[Pendahuluan
Fraktur merupakan masalah kesehatan utama karena sering terjadi, pengobatan
yang kompleks dan mahal, serta hilangnya produktivitas. Masalah diperberat bila
terjadi komplikasi berupa delayed union atau nonunions. Dalam menilai pengaruh
suatu tindakan intervensi terhadap penyembuhan fraktur, diperlukan suatu model
perlambatan penyembuhan fraktur dan suatu metode penilaian yang akurat yang
meliputi radiologi, biomekanik, dan histologi. Berbagai model perlambatan
peyembuhan fraktur telah di laporkan dengan melakukan stripping periosteal
dengan menggunakan cauter yang menghasilkan tidak hanya efek mekanik namun
juga efek termal. Selain itu, metode penilaian akurat radiologi, biomekani modern
bergantung terhadap instrumen yang belum tersedia secara masal. Penilaian
histologi melalui histomorphometri dapat dikerjakan tanpa bergantung pada
instrument modern dan mahal. Hal ini ditunjang dengan tersedianya program
image J yang merupakan program dari NIH dan dapat diperoleh secara cumacuma.
Metode
Penelitian dilakukan pada bulan Juli hingga September 2013 di Departement
Patologi Anatomi FKUI. Penilaian dilakukan terhadap 24 ekor tikus dengan
fraktur dengan dan tanpa perlakuan mekanis pada periosteum yang kemudian
dievaluasi pada minggu ke-2 dan minggu ke-4. Perlakuan mekanis pada
periosteum berupa Stripping sirkular dengan bistruri sepanjang 10mm disekitar
fraktur. Penilaian histomorfometri dilakukan secara semi-automated dengan
bantuan program image-j, meliputi penilaian parameter total area kalus, area
penulangan, area tulang rawan dan area jaringan fibrosa. Evaluasi dilakukan
dengan membandingkan perubahan pada kelompok 2 minggu, kelompok 4
minggu serta beda kelompok 2 dan 4 minggu.
Hasil
Pemeriksaan Histomorfometri minggu ke-2 dan minggu ke-4 didapatkan area
penulangan, area tulang rawan dan area jaringan fibrosa kelompok perlakuan lebih
kecil dibandingkan pada kelompok kontrol yang secara statistik bermakna. Pada
evaluasi beda histomorfometri minggu ke-2 dan minggu ke-4 antara kelompok
kontrol dan kelompok perlakuan didapatkan perlambatan proses penyembuhan
yang juga secara statistik berbeda bermakna.
Kesimpulan
Analisa histomormofetri dengan image-J dapat dilakukan tanpa bergantung pada
instrumentasi yang modern dan perlakuan mekanik pada periosteum berupa
stripping sejauh 5mm dapat menghambat penyembuhan fraktur., Introduction
Fracture is a major health problem because the complexity and expensive
treatment, and also loss of productivity that accompanying. That problem
worsened if there is complications such as delayed-union or nonunions. Many
intervention was done to prevent that complication. In assessing the effect of
intervention, a model and also analytic method that includes radiology,
biomechanics, and histology were needed. Various models of delayed fracture
healing have been reported by stripping the periosteal with cauter which produces
not only mechanical but also thermal effect. Moreover, latest radiological and
biomechanical assessment rely on instruments that are not available in every
places. Histological assessment through histomorphometri can be done without
relying on modern and expensive instruments. This evaluation method is
supported by the availability of image-J program which is a program of the NIH,
and can be obtained free of charge.
Method
The study is an experimental study that was conducted in the Department of
Pathology Faculty of Medicine, University of Indonesia, on July to September
2013. 24 rats was divided into 2 group. 1 group was performed mechanical force
to bone only to get fracture and other was done by giving mechanical force to
bone and also periosteum. Each group was evaluated at 2 weeks and 4 weeks.
Histomorfometri assessment was performed semi-automatically with the aid of
image-j software. The paramater that measure was total area of callus, newbone
area, cartilage area, and fibrotic area. Evaluation is done by comparing the
difference of 2 group in 2 weeks, 4 weeks, and also the changes of 2 and 4 weeks
of each group.
Result
From Histomorfometric examination on 2nd week and 4th week, we found that
newbone formation area, cartilage area and fibrous tissue area of treatment group
smaller than in the control group and statistically significant. We also found that
there was delaying of healing process in comparring the changing in 2nd to 4th
week of treatment group and it is also statistically significant
Conclusions
Histomormofetri analysis with image-J can be done without relying on modern
instrumentation, mechanical force on periosteum on a fracture site by periosteal
stripping could inhibit healing fracture especially in histological pattern.]
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