Lábszártörés korszerű kezelésének értékelése klinikai és kísérletes vizsgálatokkal = Clinical and experimental assessment of the up-to-date treatment of the tibial shaft fractures

A labszartores az osszes csonttores 15%-a, amely Magyarorszagon korulbelul 2500 esetet jelent evente. A torest elszenvedettek 90%-at műteti uton kezeljuk. Az utobbi időkben a labszartoresek incidenciaja emelkedett, a toresek sulyossaga fokozodott, valamint az egyre fejlettebb műteti ellatasok ellenere a szovődmenyek aranyat sem sikerult minimalisra csokkenteni. A nyilt labszartorottek ellatasa a felfuras nelkuli velőűrszeg bevezeteset kovetően lenyegesen megvaltozott, a velőűrszegezes fokozatosan vette at a vezető szerepet az egyre magasabb foku nyilt toresek ellatasaban, es alkalmassa valt a tibia proximalis es distalis harmada toreseinek kezelesere is. Uj eljaraskent a Marchetti–Vicenzi-szeget hazankban elsőkent alkalmaztuk klinikankon, ezzel a modszerrel a tibia toresei, kulonosen a distalis harmadi toresek megbizhatoan, alacsony szovődmenyarannyal rogzithetők. A labszarbrace es a felfuras nelkuli szegezes egyuttes alkalmazasat 1997-ben dolgoztuk ki, bebizonyitottuk, hogy ezzel a modszerrel a labszartoresek gyogyulasa gyorsabb, a rehabilitacio rovidebb időt vesz igenybe. A szovődmenyek klinikai kutatasa soran bebizonyitottuk, hogy a felfurasos es a felfuras nelkuli szegezes soran kulonboző mertekben valtozik a nyomas a tibiat korulvevő izomrekeszekben. Felfuras nelkuli szegezes soran a mely rekeszben statisztikailag is magasabb nyomast mertunk. Az irodalmi adatokkal szemben igazoltuk, hogy nincs osszefugges a szegezes modja, a rekeszi nyomas emelkedese es a compartmentszindroma kialakulasa kozott. A szovődmenyek alapkutatasa soran a compartmentszindromas es Volkmann ischaemias kontrakturas betegek koros harantcsikolt izomszovetenek differencial pasztazo kalorimetrias vizsgalatat vegeztuk. Igazoltuk, hogy az ep es a keringeseben karosodott izomszovet hőstabilitasaban kulonbseg van. Bebizonyitottuk, hogy az izomrekeszen beluli nyomas merteke, a serult izom strukturalis karosodasa es a kalorimetriaval mert termokemiai ertekei kozott szoros korrelacio van. A kalorimetrias vizsgalat szenzitivitasanak es specificitasanak koszonhetően nagymertekben segitheti es kiegeszitheti a helyes diagnozis felallitasat azokban az esetekben, amikor az klinikailag nem egyertelmű. | Tibial shaft fractures present 15% of all fractures, which means about 2500 cases per year in Hungary. 90% of these fractures are treated surgically. Nowadays, the incidence of tibia fractures is increased, the severity of the fractures is intensified and in spite of new surgical techniques the rate of complications is not dramatically decreased. The treatment of the open tibia fractures has basically changed since the introduction of unreamed intramedullar nails. The unreamed nails turned into the primary method in the treatment of the Grade II and III open fractures and became sufficient for the fixation of the proximal and distal third tibia fractures. In Hungary, we used the Marchetti-Vicenzi nail for the treatment of tibia fractures in first time, with this method the tibial shaft and distal part fractures can be treated safely with low rate of complication. In year 1997 we prepared the treatment concept of the combination of the dynamic brace and the undreamed intramedullar nail. We proved that by the application of this method the advantages of the two treatment form could be attached and the healing period and the rehabilitation of the injured could be shortened. During the clinical exploration of the complications we proved that different pressure levels developed in the muscular compartment around the tibia during the usage of two different surgical techniques, the reamed and unreamed nailing. In the deep compartment we measured statistically higher pressure in the cases of unreamed nailing. In contrast to the literature we can draw the conclusion that there is no relationship between the compartmental pressure changes, the chance of the development of compartment syndrome and the insertion technique of the intramedullar nails. In pursuance of the basic research of the complications we investigated the muscle samples from compartment syndrome and from Volkmann ischemic contracture with differential scanning calorimetry. We proved that there is a difference between thermal features of the intact and ischemic muscles. We demonstrated that there is a close correlation between the compartmental pressure, the structural damage of muscle tissues and thermo-chemic values measured by calorimetry. Due to their sensitivity and specificity, calorimetric examinations can help and support the clinical diagnosis in atypical cases.