Ulus Travma Acil Cerrahi Derg. 2022; 28(6): 839-848 | DOI: 10.14744/tjtes.2021.45985

Akut Rockwood Tip III/V Akromioklaviküler Çýkýklarýn Tedavisinde Açýk Çift Düðme Tekniði Kancalý Plaktan Üstündür

Furkan Yapici¹, Hanifi Üçpunar¹, Volkan Gür¹, Ahmet Sevencan², Yusuf Onur Kizilay³, Resit Karaköse¹, Yalkin Çamurcu^3
1Erzincan Üniversitesi Týp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalý, Erzincan
²MS Baltalimaný Kemik ve Eklem Hastalýklarý Eðitim ve Araþtýrma Hastanesi, Ortopedi ve Travmatoloji Kliniði, Ýstanbul
³Atlas Üniversitesi Týp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalý, Ýstanbul

AMAÇ: Bu çalýþmanýn amacý, akromiyoklaviküler eklem dislokasyonu (AKED) tedavisinde açýk çift düðme (ÇD) ve kancalý plak (KP) tekniklerini klinik ve radyolojik sonuçlar açýsýndan karþýlaþtýrmak ve hangi yöntemin daha üstün olduðunu belirlemektir.
GEREÇ VE YÖNTEM: Bu geriye dönük karþýlaþtýrmalý çalýþma, Haziran 2014 ile Þubat 2018 arasýnda bu implantlardan biriyle (22 KP ve 21 ÇD hastasý) tedavi edilen AKED hastalarýný (Rockwood tip III/V) içermektedir.
BULGULAR: Çalýþmaya yaþ ortalamasý 41.8±17.4 yýl olan toplam 43 hasta (39 erkek, 4 kadýn) katýlmýþtýr. Ortalama takip süresi 20.6±7.5 aydý. ÇD grubunda ortalama floroskopi, ameliyat ve iþe dönüþ süreleri daha kýsaydý. Sýrasýyla ÇD ve KP gruplarý için komplikasyon oranlarý %23.8 ve %54.6, yeniden ameliyat oranlarý (zorunlu implant çýkarýmý dahil) %4.8 ve %77.3, ortalama Constant skorlarý 92.1±3.4 ve 88.3±4.2, ortalama Görsel Analog skala puanlarý 0.8±1.0 ve 1.5±1.0 idi. Ýmplant çýkarýmý, KP grubundaki tüm reoperasyonlarýn ana nedeniydi. Oysa ÇD grubunun tek reoperasyonu, yeniden dislokasyona neden olan ve tünel malpozisyonundan dolayý geliþen bir korakoid sýyrýlmasýndan kaynaklandý. KP grubunda akromioklaviküler eklem artriti (%36.4) ve subakromiyal osteoliz (%31.9) sýk görüldü. ÇD grubunda en sýk görülen komplikasyon malredüksiyondu (yetersiz korrek-siyon) (%9.6).
TARTIÞMA: ÇD fonksiyonel sonuç, ameliyat sonrasý aðrý, komplikasyon ve reoperasyon oranlarý, operasyon ve floroskopi süreleri ve iþe dönme süresinde KP’den üstündür. Ayrýca KP hastalarýnýn çoðunda implant çýkarýmý nedenli reoperasyona ihtiyaç duyulmuþtur. Bu nedenle, açýk ÇD tekniði, KP prosedürüne tercih edilmelidir.

Anahtar Kelimeler: Akromiyoklaviküler eklem dislokasyonu, ameliyat sonrasý komplikasyonlar; asansörlü loop sistem; çift düðme; endobutton; kancalý plak; Rockwood sýnýflamasý; sütür düðme; tedavi sonuçlarý; tightrope.

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Open Double-Button Technique is Superior to Hook Plate in the Treatment of Acute Rockwood Type III/V Acromioclavicular Dislocations

Furkan Yapici¹, Hanifi Üçpunar¹, Volkan Gür¹, Ahmet Sevencan², Yusuf Onur Kizilay³, Resit Karaköse¹, Yalkin Çamurcu^3
1Department of Orthopedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan-Turkey
²Department of Orthopedics and Traumatology, MS Baltalimaný Bone and Joint Diseases Training and Research Hospital, Ýstanbul-Turkey
³Department of Orthopedics and Traumatology, Atlas University Faculty of Medicine, Ýstanbul-Turkey

BACKGROUND: The aim of this study is to compare open double-button (DB) and hook plate (HP) techniques in the treatment of acromioclavicular joint dislocation (ACJD) in terms of clinical and radiological outcomes and to determine which method is superior.
METHODS: This retrospective comparative study included patients with ACJDs (Rockwood Type III/V) who were treated with one of these implants (22 patients with HP, 21 patients with DB) between June 2014 and February 2018.
RESULTS: A total of 43 patients (39 men and 4 women) with a mean age of 41.8±17.4 years have participated in this study. The mean follow-up time was 20.6±7.5 months. Mean times of fluoroscopy, operation, and return to work were shorter in the DB group. Compli-cation rates were 23.8% and 54.6%, reoperation rates (including mandatory implant removals [IR]) were 4.8% and 77.3%, mean constant scores were 92.1±3.4 and 88.3±4.2, and mean Visual Analog Scale scores were 0.8±1.0 and 1.5±1.0 for the DB and HP groups, respec-tively. IR was the main reason for reoperations in the HP group, whereas the DB group’s only reoperation was caused by a coracoid cutout (due to coracoid tunnel malposition) leading to redislocation. AC joint arthritis (36.4%) and subacromial osteolysis (31.9%) were com-monly encountered in the HP group. The most frequent complication of the DB group was malreduction (initial undercorrection) (9.6%).
CONCLUSION: DB was superior to HP in functional outcome, post-operative pain, complication and reoperation rates, operation and fluoroscopy times, and time to return to work. Besides, reoperation (for IR) was needed in most of the HP patients. Therefore, the open DB technique should be preferential to the HP procedure.

Keywords: Acromioclavicular joint dislocation, double-button; endobutton; hook plate; lift loop system; post-operative complications; Rockwood classification; suture-button; tightrope; treatment outcome.

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