Erhan AYAN, Koray ÖZALP, Sadık VURALOĞLU, Mehmet DURAN, Akın Eraslan BALCI

Posterolateral kosta fraktürlerinde operatif fiksasyon: Titanyum materyal ve radyolojik uyumluluğunun değerlendirilmesi

Amaç:Posterolateral çoklu kosta fraktürlerinde kötü kaynama, dispne, kronik ağrı ve solunum fonksiyon kaybının giderilmesi.Materyal ve Metod: Otuzdokuz kosta fraktürlü hastadan altısına (%15.4) operatif fiksasyon yapıldı. Endikasyonlar organize hematom (3, %50), ağrı ve postür bozukluğu (2, %33.3) ve posttravmatik drenajdı (1, %16.7). Kırık uçlar uç uca getirilerek perforatörle vida yerleri açıldı. Titanyum plaklar, titanyum vidalarla kırık kostalara vidalandı.Bulgular: Fiksasyon yapılan kostaların tüm kırık kostalara oranı 0.57 (3.6/6.3), toraks dışı yandaş yaralanma oranı %83.3 (5/6), intratorasik yandaş yaralanma oranı %50 (organize hematom, 3/6) idi. Bütün hastalarda postoperatif erken dönemde postür bozukluğunun düzeldiği ve filmlerde kostaların anatomik pozisyonunda olduğu saptandı. Ağrı ve dispne yakınmaları ortadan kalktı. Hastanede kalış süresi 6 ± 2 gündü. Bilgisayarlı tomografi ve manyetik rezonans çekimlerinde titanyum materyallerin görüntüleri bozmadığı görüldü. FEV1 %15, FVC %19 oranında arttı.Sonuç: Başka nedenlerle torakotomi uygulanan posterolateral çoklu kosta fraktürlü hastalarda yapılacak cerrahi stabilizasyon, ağrı ve postür bozukluğunu ortadan kaldırarak hasta konforunu artıran etkin bir yöntemdir. Titanyum materyal radyolojik avantaja sahiptir.

Operative fixation for posterolateral rib fractures: Evaluation of titanium material and radiological accordance

Backgrounds: To avoid malunion, dyspnea, persistent pain and respiratory function lost in patients with posterolateral multiple ribs fractures.Methods: Of 39 patients with ribs fractures, six (15.4%) were underwent operative fixation. Indications were organized hematoma (3, 50%), pain and postural defect (2, 33%), and post-traumatic drainage (1, 16.7%). Fractured tips were approximated in the manner of end-to-end and pierced with perforator. Titanium plates were screwed down by titanium screw.Results: Rate of fixated ribs to all fractured ribs was 0.57 (3.6/6.3), extrathoracic injuries were 83.3% (5/6); intrathoracic injuries were 50% (organized hematoma, 3/6). Postural defect improved and ribs were in their anatomical position in all patients in the immediate postoperative period. Pain and dyspnea dissappeared. Postoperative hospital stay was 6 ± 2 days. Titanium materials no interfered with postoperative computed tomography and magnetic resonance imaging. A 15% increase in FEV1 and 19% in FVC occurred.Conclusions: In patients with posterolateral multiple ribs fractures who had thoracotomy for another reason, surgical stabilization is an effective method, which removes the pain and postural defect and increases the patient comfort. Titanium material has radiological advantage.

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