Tibia Kırıklarında Cerrahi Tedavi Yöntemlerinin Kompartman Basıncına Etkisi

İbrahim Avşin Öztürk; Cemil Ertürk; Ali Bilge; Mehmet Akif Altay; Nuray Altay; Uğur Erdem Işıkan

Research Article

Tibia Kırıklarında Cerrahi Tedavi Yöntemlerinin Kompartman Basıncına Etkisi

Year 2017, Volume: 14 Issue: 3, 160 - 170, 28.12.2017

İbrahim Avşin Öztürk Cemil Ertürk Ali Bilge Mehmet Akif Altay Nuray Altay Uğur Erdem Işıkan

Abstract

Amaç: Bu çalışmanın amacı, tibia diafiz kırıklarında
uyguladığımız farklı cerrahi tedavi yöntemlerinin
bacaktaki anterior, lateral ve derin posteriordan
oluşan üç kompartmandaki basınç değerlerinin
değişimini araştırmaktı.
Materyal ve Metod: Temmuz 2010 – Eylül 2012
tarihleri arasında başvuran 18 – 66 yaş arasındaki
tibia diafiz kırığı olan toplam 34 hasta çalışmaya
alındı. İki hastada iki taraflı tibia kırığı
bulunmaktaydı. Hastalar iki gruba ayrıldı. Grup 1
hastalara İlizarov eksternal fiksatör ameliyatı, Grup 2
hastalara ise intramedüller çivi ameliyatı yapıldı.
Grup 1’de 15 (ortalama yaş 30,06) ve Grup 2’de 21
(ortalama yaş 35,95) tibia diafiz kırığı değerlendirildi.
Tibia diafiz kırığı olan hastalara İlizarov eksternal
fiksatör ve intramedüller çivi ameliyatı yapılıp
bacağın anterior, lateral ve derin posterior
kompartmanlarından ameliyat öncesinde, ameliyattan
hemen sonra, ameliyat sonrası 8., 16., 24., 32., 40. ve
48. saatlerinde kompartman basınç ölçer cihazı ile
ölçümler yapılıp değerlendirildi.
Bulgular: Hiçbir hastamızda kompartman sendromu
gelişmedi. Her iki grupta, grup içi karşılaştırmalarda;
anterior, lateral ve derin posterior kompartmandaki
basınç ölçümlerinde, ameliyat öncesindeki değerlere
göre, ameliyat sonrasındaki bazı saatlerdeki
ölçümlerde basınç değerleri anlamlı olarak düşük
bulunmuştur (p<0.05). Her iki grup
karşılaştırılmasında ise, anterior ve lateral
kompartmanda; İMN grupta ameliyat sonundaki bazı
ölçüm değerleri İlizarov grubuna göre anlamlı olarak
yüksek iken (p<0.05), posterior kompartmandaki
ölçümlerde fark yoktu (p>0.05).
Sonuç: Her iki tedavi grubunda ameliyat sonrasındaki
kompartman basınç değerleri ameliyat öncesi
değerlere göre düşerken, İMN yapılan gruptaki
ölçümler İlizarov grubuna göre anterior ve lateral
kompartmanda daha yüksek gözlenmiştir. Sonuç
olarak, tibia diafiz kırıklarının cerrahi tedavisinde;
İlizarov eksternal fiksatörün kompartman basıncını
daha fazla düşürdüğü saptandı

Keywords

Tibia kırıkları, Kompartman Sendromları, İlizarov tekniği, Kırık sabitlenmesi, intramedüler

