Skafolunat instabilite tedavisinde farklı tenodez yöntemlerinin karşılaştırılması: Kadavra çalışması
Küçük Resim Yok
Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Skafolunat instabilite en sık karpal instabilite sebebidir. Bu instabilite tedavi edilmediğinde, karpal kemikler arasındaki mekanik ilişki kalıcı olarak bozulur ve radyokarpal ve midkarpal eklemlerde ilerleyici dejeneratif değişiklikler ile sonuçlanır. Henüz artrit gelişmemiş, skafolunat bağın onarıalamadığı, akut veya erken kronik yerine oturtulabilir skafolunat instabilite tedavisinde farklı tenodez yöntemleri kullanılmaktadır. Bu yöntemlerle klinik çalışmalarda erken dönemde ağrının azaldığı bildirilse de radyolojik sonuçlar, çalışmalar arasında farklılıklar göstermektedir. Bu radyolojik parametrelerin bozulması daha önce belirtildiği gibi el bilek osteoartriti ile ilişkilidir. Dolayısıyla el bilek biyomekaniğini daha iyi düzeltecek ve daha uzun süre kalıcı olacak tenodez yönteminin belirlenmesi için daha fazla çalışmaya ihtiyaç duyulmaktadır. Çalışmamızda, kadavra el bileklerinde, 2 yeni tenodez yöntemi olan spiral antipronasyon tenodezi ile anatomic ön ve arka rekonstrüksiyonunun (anatomic front and back reconstruction: ANAFAB), yaygın kullanılan bir yöntem olan üçlü ligament tenodezi (TLT; tri-ligament-tenodesis) ile radyolojik olarak karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Çalışma, 8 adet önkol, 9 adet dirsek eklem seviyesinden el parmak ucuna kadar olan toplam 17 adet taze donmuş kadavra örnekleri üzerinde gerçekleştirilmiştir.
Örnekler 3 farklı skafolunat instabilite tedavi yöntemi uygulanan gruplara rastgele dağıtılmıştır. Bunlar TLT (n: 6), spiral antipronasyon tenodezi (n: 6, 1 örnek çalışma dışı bırakılmıştır.) ve ANAFAB tenodezi (n: 5) gruplarıdır. Bütün örneklerde, skafolunat instabilite oluşturmak için SLİL, DCSS, STT, DİC, RSC ve LRL bağlar aynı şekilde kesilmiştir. Örneklere sağlam durumda, bağlar kesildikten sonra, rekonstrüksiyon yapıldıktan sonra ve hareket döngüsü sonrası olmak üzere 4 farklı durumda el bilek BT’ si çekilmiştir. Bu 4 durumun hepsinde el bilek BT’ leri 6 farklı el bilek pozisyonunda çekilmiştir. Tomografi görüntüleri üzerinden her durum ve her pozisyon için; Skafolunat (SL) mesafe, Skafolunat (SL) açı, Radyoskafoid (RS) açı, Radyolunat (RL) açı, Kapitolunat (CL) açı, Dorsal skafoid translasyonu (Dt) ölçümleri yapılmıştır. Bulgular: ANAFAB tenodez yönteminin, birçok değişkende, diğer yöntemlere göre daha çok düzelme sağlamış ve örnekleri sağlam durumlarına daha çok yaklaştırmıştır. Bu bulgu farklı pozisyonlarda birçok açı değişkeninde izlenmiştir. Antipronasyon tenodezinde ise bazı değişkenlerde, nötral pozisyonda TLT’ ye göre daha iyi sonuçlar kaydedilse de fleksiyon, radyal deviasyon ve yumruk sıkma gibi skafoidi fleksiyona zorlayan yüklenmeli pozisyonlarda sağlam duruma dönüş bozulmuştur.
Sonuç: Çok sayıda ikincil stabilizatörün yaralandığı ileri derecede skafolunat instabilite varlığında, ANAFAB tenodez yöntemi, klasik yöntem olan TLT tenodezine tercih edilebilir. Daha önce bu yaralanmalar için tanımlanan spiral antipronasyon tenodezinin sonuçları TLT’ ye benzer bulunmuştur.
