Orta şaft klavikula kırıklarında cerrahi ve konservatif tedavi sonuçlarımız
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Dosyalar
Tarih
2016
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızda erişkin orta şaft klavikula kırıkları cerrahi ve konservatif tedavi sonuçlarının; klinik, fonksiyonel ve radyolojik açıdan karşılaştırılması amaçlanmıştır. Materyal ve Method: Kliniğimizde Mart 2012-Mart 2015 tarihleri arasında klavikula orta diyafiz kırığı nedeni ile tedavi edilen 95 hasta retrospektif olarak incelendi. Konservatif ve cerrahi tedavi uygulanmış hastalar gruplara ayrılarak takiplerinde; klinik, fonksiyonel ve radyolojik olarak değerlendirildi. Kırıkların sınıflandırılmasında AO sınıflandırma sistemi kullanıldı. Klavikulanın aksiyel ve anteroposterior (AP) planda açılanmaları, skapulotorasik eklemin açılanması radyolojik olarak değerlendirildi. Fonksiyonel sonuçlar "Shoulder Pain and Disability Index (SPADI)" ve "short form 36 (SF36)" sorgulama yöntemleriyle ve izokinetik kas gücü ölçümleri ile değerlendirildi. Çalışmanın tüm analizleri SPSS 16.0 paket programı kullanılarak yapıldı. Değişkenlerin tanımlayıcı ölçüleri kategorik durumda frekans ve yüzde oranları; sayısal durumda ise ortalama±ss (ortanca, min, maks) şeklinde tablolar kullanılarak sunuldu. Tüm kesikli ve sürekli değişkenlerin normal dağılıma uyup uymadığı Kolmogorov-Smirnov test yöntemi ile analiz edildi. İkili grup karşılaştırmaları normal dağılıma uygun olan durumlarda Student t-testi, normal dağılmayan değişkenler için parametrik olmayan Mann-Whitney U testi kullanılarak yapıldı. Çoklu grup karşılaştırmalarında normal dağılıma uyan değişkenler için Tek yönlü Varyans Analizi (ANOVA), normal dağılmayan değişkenler için Kruskal-Wallis test yöntemleri tercih edildi. Kategorik değişkenler arasındaki ilişkinin tespit edilmesi amacıyla Monte Carlo düzeltmeli Ki-Kare analizi kullanıldı. Sürekli değişkenler arasındaki ilişkinin yönü ve büyüklüğünün tespit edilmesi için Pearson Korelasyon, normal dağılıma uymayan değişkenler için Spearman's Rho Korelasyon analizleri yapıldı. Bulgular: Hastaların yaş ortalaması 32.2 (18-70) idi. Hastaların %72,6'sı (n=69) erkek, %27,4'ü (n=26) kadındı. 60 (%63,2) hastaya konservatif, 35 (%36,8) hastaya ise cerrahi tedavi uygulanmıştır. Klavikula kırığı hastaların %44,2'sinde (n=42) sağ, geriye kalan kısmında ise sol taraftaydı. Klavikulanın aksiyel plan deformitesi ile skapulatorasik eklem ağrısı arasında anlamlı ilişki bulundu (p=0,058). Kanat skapulası olan hastalarda omuz skapulotorasik açısı daha yüksekti. SF36 fiziksel aktivite skoru (PCS) puan ortalaması kanat skapulası olmayan hastalarda daha yüksekti (p=0,006). İzokinetik omuz gücü ölçümleri kanat skapulası olan ya da olmayan hastalarda birbirine yakın değerlere sahipti. Skapulotorasik açı değişimleri ile tedavi yöntemleri arasındaki ilişki anlamlıydı (p=0,021). Açı değişimi olmayanlar cerrahi yöntemde daha yüksek orana sahipken (%82,8) açı değişimi pozitif olanların oranı (%33,3) konservatif yöntemde daha yüksekti. Kanat skapulası olan hastalar konservatif yöntem grubunda daha yüksekti (%30). SPADI ve SF36 PCS skorlamalarının gruplar arasında anlamlı farklılık görüldü. SPADI ağrı (p=0,008), engellilik (p=0,001) ve toplam puanları (p=0,002) AP plan deformitesi >0° olan hastalarda daha yüksek ortalamaya sahipti. En düşük ortalamalar deformitenin olmadığı hastalardaydı. SF36 fiziksel aktivite skoru puanı da AP plan deformitesi olmayan hastalarda daha yüksek ortalamaya sahipti (p<0,001). İzokinetik test sonuçlarında AP planda deformite açısı >0° hastalarda % defisit oranın daha fazla etkilendiği görüldü. Eksternal ve internal omuz hareketi izokinetik test gücü yüzde oranlarının hiçbiri gruplar arasında farklı değildi. SPADI ağrı skoru konservatif tedavi alan hastalarda daha yüksekti (p=0,018), aynı şekilde SPADI engellilik skoru konservatif tedavide daha yüksekti (p=0,003). Bu nedenle toplam SPADI skoru konservatif tedavide daha yüksek olup gruplar arasında yaklaşık 5 puanlık fark vardı (p=0,005). SF36 skorlamasının fiziksel aktivite güçlüğü bölümü gruplar arasında anlamlı düzeyde farklıydı (p=0,003). SPADI sonuçları ile orantılı olarak cerrahi tedavi yöntemi uygulanan hastalarda daha yüksekti. Eksternal ve