References

1. Gershuni DH, Mubarak SJ, Yaru NC, Lee YF. Fracture of the tibia complicated by acute compartment syndrome. Clin Orthop. 1987; 7: 217-221.
2. Hargens AR, Mubarak SJ. Current Concepts in the Pathophysiology, Evaluation and Diagnosis of Compartment Syndrome. Hand Clin. August 1998; 14(3): 371-383.
3. Hargens AR, Akeson WH, Mubarak SJ, Owen CA, Evans KL, Garetto LP. Fluid balance within the canine anterolateral compartment and its relationship to compartment syndromes. JBJS Am. 1978; 60(4): 499-505.
4. Whitesides TE, Haney TC, Morimoto K, Harada H. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop. 1975; (113): 43-51.
5. Eaton RG, Green WT. Volkmann's ischemia. A volar compartment syndrome of the forearm. Clin Orthop. 1975; (113): 58-64.
6. McQueen MM, Christie J, Court-Brown CM. Acute compartment syndrome in tibial diaphyseal fractures. JBJS Br. 1996; 78(1): 95-98.
7. Nassif JM, Gorczyca JT, Cole JK, Pugh KJ, Pienkowski D. Effect of Acute Reamed Versus Unreamed Intramedullary Nailing on Compartment Pressure When Treating Closed Tibial Shaft Fractures: A Randomized Prospective Study. Journal of Orthopaedic Trauma 2000; 14(8): 554-558.
8. Grutter R, Cordey J, Wahl D, Koller B, Regazzoni P. A biomechanical enigma: Why are tibial fractures not more frequent in the elderly? Injury. 2000; 31Suppl 3: 72-77.
9. Court-Brown CM, McBirne J. The epidemiyology of tibial fractures. JBJS. 1995; 77B: 417-421.
10. Ekeland A, Thoresen BO, Alho A, Stromsoe K, Folleras G, Haukebo A. Interlocking Intramedullary Nailing in the Treatment of Tibial Fractures: A Report of 45 Cases. Clin Orthop. 1988; 231: 205-215.
11. Blick SS, Brumback RJ, Poka A, Burgess AR, Ebraheim NA. Compartment syndrome in open tibial fractures. JBJS Am. 1986; 68(9): 1348-1353.
12. Charles AO, Mubarak SJ, Hargens AR, Laddutherford, Garetto LP, Wayne Akeson. Intramuscular pressures with limb compression, Clasification of the pathogenesis of the drug-induced muscle- compartment syndrome, The New England Journal of Medicine, May 1979; 300: 1169-1172.
13. Ascher E, Hanson JN, Cheng W. Glycine preserves function and decreases necrosis in skeletal muscle undergoing ischemia and reperfusion injury. Surgery. 2001; 129: 231-235.
14. Seekamp A, Van Griensven M, Regel G, Intramuscular partial oxygen tension monitoring in compartment syndrome - an experimental study, Eur J Emerg Med. Dec, 1997; 4: 185-192.
15. White TO, Howell GE, Will EM. Elevated intramuscular compartment pressure do not influence outcome after tibial fracture. J Trauma. 2003; 55: 1133- 1136.
16. Allen MJ, Stirling AJ, Crawshaw CV, Barnes MR. Intracompartmental pressure monitoring of leg injuries: an aid to management. JBJS Br. 1985; 67(B): 53-57.
17. Heckman MM, Whitesides TE, Grewe SR, Rooks MD. Compartment pressure in association with closed tibial fractures: the relationship between tissue pressure, compartment, and the distance from the site of the fracture. JBJS Am. 1994; 76(A): 1285-1292.
18. Triffit PD, König D, Harper WM. Compartment pressure after closed tibial shaft fracture. Their relation to functional outcome. JBJS Br. 1992; 74: 195-198.
19. McQueen MM, Christie J, Court-Brown CM. Compartment pressures after intramedullary nailing of the tibia. JBJS Br. 1990; 72: 395-397.
20. Özkayın N, Aktuğlu K. Açık ve kapalı tibia kırıklarında kompartman sendromu gelişme riski. Ulusal Travma Dergisi. 2002; 8: 170-175.
21. Altay MA, Ertürk C, Altay N, Öztürk İA, Baykara İ, Sert C, Işıkan UE. Comparison of intracompartmental pressures in a rabbit model of open and closed tibial fractures, an experımental study. The Bone Joınt J. 2013; 95-B: 111-114.
22. Ertürk C, Altay MA, Altay N, Öztürk İA, Baykara İ, Sert C, Işıkan UE. The effect of 2 different surgical methods on intracompartmaental pressure value in tibial shaft fracture: An experimental study in a rabbit model. Ulusal Travma Acil Cerrahi Dergisi. 2017; 2: 85-90.
23. Matsen FA III, Winquist RA, Krugmire RB. Diagnosis and management of compartmental syndromes, JBJS. 1980; 62: 286-291.
24. McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome, who is at risk? JBJS. 2000; 82: 200-203.

In Tibia Fractures the Effects of Different Surgical Treatment Methods on Compartment Pressure

Year 2017, Volume: 14 Issue: 3, 160 - 170, 28.12.2017

İbrahim Avşin Öztürk Cemil Ertürk Ali Bilge Mehmet Akif Altay Nuray Altay Uğur Erdem Işıkan

