Tesis

Analisis Luaran Fungsional, Radiologis dan Kualitas Hidup Pasien Unstable Acetabular Fracture Dengan dan Tanpa Keterlibatan Quadrilateral Plate Pasca Operasi di RSUPN Cipto Mangunkusumo Tahun 2010-2020 = Postoperative Functional, Radiological and Quality of Life Outcome Analysis Between Acetabular Fracture Patients with and without Quadrilateral Plate Involvement at Cipto Mangunkusumo General Hospital 2010-2020.

Latar Belakang. Unstable Acetabular fracture merupakan salah satu trauma yang kompleks. Saat ini, klasifikasi fraktur acetabulum yang paling sering digunakan adalah klasifikasi Judet-Letournel. Masih sedikit penelitian mengenai unstable acetabular fracture dengan keterlibatan quadrilateral plate. Penelitian ini dilakukan untuk mengetahui luaran fungsional, radiologis, dan kualitas hidup pasien unstable acetabular fracture dengan dan tanpa keterlibatan quadrilateral plate pasca operasi sehingga dapat memberikan data dasar sebagai pertimbangan dalam penatalaksanaan fraktur acetabulum. Metode. Penelitian ini merupakan penelitian kohort retrospektif yang dilakukan di RSUPN Cipto Mangunkusumo pada Maret 2021 – Agustus 2022. Subjek unstable acetabular fracture dengan dan tanpa keterlibatan quadrilateral plate diikutsertakan dalam penelitian ini. Penelitian ini mengevaluasi luaran fungsional (Harris Hip Score, Merle D’Aubigne, dan Oxford Hip Score), luaran radiologis (Matta Outcome Grading), dan kualoitas hidup(SF-36). Hasil. Penelitian ini menggunakan 53 subjek, terdiri atas: 28 (52,8%) subjek unstable acetabular fracture dengan keterlibatan quadrilateral plate dan 23 (47,2%) pasien lainnya merupakan unstable acetabular fracture tanpa keterlibatan quadrilateral plate. Rentang usia pada penelitian ini adalah 18-75 tahun. Approach yang digunakan pada penelitian ini yaitu: Kocher-Langenbeck, Modified Stoppa, ilioinguinal, dan ilioinguinal + KocherLangenback. Median perdarahan intraoperasi pada subjek unstable acetabular fracture dengan keterlibatan quadrilateral plate adalah 600 ml, sedangkan pada subjek tanpa keterlibatan quadrilateral plate adalah 400 ml. Subjek unstable acetabular fracture dengan keterlibatan quadrilateral plate memiliki median waktu operasi 11 hari dari awitan dengan rata-rata lama operasi 5,99 2,26, sedangkan pada subjek tanpa keterlibatan quadrilateral plate memiliki median waktu operasi 7 hari dari awitan dengan rata-rata lama operasi 4,72 1,89. Subjek unstable acetabular fracture dengan keterlibatan quadrilateral plate tercapai reduksi anatomis sebanyak 20 pasien (71,4 %), dan 8 pasien (18,6%) tercapai reduksi imperfect. Sedangkan subjek tanpa keterlibatan quadrilateral plate tercapai reduksi anatomis sebanyak 23 pasien (92 %), dan 2 pasien (8%) tercapai reduksi imperfect pasca operasi. Subjek unstable acetabular fracture dengan keterlibatan quadrilateral plate memiliki luaran fungsional, dan kualitas hidup yang secara signifikan lebih rendah dibandingkan dengan tanpa keterlibatan quadrilateral plate pada preoperasi, serta pada bulan ke 1, 6 dan 12 pasca operasi berdasarkan Harris Hip Score, Merle D’Aubigne, Oxford Hip Score, dan SF-36. Subjek unstable acetabular fracture dengan keterlibatan quadrilateral plate memiliki luaran radiologis yang secara signifikan lebih rendah dibandingkan dengan subjek tanpa keterlibatan quadrilateral plate pada 6 bulan pasca operasi berdasarkan Matta Outcome Grading (p=0,04). Kesimpulan. Subjek unstable acetabular fracture dengan keterlibatan quadrilateral plate memiliki luaran fungsional, luaran radiologis, dan kualitas hidup yang secara signifikan lebih rendah dibandingkan dengan unstable acetabular fracture tanpa keterlibatan quadrilateral plate yang ditunjukkan pada nilai Harris Hip Score, Merle D’Aubigne, dan Oxford Hip Score, Matta Outcome Grading, dan SF-36. Subjek yang difiksasi dengan quadrilateral hook plate memiliki luaran fungsional, dan radiologis yang sama dengan subjek yang difiksasi dengan intrapelvic plate, namun memiliki kualitas hidup yang lebih baik pada 12 bulan postoperasi. Subjek yang difiksasi dengan posterior collum plate memiliki luaran fungsional, radiologis dan kualitas hidup yang sama dengan suprapectineal plate. Begitu juga dengan subjek yang difiksasi dengan plateplate dan plate-lag screw.
Kata Kunci: unstable acetabular fracture, quadrilateral plate, luaran fungsional, luaran radiologis, kualitas hidup.



