Skafoid ps�doartroz tedavisinde otolog kemik grefti ve titanyum ba�s�z kan�ll� kompresyon vidas� kombinasyonu uygulama sonu�lar�

�zdemir, G�zelali; �i�ekli, �zg�r; Akg�l, Turgut; Zehir, Sinan; Y�cel, Ferit; E�kin, Deniz

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Skafoid ps�doartroz tedavisinde otolog kemik grefti ve titanyum ba�s�z kan�ll� kompresyon vidas� kombinasyonu uygulama sonu�lar� [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2014; 20(3): 199-204 | DOI: 10.5505/tjtes.2014.92255

Skafoid ps�doartroz tedavisinde otolog kemik grefti ve titanyum ba�s�z kan�ll� kompresyon vidas� kombinasyonu uygulama sonu�lar�

G�zelali �zdemir¹, �zg�r �i�ekli², Turgut Akg�l³, Sinan Zehir⁴, Ferit Y�cel⁵, Deniz E�kin²
¹Kanuni Sultan S�leyman E�itim Ve Ara�t�rma Hastanesi, Ortopedi Servisi
²�anl�urfa E�itim Ve Ara�t�rma Hastanesi, Ortopedi Servisi
³�stanbul �niversitesi �stanbul T�p Fak�ltesi Ortopedi Ve Travmatoloji Ad
⁴Hitit �niversitesi T�p Fak�ltesi Ortopedi Ve Travmatoloji Ad
⁵�anl�urfa Edessa �zel Hastanesi

AMA�: Bu �al��mada skafoid ps�doartroz tedavisinde uygulad��m�z debridman, otolog iliak kanat kemik grefti ile titanyum ba�s�z kan�le kompresyon vidas� kombinasyonunun radyolojik ve klinik sonu�lar�n� sunmakt�r.
GERE� VE Y�NTEM: 2009-2012 tarihleri aras�nda skafoid ps�doartroz tan�s� ile iliak kanat kemik grefti ve ba�s�z kan�le vida ile ameliyat edilen ve en az 12 ayl�k takibi olan 24 hastan�n 24 el bile�i geriye d�n�k olarak incelendi. Ps�doartroz standart �ekilen grafilerde k�r�k zaman�ndan sekiz hafta ge�mesine ra�men kaynama bulgusu olmamas� olarak belirlendi. Skafoid k�r�klar� Herbert s�n�flamas�na ve anatomik yerle�ime g�re s�n�fland�. Hastalar�n�n klinik de�erlendirilmesinde Mayo el bilek skorlamas� kullan�ld�.
BULGULAR: Herbert s�n�flamas�na g�re 20 hasta D1 ve d�rt hasta D2, anatomik s�n�flamaya g�re bir hasta distal, alt� hasta proksimal ve 17 hasta g�vde k�r�� olarak belirlendi. �ki hasta haricinde t�m hastalarda tam kaynama ortalama 9.5 (6 ila 15 hafta) haftada sa�land�. Son kontrollerde skafolunat ve radiolunat a��lar� s�ras� ile ortalama 32� (39� ile 50�) ve 7� (4� ile 10�) idi. �statistiksel olarak kaynama ve ps�doartroz s�releri aras�nda ba�lant� tespit edildi (p=0.003). K�r�k hatt� proksimal b�lgeye yakla�t�k�a kaynama s�resi uzamakta idi (p=0.004). Mayo el bilek skoru ortalama 86 (80-95) olarak belirlendi.
SONU�: Skafoid ps�doartroz tedavisinde volar yakla��mla iliak kanattan al�nan trikortikal otogreft ve ba�s�z kan�le kompresyon vidas� kombinasyonu, ba�ar�l� kaynama ve fonksiyonel sonu� veren bir y�ntemdir.

Anahtar Kelimeler: Ba�s�z kompresyon vidas�, el bile�i volar yakla��m; otolog iliak kemik grefti; skafoid kaynamama; skafoid ps�doartroz.

The results of autologous bone graft and titanium headless cannulated compression screw for treatment of scaphoid nonunion

G�zelali �zdemir¹, �zg�r �i�ekli², Turgut Akg�l³, Sinan Zehir⁴, Ferit Y�cel⁵, Deniz E�kin²
¹Kanuni Sultan S�leyman Training Hospital, Orthopaedics Department
²�anl�urfa Training Hospital, Orthopaedics Department
³�stanbul University, �stanbul Faculty Of Medicine, Department Of Orthopaedics
⁴Hitit University Faculty Of Medicine, Department Of Orthopaedics
⁵�anl�urfa Edessa Hospital

BACKGROUND: We aimed to present the clinical and radiological results of patients treated with debridement, iliac bone graft and titanium headless compression screw for scaphoid nonunion.
METHODS: We retrospectively evaluated 24 patients (23 males, 1 female) who underwent this technique between 2009 and 2012, with a minimum of 12 months� follow-up. Nonunion was determined as no union evidence within eight weeks on radiological view. Scaphoid fracture was classified according to Herbert classification and anatomical location. Functional evaluation was performed using the Mayo wrist scoring system.
RESULTS: According to the Herbert classification system, there were 20 D1 and 4 D2 fractures. Anatomical location included 1 distal, 6 proximal and 17 corpus. Fracture union was achieved in all but 2 patients, with a mean union time of 9.5 weeks (6-15). Scapholunate angle and radiolunate angle were measured as a mean 32� (39�-50�) and 7� (4�-10�) at the latest follow-up radiographic examination. There was a statistically significant correlation between the length of the pseudoarthrosis period and union time (p=0.003). Union time of proximal fractures was longer than of the others (p=0.004). Mayo wrist score was 86 (80-95).
DISCUSSION: Autologous iliac bone graft and titanium headless cannulated compression screw combination via volar approach is safe and effective for scaphoid nonunion.

Keywords: Autologous iliac bone graft, headless compression screw; scaphoid nonunion; scaphoid pseudoarthrosis; wrist volar approach.

G�zelali �zdemir, �zg�r �i�ekli, Turgut Akg�l, Sinan Zehir, Ferit Y�cel, Deniz E�kin. The results of autologous bone graft and titanium headless cannulated compression screw for treatment of scaphoid nonunion. Ulus Travma Acil Cerrahi Derg. 2014; 20(3): 199-204

Sorumlu Yazar: Turgut Akg�l, T�rkiye
Makale Dili: T�rk�e

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