Tolga TOLUNAY, Mehmet Orçun AKKURT, Ahmet Şükrü SOLAK

Biyomekanik bakış açısıyla, intramedüller çivilemenin tibia diyafiz kırıklarının fiksasyonu üzerindeki etkinliğinin değerlendirilmesi

Amaç: Çalışmanın amacı, tibia diyafiz kırıklarında intramedüller çivilemenin başarı oranını değerlendirmektir. Bu çalışmada ayrıca çivilerin biyomekanik avantajları da değerlendirildi ve tartışıldı. Gereç ve Yöntemler: Kilitli oymalı intramedüller çivileme, 35 hastada (25 erkek, 10 kadın; yaş ortalaması 37,14 ± 13,13) kapalı veya mini açık redüksiyon ile yapıldı. Tibia kırıklarının 27’si kapalı, 8’i açık kırıktı. Tüm hastalara oymalı ve statik kilitlemeli intramedüller çivileme yapıldı. Çalışmada hastalar Johner ve Wrush kriterlerine göre değerlendirildi. Bulgular: Ortalama takip süresi 12,5 ay (5-20 ay) idi. Hastaların hepsinde kaynama gerçekleşti. Ortalama kaynama süresi 17,02 ± 7,96 hafta idi. Tibia 1/3 distal kırığı olan dört olguda 2-5 derecelik valgus açılanması saptandı. Bir olguda, dış rotasyon 10⁰'dan fazla tespit edildi ve başka bir olguda da yürümede belirgin aksama tespit edildi. İki olguda, 6-10 mm'lik ekstremite kısalığı tespit edildi. Ayak bileği ve subtalar eklem hareketlerine göre; hastaların 27'si (%77,1) mükemmel, 7'si (%20) iyi, 1'i (%2,9) orta dereceli olarak değerlendirildi. Johner ve Wrush kriterlerine göre; hastaların %54,3'ü mükemmel, %34,3'ü iyi, %8,6'sı orta ve %2,8'i kötü olarak saptandı. Sonuçlar: Kilitli oymalı intramedüller çivilemenin, tibia diyafiz kırıklarında başarılı fonksiyonel sonuçları, yüksek kaynama oranları ve düşük komplikasyon oranları nedeniyle etkin bir tedavi olduğunu düşünmekteyiz. Biyomekanik açıdan bakacak olursak, fiksasyon alanının anti-rotasyonunun ve çivilemenin aksiyel yük paylaşım kapasitesinin, kırık iyileşmesi üzerinde kritik bir öneme sahip olduğu görülmektedir.

Anahtar Kelimeler:

Tibia diyafiz kırıkları, biyomekanik, intramedüller çivileme, kilitleme vidaları

The effectiveness of intramedullary nailing on the fixation of tibia diaphyseal fractures: Biomechanical point of view

Aim: The aim of the study was to exhibit the success rate of nailing on tibia shaft fractures. Biomechanical advantage of the nails was also evaluated and discussed in this study. Material and Methods: Reamed and static interlocking intramedullary nailing was performed with closed or mini-open reduction in 35 patients (25 males, 10 females; mean age 37.14±13.13 years). 27 fractures were closed and 8 fractures were open fractures. The evaluation in the study was performed according to Johner and Wrush criteria. Results: The mean follow-up period was 12.5 months (range 5 to 20 months). Union occurred in all patients. Mean union period was 17.02±7.96 weeks. In four cases, a valgus angulation of 2-5 degrees was detected that whom had distal third tibial fractures. In one case, an external rotation more than 10⁰ was detected and in another case, grave claudication was shown. In two cases, extremity shortening of 6-10 mm was seen. According to ankle and subtalar mobility; 27 (77.1%) of the patients were recorded as excellent, 7 (20%) good, 1 (2.9%) moderate results. According to Johner and Wrush criteria; 54.3% of the patients were recorded as excellent, 34.3% good, 8.6% moderate and 2.8% bad results. Conclusion: This study suggests that reamed interlocking intramedullary nailing is an effective method in tibia diaphyseal fractures because of successful functional results, high union and low complication rates. On the biomechanical side, anti-rotation of the fixation area and axial load sharing capacity of nailing has critical demand on fracture healing.

Keywords:

Tibia diaphyseal fractures, biomechanics, intramedullary nailing, interlocking screws,

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