Servikal faset kilitlenmesinde tedavi seçenekleri
Küçük Resim Yok
Tarih
1998
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
1978-1992 yılları arasında 14 yıllık bir dönemde Ege Üniversitesi Tıp Fakültesi Nöroşirurji Kliniğinde 45 hasta travmatik servikal faset kilitlenmesi nedeniyle tedavi edilmiştir. Bu olguların 33 ünde unilateral, 12 sinde bilateral faset kilitlenmesi saptanmıştır. Faset kilitlenmesi en sık C6-C7 seviyesinde (%38) görülmüştür. Tüm hastalara öncelikle iskelet traksiyonu ile kapalı redüksiyon denenmiştir. Redüksiyon sağlanan olgulara anterior girişim ile kemik füzyon uygulanmıştır. Son yıllarda kemik grefte ilaveten plak ile tespit de yapmaktayız. Redüksiyon sağlanamayan olgulara ise posterior girişim ile açık redüksiyon ve posterior enstrümentasyon uygulanmıştır. İlk 7 gün içinde uygulanan traksiyonlarla hastaların yaklaşık %40 ında redüksiyon sağlanabilmiştir. Ancak 7 günden sonra görülerek traksiyon uygulanan hiçbir hastada faset kilitlenmesi traksiyonla redükte edilememiştir. Faset kırığının mevcut olup olmaması redüksiyonu ciddi şekilde etkilememektedir. Anterior tespit uygulanan 15 olgudan 5 inde deformite gelişmesi üzerine bu olguların 3 üne daha sonra posterior tespit, 2 sine ise Halo ceket uygulanmıştır. Posterior girişim uygulanan 30 olgudan 9 unda daha sonra tekrar deformite gelişmiş, bu nedenle bu hastaların 3 üne ayrıca Halo ceket uygulanmıştır. Diğer 6 olguya ise anterior girişim ile kemik füzyon uygulanmıştır. Travmatik servikal faset kilitlenmesi ciddi morbiditesi ve tedavi sorunları olan bir travma şeklidir. Bu olgular için tek ve basit bir tedavi formülü yoktur.
Fourty-five patients with cervical traumatic locked facets were treated at the Department of Neurosurgery of Ege University School of Medicine during 14 years period (1978-1992). in 33 patients there were unilateral and in 12 patients bilateral locked facets. Most of the dislocations were at C6-C7 level (38%). All patients underwent a closed skeletal traction initially. For the cases that the reduction was successful, bone fusion with anterior approach was used. During the last years, this procedure was combined with a plate stabilization. If the reduction was not successful via skeletal traction, a posterior surgery together with an open reduction and instrumentation was applied. in 15 cases stabilized with anterior approach, 9 patients developed deformity, and 3 of them were operated again with posterior stabilization and 2 had a Halo jacket. in 30 cases treated with posterior approach, 9 patients have developed deformity, of which 3 had a Halo jacket. in general, we achieved closed reduction in approximately 40% of the patients who had skeletal tractions during the first 7 days of their injury. However, none of the patients receving skeletal tractions were reducted after 7 days. Presence of a facet fracture also did not effect the reduction. in conclusion, traumatic cervical locked facets is a serious trauma type with high morbidity. There is no simple algorhytm for these cases.
Fourty-five patients with cervical traumatic locked facets were treated at the Department of Neurosurgery of Ege University School of Medicine during 14 years period (1978-1992). in 33 patients there were unilateral and in 12 patients bilateral locked facets. Most of the dislocations were at C6-C7 level (38%). All patients underwent a closed skeletal traction initially. For the cases that the reduction was successful, bone fusion with anterior approach was used. During the last years, this procedure was combined with a plate stabilization. If the reduction was not successful via skeletal traction, a posterior surgery together with an open reduction and instrumentation was applied. in 15 cases stabilized with anterior approach, 9 patients developed deformity, and 3 of them were operated again with posterior stabilization and 2 had a Halo jacket. in 30 cases treated with posterior approach, 9 patients have developed deformity, of which 3 had a Halo jacket. in general, we achieved closed reduction in approximately 40% of the patients who had skeletal tractions during the first 7 days of their injury. However, none of the patients receving skeletal tractions were reducted after 7 days. Presence of a facet fracture also did not effect the reduction. in conclusion, traumatic cervical locked facets is a serious trauma type with high morbidity. There is no simple algorhytm for these cases.
Açıklama
Anahtar Kelimeler
Nörolojik Bilimler, Cerrahi
Kaynak
Türk Nöroşirürji Derg.
WoS Q Değeri
Scopus Q Değeri
Cilt
8
Sayı
2