Segmental tibial fractures treated with Ilizarov circular fixator

Slavko  Tomić; Nemanja  Slavković; Goran  Tulić; Andreja  Baljozović; Želimir Jovanović; Milan Mirković; Stanislav  Rajković; Nikola  Bogosavljević; Dušan  Šaponjski; Sladjana  Mihajlović; Danilo Jeremić

doi:10.2298/VSP190110070T

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

DOI: https://doi.org/10.2298/VSP190110070T

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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