Mehmet KOCAOĞLU, Yılmaz TOMAK, Levent ERALP, F. Erkal BİLEN

Ilizarov yöntemi ile humerus diafiz psödartrozlarının tedavisi

Amaç: Humerus diafiz psödartrozlu hastalarda Ilizarov eksternal fiksatör uygulaması değerlendirildi. Çalışma planı: Humerus diafiz psödartrozu tanısı konan 35 hasta (25 erkek, 10 kadın; ortalama yaşı 37.3; dağılım 13-69) Ilizarov eksternal fiksatör uygulaması ile tedavi edildi. Primer tedavi ile sirküler eksternal fiksatör uygulanması arasında geçen süre ortalaması 11.7 ay (dağılım 5-48 ay) idi. Hastalar ortalama 39.2 ay (24-80 ay) süreyle izlendi. Sonuçlar: Bir hasta hariç diğer tüm hastalarda (%97.14) kaynama sağlandı. Ortalama kaynama süresi 5.5 ay (3-10 ay) idi. Hastaların çoğunda çivi dibi enfeksiyonu gözlenmesine karşın, sadece üç hastada Schanz vidası çıkarılması nı gerektiren çivi dibi enfeksiyonu oluştu. Erken postoperatif dönemde üç hastada radial sinir paralizisi gözlendi. Bunların ikisi ameliyat sonrası üçüncü ayda spontan olarak iyileşirken, radial sinir lezyonu düzelmeyen bir olguda üçlü tendon transferi uygulandı. Çıkarımlar: Humerus diafiz psödartrozlarında Ilizarov yönteminin kısa kaynama süresi ile güvenli ve etkin bir alternatif tedavi yöntemi oldu¤u ve enfekte, kemik defektli, kısalık omuz-dirsek eklem hareket arkında kısıtlılık gibi sorunlu humerus psödartrozlarında ise alternatifsiz bir tedavi yöntemi olduğu sonucuna varıldı.

Anahtar Kelimeler:

Psödoartroz, Humerus kırıkları, Eksternal fiksatörler, Humerus, Ilizarov tekniği, Kırık tespiti

The treatment of pseudoarthrosis of the humeral shaft by the Ilizarov method

Objectives: We evaluated the use of Ilizarov circular external fixator in patients with pseudoarthrosis of the humeral shaft Methods: Thirty-five patients (25 males, 10 females; mean age 37.3 years; range 13-69 years) with pseudoarthrosis of the humeral shaft were treated with the Ilizarov circular external fixator. The mean interval between the primary treatment and application of the external fixator was 11.7 months (range 5-48 months). Mean follow-up was 39.2 months (range 24-80 months). Results: Union was achieved in all but one patient (%97.14), within a mean duration of 5.5 months (range 3-10 months). Although most of the patients experienced minor pin tract problems; these problems led to the removal of Schanz screws in only three patients. Radial nerve palsy developed in three patients during the early postoperative period, two of whom spontaneously recovered in three months. One patient with permanent palsy was treated by a triple tendon transfer. Conclusion: The Ilizarov external fixator is a reliable surgical alternative in the treatment of nonunions of the humerus, providing a rapid bony healing. It is the only treatment modality, enabling management of infected, defect pseudoarthrosis and in patients with extremity shortness and restricted shoulder and elbow range of motions.

Keywords:

Pseudarthrosis, Humeral Fractures, External Fixators, Humerus, Ilizarov Technique, Fracture Fixation,

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