Asetabulum kırığı sonrası primer total kalça protezi uygulanan hastalarda kullanılan kırık fiksasyon metaryallerinin fonksiyonel ve radyolojik sonuçlarının retrospektif olarak karşılaştırılması
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İpek, Enver
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Uludağ Üniversitesi
Abstract
Amaç: Asetabulum kırıkları sonrası açık redüksiyon internal fiksasyonla birlikte primer total kalça protezi uygulaması yapılan hastaların fonksiyonel,klinik ve radyolojik sonuçları değerlendirilmesi amaçlandı. Gereç ve Yöntem: Ocak 2007 - Temmuz 2018 tarihleri arasında asetabulum kırığı tanısıyla açık redüksiyon ve internal fiksasyonla birlikte primer total kalça protezi (TKP) uygulanan 57 hasta değerlendirildi. Klinik değerlendirme; Harris Kalça Skorları (HKS) ve Merle d'Aubigne - Postel (PMA) klinik değerlendirme sistemine göre yapılırken; radyolojik değerlendirme; femoral komponentlerde gevşeme Gruen zonlarına, asetabular komponentlerde osteoliz Delee ve Charnley'e heterotopik ossifikasyon (HO) Brooker sınflamasına göre yapıldı. Bulgular: 57 hastanın, 43'ü erkek, 14'ü kadın olmak üzere, ortalama yaşları 51,9 (22– 85)'dur. Hastaların 26'sı (%45,6) sağ, 31'i (%54,3) sol asetabulum kırığı mevcuttu. Ortalama takip süresi 53 ay (4,3 yıl). Yaralanma ile cerrahi arasındaki ortalama süre 20 gündür. Kırıkların 18'i (%31,5) basit, 39'u (%68,4) kompleks tipteydi, 16'sında (%28) ilave posterior çıkık mevcuttu. Ortalama HKS 85,58 (46,6-100) olarak bulundu. HKS kablo ile yapılanlarda (%89,25) yüksek bulundu. 32 (%56) hastada mükemmel 14 (%24) hastada çok iyi 7 (%14) hastada iyi 4 (%7) hastada orta sonuçlar elde edildi. Travmadan önce çalışan 31 hastanın 25'i (%81) işine geri döndü. Ortalama işe geri dönüş süresi ise 9,3 ay (2-33ay)'dı. Komplikasyon olarak enfeksiyon, erken dislokasyon, heterotopik ossifikasyon ve periprostetik kırık görüldü. Enfeksiyon nedeniyle 4 hastaya revizyon uygulandı. Brooker sınıflamasına göre 35 hastada farklı oranlarda heterotopik ossifikasyonlar mevcuttu. Bu oranlar plak ile kombine TKP uygulamalarında daha yüksek olarak tespit edildi. Sonuç: Asetabulum kırıklarından sonra yapılan primer TKP ile ağrısız ve fonksiyonel bir kalça eklemi elde edilirken, hastanın erken mobilizasyonu, erken işe dönüşü, reoperasyon riskinde azalma gözlemlenir. Çalışmamızda TKP ile kombine edilen tespit yöntemlerinin fonksiyonel ve radyolojik sonuca katkısının değerlendirilebileceğini düşünmekteyiz.
Purpose: The aim of this study was to evaluate the functional, clinical and radiological results of patients who underwent primary total hip replacement with open reduction internal fixation after acetabular fractures. Materials and methods: Between January 2007 and July 2018, 57 patients who underwent primary total hip replacement with open reduction internal fixation with the diagnosis of acetabular fracture were evaluated. Clinical evaluation was performed according to Harris hip scores and Merle deAubigne - Postel clinical evaluation system. Heterotopic ossification was performed according to Brooker classification in radiological evaluation, loosening of the femoral components Gruen, osteolysis in acetabular components were performed according to DeLee and Charnley. Results: The mean age of the patients was 51.9 (22 4385), of which 43 were male and 14 were female. 26 (45.6%) patients had right acetabular fractures and 31 (54.3%) had left acetabular fractures. The mean follow-up period was 53 months (4.3 years). The average time between injury and surgery is 20 days. 18 fractures (31.5%) were simple, and 39 (68.4%) were in the complex type, 16 (28%) of additional posterior dislocation was present. The mean harris hip score was 85.58 (46.6-100). Harris hip scores were found to be higher than those performed with cable (89.25%). In 32 patients (56%) had excellent, 14 (24%) patients had very good, 7 (14%) patients had good and 4 (7%) had moderate results. 25 (81%) of 31 patients who worked before the trauma, returned to work. The mean time to return to work was 9.3 months (2-33 months). Complications such as infection, dislocation and heterotopic ossification and periprostatic fractures were seen. Four patients underwent revision due to infection. According to the Brooker classification, 35 patients had heterotopic ossification. A higher rate was detected in patients who underwent combined THA with plate. Conclusion: While a painless and functional hip joint was obtained with primary THA after acetabular fractures, we think that the patient has early mobilization, return to early work, decrease in reoperation risk. The contribution of internal fixation materials to be used along with total hip arthroplasty to the functional and radiological results can be evaluated.
Purpose: The aim of this study was to evaluate the functional, clinical and radiological results of patients who underwent primary total hip replacement with open reduction internal fixation after acetabular fractures. Materials and methods: Between January 2007 and July 2018, 57 patients who underwent primary total hip replacement with open reduction internal fixation with the diagnosis of acetabular fracture were evaluated. Clinical evaluation was performed according to Harris hip scores and Merle deAubigne - Postel clinical evaluation system. Heterotopic ossification was performed according to Brooker classification in radiological evaluation, loosening of the femoral components Gruen, osteolysis in acetabular components were performed according to DeLee and Charnley. Results: The mean age of the patients was 51.9 (22 4385), of which 43 were male and 14 were female. 26 (45.6%) patients had right acetabular fractures and 31 (54.3%) had left acetabular fractures. The mean follow-up period was 53 months (4.3 years). The average time between injury and surgery is 20 days. 18 fractures (31.5%) were simple, and 39 (68.4%) were in the complex type, 16 (28%) of additional posterior dislocation was present. The mean harris hip score was 85.58 (46.6-100). Harris hip scores were found to be higher than those performed with cable (89.25%). In 32 patients (56%) had excellent, 14 (24%) patients had very good, 7 (14%) patients had good and 4 (7%) had moderate results. 25 (81%) of 31 patients who worked before the trauma, returned to work. The mean time to return to work was 9.3 months (2-33 months). Complications such as infection, dislocation and heterotopic ossification and periprostatic fractures were seen. Four patients underwent revision due to infection. According to the Brooker classification, 35 patients had heterotopic ossification. A higher rate was detected in patients who underwent combined THA with plate. Conclusion: While a painless and functional hip joint was obtained with primary THA after acetabular fractures, we think that the patient has early mobilization, return to early work, decrease in reoperation risk. The contribution of internal fixation materials to be used along with total hip arthroplasty to the functional and radiological results can be evaluated.
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Keywords
Asetabulum kırığı, Erken total kalça protezi, Harris kalça skoru, Brooker sınıflaması, Kombine kalça prosedürü, Acetabular fracture, Early total hip replacement, Harris hip score, Brooker classification, Combined hip procedure
Citation
Enver, İ. (2018). Asetabulum kırığı sonrası primer total kalça protezi uygulanan hastalarda kullanılan kırık fiksasyon metaryallerinin fonksiyonel ve radyolojik sonuçlarının retrospektif olarak karşılaştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.