Oğuz DURAKBAŞA, Nedret OKAN, Kerem CANBORA, Mücahit GÖRGEÇ

Travmatik kalça çıkığında tedavi sonucunu etkileyen faktörler

Amaç: Konservatif veya cerrahi yöntemlerle tedavi edilen travmatik kalça çıkıklı olgularda geç dönem izlem sonuçları ve bu sonuçlan etkileyen prognostik faktörler değerlendirildi. Çalışma planı: Travmatik kalça çıkığı nedeniyle 30 hastanın (27 erkek, 3 kadın; ort. yaş 35; dağılım 16-69) 15'i kapalı, 15'i açık redüksiyonla tedavi edildi. Çıkığa en sık yol açan neden trafik kazaları (%80) idi. Kapalı redüksiyon grubunda 10 hastada posterior, ikisinde anterior, üçünde merkezi çıkık vardı; bunların sekizi izole çıkık, yedisi kırıklı çıkık idi. Açık redüksiyon grubunda 14 hastada posterior, birinde merkezi çıkık görüldü. Bunların beşinde yalnızca kalça travması, 10'unda birden fazla travma vardı. Cerrahi tedavi altı olguda ilk 24 saat içinde; dokuz olguda 5-21. günler arasında yapıldı. Posterior çıkıklar için Thompson-Epstein, femur başında kırık varsa Pipkin; merkezi çıkıklar için Judet; anterior çıkıklar için Epstein sınıflandırması kullanıldı. Sonuçlar Matta'nın klinik ölçütlerine göre değerlendirildi. Ortalama izlem süresi 49 ay (dağılım 16-84 ay) idi. Sonuçlar: Kapalı redüksiyon grubunda 11 olguda (%73.3) yeterli (çok iyi veya iyi), dört olguda (%26.7) yetersiz (orta veya kötü) sonuç elde edildi. Bu grupta tüm izole çıkıklarda ve posteriora kıtıklı çıkığı olan üç olguda sonuç yeterli idi. Açık redüksiyon grubunda dokuz olguda (%60) yeterli, altı olguda (%40) yetersiz sonuç elde edildi. Bu grupta posterior çıkıklı dokuz olguda yeterli, beşinde yetersiz sonuç alındı. Merkezi travmatik kalça çıkıklı tüm olgularda sonuç yetersiz bulundu. Kapalı redüksiyon grubunda kınklı çıkıklı bir olguda femur başı avasküler nekrozu, dört olguda dejeneratif artrit gelişti. Açık redüksiyon grubunda altı olguda dejeneratif artrit görüldü; bunların ikisinde avasküler nekroz saptandı. Çıkarımlar: Çalışmamızda, kapalı veya açık redüksiyonla tedavi edilen travmatik kalça çıkıklarında prognozu etkileyen faktörlere ışık tutucu bulgular elde edildi.

Anahtar Kelimeler:

Kalça kırıkları, Kalça çıkığı, Tomografi, x-ışınlı bilgisayarlı, Tedavi sonucu, Kalça eklemi, Manyetik rezonans görüntüleme, Seyir

Factors affecting the results of teratment in traumatic dislocation of the hip

Objectives: We evaluated the long-term results of conservative and surgical treatment and the effect of prognostic factors on these results in patients with traumatic dislocation of the hip. Methods: The study included 30 patients (27 males, 3 females; mean age 35 years; range 16 to 69 years) with traumatic hip dislocations. The most common cause was traffic accidents (80%). Fifteen patients underwent closed reduction for posterior (n=10), anterior (n=2), and central (n=3) dislocations, of which eight were isolated and seven were fracture dislocations. Open reduction was performed in 15 patients with posterior (n=14) and central (n=l) dislocations. Of these, five patients had isolated hip trauma and 10 patients had multiple trauma. Surgery was performed within the first 24 hours (n=6) or between five and 21 days (n=9). Posterior, central, and anterior dislocations were classified according to the Thompson-Epstein, Judet, and Epstein classification systems, respectively. The Pipkin classification was also used for dislocations with femoral head fractures. The results were evaluated according to the criteria proposed by Matta. The mean follow-up was 49 months (range 16 to 84 months). Results: Following closed reduction, the results were satisfactory (very good or good) in 11 patients (73.3%, all isolated dislocations and three posterior fracture dislocations) and unsatisfactory (moderate or poor) in four patients (26.7%). Following open reduction, nine patients (60%) with posterior fracture dislocations had satisfactory and six patients (40%) had unsatisfactory outcome. The results were unsatisfactory in all the central dislocations. One patient developed avascular necrosis of the femur head and four patients developed degenerative arthritis following closed reduction. Degenerative arthritis was seen in six patients after surgical treatment, two of whom also had avascular necrosis. Conclusion: Our data may provide insight into the factors affecting the prognosis of traumatic hip dislocations treated by closed or open reduction.

Keywords:

Hip Fractures, Hip Dislocation, Tomography, X-Ray Computed, Treatment Outcome, Hip Joint, Magnetic Resonance Imaging, Prognosis,

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