İnstabil Femur İntertrokanterik Kırıklarında İki Farklı Tedavi Yönteminin Karşılaştırması

Öz

Amaç: Geriatrik popülasyonda mortalite ve morbidite oranı yüksek klinik bir durum olan kalça kırığının cerrahi tedavisinde kullanılan iki farklı yöntem olan proksimal femoral çivi ve parsiyel kalça protezinin hastalarda perioperatif farklarının, klinik açıdan iyileştirici etkilerinin ve fonksiyonel sonuçlarının literatür verileriyle karşılaştırılması amaçlandı. Gereç ve Yöntem: Eylül 2019 - Eylül 2020 arasında Evans sınıflamasına göre instabil femur intertrokanterik kırığı olarak kabul edilen 73 hasta proksimal femoral çivi (grup 1) ya da parsiyel kalça protezi (grup 2) ile tedavi edildi. Çalışmaya dahil edilen hastalar; ek hastalıkları, vücut kitle indeksleri, anestezi şekilleri, American Society of Anesthesiologists değerleri, intraoperatif kanama, ameliyat olana kadar geçen süreleri, ameliyat sonrası hastanede kalış süreleri, Harris kalça skorları, derin ven trombozu, yara yeri enfeksiyonu gibi postoperatif komplikasyonları ve ölüm oranları açısından analiz edildi. Bulgular: Hasta grubu; yaşları 65-96 arasında olan 29 erkek ve 44 kadından oluşmaktaydı. Çalışmaya dahil edilen hastalar ortalama 8,2 ay takip edildi. Hastalara ameliyat sonrası 6.ay kontrollerinde Harris kalça skoru hesaplandı. Bu skor grup 1 hastalarda ortalama 72,10 puan ve grup 2 hastalarda ortalama 65,55 puandı (p=,24). Cerrahi prosedür bakımından pre-op süre, kan gereksinimi, Harris kalça skalası açısından anlamlı fark bulunamadı. Ancak hemiartroplasti lehine olarak operasyon sonrası hastanede kalış süresi anlamlı olarak uzamıştı (p=,02). Hastaların American Society of Anesthesiologists değeri açısından, düşük ve yüksek riskli hastalarda proksimal femoral çivi, orta riskli hastalarda hemiartroplasti tercih etme eğilimimiz istatistiksel olarak anlamlı bulundu (p=,01). Takip edilen 3 hastada yara yeri enfeksiyonu ve 2 hastada periprostetik kırık gelişti. Sonuç: İnstabil femur intertrokanterik kırıklarında hem proksimal femoral çivi hem de parsiyel kalça protezi iyi klinik ve fonksiyonel sonuçlar göstermektedir ve güvenle uygulanabilir yöntemlerdir.

Anahtar Kelimeler

• Femur intertrokanterik kırık
• proksimal femur çivisi
• kalça hemiartroplastisi
• harris kalça skalası

Comparison of Two Different Treatment Methods in Unstable Femur Intertrochanteric Fractures

Öz

Objective: We aimed to compare the perioperative differences, clinical curative effects and functional results of proximal femoral nail and partial hip prosthesis, which are two different methods used in the surgical treatment of hip fracture, which is a clinical condition with high mortality and morbidity rates in the geriatric population, with literature data. Material and Method: Between September 2019 and September 2020, 73 patients who were accepted as unstable femoral intertrochanteric fractures according to the Evans classification were treated with proximal femoral nail (group 1) or partial hip replacement (group 2). Patients included in the study were analyzed; in terms of comorbidities, body mass indexes, anesthesia types, American Society of Anesthesiologists values, intraoperative bleeding, time until surgery, postoperative hospital stay, Harris hip scores, deep vein thrombosis, wound infection, and mortality rates. Results: The patient group consisted of 29 men and 44 women aged 65-96 years. The patients included in the study were followed up for an average of 8.2 months. Harris hip score was calculated for the patients at the 6th month postoperative followup. This score was an average of 72.10 points in group 1 patients and 65.55 points in group 2 patients (p=.24). No significant difference was found in terms of pre-operative time, blood requirement, Harris hip scale for different surgical procedures. However, postoperative hospital stay was significantly longer in favor of hemiarthroplasty (p=.02). In terms of the patients' American Society of Anesthesiologists value, our tendency to prefer proximal femoral nail in low and high risk patients and hemiarthroplasty in moderate risk patients was found statistically significant (p=.01). Wound infection developed in 3 patients and periprosthetic fractures in 2 patients. Conclusion: In unstable femur intertrochanteric fractures, both proximal femoral nail and partial hip prosthesis show good clinical and functional results and are safely applicable methods.

Anahtar Kelimeler

• Femoral intertrochanteric fracture
• proximal femoral nail
• hip hemiarthroplasty
• harris hipscale

Kaynakça

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