Antegrad Femoral Kilitli İntramedüller Çivileme Uygulanan Hastalarda Patellofemoral Eklemin Sagital Plan Değişikliklerinin Kuadriseps Kas Atrofisi ile İlişkisinin Değerlendirilmesi

Öz

Amaç: Antegrad femoral intramedüller çivileme sonrası patellofemoral eklemde gelişen sagital dizilim bozukluklarının kuadriseps kas atrofisi ile ilişkisini araştırmak. Gereç ve Yöntemler: Çalışmada ameliyat sonrası opere ekstremitede diz önü ağrısı olan 24 hastanın 9 erkek ve 15 kadın dinamik patellofemoral manyetik rezonans görüntüleme MRG sonuçları incelendi. Rotasyonel deformitesi ve horizontal planda patellofemoral dizilim bozukluğu olan hastalar çalışma dışı bırakıldı. Klinik değerlendirme, hastaların son takiplerinde Kujala patellofemoral skorlama sistemi ile yapıldı. Diz dinamik MRG çekimleri supin pozisyonda ve bilateral yapıldı. Sağlam ve opere ekstremitede patellofemoral eklem; istirahat ve belirlenen fleksiyon açılarında, P-PT patella-patellar tendon açı ölçümleri ve DP-TT distal patella-tüberositaz tibia mesafe ölçümleri ile değerlendirildi. Aynı zamanda kuadrisepsin kontraksiyonlu ve kontraksiyonsuz iken enine kesit alan ölçümleri yapıldı. Hastaların opere ve sağlam ekstremitelerindeki kuadriseps enine kesit alanı, P-PT açı ve DP-TT mesafe ölçümleri arasındaki ilişkiye bakıldı. Bulgular: Hastaların ortalama yaşı 39,7±13,9 yıl idi. Ortalama takip süreleri 40 16-64 ay idi. Hastaların kujala patellofemoral skorları ortalama 73,3±11,8 idi. Opere taraf P-PT açı değişimleri sağlam tarafa göre anlamlı olarak yüksek bulunurken, DP-TT mesafe değişimleri sağlam tarafa göre anlamlı olarak düşük bulundu. Aynı zamanda P-PT açısındaki artış ile DP-TT mesafesindeki azalmanın birbirleriyle anlamlı olduğu tespit edildi. Opere taraf kuadriseps kasının enine kesit alanının kontraksiyonlu ve kontraksiyonsuz değerleri, sağlam tarafa göre anlamlı olarak düşük bulundu. Sonuç: Antegrad femoral kilitli intramedüller çivileme sonrası diz önü ağrısı olan hastalarda, patellada gelişen sagital plan değişimleri ve kuadriseps atrofisi diğer nedenlerle beraber patellofemoral eklemin biyomekaniğini etkiler.

Anahtar Kelimeler

• Femur kırıkları, Patellofemoral eklem, Kuadriseps atrofisi

Evaluation of the Relationship between Sagittal Plan Changes of the Patellofemoral Joint with Quadriceps Muscle Atrophy in Patients Undergoing Antegrade Locked Intramedullary Femoral Nailing

Abstract

Objective: The aim of the study was to analyse the relationship between sagittal plane alignment instability were excluded. All the patients were given Kujala patellofemoral clinical evaluation scores at the latest follow-up. Knee dynamic MRI was performed in the supine position and bilaterally. Patellofemoral joints were assessed by means of P-PT patellapatellar tendon angle measurements and DP-TT distal patellar-tuberosity tibia distances measured at rest and in the selected flexion angles of the operated and non-operated extremity. At the same time, cross-sectional area of quadriceps measurements were made while the tendon was contracted and not contracted. The correlation between the changes in the operated and contralateral side of the quadriceps muscle mass with the alterations in the inferior patellar pole, the tibial tubercle DP-TT distances and T patella–patellar tendon P-PT angles were analysed.Results: The mean age of all participants was 39.7±13.9 years. The mean follow-up was 40 months range 16–64 . The mean Kujala patellofemoral score was 73.3±11.8. While the mean P–PT angle in operated group was significantly higher than the values in the nonoperated group p

Keywords

• Femoral fractures, Patellofemoral joint, Quadriceps atrophy

References

1. 1. Crossley KM, van Middelkoop M, Callaghan MJ, Collins NJ, Rathleff MS, Barton CJ. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: Recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). Br J Sports Med 2016; 50(14):844-52.
2. 2. Thabit G 3rd, Micheli L. Patellofemoral pain in the pediatric patient. Orthopedic Clinics of North America 1992; 23(4):567-85.
3. 3. LaBella C. Patellofemoral pain syndrome: Evaluation and treatment. Primary Care: Clinics in Office Practice 2004; 31(4):977-1003.
4. 4. Witvrouw E, Danneels L, Van Tiggelen D, Willems T, Cambier D. Open versus closed kinetic chain exercises in patellofemoral pain: A 5-year prospective randomized study. Journal of Orthopaedic & Sports Physical 2005; 35(6):390.
5. 5. Follerås G, Ahlo A, Strømsøe K, Ekeland E, Thoresen B. Locked intramedullary nailing of fractures of femur and tibia. Injury 1990; 21(6):385-8.
6. 6. Harris I, Hatfield A, Donald G, Walton J. Outcome after intramedullary nailing of femoral shaft fractures. ANZ Journal of Surgery 2003; 73(6):387-9.
7. 7. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy 1993; 9(2):159-63.
8. 8. Winquist RA, Hansen ST, Clawson DK. Closed intramedullary nailing of femoral fractures. J Bone Joint Surg 1984; 66:529-39.

