Tibia kaynama yokluğunda ekstrakorporeal şok dalga tedavisinin (ESWT) kırık iyileşmesine etkisi
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Tarih
2014
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Kaynama yokluğu tedavi yöntemlerinden olan kırık uçlarının cerrahi olarak tazelendirilmesi ile ekstrakorporeal şok dalga tedavisi (ESWT) yöntemlerinin kaynama yokluğu üzerine üzerine etkilerini karşılaştırmayı hedeflediğimiz çalışmamız Trakya Üniversitesi Hayvan Deneyleri Yerel Etik Kurulu onayı (Ek I) alınarak Trakya Üniversitesi Tıp Fakültesi Deney Hayvanları ve Araştırma laboratuvarından elde edilen 30 adet Sprague-Dawley cinsi rat üzerinde gerçekleştirildi. Ratlar, Grup I: Tibia kaynama yokluğu kontrol grubu (cerrahi kanlandırma-kırık uçları tazelendirme veya ESWT uygulanmayan grup), Grup II: Cerrahi kanlandırma ve kırık uçları tazelendirme işlemi ile tedavi edilen tibiada kaynama yokluğu grubu, Grup III: Ekstrakorporeal şok dalga tedavisi (ESWT) ile tedavi edilen tibiada kaynama yokluğu grubu olacak şekilde üç gruba ayrıldı. Grup I'deki ratlar, kaynama yokluğu modeli açısından Grup II ve Grup III'teki ratlar için kontrol grubu olarak takip edildi. Grup II'deki ratlar kaynama yokluğu modeline uygulanan açık kaynama yokluğu cerrahisi modeli, Grup III'teki ratlar ise kaynama yokluğu modeline uygulanan ekstrakorporeal şok dalga tedavisi (ESWT) modeli olarak ele alındı. Tibiada kaynama yokluğu modeli için tüm ratlarda tibia orta hattında şaftta transvers kırık oluşturuldu. Distraksiyonu sağlamak amacıyla 2/0 propylene sütür K teli etrafında 3 tur sarılarak kırık uçlarının birbirine temas etmesi engellenecek şekilde bağlandı. Tüm ratlarda (30 adet) kırık iyileşmesi için yeterli süre olan 6 hafta beklenildikten sonra kaynama yokluğu modelinin oluştuğu varsayıldı. Grup I ve Grup III ratlarda rotasyonel manevra ile distraksiyon komprese edilerek kırık uçların teması sağlandı. Grup II'deki ratlar için ise kırık uçları cerrahi olarak açılarak tazelendirilip ve kanlandırıldıktan sonra kırık uçları birbirine değecek şekilde komprese edildi. Grup II'deki ratlar kaynama yokluğu modeline uygulanan açık kaynama yokluğu cerrahisi modeli olarak takibe alındı. Grup III'teki ratlara ise kırık uçlarının komprese edilmesinin ardından postoperatif 24. saatte tibia kaynama yokluğu alanına 15 kV'luk 500 şok dalga olacak şekilde ESWT uygulandı. Ikinci cerrahilerinin 6. Haftasında her 3 gruptaki tüm ratlar sakrifiye edildi. Ratların sağ tibiaları ayakbileği ve diz eklemlerinden dezartiküle edilerek rat tibia spesimenleri radyolojik ve histopatolojik incelemeye alındı. Radyolojik olarak incelendiğinde; Grup II ve Grup III'teki kaynama derecesinin Grup I'e göre yüksek olduğu bulunurken, Grup II ile Grup III arasında anlamlı bir farkın olmadığı bulunurken, histolojik olarak incelendiğinde ise Grup III'teki histolojik skorun Grup I ve Grup II'ye göre, Grup II'deki skorun da Grup I'e göre istatistiksel olarak anlamlı derecede yüksek olduğu bulundu. Sonuç olarak kaynama yokluğu görülen uzun kemik kırıklarında ESWT kullanımı, bildirilen başarılı sonuçlar bulunması ve komplikasyonların göz ardı edilebilecek kadar az olması nedeniyle cerrahi tedaviye başvurmadan önce denenebilecek önemli bir tedavi alternatifidir.