Objective: Scapholunate instability is the most common cause of carpal instability. When this instability is left untreated, the mechanical relationship between the carpal bones is permanently disrupted, resulting in progressive degenerative changes in the radiocarpal and midcarpal joints. Different tenodesis methods are used in the treatment of acute or early chronic reducible scapholunate instability, where arthritis has not developed yet and the scapholunate ligament cannot be repaired. Although it has been reported that pain is reduced in the early follow up in clinical studies with these methods, radiological results differ between studies. The deterioration of these radiological parameters is associated with wrist osteoarthritis as previously stated. Therefore, more studies are needed to determine the tenodesis method that will improve the wrist biomechanics better and will last longer. In our study, two new tenodesis methods, spiral antipronation tenodesis, and anatomic front and back reconstruction (ANAFAB) were radiologically compared with triple ligament tenodesis (TLT; tri-ligament- tenodesis), in the cadaver wrists Materials and Methods: The study was carried out on a total of 17 fresh frozen cadaver specimens from 8 forearm and 9 elbow joints to the fingertips. Samples were randomly allocated to the groups treated with 3 different scapholunate instability treatment methods. These are TLT (n: 6), spiral antipronation tenodesis (n: 6, 1 sample was excluded) and ANAFAB tenodesis (n: 5) groups. In all examples, SLIL, DCSS, STT, DIC, RSC and LRL ligaments were cut in the same way to create scapholunate instability. Wrist CT scans were taken on the samples in 4 different situations, in intact condition, after the ligaments were cut, after the reconstruction and after the movement cycle. In all of these 4 cases, wrist CTs were taken in 6 different wrist positions. For every situation and every position through tomography images; Scapholunate (SL) distance, Scapholunate (SL) angle, Radioscaphoid (RS) angle, Radiolunate (RL) angle, Capitolunate (CL) angle, Dorsal scaphoid translation (Dt) measurements were made. Results: The ANAFAB tenodesis method provided more improvement in many variables compared to other methods and brought it closer to the healthy condition. This finding was observed in many angle variables in different positions. In antipronation tenodesis, although in some variables, better results are recorded in the neutral position compared to TLT, returning to the intact state is impaired in loaded positions such as flexion, radial deviation and clenching fist, which force the scaphoid to flexion. Conclusion: In the presence of severe scapholunate instability in which a several number of secondary stabilizers are injured, the ANAFAB tenodesis method may be preferred to the classical method, TLT tenodesis. The results of spiral antipronation tenodesis previously defined for these injuries were found to be similar to TLT.
Objective: Scapholunate instability is the most common cause of carpal instability. When this instability is left untreated, the mechanical relationship between the carpal bones is permanently disrupted, resulting in progressive degenerative changes in the radiocarpal and midcarpal joints. Different tenodesis methods are used in the treatment of acute or early chronic reducible scapholunate instability, where arthritis has not developed yet and the scapholunate ligament cannot be repaired. Although it has been reported that pain is reduced in the early follow up in clinical studies with these methods, radiological results differ between studies. The deterioration of these radiological parameters is associated with wrist osteoarthritis as previously stated. Therefore, more studies are needed to determine the tenodesis method that will improve the wrist biomechanics better and will last longer. In our study, two new tenodesis methods, spiral antipronation tenodesis, and anatomic front and back reconstruction (ANAFAB) were radiologically compared with triple ligament tenodesis (TLT; tri-ligament- tenodesis), in the cadaver wrists Materials and Methods: The study was carried out on a total of 17 fresh frozen cadaver specimens from 8 forearm and 9 elbow joints to the fingertips. Samples were randomly allocated to the groups treated with 3 different scapholunate instability treatment methods. These are TLT (n: 6), spiral antipronation tenodesis (n: 6, 1 sample was excluded) and ANAFAB tenodesis (n: 5) groups. In all examples, SLIL, DCSS, STT, DIC, RSC and LRL ligaments were cut in the same way to create scapholunate instability. Wrist CT scans were taken on the samples in 4 different situations, in intact condition, after the ligaments were cut, after the reconstruction and after the movement cycle. In all of these 4 cases, wrist CTs were taken in 6 different wrist positions. For every situation and every position through tomography images; Scapholunate (SL) distance, Scapholunate (SL) angle, Radioscaphoid (RS) angle, Radiolunate (RL) angle, Capitolunate (CL) angle, Dorsal scaphoid translation (Dt) measurements were made. Results: The ANAFAB tenodesis method provided more improvement in many variables compared to other methods and brought it closer to the healthy condition. This finding was observed in many angle variables in different positions. In antipronation tenodesis, although in some variables, better results are recorded in the neutral position compared to TLT, returning to the intact state is impaired in loaded positions such as flexion, radial deviation and clenching fist, which force the scaphoid to flexion. Conclusion: In the presence of severe scapholunate instability in which a several number of secondary stabilizers are injured, the ANAFAB tenodesis method may be preferred to the classical method, TLT tenodesis. The results of spiral antipronation tenodesis previously defined for these injuries were found to be similar to TLT.
Açıklama
Anahtar Kelimeler
Skafolunat, İnstabilite, Kadavra, Tenodez, Scapholunate, Instability, Cadaver, Tenodesis
