İbrahim TUNCAY, Ali DOĞAN, Süleyman ALPASLAN

Skafoid psödoartrozlarının tedavisinde Herbert vidası ve Kirschner teliyle tespitin karşılaştırılması

Amaç: Çalışmamızda, otojen spongioz kemik grefti ile birlikte Kirschner teli veya Herbert vidasıyla tespit uygulanan skafoid psödoartrozlu olgularda tedavi sonuçlarını karşılaştırdık. Çalışma planı: Skafoid psödoartrozu nedeniyle tedavi edilen ve en az 12 aylık takipleri tamamlanan 19 erkek olgu (ort. yaş 28, dağılım 20-41) çalışma kapsamına alındı. Otojen spongioz greftleme ardından, 10 olguda Herbert vidasıyla, dokuzunda ise Kirschner teli veya telleriyle tespit uygulandı. Psödoartroz, 15 hastanın sağ elinde, dört hastanın ise sol elinde idi. Travma ile ameliyat arasında geçen süre ortalama 20 ay (3-72 ay) idi. Kırık yeri, 13 hastada (%68) skafoid boynunda, dört olguda (%21) 1/3 proksimal ve iki olguda (%11) 1/3 distalde gözlendi. Ortalama takip süresi Herbert grubunda 16 ay (12-28 ay), Kirschner teli grubunda ise 21 ay (12-56 ay) bulundu. Sonuçlar: Her iki grupta da hiçbir olguda 10$\circ$ ve üzeri hareket kısıtlılığı saptanmadı. Ortalama radyolojik kaynama süresi, Herbert grubunda altı ay (3-20 ay), Kirschner grubunda sekiz ay (4-22 ay) bulundu. Kirschner grubunda tüm olgularda kaynama elde edildi. Herbert grubunda ise, kaynama elde edilemeyen üç olgunun (%30) ikisinde skafoidde proksimal fragman kırığı saptandı. Radyolojik sonuçlar açısından iki grup arasında anlamlı fark saptandı (p

Anahtar Kelimeler:

Kırık tespiti, internal, Ortopedik işlemler, Psödoartroz, Kemik vidaları, Karpal kemikler, El bileği eklemi, Kemik telleri, Kırıklar, kapalı, Cerrahi işlemler, operatif, Yaralar ve yaralanmalar, El bileği, Kemik nakli

Comparison between fixation with Herbert screws and Kirschner wires in the treatment of scaphoid pseudoarthrosis

Objectives: To compare the treatment results of patients with scaphoid pseudoarthrosis, who were treated by autogenous cancellous bone grafting followed by fixation with Herbert screws or Kirschner wires. Methods: The study included 19 men (mean age 28 years, range 20 to 41 years) who were treated for scaphoid pseudoarthrosis and had a minimum follow-up of 12 months. Treatment was comprised of autogenous cancellous bone grafting and fixation with Herbert screws (n=10) or Kirschner wires (n=9). Fifteen right and four left hands were affected. The mean duration between the traumatic event and surgery was 20 months (range 3 to 72 months). Fractures were localized in the proximal pole (n=4, 21%), waist (n=13, 68%), and in the distal pole (n=2, 11%). The mean follow-up was 16 months for Herbert screws, and 21 months for Kirschner wires. Results: None of the patients exhibited a loss in range of motion of 10° or more. The mean time to union was six months (range 3 to 20 months) with Herbert screws and eight months (range 4 to 22 months) with Kirschner wires. All patients had union with Kirschner wires, whereas non-union occurred in three patients with Herbert screws, two of whom had had proximal pole fractures. Radiologic outcome was significantly different between the two groups (p<0.01). Conclusion: Because of good vascularity and union potential, scaphoid pseudoarthrosis can be successively treated by an appropriate surgical technique using autogenous cancellous grafting independent of fixation materials.

Keywords:

Fracture Fixation, Internal, Orthopedic Procedures, Pseudarthrosis, Bone Screws, Carpal Bones, Wrist Joint, Bone Wires, Fractures, Closed, Surgical Procedures, Operative, Wounds and Injuries, Wrist, Bone Transplantation,

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