Tibia enfekte ve defektli psödoartroz vakalarında LRS (uzatma tipi tek eksenli eksternal fiksatör) tekniği uygulanan hastaların cerrahi tedavi sonuçlarının değerlendirilmesi
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Tarih
2020
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Hatay Mustafa Kemal Üniversitesi
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info:eu-repo/semantics/openAccess
Özet
Amaç: Tibia enfekteve defektli psödoartroz vakalarında LRS tekniği uygulanan hastaların cerrahi tedavi sonuçlarını değerlendirmek. Gereç ve Yöntem: Çalışmada, Mustafa KemalÜniversitesiTıpFakültesiHastanesi Ortopedi ve Travmatoloji kliniğinde, Ocak 2012-Temmuz 2020 tarihleri arasında konjenital nedenlerdışında, çoğunlukla ateşli silah yaralanmalarına bağlı olmak üzere değişiketiyolojiknedenlerebağlıgelişmiştibia kemiğindekemikkaybıolan, tibia kemiğinde kaynamama olan ve enfekte kaynamama tanısı almış hastaların LRS(Limb Reconstructıon System) tipi monolateral eksternal fiksatör uygulanan 172 hastamız yer almaktadır. Hastaların kemik kayıpları paley psödoartroz sınıflaması ve Solomin'inuzun kemik defekti sınıflamalarına göre sınıflandırıldı. Cerrahi sonrası ortoröntgenogram ile taşıma miktarı, uzama miktarı ve oluşan kallus dokuları değerlendirildi. Ameliyat sonrası sonuçlar ASAMİ(Association for the Study and Application of the Method of Ilizarov) kriterleri iledeğerlendirildi. Bulgular: Uygun takibi olan 172 hastanın 162'si erkek, 10'u kadındı. Hastaların yaş ortalaması 33,2±11,9 (16-76) idi. 85 hastada ortalama kemik uzatma miktarı 6,5±2.2 cm idi.60 hastada ortalama kemik kaydırma miktarı 7.9±3.1 cm di. Paley psödoartroz sınıflamasına göre 172 hastanın 33 ü(%19.2) TİP A1,10 u(%5.8) TİP A2-1,7 Sİ (%4.1) TİP A2-2,37'si (% 21,5) Tip B1, 60'ı (% 34.9) Tip B2 ve 25'i (% 14.5) Tip B3 idi. Solomin uzun kemik defekti sınıflamasına göre 172 hastanın 40'ı(%23.3) A1,8'i(%4.7)A2,44'ü(%25.6)B1,12'si(%7)B3,34'ü(%19.8)C1,22'si(%12.8)C2, 12'Si (% 7) D idi. Hastaların ortalamafiksatörsüresi357,9±179,8günidi. Eksternalfiksatörindeksi (EFİ)ortalama 122 hasta da 52,9±12.9cm/gün, radyografik konsolidasyon indeksi(RCİ) ortalamasıise 122 hastada47,2±11.7cm/gün idi. Komplikasyonlar Paley'in derecelendirilmesine göre yapıldı. ASAMİ kemik ve fonksiyonel sonuçlar:172 hasta ile yaptığımız çalışmada kemiksel sonuçlar; 87 mükemmel (50.58), 54 iyi(31.39),19 orta(% 11.04) ve 12 kötü (%6.97) sonuç olarak değerlendirildi. Hedef bölgenin kaynamadığı 5 hastamızda kötü sonuç olarak değerlendirildi. 172 hasta ile yapılan çalışmadaki fonksiyonel sonuçları sıralayacak olursak 55 mükemmel(% 31.9) 81 iyi(% 47) 26 orta(%15.1) ve 10(%5.8) tanesi de kötü sonuç olarak değerlendirildi. Sonuç: Çalışmamız oluşan komplikasyonlara ve uzayabilen eksternal fiksatör zamanına rağmen özellikle savaş cerrahisinde tibianın kemik kayıplarının, psödoartrozlarının tedavisinde LRS ile kemik taşımanın güvenli ve başarılı yöntem olarak desteklemektedir.
