Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Femoroasetabular Sıkışma Sendromunda Cerrahi Tedavi Sonuçlarının Analizi
Analysis of Surgical Treatment Outcomes in Femoroacetabular Impingement Syndrome
Murat BÜLBÜLa, Metin UZUNb, Semih AYANOĞLUa, Yunus İMRENa, Kahraman ÖZTÜRKa, Hakan GÜRBÜZa
aOrtopedi ve Travmatoloji Kliniği, Vakıf Gureba Eğitim ve Araştırma Hastanesi,
bOrtopedi ve Travmatoloji Kliniği, Acıbadem Maslak Hastanesi, İstanbul
Turkiye Klinikleri J Med Sci. 2012;32(5):1201-6
doi: 10.5336/medsci.2010-21197
Article Language: TR
Full Text
ÖZET
Amaç: Femoroasetabular sıkışma sendromu (FASS) olan hastalarda kalça dislokasyonu ile güvenli rekonstrüksiyon uyguladığımız olguların klinik sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntemler: 2006-2009 yılları arasında, kalça displazisi saptanmayan, FASS tanısı alan, ön sıkışma testi (anterior impingement sign) pozitif olan 13 erkek hasta çalışmaya dâhil edildi. Beş olguda arka sıkışma testi de pozitif olarak değerlendirildi. Ortalama yaş 39,3 (aralık 32-47) idi. Tüm olguların ameliyattan önce ve sonra kalça antero-posterior ve false profil grafileri çekildi. Ameliyattan önceki dönemde, olguların tümünde femur tipi, birinde ise eşlik eden asetabulum tipi sıkışma mevcuttu. Tüm olguların radyolojik incelemesinde asetabulum arka duvarı yetmezliği ve "cross-over" bulgusu mevcuttu. Olgular, Harris kalça skorlaması ile fonksiyonel açıdan değerlendirildi. Cerrahi dislokasyon, Ganz ve ark.nın tarif ettiği şekilde uygulandı. Trokanterik osteotomi hattı iki adet kanüllü vida ile tespit edildi. Bulgular: Ameliyat sırasında tüm olgularda femoral sıkışma nedeni ortadan kaldırıldı. Hastaların yalnızca birinde asetabulum tipi lezyonu, labrumda tam dejenerasyonu ve ayrışması mevcuttu; bu hastada labrum rezeksiyonu gerekli oldu. Hiçbir olguda trokanterik osteotomiden sonra kaynamama gözlenmedi. Ameliyattan önce Harris kalça skoru ortalaması 63,24 (aralık 55-70) olan 13 olgunun, ameliyattan iki yıl sonra skor ortalamasının 89,75 (aralık 72-98) düzeyine yükselmiş olduğu saptandı. Wilcoxon Signed Ranks testi ile yapılan istatistiki değerlendirme, hastaların Harris skorlamalarının ameliyattan önceki ve sonraki değerleri arasındaki farkın son derece anlamlı (p<0,001) olduğu tespit edildi. Tüm olgularda, ameliyattan sonraki dönemde sıkışma testleri negatif olarak tespit edildi. Sonuç: Güvenli kalça luksasyonu ile FASS olgularının cerrahi tedavisinin sonuçlarının ümit verici olduğu kanısına vardık. FASS olgularında komplikasyon/klinik düzelme oranının, klinik düzelme lehine olması nedeniyle, güvenli cerrahi dislokasyonun, tedavi için uygun bir yöntem olduğunu düşünüyoruz.

Anahtar Kelimeler: Kalça; kalça eklemi; osteoartrit,kalça; femoracetabular sıkışma
ABSTRACT
Objective: We aimed to investigate the clinical outcomes of femoroacetabular impingement syndrome (FAIS) cases who underwent reconstruction with safe hip dislocation. Material and Methods: Between 2006 and 2009, 13 male cases diagnosed with FAIS, whose anterior impingement sign was positive without hip dysplasia were included in the study. Posterior impingement test was positive in five cases. Mean age was 39.3 years (range 32-47). Pre- and post-surgical radiological investigation included hip antero-posterior and false profile x-rays in all cases. In the preoperative period, all cases had femur type impingement except one case with acetabulum type impingement. Radiological investigation revealed cross-over sign and posterior acetabuler wall insufficiency in all cases. Harris hip scoring system was used for functional asseessment. Surgical dislocation was performed as described by Ganz et al. Trochanteric osteotomy line was fixed with two cannulated screws. Results: In all cases femoral impingement cause was eliminated during the operation. Only one case had Pincer lesion, complete degeneration and dissociation that required Labrum resection. There was no nonunion following trochanteric osteotomy. The preoperative mean Harris hip score in 13 cases changed from 63.24 (range 55-70) to 89.75 (range 72-98) two years after the operation. Statistical analysed including the Wilcoxon Signed Ranks test revealed highly significant (p<0.001) differences between pre- and post-operative Harris scorings. Postoperative impingement tests were negative in all cases. Conclusion: Surgical treatment of cases with FAIS with safe hip dislocation was promising. We suggest that safe surgical dislocation is a proper method for treatment as the complication/clinical improvement ratio is in favor of clinical improvement in cases with FAIS.

Keywords: Hip; hip joint; osteoarthritis, hip; femoracetabular impingement

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