Abstract
This study was aimed to compare the effectiveness of extracorporeal shock wave therapy (ESWT) and surgical refreshment of the fracture edges on pseudoarthrosis. The study was carried out on 30 Sprague-Dawley rats provided by the Trakya University Medical Faculty Experimental Animal Research Laboratory with the approval of Trakya University Animal Experimentation Ethics Committee (Appendix I). Rats were divided into three groups. Group I: Tibia pseudoarthrosis control group (no surgery or ESWT) Group II: Tibia pseudoarthrosis group which was treated with surgical intervention for revascularisation and the refreshment of the fracture edges. Group III: Tibia pseudoarthrosis group which was treated with extracorporeal shock wave therapy (ESWT). Rats in Group I were choosen as control group in a pseudoarthrosis model. Group II rats were treated with open surgery for pseudoarthrosis to form surgery model and Group III rats were treated with extracorporeal shock wave therapy (ESWT) to form the ESWT model. A transverse midline fracture in the tibia shaft was made in all rats for tibia pseudoarthrosis model. To ensure the distraction 2/0 propylene suture wrapped three-fold around the K-wire preventing the contact between fracture ends. According to fracture healing properties of rats, we assumed that pseudoarthrosis model was formed after 6 weeks. For Group I and Group III a rotational maneuver used to compress the distracted fracture ends. For the rats in Group II a surgical approach was made to the pseudoarthrosis site and the surgical opening the fracture ends were revascularised and compressed to remain in touch. The rats in group II were followed as the model of open surgery for pseudoarthrosis model. Whereas group III rats, following the compression of the fracture ends of the tibia were applied to the 500 shock waves of 15 kV of ESWT after 24 hours of the surgery. All rats in three groups were sacrificed after six weeks following the second surgery. Right tibiae of rats were taken by disarticulation at the ankle and knee joints and the specimens were taken for radiological and histopathological examination. When specimens were examined radiologically; Group II and Group III were found to have higher fusion degree compared to Group I and that there was no significant difference between Group II and Group III; while the histological examination showed that Group III had significantly higher histological scores than Group I and Group II and that Group II had significantly higher compared to Group I. As a result, the use of ESWT in long bone fractures with pseudoarthrosis can be tried as an alternative treatment to surgery because of the reported successful results and the complications small enough to be ignored.
Abstract
This study was aimed to compare the effectiveness of extracorporeal shock wave therapy (ESWT) and surgical refreshment of the fracture edges on pseudoarthrosis. The study was carried out on 30 Sprague-Dawley rats provided by the Trakya University Medical Faculty Experimental Animal Research Laboratory with the approval of Trakya University Animal Experimentation Ethics Committee (Appendix I). Rats were divided into three groups. Group I: Tibia pseudoarthrosis control group (no surgery or ESWT) Group II: Tibia pseudoarthrosis group which was treated with surgical intervention for revascularisation and the refreshment of the fracture edges. Group III: Tibia pseudoarthrosis group which was treated with extracorporeal shock wave therapy (ESWT). Rats in Group I were choosen as control group in a pseudoarthrosis model. Group II rats were treated with open surgery for pseudoarthrosis to form surgery model and Group III rats were treated with extracorporeal shock wave therapy (ESWT) to form the ESWT model. A transverse midline fracture in the tibia shaft was made in all rats for tibia pseudoarthrosis model. To ensure the distraction 2/0 propylene suture wrapped three-fold around the K-wire preventing the contact between fracture ends. According to fracture healing properties of rats, we assumed that pseudoarthrosis model was formed after 6 weeks. For Group I and Group III a rotational maneuver used to compress the distracted fracture ends. For the rats in Group II a surgical approach was made to the pseudoarthrosis site and the surgical opening the fracture ends were revascularised and compressed to remain in touch. The rats in group II were followed as the model of open surgery for pseudoarthrosis model. Whereas group III rats, following the compression of the fracture ends of the tibia were applied to the 500 shock waves of 15 kV of ESWT after 24 hours of the surgery. All rats in three groups were sacrificed after six weeks following the second surgery. Right tibiae of rats were taken by disarticulation at the ankle and knee joints and the specimens were taken for radiological and histopathological examination. When specimens were examined radiologically; Group II and Group III were found to have higher fusion degree compared to Group I and that there was no significant difference between Group II and Group III; while the histological examination showed that Group III had significantly higher histological scores than Group I and Group II and that Group II had significantly higher compared to Group I. As a result, the use of ESWT in long bone fractures with pseudoarthrosis can be tried as an alternative treatment to surgery because of the reported successful results and the complications small enough to be ignored.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Kaynama Yokluğu, Kırık, Ekstrakorporeal Şok Dalga Tedavisi, Extracorporeal Shock Wave Therapy, Pseudoarthrosis, Fracture
