Radius distal uç kırıklarında tedavi sonrası radyolojik parametrelerin klinik sonuçlar üzerine etkisi
Küçük Resim Yok
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızda Trakya Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Kliniği'nde tek taraflı radius distal uç kırıklarında tedavi sonrası radyolojik parametrelerin klinik sonuçlarla olan ilişkisinin araştırılması amaçlanmıştır. Çalışma grubunu 2010-2018 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Kliniği'nde takip edilmekte olan radius distal uç kırığı olan 40 hasta oluşturmaktadır. Hastaların 11'i (%27,5) kadın, 29'u (%72,5) erkektir. Kırıkların 28'i (%70) eklem içi, 12'si (%30) eklem dışı olarak tespit edildi. Hastaların 7'sinin (%17,5) kapalı redüksiyon + eksternal fiksatör, 14'ünün (%35,0) kapalı redüksiyon + alçılama ve 19'unun (%47,5) açık redüksiyon + internal fiksasyon yöntemi ile tedavi edildiği belirlenmiştir. Hastaların ortalama VAS puanı 1,72 ± 2,03, DASH puanı 16,01 ± 17,58 olarak bulunmuştur. Tek taraflı radius distal uç kırıklarında tedavi sonrası radyolojik parametrelerin klinik sonuçlarla olan ilişkisinin araştırılması planlanan çalışmamızda bozuk parametresi olmayanlarda volar fleksiyon, dorsifleksiyon, supinasyon hareket açısının istatiksel olarak anlamlı ve yüksek olduğu saptanmıştır. Eklem içi basamaklaşma bozuk parametre varlığı olmayanların radial deviasyon, dorsifleksiyon hareket açısı daha yüksek ve DASH puanları da daha düşük olduğu tespit edilmiştir. Kapalı redüksiyon + alçılama ve kapalı redüksiyon + eksternal fiksatör tedavi yöntemleri ikili karşılaştırıldığında kapalı redüksiyon + alçılamanın VAS puanının istatistiksel olarak anlamlı ve yüksek olduğu bulunmuş olup DASH puanlarıyla üç tedavi yöntemi ve ikili kıyaslamalarda istatiksel olarak anlamlı fark bulunmamıştır. Çalışmamız sonucunda elde ettiğimiz verilere göre hastalarda tedavi sonrası ağrı ve fonksiyonellik açısından sonucu en çok etkileyen paramatreler, eklem içi basamaklaşma, 48 ulnar varyans ve volar tilttir. Özellikle eklem içi basamaklaşma sonuçlara en çok etki eden faktördür. Uygulanan tüm tedavilerde buna dikkat edilmelidir. Eklem içi ve eklem dışı deplase olmayan kırıklara kapalı redüksiyon + alçılama uygulanmalıdır. Deplasmanı olan ancak kabul edilebilir redüksiyon sağlanan hastalarda da kapalı redüksiyon + alçılama yapılmalıdır. Yapılan redüksiyonun sürdürülemediği, şişliği olan, açık yaraları olan hastalarda kapalı redüksiyon + eksternal fiksatör uygulanabilir. Eklem içi deplasmanı olan, redüksiyonun kabul edilebilir sınırlarda olmadığı hastalarda ise açık redüksiyon + internal fiksasyon yapılmalıdır. Ayrıca kapalı redüksiyon + alçılamanın VAS skorunu artırdığı sonucuna dayanarak; elbileğini çok aktif olarak kullanan meslek gruplarında, genç hastalarda, kırığı dominant elinde olanlarda kapalı redüksiyon + alçılama yerine kapalı redüksiyon + eksternal fiksatör veya açık redüksiyon + internal fiksasyon yapılabilir. Tüm bu veriler birlikte değerlendirildiğinde tedavi yöntemlerinin seçimi esnasında kırık tipi, hastanın yaşı, yaşam tarzı, ek sağlık problemleri, tedaviye uyum, fiziksel ve mental kapasite vb. faktörler de göz önünde tutulmalıdır ve tedavi yöntemlerini seçerken bunlara dikkat edilmesi gereklidir. Anahtar kelimeler: Radius kırıkları, DASH puanları, VAS puanları
The aim of this study is to investigate the relationship between post-treatment radiological parameters and clinical results in unilateral distal radius fractures at Trakya University Orthopedics and Traumatology Clinics. Study group consists of 40 patients with distal radius fractures who were followed up at Trakya University Orthopedics and Traumatology Policlinics between 2010-2018. 11 of the patients (%27.5) were female and 29 (%72.5) were male. 28 of the fractures (%70) were intra-articular and 12 (%30) were extra-articular. 7 of the patients (%17.5) were treated by using closed reduction + external fixator, 14 patients (%35) were treated with closed reduction + casting and 19 of them (%47.5) were treated with open reduction + internal fixation. Mean VAS score of the patients was found as 1.72 +/- 2.03, DASH score was 16.01 +/- 17.58. In our study which aimed to investigate the relationship between post-treatment radiological parameters and clinical results, the patients who do not have deteriorated parameters, were detected to have statistically significant higher volar flexion, dorsiflexion and supination movement angles. The patients who did not have deterioriated intra-articular step-off presence parameters, were found to have higher radial deviation, dorsiflexion movement angle and lower DASH scores. When closed reduction + casting and closed reduction + external fixator treatment methods were compared dually, VAS score of closed reduction + casting was found to be statistically higher however, DASH