Tibia Şaft Kırıklarının İntramedüller Çivileme Yöntemi İle Tedavisi

Yıl 2011, Cilt: 5 Sayı: 3, 104 - 108, 26.12.2011

Savaş Güner

Öz

Giriş: Tibia diafiz kırıkları, uzun kemik kırıkları içerisinde en sık karşılaşılan kırık tipidir. İntramedüller çiviler, giderek artan bir yoğunlukta tibia diafiz kırıklarının tedavisinde kullanılmaktadır. Çalışmamızda kilitli intramedüller çivileme ile tedavi edilen tibia diafiz kırıklarının radyografik ve klinik sonuçlarını sunmayı amaçladık.

Materyal ve Metod: Yüzüncü Yıl Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Kliniği’ne Ocak 2009 ile Aralık 2012 tarihleri arasında, tibia diafiz kırığı nedeniyle kilitli intramedüller çivi uygulanmış hastalar retrospektif olarak incelendi. Radyografik olarak iyileşme, ön-arka ve yan grafilerde hastanın desteksiz olarak yük vermesine izin verecek düzeyde kallus oluşumu ve/veya kırık hattının kaybolması olarak kabul edildi. Klinik iyileşme ise, hastanın kırık bölgesinde ağrısı olmadan tam yük verebilmesi ve günlük aktivitelerine dönebilmesi olarak kabul edildi.

Bulgular: Çalışma grubumuzdaki vakaların tümünde intramedüller çivi ameliyatı tedavisi ile kaynama sağlandı. Ortalama kaynama süresi 18,4 hafta olarak gözlendi. Ameliyat esnasında 24 hasta statik, 19 hasta statik ve dinamik kilitlendi. Statik kilitleme yapılan hastalarımı zın beşinde kaynama gecikmesi nedeniyle ameliyattan 3 ay sonra dinamizasyon uygulandı.
Hastaların hiçbirinde ameliyat sonrasında yara yerinde enfeksiyon veya implant enfeksiyonu gözlenmedi.

Sonuç: Tibia şaft kırıklarının tedavi seçiminde uygun hasta gurubuna yapılan intramedüller
çivi seçeneğinin erken dönemde mobilizasyona izin verilebilmesi, düşük komplikasyon oranı ve kaynama süresinin kısa olması nedeniyle tedavi seçeneğinde altın standart olduğu kanaatindeyiz.

ABSTRACT
Introduction: Diaphysis fractures of tibia are the most commonly seen type of fractures in the long bone fractures. Intramedullary nails are used to treat tibial shaft fractures with an
increasing intensity. In our study, we aimed to present the clinical and radiographic results of the tibial shaft fractures treated with intramedullary nailing.

Materials and Methods: Between January 2009 and December 2012, the patients who underwent locked intramedullary nailing therapy due to tibial diaphyseal fractures were analyzed retrospectively in our department. The healing criteria was defined as; viewing sufficient level of callus which can allow the patient bear weight without support and / or disappearance of the fracture line on anterior-posterior and lateral radiographical investigations. The clinical healing criteria were also defined as; patients’ ability to bear weight without pain
in the fracture site and to return to daily activities.

Results: The all patients who are enrolled in our study group have healed by intramedullary
nailing operation. Estimated fracture healing time was 18,4 weeks. Static screws to twentyfour patients, static and dynamic screws to nineteen patients were applied for locking in the
operations. Five patients who were applied static screw performed dynamization in the 3rd month after operation due to delayed union. Non of the patients had wounds or implant infections after the operation.

Conclusions: In the light of this data, we think that; optional treatment of the proper group of patients with intremedullary nailing, will not only allow early mobilization, low complication
rate, but short duration of union as well; so it is a gold standard for treatment option.

Anahtar Kelimeler

Tibia şaft kırığı, tedavi, intramedüller çivi

Kaynakça

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