Ulus Travma Acil Cerrahi Derg. 2015; 21(6): 503-508 | DOI: 10.5505/tjtes.2015.96166

Femur intertrokanterik kýrýklarýnýn tedavisinde proksimal femur çivisi ve hemiartroplasti sistemlerinin karþýlaþtýrýlmasý

Gokay Gormeli¹, Mehmet Fatih Korkmaz¹, Cemile Ayse Gormeli², Cihan Adanas³, Turgay Karatas⁴, Sezai Aykin Simsek^5
1Ýnönü Üniversitesi Týp Fakültesi, Turgut Özal Týp Merkezi, Ortopedi Ve Travmatoloji Anabilim Dalý, Malatya
²Ýnönü Üniversitesi Týp Fakültesi, Turgut Özal Týp Merkezi, Radyoloji Anabilim Dalý; Malatya
³Van Bölge Eðitim Ve Araþtýrma Hastanesi, Ortopedi Ve Travmatoloji Kliniði, Van
⁴Malatya Devlet Hastanesi, Genel Cerrahi Kliniði, Malatya
⁵American Hospital, Ortopedi Ve Travmatoloji Kliniði, Ýstanbul

AMAÇ: Çalýþmamýzýn amacý intertrokanterik femur kýrýðý olan yaþlý hastalarda proksimal femur çivisi (PFÇ) ve bipolar hemiartroplasti (BPH) ile tedavinin sonuçlarýný karþýlaþtýrmaktý.
GEREÇ VE YÖNTEM: Çalýþmaya Ocak 2008–Ocak 2012 arasýnda femur intertrokanterik kýrýðý nedeni ile tedavi edilen 143 hasta dahil edildi. Hastalarýn demografik verileri; AO/ASIF (Association for Osteosynthesis/Association for the Study of Internal Fixation) sýnýflamasýna göre kýrýk tipi; ASA (American Society of Anesthesiologists) skorlarý; cerrahi yöntem (PFÇ veya BPH); cerrahinin detaylarý; komplikasyonlar ve takip sonuçlarý (Harris Kalça Skoru, Ortalama Hareketlilik Skoru) kaydedildi.
BULGULAR: Cerrahi öncesi veriler PFÇ ve BPH grubunda benzerdi. Bipolar hemiartroplasti grubunda cerrahi süresi daha uzun; cerrahi sýrasýndaki kan kaybý ve mortalite oranlarý daha yüksekti (p<0.005). 30.4 (10.9) aylýk takip sonucunda Ortalama Hareketlilik Skoru’ndaki azalma ve Harris Kalça Skoru’nda anlamlý fark yoktu (p>0.05).
TARTIÞMA: Cerrahi tedavi uygulanan femur intertrokanterik kýrýklý yaþlý hastalarda PFÇ ve BPH sonuçlarýnýn her ikisi de tatmin edici olsada; daha az cerrahi ile iliþkili travma ve düþük mortalite oranlarý ile PFÇ’nin bu hastalarda daha etkili ve uygun tedavi yöntemi olarak tercih edilebileceðini düþünmekteyiz.

Anahtar Kelimeler: Bipolar hemiartroplasti, femur intertokanterik kýrýðý, Harris kalça skoru; mortalite; proksimal femur çivisi.

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Comparison of femur intertrochanteric fracture fixation with hemiarthroplasty and proximal femoral nail systems

Gokay Gormeli¹, Mehmet Fatih Korkmaz¹, Cemile Ayse Gormeli², Cihan Adanas³, Turgay Karatas⁴, Sezai Aykin Simsek^5
1Department Of Orthopedics And Traumatology, Inonu University Faculty Of Medicine, Turgut Özal Medical Center, Malatya
²Department Of Radiology, Inonu University Faculty Of Medicine, Turgut Özal Medical Center, Malatya
³Department Of Orthopedics And Traumatology, Van Training And Research Hospital, Van
⁴Department Of General Surgery, Malatya State Hospital, Malatya
⁵Department Of Orthopedics And Traumatology, American Hospital, Istanbul

BACKGROUND: The aim of this study was to compare the outcomes of intertrochanteric femur fractures treated with proximal femoral nail (PFN) and bipolar hemiarthroplasty (BPH) in elderly patients.
METHODS: A total of one hundred and forty-three patients with intertrochanteric femur fractures treated surgically between January 2008 and January 2012 were included into the study. Patient demographics, type of fracture according to Association for Osteosynthesis/ Association for the Study of Internal Fixation (AO/ASIF) classification, and the American Society of Anesthesiologists (ASA) classification system scores; type of surgical procedure (BPH or PFN), operative details, complications and follow-up scores (Harris Hip Score [HHS]; Mean Mobility Score [MMS]) were recorded.
RESULTS: The preoperative characteristics of the patients in both PFN and BPH groups were similar. BPH had higher operation times, blood loss in operation and mortality rates (p<0.005). Reoperation times were higher in PFN group (p<0.005). There were no differences with regard to the HHS and the reduction in MMS at the last follow-up with a 30.4 (10.9) months follow-up (p>0.05).
CONCLUSION: Although both PFN and BPH had satisfactory outcomes in surgically treated patients with intertrochanteric femur fractures, we recommend intertrochanteric femur fractures in the elderly tobe treated with PFN; which is an effective and appropriate treatment modality with less surgery related trauma and lower mortality rates.

Keywords: Bipolar hemiarthroplasty, femur intertrochanteric fracture, Harris Hip Score; mortality; proximal femoral nail.

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