A New Effective And Reliable Technique For Bleeding Control İn The Modified Stoppa Approach To Acetabulum Quadrilateral Region Fractures; Ligate The Obturator Artery

Year 2023, , 267 - 273, 31.12.2023

Necati Doğan

https://doi.org/10.30565/medalanya.1394770

Abstract

Aim: This study aims to share the methods of managing foci that cause bleeding in the modified Stoppa approach to acetabulum quadrilateral region fractures. In addition, it is to reveal the amount of perioperative bleeding and the clinical effect of ligated arteries in patients whose surgery was performed with advanced bleeding control technique.

Patients and methods: Between May 1, 2020, and June 30, 2023, perioperative bleeding data of 13 patients with acetabulum quadrilateral region fractures operated on with a modified Stoppa approach and advanced bleeding control technique were evaluated retrospectively. Age, gender, fracture mechanism, fracture side, fracture type, amount of perioperative bleeding, and follow-up periods were determined. The clinical effect of ligated arteries was observed in the postoperative period. In the CT scans taken in the postoperative period, the diameters of the gluteal muscles and adductor muscles were compared to the healthy side.

Results: Of the 13 patients included in the study, 5 were women, and 8 were men. While the average age was 35.6 years, the average follow-up period was 15.3 months. The average number of sponges used during the modified Stoppa approach and the amount of bleeding measured with an aspirator was 284.2 ml. The middle area of the gluteal muscles compared to the healthy side was 0.89, while the average area of the adductor muscles was 0.89. No problems related to the ligated vessels were observed in any patient during the postoperative period and outpatient follow-up.

Conclusions: Routine ligation of the obturator artery does not have any clinically observable adverse effects, and with advanced bleeding control, it facilitates both the hemodynamic management of the patient in terms of anesthesia and the management of the surgical field for the surgeon.

Keywords

Asetabulum quadrilateral fractures, modifiye stoppa aproach, bleeding foci, obturator artery

Ethical Statement

In this study, national and international ethical rules are observed.

Supporting Institution

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Thanks

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Asetabulum Quadrilateral Bölge Kırıklarına Stoppa Yaklaşımda Kanama Kontrolünde Efektif Ve Güvenilir Yeni Bir Teknik; Obturatör Arteri Bağlamak

Abstract

Amaç: Bu çalışmanın amacı asetabulum quadrilateral bölge kırıklarına modifiye stoppa yaklaşımda kanamaya neden olan odakların yönetimi konusunda elde edilen çözüm metodlarını paylaşmaktır. Ayrıca ileri kanama kontrolü tekniği ile cerrahisi sağlanan hastaların perioperatif kanama miktarını ve bağlanan arterlerin klinik etkisini ortaya çıkarmaktır.

Hastalar ve yöntem: 1 Mayıs 2020-30 Haziran 2023 tarihleri arasında asetabulum quadrilateral bölge kırığına sahip, modifiye stoppa aproach ve ileri kanama kontrolü tekniği ile opere edilen 13 hastanın perioperatif toplanan kanama verileri geriye dönük olarak değerlendirildi. Yaş, cinsiyet, kırık mekanizması, kırık tarafı, kırık tipi, perioperatif kanama miktarı ve takip süreleri belirlendi. Postoperatif dönemde bağlanan arterlerin klinik etkisi gözlemlendi. Ameliyat sonrası dönemde çekilen bilgisayarlı tomografilerde gluteal kasların ve addüktör kasların çapları sağlıklı tarafla karşılaştırıldı.

Bulgular: Çalışmaya alınan 13 hastanın 5’i kadın iken 8’i erkek idi. Ortalama yaş 35,6 iken ortalama takip süresi 15,3 ay idi. Modifiye stoppa aproach esnasında kullanılan spanç sayısı ve aspiratör ile ölçülen kanama miktarı ortalama 284,2 cc olarak hesaplandı. Gluteal kasların sağlıklı tarafa göre ortalama alanı 0,89, adduktor kasların ortalama alanı ise 0,89 olarak belirlendi. Postoperatif dönemde ve poliklinik takiplerinde hiçbir hastada bağlanan damarlar kaynaklı problem gözlenmedi.

Sonuç: Obturatör arterin rutin bağlanmasının klinik olarak gözlenebilen bir olumsuz etkisi olmadığı gibi ileri kanama kontrolü ile hem anestezi açısından hastanın hemodinamik yönetimini, hem de cerrah açısından cerrahi alan yönetimini kolaylaştırmaktadır.

Keywords

Asetabulum quadrilateral bölge kırıkları, modifiye stoppa yaklaşım, kanama odakları, obturatör arter

Ethical Statement

Bu çalışmada ulusal ve uluslararası etik kurallara uyulmuştur.

Supporting Institution

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Thanks

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