ASETABULUM KIRIKLARINDA ORTA DÖNEM KONSERVATİF VE CERRAHİ TEDAVİ SONUÇLARIMIZ

Year 2021, , 229 - 236, 15.06.2021

Recep Dinçer , Tolga Atay , Halil Burç , Yakup Barbaros Baykal , Vecihi Kırdemir

https://doi.org/10.17343/sdutfd.720754

Cited By: 1

Abstract

Amaç
Deneyimli klinikler ve cerrahlar eklem uyumunun çok
önemli olduğu asetabuler bölgeye dair tecrübelerini
yayınlamaktadır. Biz de asetabulum kırığıyla başvuran
hastaların klinik tecrübelerimiz eşliğinde orta dönem
sonuçlarını sunmayı amaçladık.
Gereç ve Yöntem
Kliniğimize Ocak 2004-Mayıs 2013 tarihleri arasında
asetabulum kırığıyla başvuran 52 hastanın, kriterleri
taşıyan 37’si çalışmaya alındı. 10 hastaya konservatif,
27 hastaya cerrahi tedavi uygulandı. Cinsiyet dağılımı
28 erkek, 9 kadın şeklindeydi. Kırıkların 23’ü
sağ tarafta, 14’ü sol asetabulumu içermekteydi. Oluş
mekanizmalarına bakıldığında 16(%43,2) hasta araç
içi trafik kazası, 13(%35,1) hasta araç dışı trafik kazası,
6 hasta yüksekten düşme ve 2 hasta da üzerine
ağırlık düşmesi sonucu meydana gelmişti. 18 vakada
eşlik eden diğer ortopedik yaralanmalar mevcuttu.
Tüm hastalara Judet grafileri ve bilgisayarlı tomografi
çekildi.
Bulgular
Ortalama takip süresi 37 ay(12-108)’dı. Kırıkların 28’i
basit kırıklardan, 9’u kompleks kırıklardan oluşmaktaydı.
8(%21,6) hastada posterior kalça dislokasyonu
bulunmaktaydı. Acilde ilk değerlendirme sonrası tüm
hastaların kalçaları redükte edildi. Kırıkların oluş mekanizması
ve kırık tipi arasında bir ilişki saptanmadı(
p=0,456). Cerrahi uygulanan grupta 2, konservatif
grupta 1 olguda kırık sonrasında oluşan siyatik hasar
mevcuttu(p=0,440). 20 hastaya Kocher-Langenbeck
(%70,9), 3 hastaya İlioinguinal (%12,5), 2 hastaya Triradyat
(%8,3), 2 hastaya da kombine (%8,3) insizyon
uygulandı. Fonksiyonel sonuçlar Harris kalça skorlamasına
göre yapıldı; konservatif grupta 6(%60) hastada
mükemmel, 2(%20) hastada iyi, 2(%20) hastada
da kötü sonuç elde edildi(p=0,659). Cerrahi uygulanan
grupta klinik fonksiyonel sonuçları 10 hastada
mükemmel, 11 hastada iyi, 3 hastada orta ve 3 hastada
kötü olarak saptadık(p=0,665).
Sonuç
Kırık tipine uygun cerrahi planlama ile anatomik redüksiyon
uygun ve uyumlu hastalarda tatmin edici sonuçlar
ortaya çıkartır. Yalnız anatomik redüksiyonun
tek başına yeterli olmadığı, ilk gelişte dislokasyonun
olması, meydana gelen femur başı ve asetabulumdaki
kıkırdak hasarı ve siyatik sinir hasarı gibi komplikasyonların
da prospektif etkisinin olduğu unutulmamalıdır.

Keywords

Asetabulum kırıkları, konservatif tedavi, posterior dislokasyon, asetabulum cerrahisi, klinik deneyim

Supporting Institution

Maddi hiçbir kurum ve kuruluştan destek alınmamıştır.

MID-TERM RESULTS OF THE CONSERVATIVE AND SURGICAL TREATMENT OF ACETABULAR FRACTURES

Abstract

Objective
Experienced clinics and surgeons publish their experiences
in the acetabular region where joint alignment
is very important. We aimed to present the mid-term
results of patients with acetabulum fractures accompanied
by our clinical experience.
Materials and Methods
Between January 2004 and May 2013, among the 52
patients who applied to our clinic with an acetabular
fracture, 37 of them met the criteria. Ten patients were
treated conservatively and 27 patients with surgical
treatment. The sex distribution was 28 males and 9
females. 23 of the fractures were on the right side
and 14 were on the left acetabulum. Mechanism of
injury, 16 (43.2%) patients were caused by traffic accidents,
13 (35.1%) patients were motor accidents, 6
patients were falling from height and 2 patients other
accidents. There were other orthopedic injuries were
present in 18 cases. All patients had Judet X-rays and
computed tomography.
Results
The average follow-up period was 37 months (12-
108). Twenty-eight patients had simple fractures and
9 patients had complex fractures. There was the posterior
hip dislocation of 8(21.6%) patients. After evaluation
in the emergency room, all dislocated hips were
reduced. There was no relation between the mechanism
of injury and the type of fracture(p=0.446).
Two of the surgical group and one of the conservative
groups had sciatic nerve palsy after fracture
(p=0.440). Twenty patients had Kocher-Langenbeck
(70.9%), 3 patients Ilioinguinal (12.5%), 2 patients Triradiat
(8.3%), and 2 patients (8.3%) combined incision.
We used a Harris hip score for functional results.
Results of score were in conservative group 6(60%)
patients excellent, 2(20%) patients good, and 2 (20%)
patients poor results(p=0.659). In the surgery group,
we found clinical functional results excellent in 10 patients,
good in 11 patients, moderate in 3 patients, and
poor in 3 patients(p=0.665).
Conclusion
Surgical planning suitable for fracture type and anatomical
reduction reveals satisfactory results in suitable
and compatible patients. It should be kept in mind that
anatomical reduction alone is not enough, complications
such as traumatic hip dislocation, cartilage damage
of the femoral head and acetabulum and sciatic
nerve palsy also have a prospective effect.

Keywords

Acetabulum fractures, acetabulum surgery, clinical experience, conservative treatment, posterior dislocation

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