TİBİA CİSİM KIRIĞININ İNTRAMEDÜLLER ÇİVİLEMESİNDE TRANSPATELLAR VE MEDİAL PARAPATELLAR YAKLAŞIMIN DİZ ÖNÜ AĞRISINA ETKİSİ

Giriş: Tibia cisim kırıklarının intramedüller çivi ile tedavisinde uygulanan transpatellar ve medialparapatellar yaklaşımın diz önü ağrısı açısından karşılaştırılması amaçlandı. Gereç ve Yöntem: Tibia cisim kırığı tanısıyla intramedüller çivi ile tedavi edilen toplam 31 (24 erkek; 7 kadın) hasta değerlendirildi. 20 olguya transpatellar; 11‘ine medial parapatellar yaklaşım uygulandı. Ortalama takip transpatellar grupta 23,5 ±17,1; medial parapatellar grupta ise 11,5,1 ±4,8 ay idi. Kırık tipi, yerleşimi, şekli ve oluşum mekanizması; oyma ve kilitleme durumları incelendi. Son kontrollerde hastalar Johner Wrush kriterlerine göre fonksiyonel ve radyolojik olarak incelendi. Diz önü ağrısının varlığı ve şiddeti açısından vizüel analog skorlama kullanıldı. Bulgular: Transpatellar grupta 20 hastanın 11‘inde (%55,0) , medial parapatellargrupta ise 11 hastanın altısında (%54,5) Diz önü ağrısı vardı, ağrının şiddeti vizüel analog skora göre transpatellar grupta ortalama 2,3 (1-3); medial parapatellar grupta ise 3,2 (1-4) puan idi ve gruplar arasında anlamlı fark yoktu. Kırık tipi dışında demografik verilerde anlamlı bir fark saptanmadı. Fonksiyonel açıdan transpatellar grupta tüm hastalardan medial parapatellar grupta ise yedi hastadan iyi ve mükemmel sonuç elde edildi. Radyolojik olarak transpatellar grupta bir olguda çivinin proksimal migrasyonu görüldü ancak diz önü ağrısı saptanmadı. Sonuç: Tibia cisim kırıklarının intramedüller çivilemesinde diz önü ağrısı açısından transpatellar ve medial parapatellar yaklaşım arasında anlamlı bir fark olmadığı her iki yaklaşımın da güvenle kullanılabileceği kanaatine vardık.

THE EFFECT OF TRANSPATELLAR AND MEDIAL PARAPATELLAR APPROACH ON ANTERIOR KNEE PAIN IN INTRAMEDULLARY NAILING OF TIBIAL SHAFT FRACTURE

Introduction: It was aimed that to compare transpatellar and medial parapatellar approach applied in the treatment of tibial shaft fractures with intramedullary nailing in terms of anterior knee pain. Material and Method: 31 patients (24 male; 7 female) treated with intramedullary nailing for tibial shaft fractures were evaluated. 20 patients were performed transpatellar approach; 11 medial parapatellar approach. Mean follow-up was 23,5 ±17,1 months in transpatellar group; 11,5 ± 4,8 in medial parapatellar group. Fracture type, location, shape and mechanism; reaming process and locking status were inspected. Patients were evaluated functionally by Johner Wrush criteria and radiologically. Presence of anterior knee pain and its severity was evaluated by visual analog scala . Results: There were anterior knee pain in 11 patients of 20 (%55,0) in transpatellar group and six of 11 (%54,5) in medial parapatellar group. Severity of pain according to visual analog score mean 2,3 (1-3) in transpatellar group and 3,2 (1-4) medial parapatellar group and there was no significant difference between the groups. No difference was found between the groups in terms of demographics except fracture type. All patients in transpatellar group and seven in medial parapatellar group had good and excellent functional result. Proximal nail migration seen in only one patient radiologically but didn‘t have anterior knee pain. Conclusion: We concluded that there is no difference between the transpatellar approach and medial parapatellar aproach in terms of anterior knee pain and those approaches could be used safely in the treatment of tibial shaft fracture with intramedullary nailing.

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