Uporedna analiza trajanja operacije i intraoperativne fluoroskopije kod intramedularne i ekstramedularne fiksacije trohanternih preloma
Sažetak
Uvod/Cilj. Zbrinjavanje trohanternih preloma butne kosti se najčešće vrši metodama intramedularne i ekstramedularne unutrašnje fiksacije. Primena Gama klina (GK) treće generacije, kao intramedularne metode, se smatra zlatnim standardom u ovoj oblasti. Samodinamizirajući unutrašnji fiksator (SUF) predstavlja ekstramedularni implantat koji se, između ostalog, koristi u lečenju trohanternih preloma. Cilj rada je bio da se uporede navedene metode fiksacije u pogledu dužine trajanja operacije i intraoperativne fluoroskopije. Metode. Studijom je bilo obuhvaćeno 89 bolesnika sa hirurški zbrinutim trohanternim prelomom. Ispitanici su bili podeljeni u dve grupe – GK grupu (43 bolesnika) i SUF grupu (46 bolesnika). Rezultati. Prosečno trajanje operacije iznosilo je 67,5 min (GK grupa), odnosno 56,0 min (SUF grupa). Prosečno trajanje intraoperativne fluoroskopije iznosilo je 84,8 s (GK grupa) i 36,7 s (SUF grupa). Između grupa ispitanika je postojala značajna statistička razlika u pogledu oba navedena parametra (p < 0,05). Povezanost između trajanja operacije i trajanja intraoperativne fluoroskopije bila je potvrđena u SUF grupi (p < 0,05; r = 0,405), ali ne i u GK grupi (p > 0,05). GK metoda je pokazala veću varijabilnost u odnosu na SUF metodu po pitanju trajanja i vrste repetitivnih hirurških manevara koji zahtevaju rendgensku proveru. Zaključak. Broj planiranih operacija u jednom danu može biti određen vrstom unutrašnje fiksacije trohanternih preloma (intramedularna ili ekstramedularna). Potrebne su dodatne analize koje uključuju i procenu doze zračenja kako bi se proverilo da li prosečno kraća intraoperativna fluoroskopija kod SUF metode može uticati na korišćenje opreme za zaštitu od rendgenskog zračenja od strane medicinskog osoblja. Ukoliko je poželjno postoperativno aktivirati inicijalno blokiranu dinamizaciju u uzdužnoj osi butne kosti, SUF metoda omogućava da se to ostvari bez potrebe za naknadnom hirurškom intervencijom sa dodatnom intraoperativnom fluoroskopijom.
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