Tahir Sadık SÜGÜN, Kemal ÖZAKSAR, Tulgar TOROS, Murat KAYALAR, Emin BAL, Fuat ÖZERKAN

Limb salvage and amputation in Type 3C tibial fractures

Amaç: Bu çalışmanın amacı Tip 3C tibia kırığı sonrası uzuv koruyucu yaklaşım ve primer ampütasyon uygulanan hastaların sonuçlarının değerlendirilmesi ve toplum standartlarıyla karşılaştırılması idi. Çalışma planı: 1993-2009 yılları arasında Tip 3C tibia kırığı tanısıyla uzuv koruyucu yaklaşım uygulanan 20 hasta ile primer ampütasyon uygulanan 14 hasta, ortalama 5.3 yıl takip süresi sonunda değerlendirildi. Grupların tedavi süreleri, komplikasyonlar, ameliyat sayıları ve işe dönüş durumları karşılaştırıldı. Yaşam kalitesi değerlendirilmesinde Kısa Form-36 (KF-36) kullanıldı; etki alanları hasta grupları arasında ve toplum standart değerleriyle karşılaştırıldı. Bulgular: Uzuv koruyucu yaklaşım uygulanan hastaların primer ampütasyon grubuna göre daha uzun tedavi sürelerinin sonunda daha fazla ameliyat geçirdikleri ve komplikasyon yaşadıkları görüldü. Uzuv koruyucu yaklaşım grubunda işe dönüş yüzdesi %59, ampütasyon grubunda %71 olarak bulundu. KF-36 etki alanlarının tümünde uzuv koruyucu yaklaşım ve primer ampütasyon uygulanan hastalar arasında istatistiksel fark saptanmadı. Hastaların fiziksel fonksiyonları, sosyal fonksiyonları, emosyonel durumları ve ağrıları toplum değerlerinden istatistiksel olarak düşük bulundu. Çıkarımlar: Tip 3C tibia kırıkları her iki tedavi yönteminde de hastaların yaşam kalitesi üzerinde olumsuz etkilere neden olmaktadır. Hastalar, tedavi sonunda topluma oranla daha kısıtlı bir fonksiyonel kapasite, ağrı komplikasyonları ve işe dönüş sorunları konusunda bilgilendirilmelidir. Ayrıca, uygun hastalar için müsait şartlar sağlandığında yüksek başarıyla uzuv koruyucu yaklaşım uygulamak mümkündür.

Tip 3C tibia kırıklarında uzuv koruyucu yaklaşım ve ampütasyon

Objective: The aim of this study was to evaluate the results of limb salvage and primary amputation treatments in patients with Type 3C tibia fractures and compare with normative population data. Methods: Limb salvage was performed in 20 patients and primary amputation in 14 patients with Type 3C tibia fractures between 1993 and 2009. Mean follow-up period was 5.3 years. Treatment times, complications, number of operations and return-to-work status of groups were compared. The Short Form-36 (SF-36) was used to assess quality of life and domains were compared among the patient groups and normative data. Results: Limb salvage patients had longer treatment periods with more operations and complications than the primary amputation group. Return-to-work percentage was 59% in the limb salvage group and 71% in the amputation group. There was no statistical difference in all SF-36 domains for limb salvage and primary amputation patients. Physical functioning, social functioning, limitation due to emotional problems and pain were statistically lower in all patients than in the general population. Conclusion: Type 3C tibia fractures treated with both limb salvage and primary amputation have negative effects on quality of life. Patients should be informed about limited functional capacity, pain complications and problems with return-to-work at the end of treatment. In addition, high rates of limb salvage can be achieved with proper conditions in suitable patients.

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