Abstract

References

1. Gershuni DH, Mubarak SJ, Yaru NC, Lee YF. Fracture of the tibia complicated by acute compartment syndrome. Clin Orthop. 1987; 7: 217-221.
2. Hargens AR, Mubarak SJ. Current Concepts in the Pathophysiology, Evaluation and Diagnosis of Compartment Syndrome. Hand Clin. August 1998; 14(3): 371-383.
3. Hargens AR, Akeson WH, Mubarak SJ, Owen CA, Evans KL, Garetto LP. Fluid balance within the canine anterolateral compartment and its relationship to compartment syndromes. JBJS Am. 1978; 60(4): 499-505.
4. Whitesides TE, Haney TC, Morimoto K, Harada H. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop. 1975; (113): 43-51.
5. Eaton RG, Green WT. Volkmann's ischemia. A volar compartment syndrome of the forearm. Clin Orthop. 1975; (113): 58-64.
6. McQueen MM, Christie J, Court-Brown CM. Acute compartment syndrome in tibial diaphyseal fractures. JBJS Br. 1996; 78(1): 95-98.
7. Nassif JM, Gorczyca JT, Cole JK, Pugh KJ, Pienkowski D. Effect of Acute Reamed Versus Unreamed Intramedullary Nailing on Compartment Pressure When Treating Closed Tibial Shaft Fractures: A Randomized Prospective Study. Journal of Orthopaedic Trauma 2000; 14(8): 554-558.
8. Grutter R, Cordey J, Wahl D, Koller B, Regazzoni P. A biomechanical enigma: Why are tibial fractures not more frequent in the elderly? Injury. 2000; 31Suppl 3: 72-77.
9. Court-Brown CM, McBirne J. The epidemiyology of tibial fractures. JBJS. 1995; 77B: 417-421.
10. Ekeland A, Thoresen BO, Alho A, Stromsoe K, Folleras G, Haukebo A. Interlocking Intramedullary Nailing in the Treatment of Tibial Fractures: A Report of 45 Cases. Clin Orthop. 1988; 231: 205-215.
11. Blick SS, Brumback RJ, Poka A, Burgess AR, Ebraheim NA. Compartment syndrome in open tibial fractures. JBJS Am. 1986; 68(9): 1348-1353.
12. Charles AO, Mubarak SJ, Hargens AR, Laddutherford, Garetto LP, Wayne Akeson. Intramuscular pressures with limb compression, Clasification of the pathogenesis of the drug-induced muscle- compartment syndrome, The New England Journal of Medicine, May 1979; 300: 1169-1172.
13. Ascher E, Hanson JN, Cheng W. Glycine preserves function and decreases necrosis in skeletal muscle undergoing ischemia and reperfusion injury. Surgery. 2001; 129: 231-235.
14. Seekamp A, Van Griensven M, Regel G, Intramuscular partial oxygen tension monitoring in compartment syndrome - an experimental study, Eur J Emerg Med. Dec, 1997; 4: 185-192.
15. White TO, Howell GE, Will EM. Elevated intramuscular compartment pressure do not influence outcome after tibial fracture. J Trauma. 2003; 55: 1133- 1136.
16. Allen MJ, Stirling AJ, Crawshaw CV, Barnes MR. Intracompartmental pressure monitoring of leg injuries: an aid to management. JBJS Br. 1985; 67(B): 53-57.
17. Heckman MM, Whitesides TE, Grewe SR, Rooks MD. Compartment pressure in association with closed tibial fractures: the relationship between tissue pressure, compartment, and the distance from the site of the fracture. JBJS Am. 1994; 76(A): 1285-1292.
18. Triffit PD, König D, Harper WM. Compartment pressure after closed tibial shaft fracture. Their relation to functional outcome. JBJS Br. 1992; 74: 195-198.
19. McQueen MM, Christie J, Court-Brown CM. Compartment pressures after intramedullary nailing of the tibia. JBJS Br. 1990; 72: 395-397.
20. Özkayın N, Aktuğlu K. Açık ve kapalı tibia kırıklarında kompartman sendromu gelişme riski. Ulusal Travma Dergisi. 2002; 8: 170-175.
21. Altay MA, Ertürk C, Altay N, Öztürk İA, Baykara İ, Sert C, Işıkan UE. Comparison of intracompartmental pressures in a rabbit model of open and closed tibial fractures, an experımental study. The Bone Joınt J. 2013; 95-B: 111-114.
22. Ertürk C, Altay MA, Altay N, Öztürk İA, Baykara İ, Sert C, Işıkan UE. The effect of 2 different surgical methods on intracompartmaental pressure value in tibial shaft fracture: An experimental study in a rabbit model. Ulusal Travma Acil Cerrahi Dergisi. 2017; 2: 85-90.
23. Matsen FA III, Winquist RA, Krugmire RB. Diagnosis and management of compartmental syndromes, JBJS. 1980; 62: 286-291.
24. McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome, who is at risk? JBJS. 2000; 82: 200-203.

There are 24 citations in total.

Details

Primary Language	Turkish
Journal Section	Research Article
Authors	İbrahim Avşin Öztürk This is me Cemil Ertürk This is me Ali Bilge This is me Mehmet Akif Altay Nuray Altay Uğur Erdem Işıkan This is me
Publication Date	December 28, 2017
Submission Date	November 27, 2017
Acceptance Date	December 3, 2017
Published in Issue	Year 2017 Volume: 14 Issue: 3

Cite

Vancouver	Öztürk İA, Ertürk C, Bilge A, Altay MA, Altay N, Işıkan UE. Tibia Kırıklarında Cerrahi Tedavi Yöntemlerinin Kompartman Basıncına Etkisi. Harran Üniversitesi Tıp Fakültesi Dergisi. 2017;14(3):160-7.

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Harran Üniversitesi Tıp Fakültesi Dergisi _/Journal of Harran University Medical Faculty