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

Yıl 2019, , 80 - 84, 30.04.2019
https://doi.org/10.24938/kutfd.522989

Öz

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.

Kaynakça

  • 1. Denis F, Davis S, Comfot T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res. 1988;227:67-81.
  • 2. König MA, Jehan S, Boszczyk AA, Boszczyk BM. Surgical management of U shaped sacral fractures: a systematic review of current treatment strategies. Eur Spine J. 2012;21(5):829-36.
  • 3. Williams SK, Quinnan SM. Percutaneous lumbopelvic fixation for reduction and stabilization of sacral fractures with spinopelvic dissociation patterns. J Orthop Trauma. 2016;30(9):318-24.
  • 4. Chen HW, Liu GD, Fei J, Yi XH, Pan J, Ou S et al. Treatment of unstable posterior pelvic ring fractures with percutaneous reconstruction plate and percutaneous sacroiliac screws: a comparative study. J Orthop Sci. 2012;17(5):580-7.
  • 5. Hak DJ, Baran S, Stahel P. Sacral fractures: Current strategies in diagnosis and management. Orthopedics. 2009;32(10):752-7. Doi:10.3928/01477447-20090818-18.
  • 6. Bydon M, Fredrickson V, De la Garza-Ramos R, Li Y, Lehman RA Jr, Trost GR et al. Sacral fractures. Neurosurg Focus. 2014;37(1):E12. Doi:10.3171/2014.5.FOCUS1474
  • 7. Dalbayrak S, Yaman O, Ayten M, Yılmaz M, Ozer AF. Surgical treatment in sacral fractures and traumatic spino pelvic instabilities. Turk Neurosurg. 2014;24(4):498-505.
  • 8. Cole JD, Blum DA, Ansel LJ. Outcome after fixation of unstable posterior pelvic ring injuries. Clin Orthop Relat Res.1996;329:160-79.
  • 9. Krappinger D, Larndorfer R, Struve P. Minimally invasive transiliac plate osteosynthesis for type C injuries of the pelvic ring: a clinical and radiological follow-up. J Orthop Trauma. 2007;21(9):595-602.
  • 10. Tornetta P III, Matta JM. Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res. 1996;329:186-93.
  • 11. Kobbe P, Hockertz I, Sellei RM, Reilmann H, Hockertz T. Minimally invasive stabilisation of posterior pelvic-ring instabilities with a transiliac locked compression plate. Int Orthop. 2012;36(1):159-64.
  • 12. Osterhoff G, Ossendorf C, Wanner GA, Simmen HP, Werner CM. Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications. Arch Orthop Trauma Surg. 2011;131(6):809-13.
  • 13. Iguchi T, Ogawa K, Doi T, Miyasho K, Munetomo K, Hiraki T et al. Computed tomography fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures. Skeletal Radiol. 2010;39(7):701-5.
  • 14. Van Zwienen CM, Van den Bosch EW, Snijders CJ, Kleinrensink GJ, Van Vugt AB. Biomechanical comparison of sacroiliac screw techniques for unstable pelvic ring fractures. J Orthop Trauma. 2004;18(9):589-95.
  • 15. Sagi HC, Ordway NR, DiPasquale T. Biomechanical analysis of fixation for vertically unstable sacroiliac dislocations with iliosacral screws and symphyseal plating. J Orthop Trauma. 2004;18(3):138-43.
  • 16. Hinsche AF, Giannoudis PV, Smith RM. Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws. Clin Orthop Relat Res. 2002;395:135-44.
  • 17. Lindahl J, Hirvensalo E. Outcome of operatively treated type-C injuries of the pelvic ring. Acta Orthop. 2005;76(5):667-78.
  • 18. Routt ML Jr, Simonian PT, Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma. 1997;11(8):584–9.
  • 19. Berber O, Amis AA, Day AC. Biomechanical testing of a concept of posterior pelvic reconstruction in rotationally and vertically unstable fractures. J Bone Jt Surg Br. 2011;93(2):237-44.

Which Technique Should Be Choosed in Posterior Pelvic Ring Injuries: Percutaneous Sacroiliac Screw Fixation Technique or Posterior Percutaneous Transiliac Plating Technique?

