Onur GÜRSAN, Mustafa ÖZKAN, Ahmet Emrah ACAN

Omuz Hemiartroplastisinde Proksimal Humerus Restorasyonunun Radyolojik Analizi ve Fonksiyonel Sonuçlar

Glenohumeral ofset, subakromiyal boşluk, tüberküllerinvertikal ve horizontal plandaki ölçümleri ve yağlıinfiltrasyonun evreleri gibi radyolojik parametreler, omuz artroplastisinde, proksimalhumerusun restorasyonu incelenirken kullanılır.Bu çalışma, hemiartroplasti sonrası hangi radyolojik parametrelerin fonksiyonel sonuçlarla daha uyumlu olduğunu belirlemek için tasarlanmıştır. 2002-2010 yılları arasında proksimalhumerus kırıkları nedeniyle hemiartroplasti ile tedavi edilen ve postoperatif bilgisayarlı tomografi (BT) taramaları olan 25 hasta değerlendirildi. Protez başın son pozisyonu, tüberküllerin restorasyonu ve supraspinatus kasının yağlı infiltrasyonuradyolojik olarak analiz edildi. Fonksiyonel değerlendirmede, Amerikan Omuz ve Dirsek Topluluğu (ASES) Skoru, Constant-Murley skoru, DASH (kol,omuz ve elkısıtlılık indeksi) skoru kullanılmıştır. Yaş aralıkları 52-84 yaş arası değişen hastaların ortalama ASES, Constant-Murley ve DASH indeks skorları sırasıyla 70, 66 ve 23 idi. Normal retroversiyona sahip protezi olan hasta grubu daha yüksek Constant-Murley ve daha düşük DASH indeks skorlarına sahipti (p<0.05). BT taramalarında 0 ila 5 mm horizontalmalpozisyonu bulunan grup daha iyi klinik sonuçlara sahipti (p<0.05).Evre 0 yağlı infiltrasyonbulunan hasta grubunda daha iyi klinik sonuçlar not edildi (p<0.05). Hemiartroplasti, proksimalhumerus kırıklarında önemli bir tedavi seçeneği olmaya devam etmektedir. Proksimalhumerus anatomisine daha yakın restorasyon elde etmek ile birlikte yağlı infiltrasyonunevresi, başarılı bir fonksiyonel sonuçta önemli bir rol oynamaktadır.

Anahtar Kelimeler:

Hemiartroplasti, Proksimal Humerus Kırığı, Yağlı İnfiltrasyon

Radiological Analysis of Proximal Humerus Restoration and Functional Outcome in Shoulder Hemiarthroplasty

In shoulder hemiarthroplasty, the glenohumeral offset, subacromial gap, vertical and horizontal measurements of tuberosities, and stage of fatty infiltration are some of the radiological parameters that evaluate the restoration of proximal humerus. This study was designed to determine which radiological parameters are more compatible with functional results after hemiarthroplasty. Twenty-five patients, who were treated between 2002 and 2010 for proximal humerus fractures with hemiarthroplasty and had post-operative computed tomography (CT) scans, were evaluated. The final position of the prosthetic head, tuberculum restoration, and fatty degeneration of the supraspinatus muscle were analysed radiologically. The American Shoulder and Elbow Society (ASES) score, Constant–Murley score, Disabilities of the Arm, Shoulder, and Hand (DASH) index score were used to determine functional performance. The mean ASES, Constant–Murley, and DASH index scores of patients aged 52 to 84 years were 70, 66, and 23, respectively. The patient group with a normal retroverted prothesis had higher Constant–Murley and lower DASH index scores (p<0.05). The group with 0 to 5 mm horizontal malpositioning in CT scans had better clinical outcomes (p<0.05). Better clinical outcomes were noted in the stage 0 fatty infiltration group (p<0.05). Hemiarthroplasty remains an important treatment option in proximal humerus fractures. In collaboration with achieving closer restoration to proximal humerus anatomy, the stage of fatty degeneration plays an important role in a successful functional result.

Keywords:

Fatty Infiltration, Hemiarthroplasty, Proximal Humerus Fracture,

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