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

Year 2019, , 80 - 84, 30.04.2019

Cem Yalın Kılınç

https://doi.org/10.24938/kutfd.522989

Cited By: 3

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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