El ekstansör tendon yaralanmalarında primer onarımın fonksiyonel sonuçlarının etiyolojik faktörler, eşlik eden yaralanmalar ve yaralanma yerlerine göre değerlendirilmesi
Öz
Amaç: Bu çalışmanın amacı, eldeki ekstansör tendon yaralanmalarının uygun primer onarım teknikleri ile cerrahi tedavisinin; yaralanma mekanizmasını, eşlik eden yaralanmaları ve yaralanma bölgelerini göz önünde bulundurarak bunların klinik ve fonksiyonel sonuçlara etkisini değerlendirmektir.
Gereç ve Yöntem: Bu çalışma 2016-2020 yılları arasında Ortopedi ve Travmatoloji Kliniği'nde ameliyat edilen 103 hastanın retrospektif olarak değerlendirildiği kesitsel bir çalışmadır. Mevcut tedavi yöntemleri etiyolojik faktörler, anatomik bölgeler, yaralanan tendon sayısı ve eşlik eden yaralanmalar açısından değerlendirildi. Komplikasyonlar ve fonksiyonel sonuçlar anatomik bölgelere, yaralanma mekanizmasına ve ek yaralanmalara göre istatistiksel olarak değerlendirildi.
Bulgular: 103 hastanın (ortalama yaş: 37,2 yaş) 114 ekstansör tendon yaralanması değerlendirildi. Ortalama takip süresi 26,8 aydı. Etiyolojik faktörler arasında en sık görüleninin kesici alet yaralanması (%57,3) olduğu görülmektedir. Keskin alet yaralanmalarında 8. hafta ve 12. ayda yapılan Miller sınıflamasına göre orta ve kötü sonuç ve komplikasyon varlığı diğer yaralanma tiplerine göre istatistiksel olarak anlamlı derecede düşük bulundu. Eşlik eden yaralanma (n: 21/103) ile komplikasyon oluşumu ve fonksiyonel sonuçlar arasında istatistiksel bir ilişki gözlendi. Yaralanma bölgelerine göre komplikasyonlar ile 8. Haftadaki fonksiyonel sonuçlar arasında fark bulunmazken, zon-2 yaralanmalarında 12. ayda istatistiksel olarak anlamlı derecede daha düşük fonksiyonel sonuçlar bulundu.
Sonuç: Başarılı postoperatif iyileşme öncelikle yaralanma tipine ve ilişkili yaralanmalara bağlı olmakla birlikte, herhangi bir bölgede uygun onarım tekniği ile cerrahi sonrası erken mobilizasyon ile iyi ve mükemmel fonksiyonel sonuçlar elde edilebilir.
Anahtar Kelimeler
Extansör Tendon Tendon Onarımı El Yaralanması Ekstansör Bölgeler
Destekleyen Kurum
Yok
Proje Numarası
Yok
Kaynakça
- Türker T, Hassan K, Capdarest-Arest N. Extensor tendon gap reconstruction: a review J Plast Surg Hand Surg. 2016;50:1-6.
- Hague MF. The results of tendon suture of the hand: A review of 500 patients. Acta Orthop Scand. 2004;24:258-234
- Kleinert HE, Verdan C. Report of the committee on tendon injuries,International Federation of Societes for Surgery of the Hand. J Hand Surg(Am). 1983;8(2):794–798
- Sameem M,Wood T,Ignacy T, Thoma A,Strumas N. A systematic review of rehabilitation protocols after surgical repair of the extensor tendons in zones V-VIII of the hand. J Hand Ther. 2011;24(4):365-372
- Wilken F, Banke IJ, Hauschild M, Winkler S, Schott K, Rudert M, Eisenhart-Rothe RV. Endoprosthetic tumor replacement: reconstruction of the extensor mechanism and complications. Orthopade. 2016;45:439-45.
- Sando IC, Chung KC. The use of dermal skin substitutes for the treatment of the burned hand. Hand Clin. 2017; 33:269-76.
