Travmatik Anterior Omuz İnstabilitesinde Açık Ve Artroskopik Bankart Tamiri Sonuçlarının Karşılaştırılması

Abstract

Amaç: Travmatik anterior omuz instabilitesi cerrahi tedavisinde açık ve artroskopik Bankart tamirinin klinik sonuçlarının karşılaştırılması amaçlandı.Materyal ve Metod: Ocak 2005 ile Ocak 2013 yılları arasında tekrarlayan anterior omuz instabilitesi nedeniyle cerrahi tedavi uygulanan 23 hastadan son kontrolleri yapılan 20 hasta (17 erkek, 3 kadın) çalışmaya dahil edildi. Hastaların 10'una açık Bankart tamiri, 10'una artroskopik Bankart tamiri uygulandı. Ağrı değerlendirmesi vizüel analog skalasına (VAS) göre yapılırken klinik sonuçlar Rowe skalası kullanılarak değerlendirildi. Ameliyat sonrası ortalama takip süresi açık tamir grubunda 37.4±27.1 ay iken, artroskopik tamir grubunda 23±6.9 ay idi. İstatistiksel değerlendirmede Shapiro-Wilk testi ile Mann-Whitney U testi kullanıldı. Bulgular: VAS skoru açık tamir grubunda 5.7±2.5, artroskopik tamir grubunda 4.1±1.9, Rowe skoru açık tamir grubunda 97.5 , artroskopik tamir grubunda 95 olarak bulundu. Klinik sonuçlar açık tamir grubunda 9 hastada (%90) mükemmel, bir hastada (10%) iyi iken, artroskopik tamir grubunda 8 hastada (80%) mükemmel, bir hastada (10%) iyi, bir hastada (10%) kötü olarak bulundu. Açık grupta 2 hastada, artroskopik grupta ise 5 hastada dış rotasyon kısıtlılığı gözlendi. İki grup arasında VAS skoru, Rowe skoru ve eklem hareket açıklığı bakımından istatistiksel olarak anlamlı fark görülmedi (p>0.05). Sonuç: Çalışmamızda artroskopik tamir ile açık tamir sonuçları, son yıllardaki çalışmalarla paralel olarak eşdeğer bulundu. Ancak artroskopik tamirin cerrahi tecrübe ve tamir yöntemlerinin gelişmesiyle, postoperatif hasta konforu ve rehabilitasyon kolaylığı nedeniyle avantajlı olduğu kanısındayız.

Objective: The purpose of the study was to compare the clinical results of open and arthroscopic bankart repair in the surgical treatment of traumatic anterior shoulder instability. Material and Methods: Out of 23 patients who had surgical treatment due to recurrent anterior shoulder instability between January 2005 and January 2013, 20 patients (17 men, 3 women) whose last controls were made were included in the study. Open Bankart repair was applied on 10 (average age 30, ranging between 17 and 43) patients and arthroscopic Bankart repair was applied on 10 (average age 21, ranging between 18 and 49) patients. While pain was assessed according to visual analog scale (VAS), clinical results were assessed by using Rowe scale. Average postoperation follow-up time was 37.4±27.1 months in the open repair group, while it was 23±6.9 months in the arthroscopic repair group. ShapiroWilk test and Mann-Whitney U test were used for statistical analysis. Results: VAS score was 5.7±2.5 in the open surgery group, while it was 4.1±1.9 in the arthroscopic group and Rowe score was 97.5 (ranging between 80 and 100), while it was 95 (ranging between 50 and 100) in the arthroscopic repair group. Clinical results were perfect in 9 (90%) patients in the open surgery group, while they were good in 1 (10%) patient. In the arthroscopic repair group, clinical results were perfect in 8 (80%) patients, good in 1 (10%) patient and bad in 1 (10%) patient. Limitation of external rotation was seen in 2 patients in the open group and in 5 patients in the arthroscopic group. No statistical difference was found between the two groups in terms of VAS score, Rowe score and range of motion (p>0.05).Conclusion: The results of arthroscopic repair and open repair in our study were found to be in parallel with the results of recent studies. However, with the developments in repair methods and surgical experiences, we are of the opinion that arthroscopic repair is more advantageous due to postoperative patient comfort and ease of rehabilitation.