ÖZET
Amaç:
Yaşlıların trokanterik kırıklarının (TF) tespitinde sıklıkla tercih edilen anatomik olmayan, düz, standart proksimal femur çivilerinin (PFN) distal ucu, ileri yaş ve osteoporoz nedeniyle eğimi artmış femurun anterior korteksi ile sıkışmaktadır. Bu çalışmada standart PFN uygulaması ile artmış femoral eğim arasındaki ilişki araştırılmıştır.
Yöntemler:
2011 ile 2015 yılları arasında TF nedeniyle PFN uygulanmış olan 111 hasta (59 erkek, 52 kadın; ortalama yaş 74,5) geriye dönük incelendi. Anterior korteks ve çivi arasındaki ilişki, çivi ve femurun distal anatomik aksları arasındaki açının (ADA) ölçümü ile değerlendirildi. Hastalar ADA açılarına göre iki gruba ayrıldı (grup 1 ADA ≤4° ve grup 2 ADA >4°). Fonksiyonel sonuçlar ve ağrı Harris Kalça Skoru (HHS) ve görsel analog skala (VAS) ile değerlendirildi. Komplikasyonlar kaydedildi.
Bulgular:
Ortalama ADA 4.5°±1.5° olarak bulundu. Grup 1’de 47 ve grup 2’de 64 hasta mevcuttu. Grup 1 ve grup 2’de ortalama HHS sırasıyla 80,6 ve 79,3 (p=0,464) ve ortalama VAS skoru 2,13 ve 5,35 (p<0,001) olarak bulundu. Beş hasta lag vidasının sıyırması nedeni ile revize edildi (iki hasta toplam kalça artroplastisi ile ve üç hasta çivi revizyonu ile). Tüm hastalarda enfeksiyon olmadan kaynama elde edildi.
Sonuç:
Femurdaki artmış eğimin, düz çivilerin anterior kortekste sıkışmasına neden olması nedeniyle özellikle Kafkas toplumlarındaki gibi göreceli olarak kısa boylu insanlarda ya da ileri osteoporotik olanlarda anterior eğimli yeni dizayn çivilere ihtiyaç duyulmaktadır.
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