Tibia Cisim Kırıklarının Tedavisinde Oymalı Kanal İçi Çivi Uygulama Sonuçlarının Değerlendirilmesi

Year 2014, Volume: 11 Issue: 1, 34 - 44, 01.04.2014

Mehmet Akif Altay Cemil Ertürk İslam Baykara Metin Yaptı Baki Volkan Çetin Kemal Yüce İbrahim Avşin Öztürk

Abstract

Amaç: Tibia kırıkları tüm uzun kemikler arasında en sık karşılaşılan kırıklardır. Genelde konservatif yaklaşımlar uygulansa da dengesiz ve açık kırıklarda cerrahi tespit gerekmektedir. Kanal içi çivi uygulamaları tibia cisim kırıklarının tedavisinde popüler bir yöntemdir. Ancak açık ve kapalı tibia kırıklarının tedavisinde oymalı ve oymasız uygulamalar üzerindeki tartışmalar halen sürmektedir. Geriye dönük olarak planlana bu çalışmanın amacı açık ve kapalı tibia cisim kırıklarının cerrahi tedavisinde oymalı kanal içi çivi uygulamalarımızın fonksiyonel ve cerrahi sonuçlarını değerlendirmektir.Materyal ve metod: Çalışmamıza tibia cisim kırığı sonrasında kilitli kanal içi çivi uygulanarak tedavi edilen 24 hasta 5 kadın ve 19 erkek dahil edildi. Hastalar kırığın şekline göre iki guruba ayrıldı. Açık kırığı olan 13 hasta ort yaş 31.7±10.7 yıl gurup 1 ve kapalı kırığı olan 11 hasta ort yaş 33.4±10.4 yıl gurup 2 olarak ayrıldı. Sonuçlar fonksiyonel ve radyolojik olarak değerlendirildi. Fonksiyonel değerlendirmede JohnerWrush kriterleri kullanıldı.Bulgular: Ortalama izlem süresi gurup 1 için 25.3±11.5 ay, gurup 2 için ise 23.7±12.6 ay idi. Her iki gurup içinde AO sınıflamasına göre kırık tiplerinin dağılımı benzerdi p > 0.05 . Fonksiyonel ve radyolojik sonuçların karşılaştırılmasında her iki gurup arasında istatistiksel olarak anlamlı bir fark yoktu p > 0.05 . Tüm kırıklarda ortalama 17.3±6.4 haftada solid kaynama sağlandı ve kalıcı sorunlara yol açabilecek herhangi bir sorunla karşılaşılmadı. Kaynamada gecikme olan iki olguda dinamizasyon uygulandı ve ilave bir işleme gereksinim kalmadan yeterli kaynama sağlandı. Johner-Wrush kriterlerine göre fonksiyonel sonuçlar 16 hastada %67 çok iyi ve 8 hastada %33 iyi idi.Sonuç: Tibia diafiz kırıklarının cerrahi tedavisinde oymalı kanal içi çiviler düşük komplikasyon oranına sahip iyi bir tedavi seçeneğidir. Orta derecede kontaminasyon gösteren açık kırıklarda da güvenle uygulanabilirler. Ancak uygulamanın başarısı cerrahi tekniğin uygun şekilde yapılmasının yanı sıra doğru endikasyonun da belirlenmesine bağlıdır

Keywords

Kırık sabitlemesi, intramedüler, tibia kırıkları, kırıklar, kapalı, kırıklar, açık

Evaluation of tibial shaft fractures treated with reamed intramedullary nailing

Abstract

Background: Tibial fractures are the most common of all long bone fractures. Although many tibial fractures may be managed conservatively, a certain subset, including unstable fractures and open fractures, require operative stabilization. Intramedullary nails have become the popular choice of implant in the treatment of tibial shaft fractures. The choice between reamed and unreamed intramedullary nailing fort he treatment of open and closed tibial fractures is an ongoing controversy. The aim of this retrospective study was to evaluate the functional and radiological results of open versus closed tibial shaft fractures treated with reamed intramedullary nailing. Methods: The study included 24 patients 5 woman and 19 man who underwent surgical treatment with intramedullary nailing for tibial shaft fractures. Patients were divided into two groups. Group 1 Open fracture included 13 patients mean age: 31.7±10.7 years . Group 2 Closed fracture consisted of 11 patients mean age: 33.4±11.4 years . Functional and radiologic results were assessed. Johner-Wrush criteria was used for functional assessment. Results: Mean follow-up periods of 25.3±11.5 months and 23.7±12.6 months in group 1 and group 2, respectively. The distrubition of fracture types according to AO classification between the two groups was similar. There was no significant difference between the two groups in terms of functional and radiological results. All fractures healed with solid union within a mean of 17.3±6.4 weeks, and there was no complication that was expected to cause permanent disability. Two patients required dynamization because of delayed union without any other additional procedures. Transient sensorial deficit occured in one patient. According to the Johner-Wrush criteria, functional results were very good in 16 patients 67% , and good in 8 patients 33% . Conclusions: Surgical treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing is an appropriate choice with a low complication rate. It can be safely used in moderately contaminated open fractures. However, success of the application, in accordance with, depends on the determination of an accurate indication as well as the surgical technique

Keywords

Fracture Fixation, Intramedullary, tibial fractures, Fractures, Closed, Fractures, Open

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