MEHMET AYVAZ, Güney YILMAZ, Erhan AKPINAR, Rıfat Emre ACAROĞLU

İnstabil pelvis kırığı ve transizyonel lomber omurgası olan bir hastada iliolomber vida tespiti ve uygulamanın kadavra üzerinde gösterilmesi

İnstabil pelvis kırıkları yüksek morbidite ve mortaliteye yol açarlar. Perkütan iliosakral vidalar instabil pelvis kırıklarının tedavisinde büyük cerrahi yaklaşımlara gerek olmadan güvenle kullanılabilmektedir. Transizyonel omurga olan hastalarda omurgaların numaralandırılması ve floroskopide görüntülenmesinde zorluklar yaşanabilir. Trafik kazasına bağlı instabil pelvis kırığı gelişen ve transizyonel lomber omurgası olan 20 yaşında bir erkek hastada iliolomber vida tespiti uygulandı. Hastada cerrahi sonrasında herhangi bir nörolojik ya da vasküler yaralanma görülmedi. Yaralanma sonrası ikinci yılda hastanın ağrısının olmadığı ve işine geri döndüğü görüldü. Vida uygulamasının anatomik yapılarla ilişkisini değerlendirmek amacıyla, erişkin erkek kadavrasına iliolomber vida yerleştirildi. Yapılan diseksiyon sonrasında, vidanın iliyak kanat lateralinden girip iliopsoas kasının içinden L5 omurga korpusuna gittiği ve L4 ve L5 spinal sinirin arkasından ve iliyak arter ve venlerin oldukça uzağından geçtiği görüldü.

Anahtar Kelimeler:

İnternal fiksatörler, Diseksiyon, Lumbar omurga, Erkek, Genç erişkin, Kadavra, Kırık tespiti, internal, Pelvis kemikleri

Percutaneous iliolumbar screw fixation in a patient with unstable pelvic fracture and transitional lumbar vertebrae and cadaveric illustration of the fixation

Unstable pelvic ring fractures cause high rates of morbidity and mortality. Percutaneous iliosacral screws provide a safe pelvic fixation obviating large surgical exposures. The presence of transitional vertebrae may present difficulties in numbering and fluoroscopic identification of lumbar discs and vertebrae. We performed percutaneous iliolumbar screw fixation for an unstable pelvic fracture due to a traffic accident in a 20-year-old male patient with transitional lumbar vertebrae. No neurologic or vascular complications were seen and the patient returned to his preinjury work and was pain-free in the second postoperative year. In order to determine the anatomic relationship of the iliolumbar screw with the major neurovascular structures, a cadaveric study was performed on the corpse of an adult man. Following dissection, it was observed that the iliolumbar screw inserted from the lateral wall of the iliac wing passed through the iliopsoas muscle and advanced to the L5 vertebral corpus posterior to the fourth and fifth lumbar roots and with a reasonably distant course from the common iliac veins and arteries.

Keywords:

Internal Fixators, Dissection, Lumbar Vertebrae, Male, Young Adult, Cadaver, Fracture Fixation, Internal, Pelvic Bones,

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