scores of three treatment methods did not show any statistically significant difference, even in dual comparisons. According to the data obtained as a result of our study, the parameters which effect the patients in pain and functionality aspects during post-treatment period are intra-articular step-off, ulnar variance and volar tilting. Especially intra-articular step-off is the most frequent effective factor. This should be taken into consideration in all treatment applications. İntra and extra-articular non-displaced fractures should be treated with closed reduction + casting. The fractures with displacement but which may have acceptable reduction also should be treated with closed reduction + casting. The patients whom reduction could not be obtained, having swelling and open wounds may be treated with closed reduction + external fixator application. The patients who have intra-articular displacement and do not have acceptable reduction must be treated with open reduction + internal fixation. Moreover, when the outcome of closed reduction + casting to increase VAS scores taken into account, elective cases may be treated with closed reduction + external fixator or open reduction + internal fixation instead of closed reduction + casting. According to the evaluation of all these data, treatment method should be chosen by considering factors such as fracture type, age of the patient, life style, additional health problems, treatment compliance, physical and mental capacity and their should be carried out carefully. Keywords: Radius fractures, DASH scores,VAS scores
The aim of this study is to investigate the relationship between post-treatment radiological parameters and clinical results in unilateral distal radius fractures at Trakya University Orthopedics and Traumatology Clinics. Study group consists of 40 patients with distal radius fractures who were followed up at Trakya University Orthopedics and Traumatology Policlinics between 2010-2018. 11 of the patients (%27.5) were female and 29 (%72.5) were male. 28 of the fractures (%70) were intra-articular and 12 (%30) were extra-articular. 7 of the patients (%17.5) were treated by using closed reduction + external fixator, 14 patients (%35) were treated with closed reduction + casting and 19 of them (%47.5) were treated with open reduction + internal fixation. Mean VAS score of the patients was found as 1.72 +/- 2.03, DASH score was 16.01 +/- 17.58. In our study which aimed to investigate the relationship between post-treatment radiological parameters and clinical results, the patients who do not have deteriorated parameters, were detected to have statistically significant higher volar flexion, dorsiflexion and supination movement angles. The patients who did not have deterioriated intra-articular step-off presence parameters, were found to have higher radial deviation, dorsiflexion movement angle and lower DASH scores. When closed reduction + casting and closed reduction + external fixator treatment methods were compared dually, VAS score of closed reduction + casting was found to be statistically higher however, DASH scores of three treatment methods did not show any statistically significant difference, even in dual comparisons. According to the data obtained as a result of our study, the parameters which effect the patients in pain and functionality aspects during post-treatment period are intra-articular step-off, ulnar variance and volar tilting. Especially intra-articular step-off is the most frequent effective factor. This should be taken into consideration in all treatment applications. İntra and extra-articular non-displaced fractures should be treated with closed reduction + casting. The fractures with displacement but which may have acceptable reduction also should be treated with closed reduction + casting. The patients whom reduction could not be obtained, having swelling and open wounds may be treated with closed reduction + external fixator application. The patients who have intra-articular displacement and do not have acceptable reduction must be treated with open reduction + internal fixation. Moreover, when the outcome of closed reduction + casting to increase VAS scores taken into account, elective cases may be treated with closed reduction + external fixator or open reduction + internal fixation instead of closed reduction + casting. According to the evaluation of all these data, treatment method should be chosen by considering factors such as fracture type, age of the patient, life style, additional health problems, treatment compliance, physical and mental capacity and their should be carried out carefully. Keywords: Radius fractures, DASH scores,VAS scores
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Ortopedi ve Travmatoloji, Orthopedics and Traumatology
