Zbrinjavanje preloma distalnog pilona tibije (AO/OTA tipa B, C) metodom spoljašnje skeletne i minimalne unutrašnje fiksacije

  • Sasa Sava Milenković Orthopaedic and Traumatology Clinic, Clinical Center Niš, Faculty of Medicine, University of Niš, Niš, Serbia
  • Milorad Mitković Orthopaedic and Traumatology Clinic, Clinical Center Niš, Faculty of Medicine, University of Niš, Niš, Serbia
  • Ivan Micić Orthopaedic and Traumatology Clinic, Clinical Center Niš, Faculty of Medicine, University of Niš, Niš, Serbia
  • Desimir Mladenović Orthopaedic and Traumatology Clinic, Clinical Center Niš, Faculty of Medicine, University of Niš, Niš, Serbia
  • Stevo Najman Faculty of Medicine, University of Niš, Niš, Serbia
  • Miroslav Trajanović Faculty of Mechanical Engineering, University of Niš, Niš, Serbia
  • Miodrag Manić Faculty of Mechanical Engineering, University of Niš, Niš, Serbia
  • Milan Mitković Orthopaedic and Traumatology Clinic, Clinical Center Niš, Faculty of Medicine, University of Niš, Niš, Serbia
DOI: https://doi.org/10.2298/1358

Sažetak


Uvod/Cilj. Prelomi distalnog pilona tibije podrazumevaju spoljašnje artikularne prelome metafize tibije i teže unutrašnje artikularne  prelome pilona tibije. Ne postoji univerzalni metod za lečenje preloma distalnog pilona tibije. Ovi prelomi se leče metodom otvorene redukcije i stabilne fiksacije (ORIF) i spoljašnjom skeletnom fiksacijom. Visok procenat komplikacija na mekom tkivu udružen nakon primarne ORIF preloma pilona, nameće upotrebu metode spoljašnje skeletne fiksacije sa minimalnom unutrašnjom fiksacijom, kao alternativnu tehniku za konačno izlečenje. Cilj rada bio je da se utvrdi efikasnost lečenja distalnog pilona tibije primenom metode spoljašnje skeletne i minimalne unutrašnje fiksacije. Metode. Prikazali smo seriju od 31 operisanog bolesnika sa prelomima pilona tibije. Bolesnici su operisani metodom spoljašnje skeletne fiksacije sa minimalnom unutrašnjom fiksacijom. Prema AO/OTA klasifikaciji 17 bolesnika imalo je prelom tipa B, a 14 prelom tipa C. Kruta spoljašnja skeletna fiksacija je transformisana u dinamičku spoljašnju skeletnu fiksaciju šest nedelja posle operacije. Rezultati. Retrospektivnom studijom analiziran je 31 bolesnik sa prelomima pilona tibije, prosečne starosti 41,81 (21–60) godina. Prosečno vreme praćenja iznosilo je 21,86 (12–48) meseci. Procenat zarastanja preloma iznosio je 90,32%, nezarastanja 3,22% i lošeg zarastanja 6,45%. Prosečno trajanje zarastanja preloma iznosilo je 14 (12–20) nedelja. Bilo je 4 (12,19%) infekcija oko klinova spoljašnjeg skeletnog fiksatora i 1 (3,22%) duboka infekcije. Artroza skočnog zgloba kao kasna komplikacija, pojavila se kod 4 (12,90%) bolesnika. Sve artroze su nastale kod bolesnika koji su imali prelom tipa C. Krajnji funkcionalni rezultati na osnovu AOFAS skora bili su odlični kod 51,61%, dobri kod 32,25%, umereni kod 12,90% i loši kod 3,22% bolesnika. Zaključak. Spoljašnja skeletna fiksacija i minimalna unutrašnja fiksacija preloma distalnog pilona tibije dobra je metoda za lečenje svih tipova intraartikularnih preloma pilona. Kod preloma tipa B i C, dinamička spoljašnja skeletna fiksacija dozvoljava rane pokrete u skočnom zglobu.

 

Ključne reči:

tibija, prelomi; ortopedske procedure; fiksatori, spoljni; fiksatori, unutrašnji; lečenje, ishod.

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Objavljeno
2017/01/20
Broj časopisa
Vol. 70 Br. 9 (2013)
Rubrika
Originalni članak