- Richards SD,Kumar G,Booth S . et al.A model for the conservative menagment of mallet finger. J Hand Surgery. 2004;29(1):61-63
- Nakamura K,Nanjyo B.Reassesment of surgery for mallet finger.Plastic and Reconstructive Surgery. 1994; 93:141-149
- Carl HD, Forst R, Schaller P. Results of primary extensor tendon repair in relation to the zone of injury and pre-operative outcome estimation. Arch Orthop Trauma Surg. 2007;127(2):115–119.
- Crosby CA, Wehbé MA. Early protected motion after extensor tendon repair. J Hand Surg. 2003;24:1061–1070
- Strauch RJ. Extensor tendon injury. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SK. Green’s Operative Hand Surgery. 6th ed. New York: Churchill Livingstone;2011:165–168.
- Howard RF, Ondrovic L, Greenwald DP. Biomechanical analysis of four-strand extensor tendon repair techniques. J Hand Surg Am. 1997;22(5):838–842.
- Altobelli GG, Conneely S, Haufler C, Walsh M, Ruchelsman DE. Outcomes of digital zone IV and V and thumb zone TI to TIV extensor tendon repairs using a running interlocking horizontal mattress technique. J Hand Surg Am. 2013 Jun;38(6):1079-83.
- Ng C, Chalmer J, Macdonald D, et al. Rehabilitation regimens following surgical repair of extensor tendon injuries of the hand: a systematic review of controlled trials. J Hand Microsurg. 2012;4:65–73.
- Wong AL, Wilson M, Girnary S, et al. The optimal orthosis and motion for extensor tendon injury in zones IVVII: A systematic review. J Hand Ther. 2017;1–9.
- Miller H. Repair of severed tendons of the hand and wrist: Statistical analysis of 300 cases. Surg GynecolObstet. 1942;75:693-8.
- Salihagić S, Zvizdić Z, Hrustemović D, Čaušević R, Hemaidi A. Modalities of extensor tendon repair related to etiological factors and associated injuries. Med Glas. 2021 Feb 1;18(1):216-221.
- Karabeg R, Arslanagic S, Jakirlic M, Dujso V, Obradovic G. Results of primary reparing of hand extensor tendons injuries using surgical treatment. Med Arch. 2013;67(3):192-4.
- Mehdinasab SA, Pipelzadeh MR, Sarrafan N. Results of primary extensor tendon repair of the hand with respect to the zone of injury. Arch Trauma Res. 2012 Fall;1(3):131-4.
Evaluation of functional results of primary repair in hand extensor tendon injuries according to etiological factors, associated injuries and injury sites
Öz
Purpose: The aim of this study was to evaluate the effect of surgical treatment of extensor tendon injuries in the hand with appropriate primary repair techniques on clinical and functional outcomes, taking into account the mechanism of injury, concomitant injuries and injury sites.
Materials and Methods: This is a cross-sectional study in which 103 patients who were operated between 2016-2020 in Orthopedics and Traumatology Clinic were evaluated retrospectively. Existing treatment modalities were evaluated in terms of etiological factors, anatomical regions, number of injured tendons, and injuries. Complications and functional outcomes were statistically evaluated according to anatomical regions, mechanism of injury and additional injuries.
Results: 114 extensor tendon injuries of 103 patients (mean age: 37.2 years) were evaluated. The mean follow-up period was 26.8 months. Among the etiological factors, it is seen that the most common one is sharp object injury (57.3%). According to the Miller classification performed at the 8th week and 12th month in sharp object injury, moderate and poor outcome and the presence of complications were found to be statistically significantly lower than other injury types. A statistical correlation was observed between the accompanying injury (n: 21/103) and the occurrence of complications and functional outcomes. While there is no difference between complications, depending on the body regions, and functional results at 8. week statistically significantly lower functional results were found in zone-2 injuries at 12 months.
Conclusion: While successful postoperative recovery primarily depends on the type of injury and associated injuries, good and excellent functional results can be achieved with early mobilization after surgery with the appropriate repair technique in any region.
