Segmental tibial fractures treated with Ilizarov circular fixator

  • Slavko Tomić Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Nemanja Slavković Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Goran Tulić University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Andreja Baljozović Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Želimir Jovanović Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Milan Mirković Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Stanislav Rajković Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Nikola Bogosavljević Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Dušan Šaponjski Clinical Centre of Serbia, Centre for Radiology and MRI, Belgrade, Serbia
  • Sladjana Mihajlović University Hospital “Dragiša Mišović”, Clinic for Gynecology, Belgrade, Serbia
  • Danilo Jeremić Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
Keywords: tibija, prelomi, fiksatori, spoljni, ilizarov tehnika, funkcija, povratak

Abstract


Uvod/Cilj. Segmentni prelomi tibije predstavljaju kompleksne povrede koje se karakterišu složenim obrascem preloma i uglavnom su posledica sila visokog intenziteta. Ove povrede predstavljaju izazov u izboru načina lečenja usled svoje sporadične prezentacije, obimne zone značajno oštećenog mekog tkiva i povećane stope komplikacija. Odlikuju se izuzetno nestabilnim intermedijarnim fragmentom i visokom učestalošću otvorenih preloma. Ilizarovljev metod svojim karakteristikama nudi mnoge prednosti nad ostalim postojećim hirurškim tehnikama. Ovaj metod, svojim perkutanim pristupom, značajno smanjuje traumu operativnog polja, čime se izbegava dodatno narušavanje biološke sredine na mestu preloma. Cilj ovog rada je analiza rezultata lečenja segmentnih preloma tibije metodom Ilizarova. Metode. Analizirali smo podatke od 30 bolesnika lečenih metodom Ilizarova u periodu od 2012. do 2017. godine. Prosečna starost bolesnika iznosila je 36 godina (24 do 65 godina). Najčešći mehanizam povređivanja bio je saobraćajni traumatizam. Otvorene prelome imalo je 22 bolesnika. Prelomi su reponirani perkutanom tehnikom, sa velikom pažnjom na uspostavljanje adekvatne dužine, rotacije i osovine potkolenice. Svim bolesnicima je bio dozvoljen oslonac od drugog postoperativnog dana. Rezultati su procenjivani prema kriterijumima Asocijacije za proučavanje i primenu metode Ilizarova. Rezultati. Koštano zarastanje ostvareno je kod svih bolesnika. Prosečno trajanje primene aparata po Ilizarovu iznosilo je 25 nedelja (19 do 36 nedelja). Koštani rezultati bili su odlični kod 23 bolesnika, dobri kod pet i umereni kod dva bolesnika. Funkcionalni rezultati bili su odlični kod 22 bolesnika, dobri kod pet i umereni kod tri bolesnka. Kod osam bolesnika konstatovana je infekcija oko igala aparata, koja je uspešno tretirana oralnom antibiotskom terapijom. Nisu uočene druge značajne komplikacije. Zaključak. Metoda po Ilizarovu predstavlja bezbedan i efikasan modalitet lečenja segmentnih preloma tibije.

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Published
2021/03/29
Section
Original Paper