internal omuz hareketleri izokinetik test güç yüzde oranları ile SF36 fiziksel aktivite skorlamasının normal dağılıma uyduğu (p>0,05) görüldü. Sonuç: Kısalığın çalışmamızda skorlamaları eksi yönde etkilediği bulundu. Kırık hattındaki açılanma klinik olarak skapular diskinezise sebep olmakta, bunun sonucunda fonksiyonda olumsuz etkilenme görülmekteydi. Açılanma olmayan hastalarda bu problem saptanmamıştır. SF36 ile SPADI türü skorlar arasında yüksek düzeyde güçlü korelasyon mevcuttu. İzokinetik kas gücü değerlendirmesi tedavi grupları arasında anlamlı fark çıkarmasa da hastalara uyguladığımız SPADI ve SF36 PCS testleri ile net bir şekilde korelasyona sahipti. Sonuç olarak klavikula orta diyafiz kırıklarında konservatif ve cerrahi tespit yöntemleri tedavide kullanılabilirler. Hastanın genel durumu, kırığın şekli, kemiğin durumu, cerrahın bilgi ve tecrübesi tedavide tercih edilecek yöntemi belirlemektedir. Literatürde bu kırıklarda skapulotorasik eklem ilişkisindeki bozulmayı direkt ölçen başka bir yayın olmaması, izokinetik ölçümün omuz skorlaması ve fonksiyonel sonuçlarla karşılaştırıldığı tek bir yayın bulunması çalışmamızın literatüre anlamlı etki sağlayacağının göstergesidir. Bütün olarak değerlendirildiğinde cerrahi tedavinin tercih edilebilirliğinin gün geçtikçe arttığı ve yayınımızın bunu destekler nitelikte olduğu gösterilmiştir. Anahtar Kelimeler: Klavikula kırığı, Orta diyafiz, İzokinetik test, SPADI, SF36
In this study, the results of surgical and conservative treatment of adult midshaft clavicle fractures were compared and their clinical, functional and radiological out comes were evaluated. Methods: Between March 2012-March 2015 period, treated 95 patients with mid-clavicular shaft fractures were analyzed retrospectively. Applied conservative and surgical patients divided into groups during follow-up; clinical, functional and radiological findings were evaluated. Applied conservative and surgical patients divided into groups during follow-up; clinical, functional and radiological findings were evaluated. AO classification system was used for the classification of fractures. Clavicle's axial and anteroposteior angulation and scapulotoracic joint angulation were evaluated radiologically. Functional result were evaluated with "Shoulder Pain and Disability Index (SPADI)" , "short form 36 (SF36)" and measurements of isokinetic muscle strength. All analyzes were performed using SPSS 16.0 software package for the study. Descriptive measures of variables presented categorical cases as the frequency and percentages; numerical cases as the mean + SD (median, min, max) with tables. All discrete and continuous variables that complied to a normal distribution were analyzed by Kolmogorov-Smirnov test. Bilateral group comparisons cases in accordance with the normal distribution Student's t-test was performed and non-parametric Mann-Whitney U test for used for not normally distributed variables. At multiple group comparisons, One-way analysis of variance (ANOVA) was preferred for normally distributed variables, Kruskal-Wallis test method was preferred for not normally distributed variables. In order to determinate the relationship between categorical variables corrected Monte Carlo Chi-square analysis was used. For determining the direction and importance of the relationship between continuous variables Pearson correlation, for variables that do not fit the normal distribution Spearman's Rho correlation analysis were performed. Results: The mean age of the patients was 32.2 (18-70). 72.6% of patients (n = 69) were male and 27.4% (n = 26) were female. 60 (63.2%) patients treated conservatively, 35 (36.8%) patients underwent surgery. Clavicle fracture in 44.2% of patients (n = 42) was at right, in the rest was at left side. There was a significant correlation between the clavicle axial deformity with scapulothoracic joint pain (p = 0.058). Patients with scapular dyskinesia have higher scapulothoracic angle. SF-36 PCS score average was higher in patients without scapular dyskinesia (p = 0.006). In patients with or without scapular dyskinesia have very similar values of isokinetic shoulder strength measurements. The relationship between scapulothoracic angle changes and treatment