Kalkaneus kırıklarında cerrahi yöntemlerle tedavi edilen hastaların klinik, radyolojik ve fonksiyonel sonuçları
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Tarih
2023
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Kalkaneus kırıkları çalışan, aktif iş yaşantısı olan, 30-40 yaş erkeklerde daha
sık görülmektedir. Tedavi edilmemiş, yeterli tedavi edilememiş ya da komplikasyon
izlenmiş hastalarda ciddi iş gücü kaybıyla beraber hasta ve çevresi için sosyoekonomik
problemler oluşturmaktadır. Çalışmamızın amacı farklı cerrahi tekniklerle opere
edilmiş hastaların klinik, fonksiyonel ve radyolojik sonuçlarını geriye dönük ortaya
koymaktır.
Yöntem: Çalışmamızda Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Ortopedi ve Travmatoloji Anabilim Dalı'nda 2010 yılı ve sonrasında kalkaneus kırığı
nedeniyle opere edilmiş ve en az 6 ay düzenli takipleri olan hastalar seçilmiş ve
retrospektif dosya taraması yapılmıştır. Hastalara başvuru esnasında standart ap ve yan
grafi ve Bilgisayarlı Tomoğrafi çekilmiş ve değerlendirilmiştir. Sınıflama için Sanders
sınıflaması kullanılmıştır. Hastaların cerrahi müdahaleye kadar geçen zaman ve yatış
süresi not edilmiştir. Ameliyat öncesi, ameliyat sonrası ve takip röntgenlerinde Böhler
ve Gissane açıları ölçülmüş, 3. ve 6. aylarda fonksiyonel sonuçlar AOFAS Skorlama
Sistemi ile değerlendirilmiştir. Takiplerde peroperatif ve postoperatif komplikasyonlar
not edilmiştir. Verilerin istatistik analizlerinde IBM SPSS Statistics Version 25.0 paket
program kullanılmıştır.
Bulgular: Çalışmamızda 83 hastanın toplam 92 kalkaneal kırığı ameliyat edildi. 20
kadın 63 erkek hastamız mevcut olup yaş ortalaması 36.55(dağılım 16-76) olarak
hesaplanmıştır. Kalkaneal kırıkların en sık etyolojisi yüksekten düşme idi. En sık
görülen kırıklar Sanders tip 3AC (%22.8) ve Sanders tip 2A (%19.6) idi. 9 hastada
açık kalkaneus kırığı mevcuttu. 68 hastaya kapalı redüksiyon ve perkütan tespit
uygulandı. 8 hastada sinüs tarsi yaklaşım açık redüksiyon ve plak ile tespit, 16 hastada
iv
ekstensil lateral yaklaşım açık redüksiyon ve plak ile tespit tercih edildi. Subtalar
artroz en sık görülen komplikasyondu. İkinci sıklıkta görülen komplikasyon ise yara
yeri komplikasyonu (enfeksiyon, flep nekrozu) idi ve yara yeri komplikasyonu
ekstensil lateral yaklaşım açık redüksiyon plak ile tespit yapılan hasta grubunda daha
sık izlenmiştir. Böhler açısının düzeltme miktarı, fonksiyonel skor ile anlamlı derecede
korele idi(p=0.004). Farklı cerrahi tekniklerin klinik, fonksiyonel ve radyolojik
sonuçlarını karşılaştırdığımızda gruplar arasında radyolojik sonuçlar benzerdi ve
anlamlı fark yoktu (p=0.10). En iyi anlamlı fonksiyonel sonuç sinüs tarsi yaklaşımı ile
opere edilen ve internal fiksasyon grubu olan hastalarda elde edildi(p=0.02). Ekstensil
lateral yaklaşım ile opere edilen hastalarda sekonder cerrahi ihtiyacı daha fazlaydı.
Sonuç: Son yıllarda yapılan çalışmalar minimal invaziv ve kapalı cerrahi tekniklerle
ameliyat edilen hastalarda invaziv tekniklere göre daha iyi klinik, fonksiyonel ve
radyolojik sonuçlar olduğunu göstermekle birlikte çalışmamız literatürü özellikle
fonksiyonel skorlarda desteklemektedir. Bu çalışmadaki sonuçlarımıza göre, Sanders
tip 3 ve 4 dahil kalkaneal kırıklarda eksternal kılavuz destekli kapalı redüksiyon
perkütan fiksasyon veya açık minimal invaziv teknikleri öneriyoruz.
