İsmail KAYA, Murat SAYIN, İnan UZUNOĞLU, Gökhan GÜRKAN, İlker Deniz CİNGÖZ, Murat ATAR, Nurullah YÜCEER

Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi

Amaç: Open-door servikal laminoplasti multipl seviye servikal myelopatisi olan hastalar için standart cerrahi seçenektir. Cerrahide laminanın bir tarafına lineer laminektomi yapılırken, karşı tarafa menteşe halini alacak şekilde kemik drillemesi yapılır. Lineer laminektomi yapılan taraf kaldırılırken diğer tarafta menteşe kırıkları meydana gelebilir. Bu kırıkların oluşmaması için olası risk faktörlerini incelemeyi amaçladık. Gereç ve Yöntemler: 2013-2018 yılları arasında open-door servikal laminoplasti operasyonu geçiren olguların dosyaları, radyolojik görüntüleri, laboratuvar sonuçları retrospektif olarak incelendi. Bulgular: Çalışmaya opere edilen 54 erkek, 24 kadın olmak üzere 78 hasta dahil edildi. Hastaların yaş ortalaması 57,8 ± 11,6 idi. Operasyon öncesi hastaların Modifiye JOA (Japanese Orthopedic Association) servikal miyelopati skorları 16,2 ± 2,1 olarak geldi. Operasyon öncesi kan Ca++ değerlerine bakıldığında 9,3 ± 0,5 mg/dl idi. Hastaların Pavlov oranı ortalaması 0,7 ± 0,2 idi. Laminalar 26 olguda sağ taraftan, 52 olguda sol taraftan açıldı. Toplam 304 lamina açıldı. Operasyon sonrası çekilen kontrol servikal BT’lerde 42 hastada lamina menteşe kırığı vardı. Menteşe kırığı olmayan hasta sayısı 36 idi. Toplamda 89 lamina seviyesinde kırık vardı. Cerrahi sonrası çekilen servikal BT’ler incelendiğinde laminaların açılma açısı (OA) ortalaması 30,6 ± 8,9 derece olarak ölçüldü. Lamina açılma açısının menteşe kırığına anlamlı ölçüde etki ettiği gözlendi. Lamina menteşe kırığı olan hastalarda OA 32,3 ± 9 (p

Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi

Aim: Open-door cervical laminoplasty is the standard surgical option for patients with multipl levelscervical myelopathy. In this surgical technique, while linear laminectomy is performed on one side ofthe lamina, bone is drilled to form a hinge on the opposite side. Hinge fractures may occur on the otherside while lifting the linear laminectomy side. Our study aimed to examine possible risk factors forpreventing these fractures.Materials and Methods: The patients’ files, radiological images, and laboratory results whounderwent cervical laminoplasty between 2013-2018 were retrospectively analyzed.Results: A total of 78 patients, 54 males and 24 females, were included in the study. The mean age ofthe patients was 57.8±11.6 years. The mean modified Japanese Orthopedic Association (JOA)cervical myelopathy scores of the patients before the operation were 16.2±2.1. When the preoperative blood Ca values were examined, the mean value was 9.3±0.5 mg/dl. The mean Pavlov ratioof the patients was 0.7±0.2. Laminas were opened from the right side in 26 cases and from the leftside in 52 cases. A total of 304 laminae were opened. In post-operative control cervical CTs, 42patients had lamina hinge fractures, and the number of patients without hinge fracture was 36. Therewere 89 fractures in total at the lamina level. When post-operative cervical tomography images wereexamined, the mean opening angle (OA) of the laminas was 30.6±8.9 degrees. The opening angle ofthe lamina was determined to affect the hinge fracture significantly. While OA was 32.3±9 degrees inpatients with lamina hinge fracture, it was found to be 28.7±8.3 in patients without fractures (p

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