Torakolomber Vertebra Kırıklarında Posterior Stabilizasyon Uygulanan Hastalarımızda Geç Dönem Sonuçlarımız

Yıl 2020, Cilt: 7 Sayı: 4, 476 - 480, 31.12.2020

Hakan Koray Tosyalı Sertan Hancıoğlu Serkan Erkan

https://doi.org/10.34087/cbusbed.723625

Öz

Bu çalışmada 2007- 2015 tarihleri arasında C.B.Ü.T.F Hastanesi Ortopedi ve Travmatoloji Kliniğinde cerrahi yolla tedavi edilen Torakolomber vertebra kırığı bulunan 17 olgunun retrospektif değerlendirilmesi yapıldı. Çalışmaya dahil edilen hastaların en genci 20, en yaşlısı 63 yaşındaydı ve hastaların yaş ortalaması 43.05 ±13,25 olarak belirlendi. Bu çalışmadaki 17 hastanın 9 ‘u (%52.9) kadın, 8‘si (%47.1) ise erkekti. Etyolojik faktör 7 olguda (%41,2) yüksekten düşme ,7 olguda (%41,2) trafik kazası, 2 olguda (%11,8) araç dışı trafik kazası ve 1 olguda (%5,9) darp idi. Olguların beşinde (%29,4) L3, üçünde (%17,6) L1, üçünde (%17,6) T12 ,ikisinde (%11,8) T8 ve bir hastada (%5,9) T10 ,bir hastada (%5,9) L2 ve bir hastada (%5,9) L4 ve bir hastada da (%5,9) L5 kırık idi. Hastaların %82,4 ini patlama tarzı kırıklar oluşturmaktadır. Ek yaralanmalara bakıldığında ise en sık fıbula şaft kırığı yaralanması görülmektedir. Hastaların hepsine posterior spinal segmental enstrumantasyon uygulandı. Tüm olgularda füzyon amacı ile hastanın kendi kemikleri karıştırılarak kullanıldı. Operasyonlarda ortalama 2 ,05 ünite kan kullanılmıştır.1 hastada implant kırılması ve yetmezliği görüldü. Hastaların ameliyat öncesinde , ameliyat sonrasında ve son kontrollerde klinik ve radyolojik sonuçları değerlendirildi. Ölçülen radyolojik parametreler arasında ayakta yan grafilerde ; anterior korpus yükseklik kaybı , sagittal indeks , lokal kifoz açısı ,anterior kompresyon açısı yer almakta idi. Ayrıca 17 hastanın, ameliyat öncesi ve son kontrollerdeki bilgisayarlı tomografide transvers ve ön-arka spinal kanal çapları değerlendirildi. Son kontrollerde hastaların klinik gözlemleri vizüel analog skala (VAS) ,Roland –morris skalası ve Oswestry skorlama sistemi kullanılarak kaydedildi ve sonuçlar değerlendirildi.

Anahtar Kelimeler

Torakolomber vertebra, posterior stabilizasyon, vertebra kırığı

Destekleyen Kurum

CELAL BAYAR ÜNİVERSİTESİ ,BİLİMSEL ARAŞTIRMA PROJESİ

Proje Numarası

2012-058

Late Results of Posterior Stabilization in Patients with Thoracolumbar Vertebral Fractures

Öz

Objective: In this study, we retrospectively evaluated 17 cases with thoracolumbar vertebra fractures who were surgically treated in Orthopaedics and Traumatology Clinics between the years January 2007 and June 2012.
Materials and Metods: In our cases mean age of the patient were 43.05 ±13,25 and the youngest patient was 20 years old whereas the oldest was 63 years old. In our study, 8 (47.1%) of the 17 patients were male and 9 (52.9%) of them were female. Etiological factor was falling from a height in 7 (41,2%) cases, traffic accident in 7 (41,2%) cases, out side traffic accident in 2 (11,8%) cases and pounding in 1 (5,9%) cases. In 5 cases (29,4%) L3, in 3 cases (17,6%) L1, in 3 cases (17,6%) T12 ,in 2 cases (11,8%) T8 ,in 1 cases (5,9%) T10 ,in 1 cases (5,9%) L2 ,in 1 case (5,9%) L4 ,and in one case (5,9%) L5 vertebrae was fractured. 82,4% of the patients have burst fractures. The most observed additional injury is fibula shaft fracture injury.
Results: Posterior spinal segmental instrumentation was performed in all casesThe radiological parameters were evaluated as loss of height in anterior corpus, sagittal index, local angle of kyphosis and anterior compresion angle in standing lateral radiographies. Moreover in 17 cases transverse and anteriorposterior spinal canal diameters were evaluated in CT assesment pre-operatively and during last controls. The clinical observation was made using visual analogue scala (VAS),Roland –Morris scala and Oswestry scoring system during last controls and the results were evaluated.
Conclusion: We conclude that canal remodelling is more effective than improvement in radiological parameters in clinical satisfaction.

