İsmail Bülent Özçelik, Berkan Mersa, Atakan Aydın, Serdar Tunçer, Samet Vasfi Kuvat

TRİANGULAR FİBROKARTİLAJ KOMPLEKS HASARLANMALARI TANI VE TEDAVİSİ; ÖN KLİNİK ÇALIŞMA

Amaç: Triangular fibrokartilaj kompleks (TFK) hasarlanması el bileği ulnar taraf ağrılarının başlıca nedenlerindendir. Bu çalışmada, TFK hasarlanması nedeni ile tedavi edilen hastaların erken dönem sonuçları değerlendirildi. Hastlar ve Metod: Kliniğimizde 2007-2009 yılları arasında 32 adet TFK hasarlanması tedavi edildi. Tüm hastalar direk röntgenogram ve MRG (magnetik rezonans görüntüleme) ile değerlendirildi. Hastaların ortalama şikayet başlama zamanları ile başvuru zamanları arası 14 ay (4-42 ay) idi. Tüm hastalara el bileği artroskopisi uygulandı. TFK hasarlanmaları, Palmer sınıflamasına göre sınıflandırıldı. En sık görülen lezyon tip 1A olup olgu sayısı 19 idi. Olgulardan 1 tanesi tip 1B, 3 tanesi tip 1C, 4 tanesi tip 1D, 5 tanesi tip 2C lezyona sahipti. TFK debridmanı her hastaya uygulandı. Periferik yırtığı olan 1 hastaya dışarıdan içeriye teknik ile sütür atıldı. Distal radioulnar eklem (DRUE) instabilitesi saptanan 7 hasta, artikuler disk debridmanı ve Fulkerson-Watson ekstraartikuler stabilizasyon yöntemi ile tedavi edildi. Ulnar stiloid fraktürü saptanan 2 hastaya artroskopik debridman sonrası açık redüksiyon ve K teli ile fiksasyon uygulandı. Skafolunat (SL) ligaman parsiyel yaralanması saptanan 4 hasta debridman ile tedavi edildi. SL ligaman total hasarlanması saptanan 2 hastaya artroskopik TFK debridmanını takiben 3 ay sonra modifiye Brunelli suturasyon yöntemi ile ligaman rekonstruksiyonu uygulandı. Hastaların ortalama takip süresi 11,6 ay (6-21 ay) idi. Bulgular: Ameliyat öncesi Quick-DASH-T (Disabilities of the Arm, Shoulder and Hand-Türkçe) semptom skorlaması ortalama 24,12 (9,09-52,27 aralığı) iken ameliyat sonrası 6,99 (2,27-25,00 aralığı) saptandı. Ameliyat öncesi visual analog skorlaması (VAS) ortalama 7,24 (4,5 -9,2 aralığı) iken ameliyat sonrası 2,12 ( 0,3 – 5,4 aralığı ) saptandı. Sonuç: TFK hasarlanmalarının distal radioulnar eklem (DRUE) ile birlikte değerlendirilerek tedavi buna göre planlanmalıdır. El bileğinde uygulanan artrokopik tedavi girişimleri ile etkin sonuçlar elde edilebilebilmektedir.

Anahtar Kelimeler:

Triangular fibrokartilaj kompleks, el bileği, tedavi

DIAGNOSIS AND TREATMENT OF TRIANGULAR FIBROCARTILAGE COMPLEX INJURY; A PRELIMINARY CLINICAL STUDY

Objectives: Triangular fibrocartilage complex (TFCC) injury is one of the leading causes for localized persistant pain at the ulnar side of the wrist. Preliminary treatment results of the patients diagnosed with TFCC injury are assessed. Patients and materials: 32 patients with TFCC injury were treated in our department between 2007-2009. All patients were evaluated with direct rontgenogram and MR imaging. Mean time between the onset of symptoms and application to the clinic was noted as 14 (4-42) months. Wrist arthroscopy was performed for each patient. TFCC injury clasified with Palmer clasification. Most of the lesions were type 1A lesions, noted at 19 of the patients. One patient had type 1B lesion, 3 patients had type 1C lesions, 4 patients had type 1D lesions and 5 patients had type 2C lesions. TFCC debridement was used for each patient. One patient with peripheral rupture was treated with suturing in an outside to inside fashion. 7 patients with distal radioulnar joint (DRUJ) instability were treated with articular disc debridement and Fulkerson-Watson extraarticular stabilization method. Two patients with ulnar styloid fractures were treated with open reduction and Kischner wire fixation following arthroscopic debridement. Four patients with partial scapholunate ligament (SL) injury were treated with debridement. Two patients with total SL rupture were treated with arthroscopic TFCC debridement followed by ligament reconstruction with modified Brunelli suturing method three months later. Mean follow-up time was noted as 11,6 months (6-21 months). Results: Mean Quick-DASH-T (Disabilities of the Arm, Shoulder and Hand-Turkish) symptom score was noted as 24,12 (range from 9,09 to 52,17) preoperatively and 6,99 (range from 2,27 to 25) postoperatively. Mean Visual Analog Scoring (VAS) was notes as 7,24 (range from 4,5 to 9,2) and 2,12 (range from 0,3 to 5,4) at the preoperative and postoperative period respectively. Discussion: Injuries of the TFCC should be evaluated together with the distal radioulnar joint (DRUJ), and the treatment should be planned accordingly. Arthroscopic procedures in the wrist yield successful results

Keywords:

Triangular fibrocartilage complex, wrist, treatment,

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