İrfan ESENKAYA, Nurzat ELMALI, Mesut MISIRLIOĞLU, Kadir ERTEM

Proksimal Tibia Medial Açık Kama Osteotomisinde Lateral Plato Kırığı Oluşumunu Önlemek İçin Alternatif Uygulama: Dana Tibialarında Deneysel Çalışma+

Amaç: Proksimal tibia medial açık kama osteotomi uygulamalarında lateral plato kırığı oluşumunu önlemek için alternatif bir yöntem tanımlamak. Gereç ve Yöntem: Bu çalışma için yaklaşık aynı yaş grubunda ve ağırlığındaki danalara ait 30 tibia kullanıldı. Rastgele iki gruba ayrıldılar; 30 tibianın 15 tanesi rastgele seçilerek Grup A'yı oluşturdular. Bunlardan 5 tanesi, yöntemin etkinliğini ve sonuçlarını göstermek için hizar ile frontal planda iki eşit parçaya ayrıldı. Kalan 10 tibia bölünmeden kullanıldı. Bu grupta, eklem yüzeyine paralel ve 1.5-2 cm distalinden bir veya iki adet Kirshner teli veya Schanz çivisi uygulandı. Sonra, lateral korteksin 2 cm mediali ile lateral tibia platosu eklem yüzeyinin 1.5 ile 3 cm distaline olmak üzere medio-lateral doğrultuda oblik veya hafif oblik osteotomiler yapıldı. Osteotomi sonrası açı skalalı distraktör ile distraksiyon uygulandı. Kalan 15 tibia Grup B'yi oluşturdu. Bunlarda 5 tanesi yöntemin etkinliğini ve sonuçlarını göstermek için hizar ile frontal planda iki eşit parçaya ayrıldı. Kalan 10 tibia bölünmeden kullanıldı. Sonra, lateral korteksin 2 cm mediali ile lateral tibia platosu eklem yüzeyinin 1.5 ile 3 cm distalinden olmak üzere medio-lateral doğrultuda oblik veya hafif oblik osteotomiler yapıldı. Osteotomi sonrası açı skalalı distraktör ile distraksiyon uygulandı. Bulgular: Grup A'da eklem yüzeyinden ve lateral korteksten daha uzak olan osteotomilerde distraksiyonun ortalama ilk 9 derecesini uygularken problem oluşmadı. Ortalama 9 derecenin üzerinde distraksiyon uygularken proksimale doğru uzanan kırık hattı oluştu. Kırık hatları Kirshner telleri veya Shanz çivileri seviyesini daha proksimale doğru aşamadılar, tel ve çivilerin altından lateral kortekse doğru yönlendiler. Tibial plato kırığı gözlenmedi. Buna karşılık Grup B'yi oluşturan osteotomilerden eklem yüzeyinin 3 cm distalinden ve lateral korteksin 2 cm medialinden yapılan osteotomilerde ortalama ilk 9.1 derece distraksiyona kadar problem oluşmadı. Bu değerlerin üzerinde ise lateral tibial plato veya lateral kortekse uzanan kırıklar saptandı. Sonuçlar: Eklem yüzeyine paralel olarak uygulanan Kirshner telleri veya Schanz çivileri oluşan kırık hattının lateral kortekse yönlenmesini sağlayarak platoda eklem içi kırık oluşumunu önlemektedir. Anahtar kelimeler: Proksimal tibial osteotomi, Yüksek tibial osteotomi, Komplikasyonlar, Deneysel çalışma, Lateral tibial plato kırığı, Teknik incelik

Anahtar Kelimeler:

Proksimal tibial osteotomi, Yüksek tibial osteotomi, Komplikasyonlar, Deneysel çalışma, Lateral tibial plato kırığı, Teknik incelik

An Alternative Technique for Prevention of Lateral Tibial Plateau Fractures During The Proximal Tibial Medial Opening Wedge Osteotomy: An Experimental Study At Calf Tibiae

Aim: Aim of this study is to define a simple method for preventing lateral tibial plateau fractures performing proximal tibia medial opening wedge osteotomy. Materials ve Methods: 30 calf tibiae in the same age and weight group were used for the experiments. They were assigned randomly into two groups. Of the 30 specimens, 15 were selected randomly as Group A. Five of them were divided in two equal parts on frontal plane with a large saw in order to observe the efficiancy of the procedures. Others were undivided. In this group, one or two provisional Kirschner wires or Schanz screws were applied 1.5-2 cm below and paralel to the articular surface. Later, oblique or nearly oblique osteotomies were performed medio-laterally 2 cm medial to the lateral cortex and 1.5 cm and 3 cm below the lateral tibial plateau. Following osteotomy, distractionwas made with angle-scale distractor. Of the 30 specimens, 15 were selected randomly as Group B. Five of them were divided in two equal parts on the frontal plane with a large saw. Others were again undivided. Oblique or nearly oblique osteotomies were performed medio-laterally 2 cm medial to the lateral cortex and 1,5 cm and 3 cm below the lateral tibial plateau. Following osteotomy, distraction was made with angle-scale distractor. Results: In Group A where the osteotomies were more distant from the articular surface and lateral cortex, no problem was seen during the first stage where the angle of distraction was mean 9.0º. Application above the mean angle of 9.0º of distraction created fracture line proximally but these lines could not pass the level of provisional Kirschner wires or Schanz screws. The fracture lines extended to the lateral cortex under the Kirshner wires or Schanz screws. Tibial plateau fracture was not observed. However in Group B osteotomy was made 3 cm distally from the articular surface and 2 cm medially from the lateral cortex, no problem was seen during the first stage where the mean angle of distraction was 9.1º. In these specimens fractures reached tibial plateau or lateral cortex above the mean of 9.1º of distraction manoeuvres. Conclusion: K-wires or Schanz screws applied paralel to the articular surface of tibial plateau guide the fracture line the lateral cortex and prevent intraarticular fracture formation on the plateau. Key words: Proximal tibial osteotomy, High tibial osteotomy, Complications, Experimental study, Lateral tibial plateau fractures, Technical trick

Keywords:

Proximal tibial osteotomy, High tibial osteotomy, Complications, Experimental study, Lateral tibial plateau fractures, Technical trick,

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