Nörolojik defisiti olmayan torakolumbar vertebra kırıklı hastalarda uygulanan cerrahilerin uzun dönem sonuçları
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Date
2009
Authors
Yaray, Osman
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Publisher
Uludağ Üniversitesi
Abstract
Çalışmamızda nörolojik defisiti olmayan travmatik torakolumbar omurga kırığı nedeniyle cerrahi tedavi olmuş hastaların radyolojik ve fonksiyonel uzun dönem sonuçları incelendi. Hastalara fonksiyonel duruma yönelik, ağrıya yönelik ve genel sağlığa yönelik olarak testler uygulandı ve omurga skolyoz grafileri ile kırık bölgesinin spot grafileri çekildi. Ayrıca daha önceden omurgaya yönelik herhangi bir cerrahi işlem geçirmemiş ve tanı konulmuş kronik hastalığı olmayan, aynı yaş ortalamasına sahip 48 kişilik kontrol grubu oluşturulup aynı testler uygulandı. Çalışmaya dahil edilen 43 hastanın travma anındaki yaş ortalaması 39 ± 13.85 (17–71), kontroldeki yaş ortalaması 48 ± 14.25 (23–77) olup, bunların 28’i erkek (%65.1), 15’i kadındı (%34.9). Hastaların %5’inde torakal bölgede, %74’ünde torakolumbar bölgede, %21’inde alt lumbar bölgede kırık vardı. Hastaların %25.6’sına (n=11) anterior enstrumantasyon, %48’ine (n=18) posterior enstrumantasyon, %32.6’sına (n=14) anterior ve posterior kombine cerrahi uygulanmıştı. Hasta grubuyla kontrol grubu test sonuçlarına göre karşılaştırıldığında fonksiyon testlerinde ve ağrı testlerinde kontrol grubunun sonuçları daha iyiyken (p<0.05) , genel sağlığa yönelik testlerde her iki grup arasında istatistiksel olarak anlamlı fark saptanmadı (p>0.05). Fonksiyonel testler, ağrıya yönelik testler ve genel sağlığa yönelik testler kendi içinde yüksek korelasyon göstermiştir. Hasta grubunu yaş, cinsiyet, yapılan cerrahi türü, kırık tipi, kırık yeri, enstrumante edilen seviye sayısı, çoklu omurga kırığı varlığı, eşlik eden travma varlığı, komplikasyon varlığı ve radyolojik bulgulara göre grupladığımızda test sonuçlarında gruplar arasında istatistiksel olarak anlamlı fark saptanmadı (p>0.05). Çalışmada ortalama dokuz yıllık takip sonunda hasta grubu ile kontrol grubu arasında fonksiyonel durum ve ağrı şiddeti açısından fark varken bu farkın hastaların günlük hayatını etkileyecek düzeyde olmadığı sonucuna varılmıştır. Genel sağlık açısından ise hasta grubu ve kontrol grubu arasında fark olmadığı düşünülmektedir. Çalışmada kullandığımız testler arasında yüksek korelasyon olduğunu gösterdik, bu ilişkinin farklı testler kullanılarak yapılan farklı çalışmaların birbiri ile kıyaslanmasında yararlı olacağını düşünmekteyiz.
In this study, we have evaluated long term radiological and functional outcomes of patients with traumatic thoracolumbar spinal fractures without neurological deficits. In order to assess the functional status, pain level and general health quality self–report tests are applied to patients. Full–length spine radiographs and spot radiographs of fracture level are obtained. Additionally, a group of 48 age–matched healthy individuals are included in this study as a control group. They declared no history of any spinal surgery and any known chronic diseases; the same tests are also applied to this group. Forty–three patients, 28 male (65.1%) and 15 female (34.9%), were included to this study. The mean age at the time of trauma was 39 ± 13.85 (17–71), and 48 ± 14.25 (23–77) at the time of control. 5% of patients had a fracture in thoracic region, 74% had a fracture at thoracolumbar junction, and 21% had a fracture in low lumbar region. The patients were treated with anterior instrumentations (n=11, 25.6%), posterior instrumentations (n=18, 48%) or with combined anterior and posterior instrumentations (n=14, 32.6%). When we compared the results of self–report tests between the patient group and the control group, the control group had better results in functional and pain–level tests (p<0.05) than the patient group, but there was no statistically significant difference between these two groups for the results of general health quality tests (p>0.05). A significant correlation was found in between the results of functional tests, pain–level tests, and general health quality tests performed in this study. We compared the test results in between patient groups divided according to age, sex, surgery type, fracture type, fracture level, number of instrumented levels, presence of multiple spinal fractures, presence of accompanying injuries, presence of complications, and radiological results and found no statistically significant difference. In this study, we found that the functional status and pain level of patients are significantly different from those of the control group after a mean nine–year of follow up period. But we think that these differences do not affect the daily life of patients, and it is also thought that there was no difference in general heath status between the patients and control group. There were high correlations in between the tests; these correlations may be useful in assessment of different studies performed by using different tests.
In this study, we have evaluated long term radiological and functional outcomes of patients with traumatic thoracolumbar spinal fractures without neurological deficits. In order to assess the functional status, pain level and general health quality self–report tests are applied to patients. Full–length spine radiographs and spot radiographs of fracture level are obtained. Additionally, a group of 48 age–matched healthy individuals are included in this study as a control group. They declared no history of any spinal surgery and any known chronic diseases; the same tests are also applied to this group. Forty–three patients, 28 male (65.1%) and 15 female (34.9%), were included to this study. The mean age at the time of trauma was 39 ± 13.85 (17–71), and 48 ± 14.25 (23–77) at the time of control. 5% of patients had a fracture in thoracic region, 74% had a fracture at thoracolumbar junction, and 21% had a fracture in low lumbar region. The patients were treated with anterior instrumentations (n=11, 25.6%), posterior instrumentations (n=18, 48%) or with combined anterior and posterior instrumentations (n=14, 32.6%). When we compared the results of self–report tests between the patient group and the control group, the control group had better results in functional and pain–level tests (p<0.05) than the patient group, but there was no statistically significant difference between these two groups for the results of general health quality tests (p>0.05). A significant correlation was found in between the results of functional tests, pain–level tests, and general health quality tests performed in this study. We compared the test results in between patient groups divided according to age, sex, surgery type, fracture type, fracture level, number of instrumented levels, presence of multiple spinal fractures, presence of accompanying injuries, presence of complications, and radiological results and found no statistically significant difference. In this study, we found that the functional status and pain level of patients are significantly different from those of the control group after a mean nine–year of follow up period. But we think that these differences do not affect the daily life of patients, and it is also thought that there was no difference in general heath status between the patients and control group. There were high correlations in between the tests; these correlations may be useful in assessment of different studies performed by using different tests.
Description
Keywords
Omurga kırıkları, Radyolojik ve fonksiyonel sonuçlar, Cerrahi tedavi, Vertebra fractures, Radiological and functional outcome, Surgical treatment
Citation
Yaray, O. (2009). Nörolojik defisiti olmayan torakolumbar vertebra kırıklı hastalarda uygulanan cerrahilerin uzun dönem sonuçları. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.