Yıl 2019, , 80 - 84, 30.04.2019
https://doi.org/10.24938/kutfd.522989

Öz

ObjectiveBesides 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 8
th postoperative week,
full weight bearing was permitted to the patients. Pelvic outcome score was
evaluated at the 3
rd 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.

Kaynakça

  • 1. Denis F, Davis S, Comfot T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res. 1988;227:67-81.
  • 2. König MA, Jehan S, Boszczyk AA, Boszczyk BM. Surgical management of U shaped sacral fractures: a systematic review of current treatment strategies. Eur Spine J. 2012;21(5):829-36.
  • 3. Williams SK, Quinnan SM. Percutaneous lumbopelvic fixation for reduction and stabilization of sacral fractures with spinopelvic dissociation patterns. J Orthop Trauma. 2016;30(9):318-24.
  • 4. Chen HW, Liu GD, Fei J, Yi XH, Pan J, Ou S et al. Treatment of unstable posterior pelvic ring fractures with percutaneous reconstruction plate and percutaneous sacroiliac screws: a comparative study. J Orthop Sci. 2012;17(5):580-7.
  • 5. Hak DJ, Baran S, Stahel P. Sacral fractures: Current strategies in diagnosis and management. Orthopedics. 2009;32(10):752-7. Doi:10.3928/01477447-20090818-18.
  • 6. Bydon M, Fredrickson V, De la Garza-Ramos R, Li Y, Lehman RA Jr, Trost GR et al. Sacral fractures. Neurosurg Focus. 2014;37(1):E12. Doi:10.3171/2014.5.FOCUS1474
  • 7. Dalbayrak S, Yaman O, Ayten M, Yılmaz M, Ozer AF. Surgical treatment in sacral fractures and traumatic spino pelvic instabilities. Turk Neurosurg. 2014;24(4):498-505.
  • 8. Cole JD, Blum DA, Ansel LJ. Outcome after fixation of unstable posterior pelvic ring injuries. Clin Orthop Relat Res.1996;329:160-79.
  • 9. Krappinger D, Larndorfer R, Struve P. Minimally invasive transiliac plate osteosynthesis for type C injuries of the pelvic ring: a clinical and radiological follow-up. J Orthop Trauma. 2007;21(9):595-602.
  • 10. Tornetta P III, Matta JM. Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res. 1996;329:186-93.
  • 11. Kobbe P, Hockertz I, Sellei RM, Reilmann H, Hockertz T. Minimally invasive stabilisation of posterior pelvic-ring instabilities with a transiliac locked compression plate. Int Orthop. 2012;36(1):159-64.
  • 12. Osterhoff G, Ossendorf C, Wanner GA, Simmen HP, Werner CM. Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications. Arch Orthop Trauma Surg. 2011;131(6):809-13.
  • 13. Iguchi T, Ogawa K, Doi T, Miyasho K, Munetomo K, Hiraki T et al. Computed tomography fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures. Skeletal Radiol. 2010;39(7):701-5.
  • 14. Van Zwienen CM, Van den Bosch EW, Snijders CJ, Kleinrensink GJ, Van Vugt AB. Biomechanical comparison of sacroiliac screw techniques for unstable pelvic ring fractures. J Orthop Trauma. 2004;18(9):589-95.
  • 15. Sagi HC, Ordway NR, DiPasquale T. Biomechanical analysis of fixation for vertically unstable sacroiliac dislocations with iliosacral screws and symphyseal plating. J Orthop Trauma. 2004;18(3):138-43.
  • 16. Hinsche AF, Giannoudis PV, Smith RM. Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws. Clin Orthop Relat Res. 2002;395:135-44.
  • 17. Lindahl J, Hirvensalo E. Outcome of operatively treated type-C injuries of the pelvic ring. Acta Orthop. 2005;76(5):667-78.
  • 18. Routt ML Jr, Simonian PT, Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma. 1997;11(8):584–9.
  • 19. Berber O, Amis AA, Day AC. Biomechanical testing of a concept of posterior pelvic reconstruction in rotationally and vertically unstable fractures. J Bone Jt Surg Br. 2011;93(2):237-44.
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Cem Yalın Kılınç

Yayımlanma Tarihi 30 Nisan 2019
Gönderilme Tarihi 6 Şubat 2019
Yayımlandığı Sayı Yıl 2019

