Retrograd İntramedüller Çivileme ile Femur Distal Nonunion Tedavisinde Otogreft Gerekli mi?

Yıl 2023, Cilt: 18 Sayı: 1, 9 - 14, 16.03.2023

Sefa Key , Şükrü Demir , Murat Gürger , Erhan Yılmaz

https://doi.org/10.17517/ksutfd.1027239

Öz

Amaç: Distal femur kırıklarında günümüzde sık kullanılan kilitli plaklar sonrasında gelişen nonunion tedavisi için retrograde intramedüller çiviler ile tedavi edilen hastalarda otogreft kullanımının kaynama süresi ve diz fonksiyonları üzerine etkisini değerlendirmek.
Gereç ve Yöntemler: Çalışmada reamerize intramedüller çivi ile tedavi edilmiş distal femur kaynaması olmayan 18 hastanın verileri retrospektif olarak incelendi. Çalışmaya femur 1/3 distalinde nonunion olan ve aktif enfeksiyon bulgusu olmayan tüm hastalar dahil edildi. Dokuz ay sonunda kaynama bulgusu olmayan ve implant yetmezliği görülen reamerize intramedüller çivi ile tedavi edilmiş hastalar incelendi. Kaynama değerlendirmesi ve diz fonksiyonları değerlendirildi. Sürekli değişkenler Student t testi kullanılarak karşılaştırıldı. P değeri <0.05 istatistiksel olarak anlamlı kabul edildi.
Bulgular: Hastaların ortalama takip süresi 24.7 (12-36) ay idi. Üç hastada varus deformitesi komplikasyon olarak izlendi. Hastaların Mize skoru esas alınarak 12’sinde iyi sonuç 3 hastada mükemmel, 3 hastada makul sonuç elde edildi. Ortalama kaynama sürelerine bakıldığında 5.2 (4-7) ay idi. Operasyon öncesi maksimum 91.7 (10-120) derece olan diz fleksiyonu, operasyon sonrası ortalama maksimum diz fleksiyonu 106 (70-120) derece bulundu. Otogreft
kullanımında kaynama süresi bakımından anlamlı farklılık gözlenmedi.
Sonuç: Distal femur nonunionlarda tedavi seçeneği olarak retrograde intramedüller çiviler ile başarılı sonuçlar alınabilir. Otogreft kullanımı kaynama süresi açısından sonucu etkilemese de bu konuda daha fazla çalışma yararlı olacaktır.

Anahtar Kelimeler

Femur distal nonunion, Retrograde intramedüller çivi, fermur distal plak

Is Autograft Necessary in the Treatment of Femur Distal Nonunion with Retrograde Intramedullary Nailing?

Öz

Objective: To evaluate the effect of auto graft use on union time and knee functions in patients treated with retrograde intramedullary nails for the treatment of nonunion after locking plates, which are commonly used today in distal femur fractures.
Materials and Methods: A retrospective study of 18 manufacturers with no intramedullary internal localization and no femoral union was studied. All people with nonunion in the 1/3 distal and without active signs are taken care of. At the end of 9 months, no sign of union and grown with intramedullary civilian after implant training were examined. Evaluation and value of union were evaluated. Continuous concordances Student’s t-test compared. P value
<0.05 was considered significant.
Results: The mean follow-up period of the patients was 24.7 (12-36) months. Varus deformity was observed as a complication in 3 patients. Based on the Mize score of the patients, good results were obtained in 12 patients, excellent results in 3 patients, and reasonable results in 3 patients. Considering the mean union times, it was 5.2 (4-7) months. The mean maximum knee flexion was 91.7 (10-120) degrees preoperatively and 106 (70-120 degrees) postoperatively. No significant difference was observed in terms of union time in auto graft use.
Conclusions: Successful results can be obtained with retrograde intramedullary nails as a treatment option in distal femoral nonunions. Although the use of auto graft does not affect the result in terms of union time, more studies on this subject would be beneficial.

Anahtar Kelimeler

Femur distal nonunion, Retrograde intramedullary nail, Fermur distal plate

Kaynakça

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