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2023, vol. 151, br. 5-6, str. 302-306
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Retrospektivna analiza različitih načina lečenja preloma zadnjeg zida acetabuluma
A retrospective analysis of different treatments of posterior acetabular wall fracture
aKlinički centar Srbije, Klinika za ortopedsku hirurgiju i traumatologiju, Beograd, Srbija bUniverzitet u Beogradu, Fakultet organizacionih nauka, Srbija cKlinički centar Srbije, Klinika za neurohirurgiju, Beograd, Srbija dUniverzitet u Beogradu, Medicinski fakultet, Institut za anatomiju, Srbija
e-adresa: medicusbane@hotmail.com
Sažetak
Uvod/Cilj Cilj rada je procena ishoda neoperativno i operativno lečenih bolesnika sa prelomima zadnjeg zida acetabuluma. Metode Procenjeno je ukupno 88 preloma acetabuluma, 31 operativno i 57 neoperativno lečenih. U operativnom lečenju korišćeni su ili samo šrafovi ili rekonstruktivne ploče i šrafovi. Trakcija kao metoda korišćena je kod bolesnika koji su lečeni neoperativno. Period praćenja je bio najmanje tri godine. Instrumenti korišćeni za procenu ishoda operativnog i neoperativnog lečenja bili su modifikovani skor Merl d'Obinje (Merle d'Aubigne), Harisov skor kuka i radiološki kriterijumi za ocenjivanje po Mati (Matta). Rezultati Imali smo statističku značajnost p < 0,005 i odlične rezultate sa 40,4% u neoperativnoj grupi i 19,4% u operativnoj grupi bolesnika koristeći Mata evaluaciju; dobre rezultate sa 49,1% za neoperativnu grupu i 48,4% za operativnu grupu. Pomoću modifikovanog instrumenta Merl D'obinje poređenje dve grupe, neoperativne i operativne, pokazalo je odlične rezultate: 56,1% za neoperativno lečene bolesnike i 25,8% za operativno lečene bolesnike. Dobri rezultati su bili kod 29,8% neoperativnih i kod 38,7% operativno lečenih bolesnika. Kada smo povezali neoperativne i operativne bolesnike, pronašli smo statističku značajnost p < 0,005 u slučaju Harisovog skora kuka; odlični rezultati su bili kod 54,4% neoperativno lečenih bolesnika. Zaključak Adekvatnu dijagnostiku i tačnu konačnu dijagnozu treba postaviti na način da se izbegne operativno lečenje ukoliko se prelom može lečiti neoperativno.
Abstract
Introduction/Objective The objective of the paper is an analysis of clinical outcomes of non-surgical conservative and operative management of patients with posterior acetabular wall fractures. Methods We investigated 88 fractures of the acetabular joint, 31 of which were treated surgically and 57 non-surgically. Only screws or reconstruction plates and screws were used for surgical treatment and traction in patients who underwent nonsurgical treatment. The study period lasted at least three years. The measures used to assess the outcome of operative, surgical and non-operative, conservative approach were Merle d'Aubigné modified score, Harris hip score, and Matta's radiometric criteria. Results Matta's evaluation criteria showed an excellent score of 40.4% in conservatively treated patients; 19.4% in patients who underwent surgery; a good score of 49.1% in conservatively treated patients; and 48.4% in patients who underwent surgery. Comparation between two patient groups differently treated, by Merle d'Aubigné tool, showed excellent results for 56.1% conservatively treated patients and 25.8% in those patients who underwent surgery, and good results in 29.8% conservatively treated patients and 38.7% in patients who underwent surgery. Harris hip score (excellent results were showed in 54.4% for non-operative-treated patients) also showed statistical significance, p < 0.005. Conclusion Proper diagnostics and a proper definitive diagnosis can help avoid surgical treatment if the fracture cannot be treated surgically, making the postoperative period more comfortable for the patient.
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