| Abstract | CILJ:
Dokazati kolika je prava vrijednost primjene vanjskog fiksatora kao trajnog i konačnog sredstva u liječenju ratnih prijeloma donjih udova.
BOLESNICI I METODE:
Analizirali smo rezultate kod 100 ranjenika kontroliranih 99 mjeseci nakon ranjavanja, a koji su zbog teških ratnih prijeloma donjih udova u KB Split od
kolovoza 1991. do kolovoza 1995. godine. Oni su uključeni u ovo istraživanje metodom slučajnog uzorka. Cjelokupna skupina ispitanika podijeljena je u dvije skupine po 50 bolesnika (25 ranjenika s ratnim prijelomom natkoljenice i 25 s ratnim prijelomom potkoljenice). Skupinu A čine ranjenici koji su liječeni primarno bez vanjskog fiksatora (unutarnja osteosinteza, imobilizacija sadrenim povojem, koštana ekstenzija). Skupinu B čine ispitanici kod kojih je primarno postavljen vanjski fiksator zadržan kao konačno sredstvo osteosinteze ili je tijekom liječenja učinjena njegova zamjena. Usporedili smo u obje skupine bolesnika podatke prikupljene iz medicinske dokumentacije i dobivene pregledom ranjenika u 2001. godini.
REZULTATI:
Vanjskim fiksatorom bez zamjene unutar 8 mjeseci izliječeno je 62% ratnih prijeloma, što je 24% više nego drugim metodama liječenja. Uspješniji je u prijeloma potkoljenice, tako da je izliječeno 28% više prijeloma potkoljenice nego natkoljenice. Oko dva mjeseca duže je vrijeme cijeljenja ratnih prijeloma i 1O dana duže trajanje bolničkog liječenja u skupini B. Postotak dubokih infekcija bio je 6%, pseudartroza 12% i reoperacija nakon sekundarnih kirurških zahvata 18% u skupini liječenih vanjskim fiksatorom što je 2% manje
nego u skupini liječenih drugim metodama. Površnu, takozvanu "pin" infekciju imalo je 22% bolesnika, što je 8% više. Kontraktura koljena bila je prisutna u 16% bolesnika u obje skupine, a gornjeg nožnog zgloba u 18% u skupini B, a 8% u skupini A. Atrofija mišića natkoljenice ispod 3 cm bila je 4% viša, a iznad 3 cm 2% manja u skupini B. Veći je bio postotak ispitanika liječenih vanjskim fiksatorom sa skraćenjem liječenog donjeg uda iznad 2 cm i iznosio 18%, što je 14 % više nego kod bez vanjskog fiksatora. Također je bio veći postotak s defektom mekih tkiva 44% u skupini B što je 20% više nego u skupini A, te
ozljedom živca ishijadikusa i fibularisa 22% u skupini B što je 10% više nego u skupini A.
Funkcijski rezultati liječenja kontroliranih bolesnika vrednovani metodom "The hospital for special surgery knee-rating score" bili su nešto lošiji u bolesnika liječenih vanjskim fiksatorom. Tako je izvrstan i dobar rezultat u skupini B bio 10% lošiji nego u skupini A. Rezultati testiranja mišićne snage ekstenzora i fleksora koljena dinamometrom "Cybex 300" pokazali su da je mišićna snaga bila smanjena za oko trećinu u usporedbi sa zdravim udom u obje skupine ali nešto više u skupini B. Radiološki rezultati su nešto lošiji bili kod ranjenika vanjskim fiksatorom. Tako su 12% češće bile deformacije zbog sraštenja u
lošem položaju, te 4% artroze koljena i gornjeg nožnog zgloba. Također u skupini B bilo je 10% manje ranjenika u radnom odnosu, a 4% ih je više u mirovini, 2% je manje društveno aktivnih i 10% ih se manje bavi sportom. Veći broj nekih komplikacija i lošiji funkcijski i radiološki rezultati u skupini B posljedica su liječenja teških i složenih prijeloma, jer je vanjski fiksator korišten 20% češće kod teških (IIIb i IIIc) i kompliciranih (C) prijeloma
nego druge primame metode liječenja.
Nije bilo statistički značajne razlike skupina bolesnika osim u odnosu na komplikacije: skraćenje liječenog uda ≥2 cm i defekt mekih tkiva, te na rezultate testiranja mišićne snage ekstenzora.
ZAKLJUČAK:
Vanjski fiksator uspješno je sredstvo liječenja ratnih ozljeda donjih udova, posebno na potkoljenici, a često jedini izbor metode liječenja u spašavanju udova i života ranjenika. |
| Abstract (english) | AIMS:
The purpose of the present study is to show the success following the extemal fixator primary treatment retained as final means of osteosynthesis to the lower limbs war-related fractures.
