Tibia plato kırığı nedeniyle opere edilen hastalarda diz fonksiyonlarının klinik ve radyolojik değerlendirilmesi
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Tarih
2010
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Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Trakya Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Kliniği'nde tibia plato kırığı nedeniyle cerrahi tedavi uygulanan 56 hastanın 57 dizi değerlendirildi. Travma anındaki klinik ve radyolojik bulguları, epikrizleri incelendi ve ileri dönem kontrollünde fizik muayeneleri yapılarak; "Opere Tibia Plato Kırıkları Poliklinik Değerlendirme" formu dolduruldu, "Diz Cemiyeti Diz Skorlamasına" göre diz ve fonksiyonel skor hesaplandı, radyolojik bulguları "Resnic Niwoyama Radyolojik Değerlendirme Kriterlerine" göre değerlendirildi. İncelenen 56 hastanın 9'u kadın (% 16.1), 47'i erkek (% 83.9) idi. Hastaların travma şekilleri; yüksekten düşme 16 (% 28.6), bisiklet-motorsiklet kazası 15 (% 26.8) , araç içi trafik kazası 10 (% 17.9), araç dışı trafik kazası 7 (% 12.5), dizi üzerine düşme 3 (% 3.4), diz üzerine ağırlık düşmesi 2 (% 3.6), darp 1 (% 1.8), ateşli silah yaralanması 1 (% 1.8), spor yaralanması 1 (% 1.8) hasta şeklindeydi. Eklemde çökme miktarı arttıkça fonksiyonel skor ve radyolojik evrede kötüye gidiş olduğu görüldü. Plak vida uygulanan hastalarda radyolojik evrenin diğer tedavi şekillerine göre daha iyi olduğu görüldü. Hastalarda CPM başlama zamanı ile diz skorları karşılaştırıldığında istatiksel olarak anlamlı bir ilişki saptanmadı. Ancak; diz ve fonksiyonel skorlamada mükemmel sonuç alınan 42 hastanın 35 (% 83.3)'i ilk 15 günde egzersize başlayan hastalardı ve bu anlamlı olarak değerlendirildi. Sonuç olarak; tibia plato kırıklarının cerrahi tedavisinde prognozu olumlu olarak etkileyen ana faktörlerin; eklemde çökmenin az olması, CPM ve egzersiz tedavilerinin ilk 15 gün içinde başlanması olduğu görüldü. Plak vida ile tespitin eksternal fiksatöre göre redüksiyon stabilitesinin korunmasında daha üstün bir yöntem olduğu düşünüldü. Anahtar kelimeler: Tibia plato, Diz fonksiyonu, Cerrahi.
Abstract
In Trakya University Medical Faculty Orthopedia and Traumatology Clinic 56 patients with 57 tibial plateau fractures were analyzed. Clinical and radiological findings were evaluated. Patient records during trauma and follow up were inspected. "Operated Tibial Plateau Fractures Follow up Assesment" form and "Knee Society Knee Score "form were used during postoperative followup. Radiologic findings evaluated up to "Resnie Niwoyama Radiologic Asessment Criteria". In 56 patients 9 (16.1 %) were women and 47(83.9 %) were men. Trauma mechanisms were; 16 fall from height (28.6 %), 15 bike ? motorcycle accident (26.8 %), 10 automobile accident (17.9 %), 7 pedestrian accident (12.5 %), 6 direct trauma (10.7 %) ( 3 fall over knee mechanism (3.4 %), 2 accident as an object fall on knee(3.6 %) ,1 caused by beating (1.8 %)), 1 gunshot wound (1.8 %) and 1 sport injury (1.8 %). Amount of articular depression correlated significantly with functional score and radiological grading. It was observed that increased articular depression comes with worse functional score and radiological grade. Statistical correlation was significant between radiologic grading and treatment type. In patients treated with plate and screw fixation, radiological grade was better than other treatment methods. When CPM starting time and knee score analyzed; 35 (83.3 %) of the 42 patients with ?perfect? knee score and functional score started exercise in the first 15 days. Statistically CPM starting time has no correlation with knee functional score and radiological grade. Although there is no statistical correlation; early CPM and early exercise programs would come with beter results. As a conclusion; in our study surgically treated tibial plateau fractures, affected positively when articular depression amount is minimum and when exercise and CPM treatment starts in first 15 days. We suggest that plate- screw fixation method is better than external fixation in protection of reduction stability. Key words: Tibial plateau, Knee functions, Surgery.
Abstract
In Trakya University Medical Faculty Orthopedia and Traumatology Clinic 56 patients with 57 tibial plateau fractures were analyzed. Clinical and radiological findings were evaluated. Patient records during trauma and follow up were inspected. "Operated Tibial Plateau Fractures Follow up Assesment" form and "Knee Society Knee Score "form were used during postoperative followup. Radiologic findings evaluated up to "Resnie Niwoyama Radiologic Asessment Criteria". In 56 patients 9 (16.1 %) were women and 47(83.9 %) were men. Trauma mechanisms were; 16 fall from height (28.6 %), 15 bike ? motorcycle accident (26.8 %), 10 automobile accident (17.9 %), 7 pedestrian accident (12.5 %), 6 direct trauma (10.7 %) ( 3 fall over knee mechanism (3.4 %), 2 accident as an object fall on knee(3.6 %) ,1 caused by beating (1.8 %)), 1 gunshot wound (1.8 %) and 1 sport injury (1.8 %). Amount of articular depression correlated significantly with functional score and radiological grading. It was observed that increased articular depression comes with worse functional score and radiological grade. Statistical correlation was significant between radiologic grading and treatment type. In patients treated with plate and screw fixation, radiological grade was better than other treatment methods. When CPM starting time and knee score analyzed; 35 (83.3 %) of the 42 patients with ?perfect? knee score and functional score started exercise in the first 15 days. Statistically CPM starting time has no correlation with knee functional score and radiological grade. Although there is no statistical correlation; early CPM and early exercise programs would come with beter results. As a conclusion; in our study surgically treated tibial plateau fractures, affected positively when articular depression amount is minimum and when exercise and CPM treatment starts in first 15 days. We suggest that plate- screw fixation method is better than external fixation in protection of reduction stability. Key words: Tibial plateau, Knee functions, Surgery.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Ortopedi, Travmatoloji, Orthopedics, Traumatology, Teknoloji, Tıp Bilimleri, Tibia Plato, Diz Fonksiyonu, Cerrahi, Tibial Plateau, Tibial Plateau, Knee Functions