Anahtar Kelimeler
Proje Numarası
Yok
Kaynakça
- Türker T, Hassan K, Capdarest-Arest N. Extensor tendon gap reconstruction: a review J Plast Surg Hand Surg. 2016;50:1-6.
- Hague MF. The results of tendon suture of the hand: A review of 500 patients. Acta Orthop Scand. 2004;24:258-234
- Kleinert HE, Verdan C. Report of the committee on tendon injuries,International Federation of Societes for Surgery of the Hand. J Hand Surg(Am). 1983;8(2):794–798
- Sameem M,Wood T,Ignacy T, Thoma A,Strumas N. A systematic review of rehabilitation protocols after surgical repair of the extensor tendons in zones V-VIII of the hand. J Hand Ther. 2011;24(4):365-372
- Wilken F, Banke IJ, Hauschild M, Winkler S, Schott K, Rudert M, Eisenhart-Rothe RV. Endoprosthetic tumor replacement: reconstruction of the extensor mechanism and complications. Orthopade. 2016;45:439-45.
- Sando IC, Chung KC. The use of dermal skin substitutes for the treatment of the burned hand. Hand Clin. 2017; 33:269-76.
- Richards SD,Kumar G,Booth S . et al.A model for the conservative menagment of mallet finger. J Hand Surgery. 2004;29(1):61-63
- Nakamura K,Nanjyo B.Reassesment of surgery for mallet finger.Plastic and Reconstructive Surgery. 1994; 93:141-149
- Carl HD, Forst R, Schaller P. Results of primary extensor tendon repair in relation to the zone of injury and pre-operative outcome estimation. Arch Orthop Trauma Surg. 2007;127(2):115–119.
- Crosby CA, Wehbé MA. Early protected motion after extensor tendon repair. J Hand Surg. 2003;24:1061–1070
- Strauch RJ. Extensor tendon injury. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SK. Green’s Operative Hand Surgery. 6th ed. New York: Churchill Livingstone;2011:165–168.
- Howard RF, Ondrovic L, Greenwald DP. Biomechanical analysis of four-strand extensor tendon repair techniques. J Hand Surg Am. 1997;22(5):838–842.
- Altobelli GG, Conneely S, Haufler C, Walsh M, Ruchelsman DE. Outcomes of digital zone IV and V and thumb zone TI to TIV extensor tendon repairs using a running interlocking horizontal mattress technique. J Hand Surg Am. 2013 Jun;38(6):1079-83.
- Ng C, Chalmer J, Macdonald D, et al. Rehabilitation regimens following surgical repair of extensor tendon injuries of the hand: a systematic review of controlled trials. J Hand Microsurg. 2012;4:65–73.
- Wong AL, Wilson M, Girnary S, et al. The optimal orthosis and motion for extensor tendon injury in zones IVVII: A systematic review. J Hand Ther. 2017;1–9.
- Miller H. Repair of severed tendons of the hand and wrist: Statistical analysis of 300 cases. Surg GynecolObstet. 1942;75:693-8.
- Salihagić S, Zvizdić Z, Hrustemović D, Čaušević R, Hemaidi A. Modalities of extensor tendon repair related to etiological factors and associated injuries. Med Glas. 2021 Feb 1;18(1):216-221.
- Karabeg R, Arslanagic S, Jakirlic M, Dujso V, Obradovic G. Results of primary reparing of hand extensor tendons injuries using surgical treatment. Med Arch. 2013;67(3):192-4.
- Mehdinasab SA, Pipelzadeh MR, Sarrafan N. Results of primary extensor tendon repair of the hand with respect to the zone of injury. Arch Trauma Res. 2012 Fall;1(3):131-4.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma |
| Yazarlar | |
| Proje Numarası | Yok |
| Yayımlanma Tarihi | 28 Aralık 2022 |
| Kabul Tarihi | 28 Eylül 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 47 Sayı: 4 |