Kaynak Göster

APA Kılınç, C. Y. (2019). POSTERİOR PELVİK HALKA YARALANMALARINDA HANGİ TEKNİK SEÇİLMELİDİR: PERKÜTAN SAKROİLİAK VİDA FİKSASYONU YA DA POSTERİOR PERKUTAN TRANSİLİAK PLAK FİKSASYONU?. The Journal of Kırıkkale University Faculty of Medicine, 21(1), 80-84. https://doi.org/10.24938/kutfd.522989
AMA Kılınç CY. POSTERİOR PELVİK HALKA YARALANMALARINDA HANGİ TEKNİK SEÇİLMELİDİR: PERKÜTAN SAKROİLİAK VİDA FİKSASYONU YA DA POSTERİOR PERKUTAN TRANSİLİAK PLAK FİKSASYONU?. Kırıkkale Üni Tıp Derg. Nisan 2019;21(1):80-84. doi:10.24938/kutfd.522989
Chicago Kılınç, Cem Yalın. “POSTERİOR PELVİK HALKA YARALANMALARINDA HANGİ TEKNİK SEÇİLMELİDİR: PERKÜTAN SAKROİLİAK VİDA FİKSASYONU YA DA POSTERİOR PERKUTAN TRANSİLİAK PLAK FİKSASYONU?”. The Journal of Kırıkkale University Faculty of Medicine 21, sy. 1 (Nisan 2019): 80-84. https://doi.org/10.24938/kutfd.522989.
EndNote Kılınç CY (01 Nisan 2019) POSTERİOR PELVİK HALKA YARALANMALARINDA HANGİ TEKNİK SEÇİLMELİDİR: PERKÜTAN SAKROİLİAK VİDA FİKSASYONU YA DA POSTERİOR PERKUTAN TRANSİLİAK PLAK FİKSASYONU?. The Journal of Kırıkkale University Faculty of Medicine 21 1 80–84.
IEEE C. Y. Kılınç, “POSTERİOR PELVİK HALKA YARALANMALARINDA HANGİ TEKNİK SEÇİLMELİDİR: PERKÜTAN SAKROİLİAK VİDA FİKSASYONU YA DA POSTERİOR PERKUTAN TRANSİLİAK PLAK FİKSASYONU?”, Kırıkkale Üni Tıp Derg, c. 21, sy. 1, ss. 80–84, 2019, doi: 10.24938/kutfd.522989.
ISNAD Kılınç, Cem Yalın. “POSTERİOR PELVİK HALKA YARALANMALARINDA HANGİ TEKNİK SEÇİLMELİDİR: PERKÜTAN SAKROİLİAK VİDA FİKSASYONU YA DA POSTERİOR PERKUTAN TRANSİLİAK PLAK FİKSASYONU?”. The Journal of Kırıkkale University Faculty of Medicine 21/1 (Nisan 2019), 80-84. https://doi.org/10.24938/kutfd.522989.
JAMA Kılınç CY. POSTERİOR PELVİK HALKA YARALANMALARINDA HANGİ TEKNİK SEÇİLMELİDİR: PERKÜTAN SAKROİLİAK VİDA FİKSASYONU YA DA POSTERİOR PERKUTAN TRANSİLİAK PLAK FİKSASYONU?. Kırıkkale Üni Tıp Derg. 2019;21:80–84.
MLA Kılınç, Cem Yalın. “POSTERİOR PELVİK HALKA YARALANMALARINDA HANGİ TEKNİK SEÇİLMELİDİR: PERKÜTAN SAKROİLİAK VİDA FİKSASYONU YA DA POSTERİOR PERKUTAN TRANSİLİAK PLAK FİKSASYONU?”. The Journal of Kırıkkale University Faculty of Medicine, c. 21, sy. 1, 2019, ss. 80-84, doi:10.24938/kutfd.522989.
Vancouver Kılınç CY. POSTERİOR PELVİK HALKA YARALANMALARINDA HANGİ TEKNİK SEÇİLMELİDİR: PERKÜTAN SAKROİLİAK VİDA FİKSASYONU YA DA POSTERİOR PERKUTAN TRANSİLİAK PLAK FİKSASYONU?. Kırıkkale Üni Tıp Derg. 2019;21(1):80-4.

Bu Dergi, Kırıkkale Üniversitesi Tıp Fakültesi Yayınıdır.