Ekstremite yerleşimli yabancı cisimlerin görüntülenmesinde ve cerrahi tedavide

Year 2013, Volume: 47 Issue: 6, 387 - 392, 07.02.2014

Tuhan Kurtulmus Necdet Saglam Gursel Saka Mehmet Imam Fuat Akpinar

Abstract

Amaç: Bu çalışmada yabancı cisim batması olan olgularda tanı ve tedavideki zorlukları ve bu konuda dikkat edilmesi gereken noktaları değerlendirmeyi amaçladık.
Çalışma planı: Şubat 2005 ve Temmuz 2011 tarihleri arasında yabancı cisim batması nedeniyle ameliyat edilen 295 olgu (150 erkek, 145 kadın; ortalama yaş 26.82±16.84; dağılım: 3-79) geriye yönelik olarak incelendi. Etkilenen taraf, yabancı cismin türü, lokalizasyonu, şikayetler, görüntülemede hangi tekniğin tercih edildiği, yaralanmanın olduğu mevsim, yabancı cismin vücuttaki etkileri, yaralanma ile cerrahi müdahale arasında geçen süre, çıkarma endikasyonu, anestezi tipi, cerrahi tedavi esnasında skopi kullanımı ile cerrahi girişimin komplikasyonları değerlendirildi.
Bulgular: Yabancı cismin 157 olguda sağ, 138 olguda ise sol ekstremitede olduğu görüldü. Dört olguda dirsekte, 6 olguda ön kolda, 6 olguda el bileğinde, 75 olguda elde, 1 olguda kalçada, 7 olguda uylukta, 11 olguda diz çevresinde, 6 olguda diz ekleminde, 10 olguda kruriste, 8 olguda ayak bileğinde ve 161 olguda ise ayak tabanındaydı. Yaralanma dönemi 148 olguda yaz, 107 olguda kış, 35 olguda ilkbahar ve 5 olguda sonbahar mevsimi olarak belirlendi. Ekstremitelerden 216 iğne, 33 metal, 28 cam, 10 tahta, 4 plastik, 4 taş parçası çıkartıldı. Yaralanma ile operasyon arasında geçen süre 135 olguda 1, 114 olguda 2-10, 22 olguda 11-30, 13 olguda 30-365 gün iken, 11 olguda çıkartma işlemi 365 gün sonrasında gerçekleştirildi.
Çıkarımlar: Yabancı cisim batması, enfeksiyon, migrasyon, eklemlerde hareket kısıtlılığı gibi çeşitli komplikasyonlarla sonuçlanabilir. Ayrıntılı anamnezle birlikte fizik ve radyolojik muayeneler, bu hastaların tedavilerinden en iyi sonuç alınması yönünden son derece önem taşımaktadır.

Keywords

Çıkartma; ekstraksiyon; ekstremiteler; yabancı cisimler.

Tips and tricks in the diagnostic workup and the removal of foreign bodies in extremities

Abstract

Objective: The aim of this study was to analyze the diagnostic and therapeutic challenges during the removal of foreign bodies in extremities, and to provide relevant tips and tricks.
Methods: The medical records of 295 patients (150 men, 145 women; mean 26.82±16.84 years; range: 3 to 79 years) who underwent foreign body removal from their limbs between February 2005 and July 2011, were retrospectively reviewed. Side of the extremity, foreign body type, location, complaints, imaging technique, the season of injury, the effects of foreign body in the body, the time between injury and extraction, indication forextraction, type of anesthesia, the use of fluoroscopy during the surgical procedure, and complications of surgical intervention were analyzed.
Results: The injury was in the right limb in 157 patients and in the left limb in 138 patients. Foreign bodies were in the elbow in 4 cases, in the forearm in 6, in the wrist in 6, in the hand in 75, in the hip in 1, in the thigh in 7, around the knee joint in 11, in the knee joint in 6, in the lower leg in 10, in the ankle in 8, and in the foot sole in 161. The season of injury was summer in 148 cases, winter in 107, spring in 35, and autumn in 5. The removed foreign bodies were needles in 216 cases, metallic objects in 33, pieces of glasses in 28, pieces of wood in 10, pieces of plastic in 4, and pieces of stone in 4. The time between the injury and foreign body removal was 1 day in 135 cases, 2 to 10 days in 114, 11 to 30 days in 22, and 30 to 365 days in 13. The removal time was longer than 1 year such in 11 cases.
Conclusion: Foreign body injuries may result in serious complications such as infection, migration and joint stiffness. A throughout history and physical and radiological examinations are of tremendous importance to achieve the best outcome in these patients. 

Keywords

Extraction, foreign bodies, limbs, extraction, removal

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