Çocuk Femur Diafiz Kırıklarında Titanyum Elastik Çivi veya Traksiyon–Pelvipedal Alçı Kullanımı
Özet
Beş ile on beş yaş arası çocuklarda görülen femur diafiz kırıklarının tedavisinde titanyum elastik çivi (TEÇ) ile iskelet traksiyonu-pelvipedal alçılama (İTPPA) yöntemlerinin klinik sonuçları retrospektif olarak karşılaştırılmıştır. Toplam otuz üç hastanın incelendiği araştırmada, TEÇ uygulanan grupta Flynn kriterlerine göre çoğunlukla mükemmel sonuçlar elde edilmiş; kemik kaynama, tam yükle basma, okula dönme ve hastanede kalış süreleri İTPPA grubuna kıyasla anlamlı derecede kısa bulunarak yüksek aile memnuniyeti sağlanmıştır. Geleneksel bir yöntem olan İTPPA grubunda ise koronal, sagittal ve rotasyonel dizilim bozuklukları ile ekstremite uzunluk uyuşmazlığı (kısalık) oranları belirgin şekilde daha yüksek saptanmış, ancak diz fleksiyon derecesinin bu grupta daha fazla olduğu görülmüştür. Her iki tedavi modelinde de hastaların yaşı ilerledikçe kemik kaynama süresinin uzadığı; kırık şekline göre yapılan değerlendirmede ise TEÇ grubunda spiral, İTPPA grubunda ise transvers kırıklarda kaynamanın daha geç tamamlandığı belirlenmiştir. Sonuç olarak, günümüz modern tıp pratiğinde cerrahi yaklaşımlar ön planda olsa da, cerrahi imkanların kısıtlı olduğu durumlarda İTPPA yönteminin de uygun endikasyon ve yakın takiple hala uygulanabilir, unutulmaması gereken alternatif bir tedavi seçeneği olduğu vurgulanmıştır.
The clinical outcomes of titanium elastic nail (TEN) and skeletal traction-spica casting (STSC) methods in the treatment of femoral shaft fractures in children aged five to fifteen years were retrospectively compared. In the study examining a total of thirty-three patients, mostly excellent results were obtained in the TEN group according to Flynn criteria; the durations of bone healing, full weight-bearing, return to school, and hospital stay were found to be significantly shorter compared to the STSC group, ensuring high family satisfaction. In the STSC group, which is a traditional method, the rates of coronal, sagittal, and rotational malalignment as well as limb length discrepancy (shortening) were detected to be significantly higher, whereas the degree of knee flexion was observed to be greater in this group. In both treatment models, it was determined that the bone healing time prolonged as the age of the patients advanced; in the evaluation made according to the fracture pattern, healing was completed later in spiral fractures in the TEN group and in transverse fractures in the STSC group. In conclusion, although surgical approaches are prominent in today's modern medical practice, it is emphasized that the STSC method is still an alternative treatment option that should not be forgotten and can be used with appropriate indications and close follow-up when surgical facilities are limited.
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