Ön kol seviyesi arter yaralanmalarının fonksiyonel sonuçları
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Dosyalar
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve amaç: Bu çalışmada, ön kol seviyesindeki arter yaralanmalarının eşlik ettiği laserasyonlar araştırılmıştır. Arterial dolaşım antekübital fossadan itibaren çatallanarak Radial ve Ulnar arterlere ve bu alandaki çeşitli arter kısımlarından köken alan interossöz dallara ayrılır. Palmar seviyedeyse, yüzeyel ve derin arkus meydana geldiğinden tek arter yaralanmasında el dolaşımında anlamlı etkilenme meydana gelmez, fakat her iki ana arter kesilirse el dolaşımı bozulabilir. Çalışmamızda tek arterin tutulduğu yaralanmalarda meydana gelen klinik ve fonksiyonel sonuçlar irdelendi. Çalışmamız tanımlayıcı vasıfta olup belli bir yönü bulunmamaktaydı. Gereç ve yöntem: Kliniğimizde opere edilmiş tek arteri kesilen ön kol yaralanmalı olgulardan en az 1 yıllık takibini doldurmuş en güncelden geriye doğru 108 uygun olgu tarandı ve güncel muayene için hastaneye davet edildi. 38 olgu katılımı sağlanabildi. En sık yaralanma şekli cam kesisi (%62), sonra elektrikli testere (%26) kaydedildi. Bu hastalara sübjektif formlar doldurulduktan sonra manuel doppler ve Allen testi ile dolaşım, 2 nokta ayrımı ve Weinstein monofiaman testi ile duyu, el ve pinçgrip dinamometre cihazları ile kuvvet muayenesi ve ardından eldeki sıcaklık dağılımını öğrenmek için kızılötesi temelli cihazla yüzeysel sıcaklık ölçümü uygulandı. Elde edilen değerler istatistiksel analize tabi tutuldu; bu amaçla SPSS 25® uygulaması kullanıldı, CI (güven aralığı) %95 kabul edildi, p< .05 değerler anlamlı kabul edildi. Bulgular: Olguların çoğunluğu baskın olan sağ tarafını (%68,4) yaralamış erkeklerden (%92,6) oluşmaktaydı. Median yaş 34,5(10-82) olarak kaydedildi. Cama yumruk atma (n=62, %57,4) anlamlı bir biçimde (p<0,05) çoğunluğu oluşturmakta ve istatistiksel açıdan anlamlı (p<0,05) düzeyde daha iyi ve bunun aksine elektrikli alet yaralanmaları anlamlı biçimde (p<0,05) daha kötü klinik sonuçlar (QDASH) sergilemekteydi. Yaralanma şiddeti (MHISS) skorları ulnar arteri (UA) yaralanmış olgular için anlamlı (p<0,05) biçimde daha yüksek prezante olmakta ve bu olgularda ulnar sinir (UN) yaralanması anlamlı bir şekilde (p<0,001) eşlik etmekte ve bu sinirin yaralanması klinik sonuçları etkileyen en anlamlı (p<0,05) parametre olarak karşımıza çıkmaktaydı. Vakaların arter patens oranı 27/38 (%71) literatürle korele bir sonuçtu.Arter patensi sigara (n=22, %57,8 içici) ile anlamlı bir ilişki sergilememekte, fakat kötü klinik sonuçlar anlamlı bir biçimde (p<0,05) sigarayla ilintiliydi. Sonuç: Çalışmamızda irdelenen olguların çoğunluğu önlenebilen travma etyopatogenezine sahipti. Çok ciddi yaralanma şekilleri hariç olguların tamamına yakını belli bir süre içerisinde işine/eski hayatına (%86,8) belli sekel oranıyla da olsa dönmüştü. Sonuç olarak; sadece cerrahi anlamda değil, bu popülasyonla profesyonel olarak uğraşmak ciddi sabır ve sağduyu gerektirmektedir. Psikiyatrik sorunların etkin biçimde çözümü ve elektrikli aletlerin daha dikkatli kullanımı bu vakaların anlamlı olarak azalmasını sağlayabilir. Sonuç olarak; olgular yeterli tedavi aldıklarından tatminkar klinik sonuçlar ortaya konabilmiştir.
