HUBUNGAN MORFOMETRI HIP DAN PELVIS DENGAN FRAKTUR INTERTROKANTER FEMUR DAN DERAJAT KEPARAHANNYA

MUHAMMAD NASRULLAH, Dr.dr.Puntodewo, M.Kes, Sp.OT(K)

2015 | Tesis | SP ORTHOPAEDIK DAN TRAUMATOLOGI

Latar belakang: Fraktur neck femur dan intertrokanter memiliki frekuensi yang sama. Osteoporosis dipercayai sebagai suatu faktor prediktif untuk terjadinya suatu fraktur femur proximal pada populasi tua. Morfometri femur proximal berhubungan dengan resiko fraktur neck femur. Posisi hip yang valgus akan mengurangi efektivitas abduktor karena lengan gaya yang pendek, meningkatkan beban pada head femur dan area trokanter sebaliknya mengurangi tekanan pada neck femur. Metode: 45 foto pelvis proyeksi anterior posterior pasien fraktur intertrokanter femur dievaluasi dan di bandingkan foto pelvis normal sesuai usia. Enam morfometri, neck shaft angle (NSA), medial offset (MO), midpelvis caput distance (MCD), femoral neck length (FNL), acetabulum-acetabulum distance (AcAc) dan acetabulum-head distance (AcH) diukur. Foto ini juga dinilai dan diklasifikasikan berdasrakan Singh index, klasifikasi OTA/AO dan Boyd Griffin. Korelasi statistik dan regresi logistik dilakukan untuk menilai hubungan masing-masing parameter dengan terjadinya fraktur dan klasifikasinya. Hasil: Indek Singh tidak didapatkan perbedaan bermakna pada foto yang dinilai (p=0,802). Neck shaft angle, medial offset and femoral neck length ditemukan lebih besar pada kelompok fraktur (p=0.00), sedangkan tidak demikian mid-caput pelvis distance (p=0,203), acetabulum-acetabulum distance (p=183) dan acetabulum head distance (p=0,564). Regresi logistik menujukkan NSA, MO dan AcH merupakan faktor prediktif kejadian fraktur intertrokanter femur. Tidak ada korelasi antara NSA, MCD, MO, FNL, and AcAc baik dengan klasifikasi AO/OTA maupun Boyd Griffin. Singh index and AcH berkorelasi bermakna dengan klasifikasi fraktur intertrokanter sesuai Boyd Griffin. Regresi logistik tidak ditemukan kemaknaan. Simpulan: Morfometri femur proximal berbeda antara pasien yang menderita fraktur intertrokanter femur dengan NSA, MO dan AcH sebagai faktor prediktif. Morfometri ini mempengaruhi terjadinya fraktur karena derajat osteoporosis ditemukan sama. Walaupun demikian, tidak ditemukan korelasi dengan derajat keparahan fraktur kecuali jarak acetabulum ke head dan indek Singh dengan klasifikasi Boyd Griffin. Kata Kunci: Intertochanter femur fracture, morphometri, Singh index, klasifikasi AO/OTA dan Boyd Griffin.

Background: Femoral neck fractures and intertrochanteric fractures occur with about the same frequency. Osteoporotic condition believed as predictive factor lead to succeptibility of hip fracture in elderly. Proximal femur shape associate with the risk of neck fracture. Valgus condition of the hip will reduces the effectiveness of the abductors because of a shorter moment arm, increases the load on the femoral head and trochanter area, and decreases the load on the femoral neck. Methods: 45 anterior-posterior projection pelvis x-ray of intertrochanter femur fracture patient was evaluated and compared in an age-matched non fracture x-ray. Six morphometri, neck shaft angle (NSA), medial offset (MO), midpelvis caput distance (MCD), femoral neck length (FNL), acetabulum-acetabulum distance (AcAc) and acetabulum-head distance (AcH) was measured. This x ray was reviewed and classify for Singh index, AO/OTA and Boyd Griffin classification also. Statistic correlation and logistic regression was performed to evaluate each parameter with intertrochanter femur fracture and its classification. Result: There was no significant different of Singh Index in an age-matched x ray (p=0,802). The Neck Shaft Angle, Medial Offset and Femoral neck length was significantlay larger in fracture group (p=0.00), whereas mid-caput pelvis distance (p=0,203), acetabulum-acetabulum distance (p=183) and acetabulum head distance (p=0,564) was not. Logistic regression found NSA, MO and AcH was predictive in intertochanteric fracture occurence. There was no correlation found betwen NSA, MCD, MO, FNL, and AcAc with AO/OTA as well as Boyd Griffin classification. Singh index and AcH was correlate significantly with Boyd Griffin classification of intertrochanteric fracture. Standarized logistic regression found no significancies. Conclusion: The proximal femur morphometri was differ in patient who sustained intertrochanter femur fracture with NSA, MO and AcH was predictive. This morphometri was roled as the cause of fracture while the osteoporotic condition was equal. Otherwise, there was no correlation with degree of severity of intertrochanteric fracture except acetabulum head distance and Singh index for Boyd Griffin classification. Keywords: Intertochanter femur fracture, morphometri, Singh index, AO/OTA and Boyd Griffin classification.

Kata Kunci : : Intertochanter femur fracture, morphometri, Singh index, klasifikasi AO/OTA dan Boyd Griffin