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Abstract

Objective: We aimed to compare the results of surgeries for intracapsular femoral neck fractures with cannulated screws(CS) and dynamic hip screw(DHS), due to lack of evidence which implant for internal fixation of femoral neck fractures is better .Methods: In our clinic between September 2005 and November 2009, 38 patients were operated with intracapsular transcervical fracture of collum femoris between17 to 65 years of age. Eighteen were operated with DHS(47.4%) and 20 were operated with CS fixation(52.6%).Results: 16 patients (42.1%) were female and 22 (57.9%) were male and the mean age was 37.13 years. The mean duration of follow-up was 18.05 months. 26 patients were operated in 1st -3rd day (68.4%), 9 patients were operated in 4 to 7 day (23.7%), 3 patients were operated in after 7th day (7.9%). In the DHS group, 9 (50%) patients had avascular necrosis (AVN), 6 (33.3%) patients had implant failure, 3 (16.7%) patients had delayed union, 5 (27.8%) patients had nonunion, 1 (5.6%) patient had infection, and 1 (5.6%) patient had myositis ossificans. According to the criteria of Salvati Wilson hip joint assessment, in the DHS group 8 patients (44.4%) were very good, 5 patients (27.8%) were good, 5 patients (27.8%) were moderate. Salvati score was evaluated as average of 28 points . İn the CS group, 8 (40%) patients had AVN, 1 (5%) had delayed union, 3 (15%) of the cases had nonunion and 1 (5%) patients infection was detected. According to the criteria of the Salvati-Wilson, in the CS group13 (65%) of them are very good, 5 (25%) were good, 2 (10%) were assessed as moderate. Salvati score was evaluated as average of 33 points . In the CS group none of the patients had implant failure, in the DHS group 6 patients had implant failure (33.3%) (p<0,05).Conclusion: Except for the high rate of implant failure detection in the DHS group method, no significant difference between complications and functional results between two groups. J Clin Exp Invest 2015; 6 (3): 256-262

Keywords

• femoral neck fractures, dynamic hip screw, cannulated screw

Femur boyun kırıklarının tedavisinde kanüllü vida ile dinamik kalça vidasının karşılaştırılması

Öz

Amaç: Femur boyun kırıklarının internal fiksasyonu için hangi implantın üstün olduğunu gösteren belirgin kanıtların olmaması nedeniyle intrakapsuler femur boyun kırıklarında kanüllü vida (KV) ve dinamik kalça vidası (DKV) ile yapılan cerrahilerin sonuçlarını karşılaştırmayı amaçladık. Yöntemler: Kliniğimizde Eylül 2005 ile Kasım 2009 tarihleri arasında, 17 ila 65 yaş arası DKV ve KV ile cerrahi tedavi uygulanan intrakapsüler collum femoris kırıklı, düzenli kontrolleri olan hastalardan transservikal kırığı olan hastalar çalışmaya dahil edildi. Olgular 2 grupta incelendi. DKV uygulanan olgular 1. Grup, KV uygulanan olgular ise 2.grup olarak belirlendi. 38 hastanın 18’ine(%47,4) DKV, 20’sine(%52,6) KV ile osteosentez uygulandı. Bulgular: Hastaların 16’sı(%42,1) kadın, 22’si(%57,9) erkek idi ve ortalama yaşları 37,13(17-65) idi. Takip süresi ortalama 18,05(2-57) ay idi. Hastaların 26’sı(%68,4) 1-3. günde, 9’u(%23,7) 4-7.günde ve 3’ü(%7,9) 7.günden sonra operasyona alınmıştır. DKV grubunun 9(%50)’unda avasküler nekroz(AVN), 6(%33,3)’sında implant yetmezliği, 3(%16,7)’ünde geç kaynama, 5(%27,8)’inde kaynamama, 1(%5,6)’inde enfeksiyon ve 1(%5,6) hastada da miyozitis ossifikans saptandı. DKV grubunda Salvati-Wilson kalça eklemi değerlendirme kriterine göre hastalarımızın 8’i(%44,4) çok iyi, 5’i(%27,8) iyi, 5’i(%27,8) orta olarak değerlendirildi. Salvati puanı ortalama 28 puan olarak değerlendirildi(16-40). KV grubunun 8(%40)’inde AVN, 1 (%5)’inde geç kaynama, 3 (%15)’ünde kaynamama ve 1 (%5) hastada ise enfeksiyon tespit edildi. KV grubunun Salvati-Wilson kalça eklemi değerlendirme kriterine göre 13 (%65)’ü çok iyi, 5 (%25)’i iyi, 2 (%10)’si orta olarak değerlendirildi. Salvati puanı ortalama 33 puan olarak değerlendirildi (18-40). KV ile opere edilen hiçbir hastada implant yetmezliği gelişmezken DKV uygulanan grupta bu oran %33,3 idi (p < 0,05). Sonuç: Femur boyun kırıklarının internal fiksasyon ile tedavisinde DKV ile tespit yönteminde implant yetmezliği oranının yüksekliği dışında her iki tespit yönteminde komplikasyon ve fonksiyonel sonuçlar arasında anlamlı fark bulunamadı.

Anahtar Kelimeler

• Femur boyun kırıkları, dinamik kalça vidası, kanüllü vida

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