Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon

BENLİ, İ. Teoman; KAYA, Alper; GÜÇLÜ, BERK

Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon

İ. Teoman BENLİ, (Ufuk Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Alper KAYA, (Ufuk Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Berk GÜÇLÜ (Ufuk Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Journal of Turkish Spinal Surgery

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Yıl: 2008 Cilt: 19 Sayı: 4 Sayfa Aralığı: 435 - 446 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon

Öz:

Amaç: Omurganın instabilitesine yol açan, omurga destrüksiyonu ve nöral bozuklukların eşlik ettiği tüberküloz spondilit vakalarının cerrahi tedavisinde, anterior radikal debridman ve anterior destek greftlemeden oluşan Hong Kong prosedürü altın standarttır. Son yıllarda artan anterior enstrümantasyon uygulamalarının sonuçlarına ait yayınlarda birden fazla omur seviyesi tutulumunda, tekniğin yetersiz kaldığı bu nedenle bu vakalarda posterior enstrümantasyonla füzyon sahasının korunması önerilmektedir. Prospektif randomize olarak planlanan bu çalışmada, vida – çift rod ile anteriordan enstrümante edilen, birden fazla mobil segmentin tutulumu olan 45 hastanın minimum 5 yıllık sonuçları değerlendirilmesi amaçlanmıştır.Yöntem: Radyolojik olarak kifotik açılanma, global kifoz, klinik olarak SRS – 22 skorları preoperatif, postoperatif ve son kontrollerde belirlenerek mukayese edilmiştir.Bulgular: Preoperatif ortalama 23.9° ± 12.1° olan lokal kifoz açısının postoperatif ortalama 3.2° ± 4.1°’ye indirildiği ve ortalama % 86.0 ± 16.7 korreksiyon oranı sağlandığı, bu düzelmenin istatistiki olarak anlamlı olduğu belirlenmiştir (p < 0.05). Postoperatif korreksiyon oranları ile karşılaştırıldığında istatistiki olarak farksız olacak şekilde son kontrolde % 81.0 ± 18.1 final korreksiyon oranı elde edildiği ve minimal bir korreksiyon kaybı olduğu saptanmıştır. Hastaların tamamında fizyolojik sınırlarda torakal kifoz açılarının elde edildiği de görülmüştür. Preoperatif ağrı, mental durum, görünüm, fonksiyon ve tedaviden tatmin düzeylerinde istatistiki olarak anlamlı bir düzelme sağlanarak, hastaların tamamında son kontrolde tatmin edici sonuç sayılan 4 ve üzeri skorlara sahip oldukları belirlenmiştir. Hastaların tamamında solid füzyon kitlesi elde edilmiş, erken veya geç lokal veya sistemik komplikasyona, enfeksiyonun nüksü veya reaktivasyonuna rastlanmamıştır.Sonuç: Bu çalışmanın verileri ışığında, tüberküloz spondilitte iki veya daha çok tutulumu olan hastalarda da, anterior çift rod-vida sistemi ile uzun fiksasyonun güvenle uygulanabileceği ve yüksek korreksiyon oranları, minimal korreksiyon kayıpları ile başarılı sonuçlar alınabildiği fikri elde edilmiştir.

Anahtar Kelime: Tüberküloz, spinal Kemik hastalıkları, enfeksiyöz İleriye dönük çalışma enstrümantasyon Tüberküloz, osteroartiküler Rastgele kontrollü çalışmalar Spondilit

Konular: Cerrahi

Anterior instrumentation in multiple segment tuberculosis spondylitis

Öz:

Aim: Hong Kong procedure that consits of radical debridement and strut grafting is the gold standard in the surgical treatment of tuberculosis spondylitis cases that associated with spinal instability, deformity and neural defects. In recent literature about anterior instrumentations, posterior instrumentation is recommended in multipl spinal involvement to protect the fusion area because of inadequate anterior techniques. In this prospective randomised study, we investigated the minimum 5 years results of screw – dual rod anterior instrumentation in 45 patients that had multipl mobile segment involvement. Method: Radiologically kyphotic angulation, global kyphosis and clinically SRS-22 scores were determined in preoperatively, postoperatively and at last follow-ups and these datas were compared. Results: The mean preoperative kyphosis angle was decreased from 23.9° ± 12.1° to 3.2° ± 4.1° postoperatively that shows average 86.0 ± 16.7 % correction rates and it is found statistically significant (p < 0.05). Physiologic thoracic kyphosis angles obtained in all of the patients. 4 or more scores obtained in SRS-22 questionnaire showed satisfactory results at the last followup in all patients, and statistically significant improvements obtained in preoperative pain, mental status, appareance, function and satisfaction from treatment. All patients demonstrated solid fusion mass without early or late local or systemic complications, recurrence and reactivation. Conclusion: According to the datas of this study it is thought that satisfactory results can be obtained with long fixation with anterior dual rod- screw system safely and high correction rates with minimal correction loss in tuberculosis spondylitis patients that have two or more segment involvement.

Anahtar Kelime: instrumentation Tuberculosis, Osteoarticular Randomized Controlled Trial Spondylitis Tuberculosis, Spinal Bone Diseases, Infectious Prospective Studies

Konular: Cerrahi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	BENLİ İ, KAYA A, GÜÇLÜ B (2008). Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon. , 435 - 446.
Chicago	BENLİ İ. Teoman,KAYA Alper,GÜÇLÜ BERK Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon. (2008): 435 - 446.
MLA	BENLİ İ. Teoman,KAYA Alper,GÜÇLÜ BERK Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon. , 2008, ss.435 - 446.
AMA	BENLİ İ,KAYA A,GÜÇLÜ B Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon. . 2008; 435 - 446.
Vancouver	BENLİ İ,KAYA A,GÜÇLÜ B Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon. . 2008; 435 - 446.
IEEE	BENLİ İ,KAYA A,GÜÇLÜ B "Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon." , ss.435 - 446, 2008.
ISNAD	BENLİ, İ. Teoman vd. "Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon". (2008), 435-446.

APA	BENLİ İ, KAYA A, GÜÇLÜ B (2008). Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon. Journal of Turkish Spinal Surgery, 19(4), 435 - 446.
Chicago	BENLİ İ. Teoman,KAYA Alper,GÜÇLÜ BERK Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon. Journal of Turkish Spinal Surgery 19, no.4 (2008): 435 - 446.
MLA	BENLİ İ. Teoman,KAYA Alper,GÜÇLÜ BERK Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon. Journal of Turkish Spinal Surgery, vol.19, no.4, 2008, ss.435 - 446.
AMA	BENLİ İ,KAYA A,GÜÇLÜ B Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon. Journal of Turkish Spinal Surgery. 2008; 19(4): 435 - 446.
Vancouver	BENLİ İ,KAYA A,GÜÇLÜ B Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon. Journal of Turkish Spinal Surgery. 2008; 19(4): 435 - 446.
IEEE	BENLİ İ,KAYA A,GÜÇLÜ B "Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon." Journal of Turkish Spinal Surgery, 19, ss.435 - 446, 2008.
ISNAD	BENLİ, İ. Teoman vd. "Çoklu seviye tüberküloz spondilitte anterior enstrümantasyon". Journal of Turkish Spinal Surgery 19/4 (2008), 435-446.