Introduction: This study focuses on forearm injuries associated with arterial lacerations. Arterial vasculature originates from antecubital fossa and bifurcates into Radial & Ulnar arteries as well as interosseous variational branches attending major branches above this zone. These arteries unite into superficial and deep arches at the palmar level which backs up the hand in case of a single forearm arterial injury, yet both arterial lacerations may impair proper circulation of the hand. Single arterial injuries of the forearm were assessed according to clinical and functional outcomes. We conducted a descriptive study which neglected timeline direction. Material & method: 108 consecutive, minimum 1-year followed-up, singe artery lacerated forearm injuries operated in our clinic were assessed retrospectively and were summoned for a clinical visit in which only 38 cases attended. Most common injury type was glass cut (62%), followed by power saw injury (26%). After cases were asked to fill subjective questionnaires, hand circulation via handheld doppler and Allen’s test, hand sensation via two-point discrimination and Weinstein’s monofilament test, handgrip via hand dynamometer and pinch grip tests and finally thermodistribution via thermal camera device were assessed. Results were analyzed statistically via SPSS 25® with a CI of 95% and outcomes p <, 05 admitted as significant. Results: Majority of cases consisted of right-handed (68,4%) men (92,6%) with the same hand affected. The median age was 34,5 (10-82). Punching glass had a significantly (p<0,05) greater rate (n=62, 57,4%) among all causes which exhibited significantly better clinical results (QDASH), on the other hand, power-tools injuries manifested significantly worse clinical results in statistical terms. Cases associated with Ulnar artery (UA) lacerations were introduced to our hospital with significantly (p<0,05) more severe injuries (according to MHISS), which appeared to be significantly (p<0,001) associated with the Ulnar nerve lesion where UN lesion appeared to be the most significant (p<0,05) parameter affecting clinical outcomes. Patency rates for artery repairs were 27/38 (71%) correlated with the literature. Arterial patency didn’t demonstrate a significant association with tobacco consumption (n=22, 57,8% smoker), yet worse clinical scores were significantly (p<0,05) explained by it. Conclusion: Most of our cases appeared to be having preventable trauma etiopathogenesis. Practically every individual (total 86,8%) returned back to former work or lifestyle with acceptable sequellae rates within variable periods of time, except those with major injury types. After all, coping this population demands tremendous professional tolerance and empathy, yet not only in terms of surgical challenge. An effective solution to psychiatric issues and more precise usage of power tools may lead to a major decrease in the amount of these cases. Eventually; adequate treatment of the patients lead to satisfactory clinical outcomes.
Introduction: This study focuses on forearm injuries associated with arterial lacerations. Arterial vasculature originates from antecubital fossa and bifurcates into Radial & Ulnar arteries as well as interosseous variational branches attending major branches above this zone. These arteries unite into superficial and deep arches at the palmar level which backs up the hand in case of a single forearm arterial injury, yet both arterial lacerations may impair proper circulation of the hand. Single arterial injuries of the forearm were assessed according to clinical and functional outcomes. We conducted a descriptive study which neglected timeline direction. Material & method: 108 consecutive, minimum 1-year followed-up, singe artery lacerated forearm injuries operated in our clinic were assessed retrospectively and were summoned for a clinical visit in which only 38 cases attended. Most common injury type was glass cut (62%), followed by power saw injury (26%). After cases were asked to fill subjective questionnaires, hand circulation via handheld doppler and Allen’s test, hand sensation via two-point discrimination and Weinstein’s monofilament test, handgrip via hand dynamometer and pinch grip tests and finally thermodistribution via thermal camera device were assessed. Results were analyzed statistically via SPSS 25® with a CI of 95% and outcomes p <, 05 admitted as significant. Results: Majority of cases consisted of right-handed (68,4%) men (92,6%) with the same hand affected. The median age was 34,5 (10-82). Punching glass had a significantly (p<0,05) greater rate (n=62, 57,4%) among all causes which exhibited significantly better clinical results (QDASH), on the other hand, power-tools injuries manifested significantly worse clinical results in statistical terms. Cases associated with Ulnar artery (UA) lacerations were introduced to our hospital with significantly (p<0,05) more severe injuries (according to MHISS), which appeared to be significantly (p<0,001) associated with the Ulnar nerve lesion where UN lesion appeared to be the most significant (p<0,05) parameter affecting clinical outcomes. Patency rates for artery repairs were 27/38 (71%) correlated with the literature. Arterial patency didn’t demonstrate a significant association with tobacco consumption (n=22, 57,8% smoker), yet worse clinical scores were significantly (p<0,05) explained by it. Conclusion: Most of our cases appeared to be having preventable trauma etiopathogenesis. Practically every individual (total 86,8%) returned back to former work or lifestyle with acceptable sequellae rates within variable periods of time, except those with major injury types. After all, coping this population demands tremendous professional tolerance and empathy, yet not only in terms of surgical challenge. An effective solution to psychiatric issues and more precise usage of power tools may lead to a major decrease in the amount of these cases. Eventually; adequate treatment of the patients lead to satisfactory clinical outcomes.
Açıklama
Anahtar Kelimeler
Ön Kol Arter, Cama Yumruk, Testere, Forearm, Artery, Punching Glass, Power-Saw