Object: To evaluate the surgical treatment results of patients applied LRS technique in cases of tibia infected and defected pseudoarthrosis Materials And Methods: In the study, there are 172 patients who received LRS (Limb Reconstruction System) type monolateral external fixator which a diagnosis of bone loss in the tibial bone, nonunion in the tibial bone and infected nonunion developed due to various etiological reasons, mostly due to firearm injuries, excluding congenital causes, in the Orthopedics and Traumatology clinic of Mustafa Kemal University Faculty of Medicine Hospital between January 2012 and July 2020. Bone losses of the patients were classified according to the Paley pseudoarthrosis classification and Solomin's long bone defect classification. Amount of transport, amount of elongation and callus tissues were evaluated with orthoroentgenogram at Postoperative. Postoperative results were evaluated according to ASAMI (Ilizarov Method Study and Application Association) criteria. Results: 162 of 172 patients were men and 10 were women. The mean age of the patients was 33.2 ± 11.9 (16-76). The average amount of bone lengthening was 6.5 ± 2.2 cm in 85 patients. The average amount of bone shift in 60 patients was 7.9 ± 3.1 cm.According to the Paley pseudoarthrosis classification, 33 (19.2%) of 172 patients were TYPE A1, 10 of 172 patients (5.8%) TYPE A2-1, 7 (4.1%) of 172 patients TYPE A2-2, 37 (21%) of 172 patients 5) Type B1, 60 (34.9%) of 172 patients were Type B2 and 25 (14.5%) of 172 patients were Type B3. According to Solomin long bone defect classification, 40 (23.3%) of 172 patients were A1, 8 (4.7%) of 172 patients were A2, 44 (25.6%) of 172 patients were B1, 12 (7%) of 172 patients were B3, 34 (19.8%) of 172 patients were C1, 22 (12.8%) of 172 patients were C2, 12 of them (7%) were D. Average of fixation time of the patients was 357.9 ± 179.8 days. The average external fixator index (EFI) was 52.9 ± 12.9 cm and radiographic consolidation index (RCI) was 47.2 ± 11.7 xiv cm / day in 122 patients. Complications were made according to Paley's rating. According to ASAMI, the bone and fonctionel results in our study with 172 patients were 87 excellent (50.58), 54 good (31.39), 19 fair (11.04%) and 12 poor (6.97%). 5 patients in whom the target area wasn't union were evaluated as bad results. If we list the functional results in the study conducted with 172 patients, 55 excellent (31.9%) 81 good (47%) 26 fair (15.1%) and 10 (5.8%) were evaluated as poor results Conclusion: Our study supports bone transport with LRS as a safe and successful method in the treatment of bone loss and pseudoarthrosis of the tibia, especially in war surgery, despite the complications and extending external fixator time.
Object: To evaluate the surgical treatment results of patients applied LRS technique in cases of tibia infected and defected pseudoarthrosis Materials And Methods: In the study, there are 172 patients who received LRS (Limb Reconstruction System) type monolateral external fixator which a diagnosis of bone loss in the tibial bone, nonunion in the tibial bone and infected nonunion developed due to various etiological reasons, mostly due to firearm injuries, excluding congenital causes, in the Orthopedics and Traumatology clinic of Mustafa Kemal University Faculty of Medicine Hospital between January 2012 and July 2020. Bone losses of the patients were classified according to the Paley pseudoarthrosis classification and Solomin's long bone defect classification. Amount of transport, amount of elongation and callus tissues were evaluated with orthoroentgenogram at Postoperative. Postoperative results were evaluated according to ASAMI (Ilizarov Method Study and Application Association) criteria. Results: 162 of 172 patients were men and 10 were women. The mean age of the patients was 33.2 ± 11.9 (16-76). The average amount of bone lengthening was 6.5 ± 2.2 cm in 85 patients. The average amount of bone shift in 60 patients was 7.9 ± 3.1 cm.According to the Paley pseudoarthrosis classification, 33 (19.2%) of 172 patients were TYPE A1, 10 of 172 patients (5.8%) TYPE A2-1, 7 (4.1%) of 172 patients TYPE A2-2, 37 (21%) of 172 patients 5) Type B1, 60 (34.9%) of 172 patients were Type B2 and 25 (14.5%) of 172 patients were Type B3. According to Solomin long bone defect classification, 40 (23.3%) of 172 patients were A1, 8 (4.7%) of 172 patients were A2, 44 (25.6%) of 172 patients were B1, 12 (7%) of 172 patients were B3, 34 (19.8%) of 172 patients were C1, 22 (12.8%) of 172 patients were C2, 12 of them (7%) were D. Average of fixation time of the patients was 357.9 ± 179.8 days. The average external fixator index (EFI) was 52.9 ± 12.9 cm and radiographic consolidation index (RCI) was 47.2 ± 11.7 xiv cm / day in 122 patients. Complications were made according to Paley's rating. According to ASAMI, the bone and fonctionel results in our study with 172 patients were 87 excellent (50.58), 54 good (31.39), 19 fair (11.04%) and 12 poor (6.97%). 5 patients in whom the target area wasn't union were evaluated as bad results. If we list the functional results in the study conducted with 172 patients, 55 excellent (31.9%) 81 good (47%) 26 fair (15.1%) and 10 (5.8%) were evaluated as poor results Conclusion: Our study supports bone transport with LRS as a safe and successful method in the treatment of bone loss and pseudoarthrosis of the tibia, especially in war surgery, despite the complications and extending external fixator time.
Açıklama
Anahtar Kelimeler
Ortopedi ve Travmatoloji, Orthopedics and Traumatology, Kemik defekti, kemik kaydırma, psödoartroz, LRS, Bone defect, bone shift, pseudoarthrosis, LRS
