CERRAHİ OLARAK TEDAVİ EDİLEN TİBİA PLATO KIRIKLARINDA RASMUSSEN RADYOLOJİK VE KLİNİK SKORLARI OSTEOARTRİT EVRESİNİ ETKİLER Mİ?

Öz

Amaç: Bu çalışmanın amacı tibia plato kırıklarının sonuçlarını etkileyen faktörleri araştırmak ve Rasmussen radyolojik ile klinik skorlar ve bu skorların osteoartirit evresi arasındaki ilişkinin değerlendirilmesidir.             Gereç ve Yöntem: Ankara Numune Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji A Kliniğinde 2007 Ocak–2013 Haziran tarihleri arasında tibia plato kırığı tanısı ile cerrahi tedavisi yapılan 30 hasta  çalışmaya alındı. Hastaların sonuçları retrospektif olarak değerlendirildi.

Bulgular: 21’i (%70) erkek, 9’u (% 30) kadındı. Hastaların yaş aralığı 18-71 arasında değişmekte olup ortalama yaş 45,7±15.2 olarak bulundu. Çalışmaya alınan 30 hastanın toplamda 30 plato kırığının 16 (%53.3) kırık solda, 14 (% 46.6) kırık sağ taraftaydı. Hastalar ortalama 3 (1-14) gün içerisinde ameliyat edildi. Ortalama takip süresi 23.3±17.8 (6-72) ay olarak bulundu.

Yaralanma mekanizması 10 hastada araç içi trafik kazası, 3 hastada araç dışı trafik kazası, 7 hastada yüksekten düşme, 6 hastada basit düşme, 1 hastada spor yaralanması, 1 hastada ateşli silah yaralanması, 2 hastada ise darp idi.

Kırıkların dağılımı açısından incelendiğinde Schatzker sınıflamasına göre 6 kırık tip 1, 11 kırık tip 2, 1 kırık tip 3, 3 kırık tip 4, 8 kırık tip 5, 1 kırık tip 6  idi. Tespit materyali olarak 24 hastada Liss plağı, 6 hastada kanüllü vida, 1 hastada da hem liss plağı ve kanüllü vida kullanıldı. Rasmussen klinik değerlendirilmesine göre 19 hastada mükemmel, 8 hastada iyi, 3 hastada orta sonuçlar elde edilmiştir. Rasmussen radyolojik değerlendirilmesinde ise 2 hastada mükemmel, 17 hastada iyi, 8 hastada orta, 3 hastada kötü sonuçlar elde edilmiştir.

Olgular komplikasyon açısından değerlendirildiğinde 8 olguda eklem hareket kısıtlılığı, 1 olguda derin ven trombozu. 2 olguda biri tamamiyle iyileşmiş safen sinirin infrapatellar sinir yaralanması, 4 olguda antibiyotik tedavisine yanıt veren yüzeyel yumuşak doku enfeksiyonu saptandı.

Sonuç: Sonuç olarak tibia plato kırıkları eklemi ilgilendiren kırıklar olduğundan, kırığın tipi ve yeri, yer degistirme ve parçalanmanın derecesi ve eslik eden kemik ve yumusak doku hasarları dikkate alınarak uygun cerrahi yöntem seçilmelidir. Rasmussen radyolojik ve klinik skorlar ile osteoartrit evresi arasında bir ilişki saptanamamıştır. Rasmussen klinik skorlar ile radyolojik skorlar arasında orta dereceden ilişki mevcuttur.

Anahtar Kelimeler

• Rasmussen kriterleri,Schatzker sınıflandırması

DOES RASMUSSEN RADIOLOGICAL AND CLINICAL SCORES OF PATIENTS WHOM WERE TREATED SURGICALLY FOR TIBIAL PLATEAU FRACTURES EFFECT OSTEOARTHRITIS GRADE?

Öz

    

          Objective: The aim of this study is to research the factors affecting the result of tibia plateau fractures and evaluating the correlation between the clinic scores and Rasmussen radiologic and osteoarthritis stage.

Material and Methods: Between January 2007 and June 2013, in the Department of Orthopaedics and Traumatology of Ankara Numune Education and Research Hospital Clinic A 30 patients who were made surgical treatment diagnosed with tibia plateau fractures evaluated.  Results of patients were evaluted retrospectively.

Results: 21(%70) of patients were male and remaining 9 (%30) were female. The ages of the patients were between 18-71 and average patient age was 45.7± 15.2. 16 fractures were located on the left side and 14 were on the right side. The surgical treatment of these case patients complited between 1-14 days. The average follow-up was 23.3±17.8(6-72) months.

The most common mechanism of injury was motor wehicle accident.

The fractures were classified according to Schtazker. There were 6 type I, 11 type II, 1 type III, 3 Type IV, 8 type V and 1 type VI. We used Liss plate in 23 patients, cannulated screw in 6 patients and both liss plate and canulated screw in one patient. According to Rasmussen clinical score, 19 cases had an excellent result, 8 cases had a good result, 1 case had a modarete result. According to Rasmussen radiological score, 2 cases had an excellent result, 17 cases had a good result, 8 case had a modarete result 3 cases bad result.

Postoperative complications included superficial infections in four patients, arthrofibrosis in eight patients, deep vein thrombosis in one patient and infrapatellar nerve injury in one patients.

Conclusion: Consequently, as tibial plateau fractures are articular fractures, proper surgical method should be selected by taking into consideration the type and area of fracture, degree of migration and fracture, and the accompanying damages of bone and soft tissue.

Anahtar Kelimeler

• Rasmussen score,Schatzker’s classification,Tibial plateau fracture

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