Published 2011 | Version v1
Journal article Open

Lečenje pseudoartroza potkolenice metodom Ilizarova - naša iskustva

Creators

  • 1. Univerzitet Privredna akademija u Novom Sadu
  • 2. Farmaceutski fakultet
  • 3. ROR icon University of Novi Sad
  • 4. Medical Faculty University of Novi Sad
  • 5. Clinical center of Vojvodina

Description

SAZETAK

Uvod: Jedna od komplikacija lečenja preloma potkolenice je nastanak pseudoartroza koje se u kasnijem tokumogu leciti na vise nacina (DCP place sa kostanim graftom, intramedularni klinovi, itd). Metoda transosealneosteosinteze po llizarovu je pored ostalih primenjivana na nasoj klinici u lecenju ovakvih komplikacija.

Cilj rada: je evaluacija postoperativnih rezultata kod bolesnika sa pseudoartroticnim procesom na raznimnivoima potkolenice.

Materijal i metode: Na Klinici za ortopedsku hirurgiju i traumatologiju Klinickog centra Vojvodina u Novom Saduu periodu od 2005. do 2010. godine leceno je 39 pacijenata sa razlicitim tipovima pseudoartroza potkolenice. Polna struktura analizirane grupe bila je 34 (87%) osobe muskog pola i 5 (13%) zenskog pola. Po starosnim grupama broj pacijenata je iznosio 3 (7%) od 18 do 30, 9 (23 %) od 31 do 40, 10 (26%) od 41 do SO, 9 (23%) od51 do 60, 8 (21%) od 61 i vise godina. Najmladi pacijent je imao 21 a najstariji 63 godine. Prosecna starostispitanika je bila 42 godine . Do nastanka pseudoartroze pacijenti su prethodno leceni : plofom i zavrtnjima 11pacijenata (28%), gipsanom imobilizacijom 15 (38%), spoljasnjim fiksatorom 10 (26%) i intramedularnimklinom 3 (8%) . U Rtg klasifikaciji imali smo hipotrofickih pseudoartroza 12 (31 %), normotrofickih 10 (26%),hipertrofickih 13 (33%) i neoartroza 4 (10%) . U operativnom lecenju najcesce smo koristili monolokalnu zatvorenu kompresionu osteosintezu u 19 ( 49%) slucajeva, otvorenu monolokalnu kompresionu osteosintezu u 6 (15%) slucajeva, zatvorenu monolokalnu naizmenicnu distrakciono-kompresionu osteosintezu 8 (21%) i u 6(15%) slucajeva zatvorenu monolokalnu sinhronu kompresiono-distrakcionu osteosintezu. Sve manipulacijeaparatom izvodene su u bolnickim uslovima a kasnije pracene radiografski u poliklinickoj sluzbi.

Rezultati: Prosečno vreme nosenja aparata je iznosilo 5 ( 4-6) meseci. Potpuno izlecenje je zabelezeno kod 37(94,8%) pacijenata dok je kod 2 (5,2%) ponovo aplikovan aparat (infekcija). Analizirali smo kostane (zarastanje, deformacija, infekcija i inegalitet) i funkcionalne (kontraktura skocnog zgloba i kolena, hramanje, simpaticka distrofija, bol i inaktivitet) rezultate. Parametri ukazuju da je kod 23(59%) pacijenta rezultat bio odlican, kod 9(23%) dobar, kod 5 (13%) osrednji a kod 2 (5%) los. U odnosu na funkcionalne parametre rezultat je kod 25(64%) pacijenata bio odlican, kod 9 (23%) dobar, kod 3 (8%) osrednji a kod 2 (5%) los.

Zaključak: Nasa iskustva u lecenju svih vrsta pseudoartroza potkolenice metodom transosealne osteosinteze poIlizarovu potvrduju da se radi o suverenoj metodi za lecenje ovakvih komplikacija preloma.

Kljucne reči: aparat po Ilizarovu, transosealna osteosinteza, pseudoartroza

Abstract (English)

SUMMARY

Introduction: One of the crural fracture complications is pseudoarthrosis which can be treated using severalmethods (DCP plates with bone graft, intramedullary nailing, etc). One of the methods used in our clinic was theIlizarov method.

Objectives: the evaluation of postoperative results in patients with pseudoarthrotic process at various levels of the lower leg.

Material and methods: In the Clinic for Orthopaedic Surgery and Traumatology in Novi Sad, in the period from 2005 to 2010, 39 patients with different types of crural pseudoarthrosis were treated. Thirty-four (87%) were male patients, and five (13%) were female patients. We had 3 (7%) patients in the age group 18-30 years old, 9 (23%)in the age group 31-40, 10 (26%) in the age group 41-50, and 8 (21%) in the age group 61 and older. The youngest patient was 21 years old, and the oldest was 63 years old. The average age of the patients was 42. Patients werepreviously treated by: plates and screws 11(28%) patients, a cast 15 (38%) patients, external fixator 10 (26%)patients, intramedullary nail 3 (8%) patients. We had 12 (31 %) cases of hypotrophic pseudoarthrosis, 10 (26%)cases of normotrophic pseudoarthrosis, 13 (33%) cases of hypertrophic pseudoarthrosis, and 4 (10%) cases of rosis. We used mono local closed compression osteosynthesis in 19 ( 49%) cases, monolocal open compression osteosynthesis in 6 (15%) cases, monolocal closed compression-distractional osteosynthesis in 8(21 %) cases, and monolocal synchronous compression-distractional osteosynthesis in 6 (15%) cases. All manipulations with the device were performed in our hospital, and patients were later regularly examined in our polyclinic.

Results: Average treatment period was 5 (4-6) months. Complete recovery was recorded in 37 (94,8%) cases, whereas in 2 (5,2%) cases the device had to be reapplied due to infection. We analyzed bone parameters (healing, deformation, infection, limb length inequality) and functional parameters (ankle and knee contracture, limping, sympathetic dystrophy, pain, physical inactivity). Bone parameters show that in 23 (59%) cases the results were excellent, in 9 (23%) cases good, in 5 (13%) cases medium, and in 2 (5%) cases the results were unsatisfactory. Functional parameters show that in 25 (64%) cases the results were excellent, in 9 (23%) cases good, in 3 (8%)cases medium, in 2 (5%) cases the results were unsatisfactory.

Conclusions: Our experience confirms that treatment by the Ilizarov apparatus for transosseous osteosynthesis is a reliable method for treating crural fracture complications such as pseudoarthrosis.Key words: Ilizarov apparatus, transosseous osteosynthesis, pseudoarthrosis

Keywords: Ilizarov apparatus, transosseous osteosynthesis, pseudoarthrosis

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