Anahtar Kelimeler

Thoracolumbar vertebra, posterior stabilization

Proje Numarası

2012-058

Kaynakça

• Referans1 Yılmaz G, Acaroğlu E. Torakolomber bölge omurga yaralanmaları. Türkiye Klinikleri J surg med sci 2006;2(30):5-10.
• Referans2 White AA, Panjabi MM. Clinical biomechanics of the spine, 2nd Edition Lippincott Williams & Wilkins, Philadelphia, 1990, pp: 115-117.
• Referans3 Benli İT, Tandoğan NR, Kış M, Tüzüner M, Mumcu EF, Akalın S, Çıtak M. Cotrel –Dubousset instrumentation in the treatment of unstable thoracic and lumbar spine fractures. Arch Orthop Trauma Surg 1994; 113: 88 – 92.
• Referans4 Eastlack RK, Bono CM. Fractures anddislocations of the thoracolumbar spine. In: RW, Heckman JD, Court-Brown CM (Eds.).Rockwood and Green’s Fractures in Adults. Vol. 2, 5th Ed., Lippincott Williams Wilkins,Philadelphia, 2001; 1543-1580.
• Referans5 Knop C, Fabian H, Bastian L, Blauth M. Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine 2001; 26 (1): 88-89.
• Referans6 Marco RA, Kushwaha VP. Thoracolumbar burstfractures treated with posterior decompression and pedicle screw instrumentationsupplemented with balloon – assisted vertebroplasty and calcium phosphate reconstruction. J Bone Joint Surg 2009; 91 – A(1): 20 – 28.
• Referans7 McLain RF, Burkus JK, Benson DR. Segmental instrumentation for thoracic and thoracolumbar fractures: prospective analysis constructs survival and five – year follow. Spine J 2001; 1 (5): 310 – 323.
• Referans8 Scholl BM, Theiss SM, Kirkpatrick JS. Short segment fixation of thoracolumbar burst fractures. Orthopaedics 2006; 29 (8): 703 –708.
• Referans9 Vaccaro AR, Kim DH, Brodke DS, Harris M, Chapman J, Schildhauer T, Routt MLC, Sasso RC. Diagnosis and Management of Thoracolumbar Spine Fractures. An Instructional Course Lecture, American Academy of Orthopaedic Surgeons. J Bone Joint Surg Am. 2003; 85-A: 2455-70.
• Referans10 Zdeblick TA, Sasso RC, Vaccaro AR, Chapman JR, Harris MB. Surgical treatment of thoracolumbar fractures. Instr Course Lect 2009; 58: 639 – 644.
• Referans11 Roy Camille R., Saillant G., Mazel C.: Plating of Thoracic, Thoracolumbar and Lumbar Injuries with Pedicle Screw Plates. Orthop. Clin. North Am. 17: 147–159, 1986
• Referans12 Gertzbein SD, Court-Brown CM, Marks P, et al. (1988) The neurologic outcome following surgery for spinal fractures. Spine 13:641–4.
• Referans13 Cotler JM, Vernace JV, Michalski JA. (1986): The use of Harrington rods in thoracolumbar fractures. Orthop Clin N Am 17: 87-103.
• Referans14 Dickson JH, Harrington PR, Erwin WD. (1978): Results of reduction and stabilization of the severely fractured thoracic and lumbar spine. J Bone and Joint Surg 60-A: 799-805.
• Referans15 Ebelke DK., Asher MA, Neft JR., Kraker DP.: Survivorship Analysis of VSP Spine Instrumentation in the Treatment of Thoracolumbar and Lumbar Burst Fractures. Spine, 16(Supp.): 428–432, 1991.
• Referans16 Graziano GP: Cotrel-Dubousset hook and rod combinations for spine fractures. Journal of Spinal Disorders 6: 380-385, 1993
• Referans17 Alvine GF, Swain JM, Asher MA, et al. (2004) Treatment of thoracolumbarburst fractures with variable screw placement or Isola instrumentation and arthrodesis: case series and literature review. J Spinal Disord Tech. 17(4):251 –64
• Referans18 McLain RF, Sparling E, Benson DR (1993) Early failure of short-segment pedicle instrumentation of thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am 75(2):162–7. traumatic thoracolumbar vertebral fractures. Spine 27(5):543–8.
• Referans19 Weinstein JN, Collalto P, Lehmann TR. Thoracolumbar “burst” fractures treated conservatively: a long-term follow-up. Spine 1988; 13: 33-38
• Referans20 Denis F, Armstrong GW, Searls K, Matta L. Acute thoracolumbar burst fractures in the absence of neuralgic defisit. A comparison between operative and non-operative treatment. Clinical Orthopedics and Related Research 1984: 189; 1-9.
• Referans21 Shen WJ, Liv TJ, Shen YS. Non operative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic defisit. Spine 2001; 26 (9): 1038 –1045.
• Referans22 Saifuddin A. MRI of acute spinal trauma. Skeletal Radiol 2001; 30: 237-246.
• Referans23 Yazar T, Acar B. Yatay konumlu konvansiyonel MRG’de aksiyel kompresyon ve traksiyon uygulaması omurga değerlendirimesi için anlamlı mıdır? The Journal of Turkish Spinal Surgery. 2009; 20 (4): 11-18.
• Referans24 Knop C, Fabian H, Bastian L, Blauth M. Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine 2001;26(1): 88-89
• Referans25 McNamara MJ, Stephens GC, Spengler DM. Transpedicular short-segment fusions for treatment of lumbar burst fractures. J Spinal Disorders 1992; 5(2): 183-187.