Os acromiale: anatomy and surgical implications. J Bone Joint Surg [Br]1993;75:551-5.
2. Warner JJ, Beim GM, Higgins L. The treatment of symptomatic os acromiale. J Bone Joint Surg [Am] 1998;80:1320-6.
3. Peckett WR, Gunther SB, Harper GD, Hughes JS, Sonnabend DH. Internal fixation of symptomatic os acromiale: a series of twenty-six cases. J Shoulder Elbow Surg 2004;13:381-5.
4. Hutchinson MR, Veenstra MA. Arthroscopic decompression of shoulder impingement secondary to Os acromiale. Arthroscopy 1993;9:28-32.
5. Mudge MK, Wood VE, Frykman GK. Rotator cuff tears associated with os acromiale. J Bone Joint Surg [Am] 1984; 66:427-9.
6. Richards RR. Redefining indications and problems of shoulder arthrodesis. In: Warner JP, Iannotti JP, Gerber C, editors. Complex and revision problems in shoulder surgery. Philadelphia: Lippincott-Raven; 1997. p. 319-38.
7. Jehmlich S, Holovacs TF, Warner JP. Treatment of the symptomatic os acromiale. In: Russell FW, Edward VC, editors. Techniques in shoulder & elbow surgery. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 214-8.
8. Cofield RH, Lanzer WL. Pathology of rotator cuff tearing in methods of tendon repair. Orthop Trans 1985;9:42. [Abstract]
9. Magee DJ. Shoulder. In: Orthopedic physical assessment. 3rd ed. Philadelphia: W. B. Saunders; 1997. p. 175-240.
10. Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg [Am] 1986;68:1136-44.
11. Burkhart SS. Os acromiale in a professional tennis player. Am J Sports Med 1992;20:483-4.
12. De Palma AF. Congenital anomalies and variational anatomy of the shoulder. In: Rockwood CA, Matsen FA, Wirth MA, Lippitt SB, editors. The shoulder. 3rd ed. Philadelphia: W. B. Saunders; 2004. p. 94-144.
13. Neer CS. Treatment of non-outlet impingement lesions. In: Shoulder reconstruction. Philadelphia: W. B. Saunders; 1990. p. 138-42.
14. Armengol J, Brittis D, Pollock RG, Flatow EL, Self EB, Bigliani LU. The association of an unfused acromial epiphysis with tears of the rotator cuff: a review of 42 cases. Orthop Trans 1994;17:975-6
15. Osaki M, Kondo M. Rotator cuff tear associated with os acromiale. J Shoulder Elbow Surg 1993;2:S35.
16.Wright RW, Heller MA, Quick DC, Buss DD. Arthroscopic decompression for impingement syndrome secondary to an unstable os acromiale. Arthroscopy 2000;16:595-9.
17. Hertel R, Windisch W, Schuster A, Ballmer FT. Transacromial approach to obtain fusion of unstable os acromiale. J Shoulder Elbow Surg 1998;7:606-9.
18. Satterlee CC. Successful osteosynthesis of an unstable mesoacromion in 6 shoulders: a new technique. J Shoulder Elbow Surg 1999;8:125-9.
19. Ryu RK, Fan RS, Dunbar WH 5th. The treatment of symptomatic os acromiale. Orthopedics 1999;22:325-8.
20. Akpınar S, Demirhan M, Akman S Atalar AC. Os acromiale anatomy and indications (Case report and current concept). [Article in Turkish] Acta Orthop Traumatol Turc 1998;32:69-72.
21. Sener M, Aydin H, Aynaci O. Os acromiale: a rare cause of shoulder impingement syndrome. [Article in Turkish] Acta Orthop Traumatol Turc 2000;34:92-5.