Mehmet Uğur ÖZBAYDAR, Murat TONBUL, MEHMET ALTUN, Okan YALAMAN

Travma sonrası tekrarlayan anterior-inferior glenohumeral instabilitelerin selektif kapsül kaydırma tekniği ile tamiri

Amaç: Travrria sonrası tekrarlayan anterior-inferior gleno-Eumeral instabilite tanısıyla selektif kapsül kaydırma ameliyatı yapılan hastaların fonksiyonel sonuçları değerlendirildi. Çalışma planı: Çalışmada, travma sonrası tekrarlayan anterior-inferior glenohumeral instabilite nedeniyle selektif kapsül kaydırma tekniği uygulanan 16 hasta (15 erkek, 1 kadın; ort. yaş 30; dağılım 25-38 yıl) incelendi. Çıkıklar 14 hastada ciddi, ikisinde hafif travmadan sonra oluşmuştu. Ameliyattan önce ortalama çıkık sayısı 14 (dağılım 4-45) idi. Ameliyattan önce yapılan manyetik rezonans incelemelerinde tüm hastalarda Bankart lezyonu, %20'sinde ise Hill-Sachs lezyonu saptandı. Hastalar, Amerikan Omuz ve Dirsek Cerrahları standart omuz değerlendirme formuna (ASES) ve Rowe Bankart tamiri için skorlama tablosuna göre değerlendirildi. Ameliyattan önce ve sonra tüm hastalarda omzun ön-arka ve aksiller radyografileri çekildi. Eklem hareket açıklığı gonyometre ile, kas güçleri ise manuel olarak ölçüldü. Hastalar ortalama 41 ay (dağılım 21-74 ay süreyle izlendi. İstatistiksel değerlendirmede t-testi kullanıldı. Sonuçlar: Ameliyat öncesi ve sonrası ortalama ASES skorları anlamlı farklılık gösterdi (63.2 ve 95.8; p

Anahtar Kelimeler:

Eklem kapsülü, Çıkıklar, Eklem instabilitesi, Hareket açıklığı, eklem, Omuz eklemi

Treatment of recurrent post-traumatic anterior-inferior glenohumeral instabilities with the selective capsular shift technique

Objectives: We evaluated the functional results of treatment with the selective capsular shift technique in patients with recurrent post-traumatic anterior-inferior glenohumeral instability. Methods: The study included 16 patients (15 males, 1 female; mean age 30 years; range 25 to 38 years) who underwent selective capsular shift operation for recurrent post-traumatic anterior-inferior glenohumeral instability. Dislocations occurred following severe (n=14) or mild (n=2) trauma. Preoperatively, the mean number of dislocations was 14 (range 4 to 45) and magnetic resonance imaging showed a Bankart lesion in all the patients and a Hill-Sachs lesion in 20%. The patients were evaluated according to the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and Rowe's scoring for Bankart repair. Preoperative and postoperative anteroposterior and axillary x-rays were obtained from all the patients. Range of motion was measured with a goniometer and manual muscle strength tests were performed. The mean follow-up was 41 months (range 21 to 74 months). Statistical analysis was made using the t-test. Results: The mean preoperative and postoperative ASES scores differed significantly (63.2 vs 95.8; p<0.05). The mean Rowe score was 92.5 (range 70 to 100). Strength of the infraspinatus, supraspinatus, and subscapularis muscles increased significantly (p<0.05). The results were excellent in 12 patients (75%), good in two patients (12.5%), and fair in two patients. Fifteen patients (93.8%) expressed satisfaction with the operation and results. Conclusion: Addition of the selective capsular shift technique to the Bankart repair procedure improves stability and preserves the range of motion of the glenohumeral joint in patients with anterior-inferior glenohumeral instability accompanied by a Bankart lesion and capsular injury or laxity.

Keywords:

Joint Capsule, Dislocations, Joint Instability, Range of Motion, Articular, Shoulder Joint,

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