Ulus Travma Acil Cerrahi Derg. 2020; 26(2): 265-273 | DOI: 10.14744/tjtes.2019.88472

Cerrahi olarak tedavi edilen asetabulum kýrýklarý: Prognozu hangi parametreler etkiler?

Utku Bilekdemir¹, Osman Civan², Ali Cavit³, Hakan Özdemir^4
1Silifke Devlet Hastanesi Ortopedi ve Travmatoloji Kliniði, Mersin
²Elmalý Devlet Hastanesi Ortopedi ve Travmatoloji Kliniði, Antalya
³Uludað Üniversitesi Týp Fakültesi,Ortopedi ve Travmatoloji Anabilim Dalý, Bursa
⁴Akdeniz Üniversitesi Týp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalý, Antalya

AMAÇ: Çalýþmada, cerrahi yöntemlerle tedavi edilen asetabulum kýrýklarýnda uyguladýðýmýz cerrahi yaklaþýmlarý, oluþan komplikasyonlarý ve elde edilen klinik ve radyolojik sonuçlarý deðerlendirerek prognoz üstünde etkin olan parametreleri saptamak amaçlandý.
GEREÇ VE YÖNTEM: Ocak 1994–Ocak 2014 tarihleri arasýnda deplase asetabulum kýrýðý tanýsýyla cerrahi tedavi uygulanan 144 olgudan, en az iki yýl süreyle klinik ve radyolojik takipleri yapýlan (ortalama takip süresi 34 ay, daðýlýmý 2–8 yýl) ve yaþ ortalamasý 36.3 yýl (19–67 yýl) olan 75’i erkek, 28’i kadýn toplam 103 hasta çalýþmaya alýndý.
BULGULAR: Hastalarýn klinik olarak %64’ünde mükemmel ve iyi, %36’sýnda orta ve kötü sonuç, radyolojik olarak ise %57.3’ünde mükemmel ve iyi, %42.7’sinde orta ve kötü sonuç elde edildi. Kýrýðýn kompleks olmasý (ki-kare p=0.023), travma ile operasyon arasý sürenin artmasý (p=0.039), cerrahi sürenin altý saatten uzun sürmesi (ki-kare p<0.001), eklem içi basamaklaþmanýn 3 mm’den fazla olmasý (Fisher’s p=0.033), mekanik blok oluþturan komplikasyonlarýn geliþmesi (ki-kare p<0.001) klinik sonuçlarý kötüleþtirmekteydi. Hastalarýn yaþýnýn klinik sonuç üzerine anlamlý etkisi yoktu (p=0.461).
TARTIÞMA: Cerrahi olarak tedavi edilen asetabulum kýrýklarýnýn prognozuna etki eden üç temel parametrenin; kýrýk tipi, cerrahi giriþim süresi ve redüksiyon kalitesi olduðu, travma ile operasyon arasýnda geçen sürenin sonuçlarý dolaylý olarak etkilediði, avasküler nekroz, heterotropik ossifikasyon ve artirtin ise sadece uzun dönem sonuçlarý üzerinde olumsuz etkiler yarattýðý tespit edildi.

Anahtar Kelimeler: Asetabulum, asetabulum kýrýklarý; asetabulum kýrýklarý cerrahi tedavisi; asetabulum kýrýklarý prognozu; kýrýklar; pelvis kýrýklarý.

---

Acetabular fractures treated surgically: Which of the parameters affect prognosis

Utku Bilekdemir¹, Osman Civan², Ali Cavit³, Hakan Özdemir^4
1Department of Orthopaedics and Traumatology, Silifke State Hospital, Mersin-Turkey
²Department of Orthopaedics and Traumatology, Elmalý State Hospital, Antalya-Turkey
³Department of Orthopaedics and Traumatology, Uludað University Faculty of Medicine, Bursa-Turkey
⁴Department of Orthopaedics and Traumatology, Akdeniz University Faculty of Medicine, Antalya-Turkey

BACKGROUND: This study aims to evaluate the surgical approaches, complications, clinical and radiological findings in acetabular fractures treated with surgical methods and to determine the parameters affecting prognosis.
METHODS: Out of 144 patients undergone surgical treatment with the diagnosis of displaced acetabular fractures between 1994 and 2014, a total of 103 patients with 75 male and 28 female with a mean age of 36.3 years (range 19–67 years) whom clinical and radiologic follow-ups (mean: 34 months, range 2–8 years) were performed at least for two years were included in this study.
RESULTS: Clinically excellent to good outcomes were obtained in 64% of the patients and moderate to poor outcomes were recorded in 36% of the patients, while radiologically excellent to good outcomes were achieved in 57.3% of the patients and moderate to poor outcomes were recorded in 42.7% of the patients. Presence of one of the complications, creating mechanical block (chi-square p<0.001), complex fractures (chi-square p=0.023), increased duration between trauma and operation (p=0.039), operational time taking longer than six hours (chi-square p<0.001), more than 3 mm intra-articular step (Fisher’s p=0.033), avascular necrosis (p<0.001), arthritis (p=0.006) and heterotopic ossification (p=0.007) worsened the clinical outcomes (chi-square p<0.001). The age of the patient was not effective on the clinical outcome (p=0.461).
CONCLUSION: It was found that three major parameters affecting the prognosis of acetabular fractures are as follows: type of fracture, operational time and reduction quality. The duration between trauma and operation indirectly affects the outcomes. Avascular necrosis, heterotopic ossification and arthritis may cause negative effects only on long term outcomes.

Keywords: Acetabular fractures, acetabulum; fractures; pelvic fractures; prognosis of acetabular fractures; surgical treatment of acetabular fractures.

---

ATIF KOPYALA