Avtor/Urednik		Andoljšek, Matej
Naslov		Zapleti pri žebljanju pertrohanternih zlomov z IMHS žebljem
Prevedeni naslov		Complications after nailing of the pertrochanteric fractures with IMHS nail
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 75, št. 5
Leto izdaje		2006
Obseg		str. 309-14
Jezik		slo
Abstrakt		Intramedullary hip nails, which combine the advantages of intramedullary fixation with those of a sliding screw, should diminish the incidence of complications after osteosynthesis of the pertrochanteric fractures. Despite less mechanical failures, this has not happened. However, some new specific complications have occured. In this retrospective study of the pertrochanteric fractures treated with IMHS nail, the author is analysing the importance of experience and the impact of »learning curve« on incidence of complications. Between March 1996 and July Z999 65 patients with 65 non pathologic pertrochanteric fractures were operated with IMHS nail. Thirty-one were operated in 1996/97 (Group 1), thirty four later on (Group II). Between the groups there were no differences in demographic characteristics, types of fractures, used material or outcome. Twelve out of 65 patients (eight from Group 1, four from Group II) had at least one complication. In five patients there was a crack of femoral diaphisis. In two reduction of the fracture was insufficient. In another two the hip screw protruded into the joint One fracture dislocated secondarely. Three patients had infection. One non-union of the femoral neck showed after removal of the nail 2.5 years postinjury. Stratified statistical analysis showed that Group l had signifficantly more mechanical complications (insufficient reduction, hip screw protrusion, secondary dislocation), whereas differences between the groups in jemur cracks, infection and non-union were insignificant. This comparative study has shown frequent complications after nailing of the pertrochanteric fractures and that with growing experience the incidence of complications decreases. All this points to an important »learning curve«.
Izvleček		Intramedularni kolčni žeblji, ki združujejo prednosti intramedularne učvrstitve in drsečega kolčnega vijaka, naj bi zmanjšali incidenco zapletov po osteosintezah nestabilnih pertrohanternih zlomov. Kljub redkejšim mehanskim zapletom se zaradi pojava nekaterih novih, za žeblje specifičnih zapletov, to ni zgodilo. V retrospektivni študiji avtor analizira vpliv (ne)izkušenj oz. »učne krivulje« na pojav zapletov pri žebljanju pertrohanternih zlomov. Med marcem 1996 in julijem 1999 so na kirurškem oddelku Splošne bolnišnice Jesenice z žebljem IMHS oskrbeli 65 poškodovancev s 65 nepatološkimi pertrohanternimi zlomi. Enaintrideset poškodovancev je bilo operiranih v letih 1996/97 (Skupina I), štiriintrideset v letih 1998/99 (Skupina II). Med skupinama ni bilo pomembnih razlik v demografskih značilnostih, vrsti zlomov, uporabljenem osteosintetskem materialu niti v končnih rezultatih zdravljenja. Dvanajst operiranih poškodovancev (osem iz Skupine I, štirje iz Skupine II) je imelo vsaj en zaplet Pri petih poškodovarncih je med operacijo prišlo do pokanja diafize stegnenice, pri dveh uravnava odlomkov ni bila uspešna, pri dveh je kolčni vijak prodrl v sklep, pri enem je prišlo do sekundarnega premika odlomkov, pri treh poškodovancih se je razvilo vnetje. En zlom v predelu vratu ni zarasel, kar se je pokazalo po odstranitvi žeblja dve leti in pol po poškodbi. Stratificirana statistična analiza je pokazala, da je bilo mehanskih zapletov (nepopolna uravnava, protruzija materiala, sekundarna dislokacija) pomembno več v Skupini I, medtem ko razlike pri ostalih zapletih niso pomembne. V primerjalni študiji avtor ugotavlja, da so zapleti pri žebljanju pertrohanternih zlomov razmeroma pogosti in da incidenca mehanskih zapletov pri žebljanju pertrohanternih zlomov z izkušnjami pada, kar kaže na pomembno »učno krivuljo«.
Deskriptorji		HIP FRACTURES FRACTURE FIXATION BONE NAILS BONE SCREWS TREATMENT OUTCOME