Eklem Dışı Tibia Kırıkları Tedavisinde Minimal İnvaziv Plak Osteosentez Uygulama Sonuçlarını Etkileyen Faktörler

Factors Effecting Results Of Minimally Invasive Plate Osteosynthesis For Extra-Articular Tibia Fractures

Özet

Amaç: Bu çalışmada eklem dışı tibia kırıkları minimal invaziv plak osteosentezi (MİPO) ile tedavi edilen hastalar değerlendirilerek hasta ve tedavi yöntemine ait çeşitli faktörlerin; fonksiyonel, klinik ve radyografik sonuçlara olan etkisinin araştırılması amaçlanmıştır.Gereç ve Yöntemler: Ekim 2010 – Nisan 2014 tarihleri arasında eklem dışı tibia kırıkları MİPO tekniği ile tedavi edilen 33 hasta değerlendirildi. Ameliyat öncesi hasta faktörleri, fonksiyonel skor ve ameliyat esnasındaki cerrahi teknikle ilgili faktörler ile fonksiyonel skor, klinik ve radyolojik sonuçlar ile kıyaslandı.Bulgular: Ortalama yaş 46,1 (20-70) idi. Kırıkların %12,1’i proksimalde, %33,3’ü diafizde, 18 (%54,5)’i distalde oluşmuştu. Kırıkların 4 (%12,1)’i tip 1 açık, 4 (%12,1)’i tip 2 açık, diğer 25 (%75,8) kırık ise kapalı kırıktı. Tüm hastaların kırıkları ortalama 21,2 haftada kaynadı. Direkt travma sonucu daha sık görülen parçalı kırıkların daha geç kaynadığı tespit edildi. Komplikasyon gelişen altı hastanın kırığı daha geç kaynadı. Dizilim bozukluğu 5 dereceden fazla olan hasta sayısı ameliyat sonrası 3 (%9,1) iken, 12. ayda 4 (%12,1) olarak tespit edildi. Fonksiyonel durumları LEFS skoru ile değerlendirilen hastaların LEFS skorundaki ortalama 4,72 puanlık düşüşü klinik olarak anlamlı değildi. Plak kırık uzunluk oranının; kaynama süresi, dizilim ve LEFS skorundaki değişimle ilişkisi olmadığı görüldü. Sonuç: MİPO yöntemi özellikle parçalı kırıklarda ve metafizer bölge kırıklarında göreceli stabilite ve biyolojik kaynamanın avantajları ile hızlı kaynama sağlayarak fonksiyonel iyileşmeyi sağlamaktadır. Diafizer bölgenin basit kırıklarında açısal ve torsiyonel stabil fiksasyon sağlaması sebebi ile MİPO alternatif bir tedavi yöntemidir.

Abstract

Aim: In this study we aimed to analyze the relationships between patient and treatment related factors and healing time, alignment, LEFS score by evaluating the results of patients whom were treated with MIPO for extra-articular tibial fractures. Material and Method: Thirty-three patients with extra-articular tibial fractures that were treated with MIPO between October 2010- April 2014 in our clinic were included in the study. Patient related factors and surgical technique details were compared with functional, clinical and radiological results. Results: Mean age of 33 patients was 46.1 (20-70). 12.1% of fractures was proximal, 33.3% was diaphyseal, 54.5% was distal; 4 (12.1%) of them were type 1 open, 4 (12.1%) were type 2 open, remaining 25 (75.8%) were closed fractures. All fractures were healed an average of 21.2 weeks. Comminuted fractures which are result of direct trauma frequently healed later. Also fractures of six patients with complications healed within longer union times. There were 3 (9.1%) patients with more than 5 degrees malalignment at the beginning and 4 (12.1%) at 12th month. Patients’ functional status which were evaluated with LEFS score showed 4.72 decrease at an average but this much is clinically not significant. Plate span ratio was not correlated with union time, malalignment and change in LEFS score. Conclusion: MIPO method allows rapid functional healing especially in comminuted fractures and metaphyseal region fractures with relative stability and advantages of biologically healing. With torsional and angular stability MIPO is a good treatment option in simple fractures of diaphyseal region. this study we aimed to analyze the relationships between patient factors, treatment factors and healing time, alignment, LEFS score by evaluating the results of patients whom were treated with MIPO for extra-articular tibial fractures.Material and Method: In our study pre-operative patient factors and functional scores of 33 patients whose extra-articular tibial fractures were treated with MIPO between October 2010- April 2014 and intra-operative surgical technique factors were checked against functional, clinical and radiological results. Results were statistically compared.Results: Mean age of 33 patients was 46.1 (20-70). 12.1% of fracture was proximal, 33.3% was diaphyseal, 54.5% was distal tibial fracture; 4 (12.1%) of them were type 1 open, 4 (12.1%) were type 2 open, other 25 (75.8%) were closed fractures. All fractures healed within a mean of 21.2 weeks union time. Comminuted fractures which occur with direct trauma more frequently healed within longer union times. Fractures of six patients with complication healed within longer union times. There were 3 (9.1%) patients with more than 5 degrees malalignment at the beginning and 4 (12.1%) at 12th month. Patients’ functional status were evaluated with LEFS score and 4.72 point drop in mean is clinically not important. Plate span ratio is not related with union time, alignment and change in LEFS score. Conclusion: MIPO method allows rapid functional healing especially in comminuted fractures and metaphyseal region fractures with relative stability and biologically union. MIPO is a good treatment option with torsional and angular stability in simple fractures of diaphyseal region.