was significant (p = 0.021). No angular change has a higher rate (82.8%) in surgical treatment and positive angle change (33.3%) has higher rate in conservative treatment. Winging scapula has a higher rate in conservative grup (30%). SPADI and SFA 36 PCS scores were significantly different between groups. SPADI pain (p = 0.008), disability (p = 0.001) and total score (p = 0.002) had higher than average in patients whose AP plans deformity is > 0 °. The lowest averages were in patients without deformity. SF-36 PCS score was also higher than average in patients with non-AP deformity (p <0.001). In isokinetic test results patients with AP deformity angle >0 ° have more defisit percent. The external and internal shoulder motion isokinetic testing power percentage did not differ between any of the groups. SPADI pain scores were higher in patients with conservative treatment (p = 0.018), also the SPADI disability scores were higher in conservative treatment (p = 0.003). Therefore, the total score of the SPADI had difference between groups as about a 5 point higher in conservative treatment (p = 0.005). SF-36 PCS score was significantly different between the groups (p = 0.003) and in line to SPADI at the results of surgical treatment. External and internal shoulder movements with isokinetic strength testing percentages fit to SF36 pcs normal distribution. (p<0.05) Conclusions: In this study we found that shortening couses lower scores. Scapular dyskinesia causes angulation of the fracture clinically, resulting in negative effects were seen in the function. These problems have not been detected in patients without angulation. SF36 and SPADI has strong correlation at high levels. There is no significant difference between treatment groups with the isokinetic muscle strength tests but isokinetic test has strong correlation with SPADI and SF36 pcs. As a result of conservative and surgical treatment, both can be used as treatment method in mid diaphyseal fracture of the clavicle. General condition of the patient, the type of fracture, the condition of the bone, the surgeon's knowledge and experience determine the choice of treatment method. In the literatüre there is no other direct measurement of scapulothoracic joint deterioration and there is only one publication that compared shoulder functional scores with isokinetic strenght so this is an indication that our study provides significant influence to literature. On the whole assessment of the preferability of surgical treatment increased day by day and this publication had supported that. Keywords: Clavicle fracture, Middle shaft, Isokinetic testing, SPADI, SF-36
In this study, the results of surgical and conservative treatment of adult midshaft clavicle fractures were compared and their clinical, functional and radiological out comes were evaluated. Methods: Between March 2012-March 2015 period, treated 95 patients with mid-clavicular shaft fractures were analyzed retrospectively. Applied conservative and surgical patients divided into groups during follow-up; clinical, functional and radiological findings were evaluated. Applied conservative and surgical patients divided into groups during follow-up; clinical, functional and radiological findings were evaluated. AO classification system was used for the classification of fractures. Clavicle's axial and anteroposteior angulation and scapulotoracic joint angulation were evaluated radiologically. Functional result were evaluated with "Shoulder Pain and Disability Index (SPADI)" , "short form 36 (SF36)" and measurements of isokinetic muscle strength. All analyzes were performed using SPSS 16.0 software package for the study. Descriptive measures of variables presented categorical cases as the frequency and percentages; numerical cases as the mean + SD (median, min, max) with tables. All discrete and continuous variables that complied to a normal distribution were analyzed by Kolmogorov-Smirnov test. Bilateral group comparisons cases in accordance with the normal distribution Student's t-test was performed and non-parametric Mann-Whitney U test for used for not normally distributed variables. At multiple group comparisons, One-way analysis of variance (ANOVA) was preferred for normally distributed variables, Kruskal-Wallis test method was preferred for not normally distributed variables. In order to determinate the relationship between categorical variables corrected Monte Carlo Chi-square analysis was used. For determining the direction and importance of the relationship between continuous variables Pearson correlation, for variables that do not fit the normal distribution Spearman's Rho correlation analysis were performed. Results: The mean age of the patients was 32.2 (18-70). 