Aim: Calcaneal fractures are more common in working males between the ages 30-40 that have an active lifestyle. In patients with untreated, nontreatable cases or cases with complications, there is severe loss of manpower alongside socioeconomic problems for the patient and his environment. The aim of our study is analyze the clinical, functional and radiologic outcomes of patients operated with different surgical techniques. Method: In our study, patients that were operated due to calcaneal fractures at Necmettin Erbakan University Meram Faculty of Medicine, Department of Orthopaedics and Traumatology in 2010 and later and that presented for follow- ups regularly for at least 6 months were selected and retrospectively studied. All patients were evaluated with standart Ap and lateral radiographs and Computer Tomography scans at admission to emergency department. Sanders classification was used for categorization. Time until surgical intervention and the duration of hospitilization was noted. The Böhler and Gissane angles were measured in preoperative, postoperative and follow-up X-rays. Functional outcomes evaluated with AOFAS Scoring System at the 3rd and 6th months of follow-up. Peroperative and postoperative complications during the follow-ups were also noted. The IBM SPSS Statistics Version 25.0 packet program was used in the stastical analysis of data. Results: In our study, a total of 92 calcaneal fractures of 83 patients was operated. There are 20 female and 63 male with the mean age of 36.55 years (range, 16 -76). The most common etiology of calcaneal fractures was high falls. The most common fractures were Sanders type 3AC (%22.8) and Sanders type 2A (%19.6). There were open calcaneal fractures in 9 patients. Close reduction and percutaneous fixation was done for 68 patients. Open reduction via sinus tarsi approach and internal fixation with vi plate for 8 patients and open reduction via extensile lateral approach and internal fixation with plate for 16 patients were preferred. Subtalar artritis was the most common complicatio. The second most common complication was surgical site problems (infection, flap necrosis) which was more common in patients treated with the extensile lateral exposure and fixation with plate. Corection amount of Böhler angle was correlated with functional score significantly (p=0.004). When we compared the clinical, functional and radiological outcomes of different surgical techniques, radiological outcomes between the groups were similar and there was no significant difference (p=0.10). The best significant functional outcome was obtained in patients operated with the sinus tarsi approach and internal fixation group (p=0.02). The need for secondary surgical intervention due to complicaitons were more frequent in patients operated with the extensile lateral exposure. Coclusion: Recent studies have indicated that there better clinical, functional and radiological outcomes in patients operated with minimally invasive and close surgical techniques, compared with invasive techniques, and our study supports this especially in fuctional scores. According to our results of this study we suggest external guide supported close reduction percutaneous fixation or open minimally invasive techniques in calcaneal fractures, including in Sanders type 3 and 4.
Aim: Calcaneal fractures are more common in working males between the ages 30-40 that have an active lifestyle. In patients with untreated, nontreatable cases or cases with complications, there is severe loss of manpower alongside socioeconomic problems for the patient and his environment. The aim of our study is analyze the clinical, functional and radiologic outcomes of patients operated with different surgical techniques. Method: In our study, patients that were operated due to calcaneal fractures at Necmettin Erbakan University Meram Faculty of Medicine, Department of Orthopaedics and Traumatology in 2010 and later and that presented for follow- ups regularly for at least 6 months were selected and retrospectively studied. All patients were evaluated with standart Ap and lateral radiographs and Computer Tomography scans at admission to emergency department. Sanders classification was used for categorization. Time until surgical intervention and the duration of hospitilization was noted. The Böhler and Gissane angles were measured in preoperative, postoperative and follow-up X-rays. Functional outcomes evaluated with AOFAS Scoring System at the 3rd and 6th months of follow-up. Peroperative and postoperative complications during the follow-ups were also noted. The IBM SPSS Statistics Version 25.0 packet program was used in the stastical analysis of data. Results: In our study, a total of 92 calcaneal fractures of 83 patients was operated. There are 20 female and 63 male with the mean age of 36.55 years (range, 16 -76). The most common etiology of calcaneal fractures was high falls. The most common fractures were Sanders type 3AC (%22.8) and Sanders type 2A (%19.6). There were open calcaneal fractures in 9 patients. Close reduction and percutaneous fixation was done for 68 patients. Open reduction via sinus tarsi approach and internal fixation with vi plate for 8 patients and open reduction via extensile lateral approach and internal fixation with plate for 16 patients were preferred. Subtalar artritis was the most common complicatio. The second most common complication was surgical site problems (infection, flap necrosis) which was more common in patients treated with the extensile lateral exposure and fixation with plate. Corection amount of Böhler angle was correlated with functional score significantly (p=0.004). When we compared the clinical, functional and radiological outcomes of different surgical techniques, radiological outcomes between the groups were similar and there was no significant difference (p=0.10). The best significant functional outcome was obtained in patients operated with the sinus tarsi approach and internal fixation group (p=0.02). The need for secondary surgical intervention due to complicaitons were more frequent in patients operated with the extensile lateral exposure. Coclusion: Recent studies have indicated that there better clinical, functional and radiological outcomes in patients operated with minimally invasive and close surgical techniques, compared with invasive techniques, and our study supports this especially in fuctional scores. According to our results of this study we suggest external guide supported close reduction percutaneous fixation or open minimally invasive techniques in calcaneal fractures, including in Sanders type 3 and 4.
Açıklama
Anahtar Kelimeler
Kalkaneus kırıkları, Ekstensil lateral yaklaşım, Minimal invaziv, Sinüs tarsi yaklaşım, Kapalı redüksiyon perkütan fiksasyon, AOFAS skoru, Calcaneal fractures, Extensile lateral approach, Minimally invasive, Sinus tarsi approach, Closed reduction percutaneous fixation, AOFAS score
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Demirel, A. (2023). Kalkaneus kırıklarında cerrahi yöntemlerle tedavi edilen hastaların klinik, radyolojik ve fonksiyonel sonuçları. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Ortopedi ve Travmatoloji Anabilim Dalı, Konya.