Background. Unstable Acetabular fracture is complex trauma. Currently, the most commonly used classification of acetabular fractures is the Judet-Letournel classification. There are very few studies regarding unstable acetabular fractures with quadrilateral plate involvement. This study was conducted to determine the functional, radiological, and quality of life outcomes of unstable acetabular fracture patients with and without postoperative quadrilateral plate involvement so that it can provide basic data as a consideration in the management of acetabular fractures. Method. This study is a retrospective cohort study conducted at Cipto Mangunkusumo General Hospital in March 2021 – August 2022. Subjects with unstable acetabular fractures with and without quadrilateral plate involvement were included in this study. This study evaluates functional outcomes (Harris Hip Score, Merle D'Aubigne, and Oxford Hip Score), radiological outcomes (Matta Outcome Grading), and quality of life (SF-36). Results. This study used 53 subjects, consisting of: 28 (52.8%) unstable acetabular fracture with quadrilateral plate involvement and 23 (47.2%) patients without quadrilateral plate involvement. The age range was 18-75 years. The approaches used in this study are: Kocher-Langenbeck, Modified Stoppa, ilioinguinal, and ilioinguinal + Kocher-Langenback. The median intraoperative bleeding in unstable acetabular fracture subjects with quadrilateral plate involvement was 600 ml, whereas in subjects without quadrilateral plate involvement was 400 ml. Subjects with unstable acetabular fractures with quadrilateral plate involvement had a median operating time of 11 days from onset with a mean length of surgery of 5.99 ±2.26, whereas subjects without involvement of the quadrilateral plate had a median operating time of 7 days from onset with a mean length of time operation 4.72±1.89. Subjects with unstable acetabular fracture with quadrilateral plate involvement achieved anatomical reduction in 20 patients (71.4 %), and 8 patients (18.6%) achieved imperfect reduction. While the subjects without quadrilateral plate involvement achieved anatomical reduction in 23 patients (92 %), and 2 patients (8%) achieved imperfect reduction. Subjects with unstable acetabular fracture with quadrilateral plate involvement had significantly lower functional outcomes and quality of life compared to those without quadrilateral plate involvement preoperatively, 1, 6 and 12 months postoperatively based on the Harris Hip Score, Merle D'Aubigne, Oxford Hip Score, and SF-36. Subjects with unstable acetabular fracture with xi Universitas Indonesia quadrilateral plate involvement had a significantly lower radiological outcome than subjects without quadrilateral plate involvement at 6 months postoperatively according to Matta Outcome Grading (p=0.04). Conclusion. Subjects with unstable acetabular fractures with quadrilateral plate involvement had significantly lower functional, radiological and quality of life outcomes compared to subjeks without quadrilateral plate involvement as indicated by the Harris Hip Score, Merle D'Aubigne, and Oxford Hip Score, Matta Outcome Grading, and SF- 36. Subjects fixed with quadrilateral hook plate had the same functional and radiological outcomes as subjects fixed with intrapelvic plate, but had a better quality of life at 12 months postoperatively. Subjects fixed with the posterior collum plate had the same functional, radiological and quality of life outcomes as the suprapectineal plate. Likewise, subjects were fixed with plate-plate and plate-lag screws.
Keywords: unstable acetabular fracture, quadrilateral plate, functional outcome, radiological outcome, quality of life.