Koray TOSYALI, Sert HANCIOĞLU, Serkan ERKAN

Torakolomber Vertebra KırıklarındaPosterior Stabilizasyon Uygulanan Hastalarımızda Geç Dönem Sonuçlarımız

Giriş ve Amaç: Bu çalışmada 2007- 2015 tarihleri arasında Ortopedi ve Travmatoloji Kliniğinde cerrahi yolla tedavi edilen Torakolomber vertebra kırığı bulunan 17 olgunun retrospektif değerlendirilmesi yapıldı. Gereç ve Yöntemler: Çalışmaya dahil edilen hastaların en genci 20, en yaşlısı 63 yaşındaydı ve hastaların yaş ortalaması 43.05 ±13,25 olarak belirlendi. Bu çalışmadaki 17 hastanın 9 ‘u (%52.9) kadın, 8‘si (%47.1) ise erkekti. Etyolojik faktör 7 olguda (%41,2) yüksekten düşme ,7 olguda (%41,2) trafik kazası, 2 olguda (%11,8) araç dışı trafik kazası ve 1 olguda (%5,9) darp idi. Olguların beşinde (%29,4) L3, üçünde (%17,6) L1, üçünde (%17,6) T12 ,ikisinde (%11,8) T8 ve bir hastada (%5,9) T10 ,bir hastada (%5,9) L2 ve bir hastada (%5,9) L4 ve bir hastada da (%5,9) L5 kırık idi. Hastaların %82,4 ini patlama tarzı kırıklar oluşturmaktadır. Ek yaralanmalara bakıldığında ise en sık fıbula şaft kırığı yaralanması görülmektedir. Bulgular: Hastaların hepsine posterior spinal segmental enstrumantasyon uygulandı. Tüm olgularda füzyon amacı ile hastanın kendi kemikleri karıştırılarak kullanıldı. Operasyonlarda ortalama 2 ,05 ünite kan kullanılmıştır.1 hastada implant kırılması ve yetmezliği görüldü. Hastaların ameliyat öncesinde , ameliyat sonrasında ve son kontrollerde klinik ve radyolojik sonuçları değerlendirildi. Ölçülen radyolojik parametreler ayakta yan grafilerde ; anterior korpus yükseklik kaybı , sagittal indeks , lokal kifoz açısı ,anterior kompresyon açısı yer almakta idi. Ayrıca 17 hastanın, ameliyat öncesi ve son kontrollerdeki bilgisayarlı tomografide transvers ve ön-arka spinal kanal çapları değerlendirildi. Son kontrollerde hastaların klinik gözlemleri vizüel analog skala (VAS), Roland –Morris skalası ve Oswestry skorlama sistemi kullanıldı ve değerlendirildi. Sonuç: Klinik memnuniyette radyolojik parametrelerdeki düzelmeden ziyade kanal remodelasyonun daha etkın olduğu sonucuna vardık.

Late Results of Posterior Stabilization in Patients with Thoracolumbar Vertebral Fractures

Objective: In this study, we retrospectively evaluated 17 cases with thoracolumbar vertebra fractures who were surgically treated in Orthopaedics and Traumatology Clinics between the years January 2007 and June 2012. Materials and Metods: In our cases mean age of the patient were 43.05 ±13,25 and the youngest patient was 20 years old whereas the oldest was 63 years old. In our study, 8 (47.1%) of the 17 patients were male and 9 (52.9%) of them were female. Etiological factor was falling from a height in 7 (41,2%) cases, traffic accident in 7 (41,2%) cases, out side traffic accident in 2 (11,8%) cases and pounding in 1 (5,9%) cases. In 5 cases (29,4%) L3, in 3 cases (17,6%) L1, in 3 cases (17,6%) T12 ,in 2 cases (11,8%) T8 ,in 1 cases (5,9%) T10 ,in 1 cases (5,9%) L2 ,in 1 case (5,9%) L4 and in one case (5,9%) L5 vertebrae was fractured. 82,4% of the patients have burst fractures. The most observed additional injury is fibula shaft fracture injury. Results: Posterior spinal segmental instrumentation was performed in all casesThe radiological parameters were evaluated as loss of height in anterior corpus, sagittal index, local angle of kyphosis and anterior compresion angle in standing lateral radiographies. Moreover in 17 cases transverse and anteriorposterior spinal canal diameters were evaluated in CT assesment pre-operatively and during last controls. The clinical observation was made using visual analogue scala (VAS),Roland –Morris scala and Oswestry scoring system during last controls and the results were evaluated. Conclusion: We conclude that canal remodelling is more effective than improvement in radiological parameters in clinical satisfaction.

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