PATIENTS AND METHODS:
The follow-up examinations in 100 randomised wounded persons were performed on average 99 months after the injury. They were all treated at KB Split in the 1991-1995 period, for heavy war-related fractures to the lower limbs bone. Patients were divided into two different groups, 50 patients each (25 with the fracture in the upper leg, and 25 in the lower). Group A consists of the patients treated primarily without the extemal fixation (plaster cast immobilization, sceletal traction or internal osteosynthesis). Group B consists of the patients treated primary with extemal fixator. We compared the data to collect from medical documentations and from control-examined the patients at 2001.
RESULTS:
Using the extemal fixator primary treatment retained as final means of osteosynthesis, with average treatment duration of 8 months 62% of the fractures were healed, what is 24% more successful in treatment than other methods. Comparing the data related to the treatment of the upper and the lower leg, we found that we cured 28% more of the lower leg fractures. About a two month prolonged period of bone healing and longer hospital treatment for 1O days was in the B group. The deep infection was present in 6%, nonunion in 12%, the muscular atrophy
more than 3 cm of the difference in circumference in 16% and 18% needed reoperation after the secondary surgical procedure patients in the B group, what is less 2% than in the A group. Superficial infection was recorded 22%, the stiff ankle 18%, the shortening of the leg of less
than 2 cm 14%, the shortening of more than 2 cm 18%, the muscular atrophy less than 3 cm of the difference in circumference 66%, soft tissue damage 44% and sciatic and fibular nerve palsy 22% in the B group, was more than in the A group. Functional results in treatment of
the controlled patients valued by "The hospital for special surgery knee-rating score" method were slightly lower with the patients treated by extemal fixator. Thus the excellent and good result in the B group was 10% worse than in the A group, and the results are better in both
AIMS:
The purpose of the present study is to show the success following the extemal fixator primary treatment retained as final means of osteosynthesis to the lower limbs war-related fractures.
PATIENTS AND METHODS:
The follow-up examinations in 100 randomised wounded persons were performed on average 99 months after the injury. They were all treated at KB Split in the 1991-1995 period, for heavy war-related fractures to the lower limbs bone. Patients were divided into two different groups, 50 patients each (25 with the fracture in the upper leg, and 25 in the lower). Group A consists of the patients treated primarily without the extemal fixation (plaster cast immobilization, sceletal traction or intema} osteosynthesis). Group B consists of the patients treated primary with extemal fixator. We compared the data to collect from medical documentations and from control-examined the patients at 2001.
RESULTS:
Using the extemal fixator primary treatment retained as final means of osteosynthesis, with average treatment duration of 8 months 62% of the fractures were healed, what is 24% more successful in treatment than other methods. Comparing the data related to the treatment of the upper and the lower leg, we found that we cured 28% more of the lower leg fractures. About a two month prolonged period of bone healing and longer hospital treatment for 1O days was in the B group. The deep infection was present in 6%, nonunion in 12%, the muscular atrophy
more than 3 cm of the difference in circumference in 16% and 18% needed reoperation after the secondary surgical procedure patients in the B group, what is less 2% than in the A group. Superficial infection was recorded 22%, the stiff ankle 18%, the shortening of the leg of less
than 2 cm 14%, the shortening of more than 2 cm 18%, the muscular atrophy less than 3 cm of the difference in circumference 66%, soft tissue damage 44% and sciatic and fibular nerve palsy 22% in the B group, was more than in the A group. Functional results in treatment of
the controlled patients valued by "The hospital for special surgery knee-rating score" method were slightly lower with the patients treated by extemal fixator. Thus the excellent and good result in the B group was 10% worse than in the A group, and the results are better in both groups with the fracture of the lower leg. Results of the testing of muscular strength extensors and flexors of the knee using a "Cybex 300" dynamometer show some larger deficiency of the muscular strength of the treated lower extremity in comparison with the healthy one in the B
group than in the A group. Both groups show deficiency of the muscular strength in the upper then the lower leg. The x-ray findings were some worse in the B group. Malalignment following the inadequately repaired fractures occured more 12% and adjancet joints arthrosis 4% in the B group. Bone defect on site of fracture was present more 2% in the A group. Also was employed less 10%, at pension more 4%, social active less 2% and sports occupy less 10% casualties in the B group. Higher incidence of complications and some worse functional results with inadequate x-ray findings in the B group were consequence of tretment because extemal fiksator is 20% more practiced for heavier (Illb and lile according Gustilo) and complicated (C) war-related fractures of treatment. There were no statistically significant differences between the groups except to the incidence of complications for shortening ≥2 cm and tissue defect and test results of muscle strength of the extensor. |
