POSTERİOR PELVİK HALKA YARALANMALARINDA HANGİ TEKNİK SEÇİLMELİDİR: PERKÜTAN SAKROİLİAK VİDA FİKSASYONU YA DA POSTERİOR PERKUTAN TRANSİLİAK PLAK FİKSASYONU?

Abstract

Amaç: Sakrum kırıklarının tanı ve tedavisi zor olmakla birlikte, hangi cerrahi prosedürün kullanılacağı tartışmalıdır. Amacımız, kliniğimizde sıkça kullandığımız posterior iliosakral vida ile posterior perkutantransiliak plağın uygulanabilirliğini ve postoperatif sonuçlarını karşılaştırmaktır.

Gereç ve Yöntem: Haziran 2013 – Haziran 2018 arasında Muğla Sıtkı Koçman Üniversitesi Tıp Fakültesi Hastanesinde stabil olmayan posterior pelvik halka yaralanması nedeniyle opere edilen ve minimum 6 aylık takibi bulunan 29 hasta çalışmaya dahil edildi. Hasta veri/grafileri, hasta demografisi, travmanın cinsi, posterior cerrahi süresi, skopi görüntüleme sayısı, postoperatif komplikasyonlar açısından incelendi. Hastaların cerrahiden 8 hafta sonra tam yükle basmasına izin verildi.  Postoperatif 3. ayda Pelvik Outcome Skor değerlendirildi. 

Bulgular: Pelvik Outcome Skor ile fiksasyon tipleri arasında anlamlı fark bulunmadı (p>1.0). Pelvik Outcome Skor ile cinsiyet arasında anlamlı fark yoktur (p>1.0).  Pelvik Outcome Skor ile yaş arasında anlamlı fark saptanmamıştır (p=0.056).

Cerrahi işlem süresi, posterior perkutan plak uygulanan hastalarda ortalama 35.3 dakika, perkutan vida fiksasyon uygulanan hastalarda ise ortalama 48.56 dakika (32-67 dk) olarak bulundu (p<0.001). Cerrahi sırasında çekilen skopi şut sayısına bakıldığında perkutan posterior pelvik plak uygulanan grupta ortalama 2.46 şut, posterior vida fiksasyon yapılan grupta ise ortalama 37.3 şut olarak bulundu (p<0.001).

Sonuç: Her iki yöntem ile tedavi sonuçları benzer olarak bulunmuştur. Posterior perkutan transiliak plak fiksasyonu kullanılan hastalarda, ameliyat süresi daha kısa olup skopiye maruziyet oldukça azdır.

Keywords

• Posterior,pelvis kırığı,sakrum kırığı,plak,vida

Which Technique Should Be Choosed in Posterior Pelvic Ring Injuries: Percutaneous Sacroiliac Screw Fixation Technique or Posterior Percutaneous Transiliac Plating Technique?

Abstract

Objective: Besides the difficulties in both the diagnosis and treatment of sacral fractures, there exists controversy for choosing surgical procedure. The aim of our study is to compare the applicability and the postoperative results of percutaneous sacroiliac screw fixation technique and posterior percutaneous transiliac plating technique, which are the commonly used techniques in our clinic.

Material and Method: A total of 29 patients who were operated for unstable posterior pelvic ring injury in Mugla Sıtkı Koçman University Medical Faculty Hospital between May 2013 and June 2018 with a minimum follow-up of 6 months were included in the study. Patient data/radiographs were reviewed for patient demographics, type of the trauma, duration of surgery, operative time, number of intraoperative fluoroscopic imaging, postoperative complications. After the 8th postoperative week, full weight bearing was permitted to the patients. Pelvic outcome score was evaluated at the 3rd month postoperatively.

Results: There was no significant difference between Pelvic Outcome Score and fixation types (p>1.0). There was no significant difference between gender and Pelvic Outcome Score (p>1.0). There was no significant difference between age and Pelvic Outcome Score (p=0.056). The mean duration of surgery was 35.3 minutes in patients who underwent posterior percutaneous transiliac plating, and 48.56 minutes (32-67 min) in patients who had percutaneous sacroiliac screw fixation (p<0.001). When the number of introperative fluoroscopy imaging was evaluated, it was found that the average number of imaging was 2.46 and 37.3 in the posterior percutaneous transiliac plating technique and percutaneous sacroiliac screw fixation technique, respectively (p<0.001).

Conclusion: Treatment results were similar with both methods. In patients with posterior percutaneous transiliac plate fixation, duration of surgery is shorter and the exposure to the fluoroscopy is quite low.

Keywords

• Posterior,pelvic fracture,sacrum fracture,plaque,screw

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