Yasin Emre KAYA, Metin CELİK, Tolgahan KURU, Abdullah Alper ŞAHİN, Cengiz ISİK, Fuat AKPİNAR

Distal Tibia Şaft Kırıklarının İntramedüller Çivi ile Tespitinde Distal Kilitleme Şeçeneklerinin Koyun Tibialarında Biyomekanik Karşılaştırılması

GİRİŞ ve AMAÇ: Tibia kırıklarının intramedüller çivi ile tedavisinde kullanılan çeşitli distal kilitleme metodları mevcuttur. Fakat günümüzde bu metodlardan herhangi birinin üstünlüğü konusunda görüş birliği yoktur.DSBLS distal kilitleme bolt vidası yeni geliştirilen bir metodudur.Çalışmamızda DSBLS ile, iki vida ile ve üç vida ile kilitleme seçeneklerini, aksiyel yüklenme kuvvetine karşı biyomekanik olarak mukayese edip aksiyel yüklenme kuvvetine karşı en dayanıklı seçeneği bulmayı amaçladık.YÖNTEM ve GEREÇLER: Tüketim amacıyla kesilmiş 6 aylık koyunlardan 16 adet koyun tibiası elde edildi. Bu tibiaların her birini eklem hattının 6 cm proksimalinden osteotomize ettik ve transvers kırık hattı oluşturduk. Elde edilen 16 adet distal tibia fragmanı 4 gruba ayrıldı. Her gruptaki 4 adet distal tibia fragmanına 8 mm kanülsüz intramedüller çivi oyma işlemi yapılmadan yerleştirdi ve farklı metodlarla distal kilitleme yapıldı. Grup 1’ de 2 adet vida 2 adet mediolateral,ZIMED marka , grup 2’de 3 adet vida 2 mediolateral, 1 anteroposterior, ORTHOFIX marka , grup 3’te DSBLS TST marka ve grup 4’ te grup 2’ dekilere göre daha küçük çaplı 3 adet vida 2 mediolateral, 1 anteroposterior,TIPMED marka kullanılarak distal kilitleme yapıldı. Kocaeli Üniversitesi Cad-Cam laboratuarında,Üniversal Çekme – Basma Test Cihazı ile deneklerin her birine aksiyel yüklenme uygulandı.Her denekte distal vida kırılması ile birlikte test sonlandırıldı. Her denekten kuvvet, zaman ve deformasyon verileri alınıp istatistiksel olarak mukayese edildi.BULGULAR: Aldığımız istatistik sonuçlarına göre, aksiyel yüklenme karşısında, distal kilitleme bolt vidası ile kilitleme seçeneğini DSBLS, grup 3 , çalışmamızda yer verdiğimiz ikili grup 1 ve üçlü grup 2, 4 kilitleme seçeneklerinden istatistiksel olarak anlamlı şekilde üstün bulduk. Ayrıca üçlü kilitleme metodunu grup 2, 4 ikili kilitleme metoduna grup 1 göre üstün bulduk. Üçlü kilitleme metodlarını grup 2, 4 kendi aralarında mukayese ettiğimizde vida kor çapı daha yüksek olan grup 2’ nin grup 3’ e göre üstün olduğu sonucuna ulaştık.TARTIŞMA ve SONUÇ: Çalışmamızda DSBLS nin aksiyel yüklenme kuvvetine karşı, üçlü ve ikili distal kilitleme seçeneklerine göre anlamlı şekilde üstün bulunmuştur.

Anahtar Kelimeler:

Distal kilitleme vidası, vida yetmezliği, tibia kırıkları, intramedüller çivileme, distal kilitleme bolt vidası, DSBLS, biyomekanik çalışma

Bıomechanıcal Comparison of Distal Interlocking Methods in Sheep Tibia Models,Used in Fixation of Distal Tibia Shaft Fractures with Intramedullary Nails

INTRODUCTION: There are different types of distally interlocking methods used in intramedullary nailing of tibia fractures. But there is no concensus about the superiority of these methods.DSBLS distally locking bolt screw is a new improved recently. In our study, we compared DSBLS, double screw distally locking and tirple screw distally locking methods againts axial loading forces biomechanically and we aimed to find the most resistant method to axiel loading.METHODS: 16 pieces of tibia were extracted from sheeps slaughtered for consumption. We osteotomized these tibias 6 cm proximal from tibiotalar joint to make up a transverse fracture model.We divided 16 distal tibia portions into 4 groups. 8 mm solid intramedullary nails were implanted to tibias without reaming and locked distally with different methods in each groups. In we used 2 screws both in mediolateral position,ZIMED in group 1, 3 screws two mediolateral, one anteroposterior position,ORTHOFIX in group 2, DSBLS TST in group 3 and 3 screws with a smaller diameter two mediolateral, one anteroposterior position,TIPMED in group 4 for distal interlocking. Axial load was applied to all experimentals by Universal Traction – Distraction Test Machine in CadCam laboratuary, Kocaeli University. Tests were ended with screw breakage. Force, time and deformation datas were recorded and compared statistically.RESULTS: According to statistic results, resistance to axial loading forces of distally locking bolt screw DSBLS, group 3 was statistically higher than double group 1 or triple group 2, 4 screw distal locking methods. Beside this, resistance to axial laoding forces of triple screw locking method group 2, 4 was statistically higher than double screw locking method group 1 . When we compared triple screw locking methods, group 2 with larger diameter screws was more resitant than group 4.DISCUSSION AND CONCLUSION: In our study, DSBLS was significantly superior to axial loading force compared to triple and double distal locking options.

Keywords:

Distally locking screw, screw failure, tibia fractures, intramedullary nailing, distally locking bolt screw, DSBLS, biomechanic study,

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