72.6% of patients (n = 69) were male and 27.4% (n = 26) were female. 60 (63.2%) patients treated conservatively, 35 (36.8%) patients underwent surgery. Clavicle fracture in 44.2% of patients (n = 42) was at right, in the rest was at left side. There was a significant correlation between the clavicle axial deformity with scapulothoracic joint pain (p = 0.058). Patients with scapular dyskinesia have higher scapulothoracic angle. SF-36 PCS score average was higher in patients without scapular dyskinesia (p = 0.006). In patients with or without scapular dyskinesia have very similar values of isokinetic shoulder strength measurements. The relationship between scapulothoracic angle changes and treatment was significant (p = 0.021). No angular change has a higher rate (82.8%) in surgical treatment and positive angle change (33.3%) has higher rate in conservative treatment. Winging scapula has a higher rate in conservative grup (30%). SPADI and SFA 36 PCS scores were significantly different between groups. SPADI pain (p = 0.008), disability (p = 0.001) and total score (p = 0.002) had higher than average in patients whose AP plans deformity is > 0 °. The lowest averages were in patients without deformity. SF-36 PCS score was also higher than average in patients with non-AP deformity (p <0.001). In isokinetic test results patients with AP deformity angle >0 ° have more defisit percent. The external and internal shoulder motion isokinetic testing power percentage did not differ between any of the groups. SPADI pain scores were higher in patients with conservative treatment (p = 0.018), also the SPADI disability scores were higher in conservative treatment (p = 0.003). Therefore, the total score of the SPADI had difference between groups as about a 5 point higher in conservative treatment (p = 0.005). SF-36 PCS score was significantly different between the groups (p = 0.003) and in line to SPADI at the results of surgical treatment. External and internal shoulder movements with isokinetic strength testing percentages fit to SF36 pcs normal distribution. (p<0.05) Conclusions: In this study we found that shortening couses lower scores. Scapular dyskinesia causes angulation of the fracture clinically, resulting in negative effects were seen in the function. These problems have not been detected in patients without angulation. SF36 and SPADI has strong correlation at high levels. There is no significant difference between treatment groups with the isokinetic muscle strength tests but isokinetic test has strong correlation with SPADI and SF36 pcs. As a result of conservative and surgical treatment, both can be used as treatment method in mid diaphyseal fracture of the clavicle. General condition of the patient, the type of fracture, the condition of the bone, the surgeon's knowledge and experience determine the choice of treatment method. In the literatüre there is no other direct measurement of scapulothoracic joint deterioration and there is only one publication that compared shoulder functional scores with isokinetic strenght so this is an indication that our study provides significant influence to literature. On the whole assessment of the preferability of surgical treatment increased day by day and this publication had supported that. Keywords: Clavicle fracture, Middle shaft, Isokinetic testing, SPADI, SF-36
Açıklama
Anahtar Kelimeler
Cerrahi tedavi, Surgical treatment, Egzersiz testi, Exercise test, Konservatif tedavi, Conservative therapy
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Koç, M. R. (2016). Orta şaft klavikula kırıklarında cerrahi ve konservatif tedavi sonuçlarımız. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Ortopedi ve Travmatoloji Anabilim Dalı, Konya.
