CERRAHİ OLARAK TEDAVİ EDİLEN TİBİA PLATO KIRIKLARINDA RASMUSSEN RADYOLOJİK VE KLİNİK SKORLARI OSTEOARTRİT EVRESİNİ ETKİLER Mİ?

Year 2018, Volume: 51 Issue: 1, 26 - 32, 30.03.2018

Yunus Demirtaş , Sualp Turan

Abstract

Amaç: Bu çalışmanın amacı tibia plato kırıklarının
sonuçlarını etkileyen faktörleri araştırmak ve Rasmussen radyolojik ile klinik
skorlar ve bu skorların osteoartirit evresi arasındaki ilişkinin
değerlendirilmesidir.             Gereç ve Yöntem: Ankara Numune Eğitim ve Araştırma Hastanesi Ortopedi ve
Travmatoloji A Kliniğinde 2007 Ocak–2013 Haziran tarihleri arasında tibia plato
kırığı tanısı ile cerrahi tedavisi yapılan 30 hasta  çalışmaya alındı. Hastaların sonuçları retrospektif olarak değerlendirildi.

Bulgular: 21’i (%70) erkek, 9’u (% 30) kadındı. Hastaların yaş
aralığı 18-71 arasında değişmekte olup ortalama yaş 45,7±15.2 olarak bulundu. Çalışmaya
alınan 30 hastanın toplamda 30 plato kırığının 16 (%53.3) kırık solda, 14 (%
46.6) kırık sağ taraftaydı. Hastalar ortalama 3 (1-14) gün içerisinde ameliyat
edildi. Ortalama takip süresi 23.3±17.8 (6-72) ay olarak bulundu.

Yaralanma
mekanizması 10 hastada araç içi trafik kazası, 3 hastada araç dışı trafik
kazası, 7 hastada yüksekten düşme, 6 hastada basit düşme, 1 hastada spor
yaralanması, 1 hastada ateşli silah yaralanması, 2 hastada ise darp idi.

Kırıkların
dağılımı açısından incelendiğinde Schatzker sınıflamasına göre 6 kırık tip 1,
11 kırık tip 2, 1 kırık tip 3, 3 kırık tip 4, 8 kırık tip 5, 1 kırık tip 6  idi. Tespit materyali olarak 24 hastada Liss
plağı, 6 hastada kanüllü vida, 1 hastada da hem liss plağı ve kanüllü vida
kullanıldı. Rasmussen klinik değerlendirilmesine göre 19 hastada
mükemmel, 8 hastada iyi, 3 hastada orta sonuçlar elde edilmiştir. Rasmussen
radyolojik değerlendirilmesinde ise 2 hastada mükemmel, 17 hastada iyi, 8
hastada orta, 3 hastada kötü sonuçlar elde edilmiştir.

Olgular komplikasyon
açısından değerlendirildiğinde 8 olguda eklem hareket kısıtlılığı, 1 olguda
derin ven trombozu. 2 olguda biri tamamiyle iyileşmiş safen sinirin
infrapatellar sinir yaralanması, 4 olguda antibiyotik tedavisine yanıt veren
yüzeyel yumuşak doku enfeksiyonu saptandı.

Sonuç: Sonuç olarak tibia plato
kırıkları eklemi ilgilendiren kırıklar olduğundan, kırığın tipi ve yeri, yer
degistirme ve parçalanmanın derecesi ve eslik eden kemik ve yumusak doku
hasarları dikkate alınarak uygun cerrahi yöntem seçilmelidir. Rasmussen
radyolojik ve klinik skorlar ile osteoartrit evresi arasında bir ilişki
saptanamamıştır. Rasmussen klinik skorlar ile radyolojik skorlar arasında orta
dereceden ilişki mevcuttur.

Keywords

Rasmussen kriterleri, Schatzker sınıflandırması

DOES RASMUSSEN RADIOLOGICAL AND CLINICAL SCORES OF PATIENTS WHOM WERE TREATED SURGICALLY FOR TIBIAL PLATEAU FRACTURES EFFECT OSTEOARTHRITIS GRADE?

Abstract

    

          Objective: The aim of this study is
to research the factors affecting the result of tibia plateau fractures and
evaluating the correlation between the clinic scores and Rasmussen radiologic
and osteoarthritis stage.

Material and Methods: Between January 2007 and
June 2013, in
the Department of Orthopaedics and Traumatology of Ankara Numune Education and
Research Hospital Clinic A 30 patients who were made surgical treatment
diagnosed with tibia plateau fractures evaluated.  Results of patients were evaluted retrospectively.

Results: 21(%70) of patients were male and remaining 9 (%30)
were female. The ages of the patients
were between 18-71 and average patient age was 45.7± 15.2. 16 fractures were
located on the left side and 14 were on the right side. The surgical treatment
of these case patients complited between 1-14 days. The average follow-up was
23.3±17.8(6-72) months.

The most common mechanism
of injury was motor wehicle accident.

The fractures were
classified according to Schtazker. There were 6 type I, 11 type II, 1 type III,
3 Type IV, 8 type V and 1 type VI. We used Liss plate in 23 patients,
cannulated screw in 6 patients and both liss plate and canulated screw in one
patient. According to Rasmussen clinical score, 19 cases had an excellent
result, 8 cases had a good result, 1 case had a modarete result. According to
Rasmussen radiological score, 2 cases had an excellent result, 17 cases had a
good result, 8 case had a modarete result 3 cases bad result.

Postoperative
complications included superficial infections in four patients, arthrofibrosis
in eight patients, deep vein thrombosis in one patient and infrapatellar nerve
injury in one patients.

Conclusion: Consequently, as tibial
plateau fractures are articular fractures, proper surgical method should be
selected by taking into consideration the type and area of fracture, degree of
migration and fracture, and the accompanying damages of bone and soft tissue.

Keywords

Rasmussen score, Schatzker’s classification, Tibial plateau fracture

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