9. 9. Yildirim AO, Aksahin E, Sakman B, Kati YA, Akti S, Dogan O, et al. The effect of rotational deformity on patellofemoral parameters following the treatment of femoral shaft fracture. Archives of Orthopaedic and Trauma Surgery 2013; 133(5):641-8.
10. 10. Laurin CA, Levesque H, Dussault R, Labelle H, Peides J. The abnormal lateral patellofemoral angle: A diagnostic roentgenographic sign of recurrent patellar subluxation. JBJS 1978; 60(1):55-60.
11. 11. Shellock FG, Mink JH, Fox JM. Patellofemoral joint: Kinematic MR imaging to assess tracking abnormalities. Radiology 1988; 168(2):551-3.
12. 12. Aksahin E, Ganal I, Dogan Ö, Hapa O, Yüksel H, Deren T, et al. Sa4. 13 Anterior knee pain after tibial nailing: What is the role of patellofemoral joint kinematics? Injury 2013; 44:S26-S7.
13. 13. Merchant AC, Mercer RL. Lateral release of the patella: A preliminary report. Clinical orthopaedics and related research 1974; 103:40-5.
14. 14. Sanchis-Alfonso V. Pathophysiology of anterior knee pain. Patellofemoral pain, instability, and arthritis: Springer, Valencia, 2010:1-16.
15. 15. Ostrum RF, Agarwal A, Lakatos R, Poka A. Prospective comparison of retrograde and antegrade femoral intramedullary nailing. J Orthop Trauma 2000; 14(7):496- 501.
16. 16. Chan KY, Singh VA, Mariapan S, Chong ST. Antegrade versus retrograde locked intramedullary nailing for femoral fractures: Which is better? European Journal of Trauma and Emergency Surgery 2007; 33(2):135-40.
17. 17. Zhang F, Zhu L, Li Y, Chen A. Retrograde versus antegrade intramedullary nailing for femoral fractures: a meta-analysis of randomized controlled trials. Current Medical Research and Opinion 2015; 31(10):1897-902.
18. 18. Kaya D, Citaker S, Kerimoglu U, Atay OA, Nyland J, Callaghan M, et al. Women with patellofemoral pain syndrome have quadriceps femoris volume and strength deficiency. Knee Surgery, Sports Traumatology, Arthroscopy 2011; 19(2):242-7.
19. 19. Helmy N, Jando VT, Lu T, Chan H, O’brien PJ. Muscle function and functional outcome following standard antegrade reamed intramedullary nailing of isolated femoral shaft fractures. J Orthop Trauma 2008; 22(1):10- 5.
20. 20. Callaghan M, Oldham J. Quadriceps atrophy: to what extent does it exist in patellofemoral pain syndrome? British Journal of Sports Medicine 2004; 38(3):295-9.
21. 21. Davies GJ, Heiderscheit B, Brinks K. Test interpretation. Isokinetics in human performance. Florida, 2000:3-24.
22. 22. Dvir Z, Shklar A, Halperin N, Robinson D, Weissman I, Ben-Shoshan I. Concentric and eccentric torque variations of the quadriceps femoris in patellofemoral pain syndrome. Clinical Biomechanics 1990; 5(2):68-72.
23. 23. Danckwardt-lillieström G, Sjögren S. Postoperative restoration of muscle strength after intramedullary nailing of fractures of the femoral shaft. Acta Orthopaedica Scandinavica 1976; 47(1):101-7.
24. 24. Fisher RL. Conservative treatment of patellofemoral pain. The Orthopedic clinics of North America 1986; 17(2):269-72.
25. 25. Kapp W, Lindsey RW, Noble PC, Rudersdorf T, Henry P. Long-term residual musculoskeletal deficits after femoral shaft fractures treated with intramedullary nailing. Journal of Trauma and Acute Care Surgery 2000; 49(3):446-9.
26. 26. Mira AJ, Markley K, Greer 3rd R. A critical analysis of quadriceps function after femoral shaft fracture in adults. JBJS 1980; 62(1):61-7.
27. 27. Resorlu H, Zateri C, Nusran G, Goksel F, Aylanc N. The relation between chondromalacia patella and meniscal tear and the sulcus angle/trochlear depth ratio as a powerful predictor. Journal of back and musculoskeletal rehabilitation. 2017(Preprint):1-6.
28. 28. Murray TF, Dupont J-Y, Fulkerson JP. Axial and lateral radiographs in evaluating patellofemoral malalignment. The American Journal of Sports Medicine 1999; 27(5):580-4.
29. 29. Anterior knee pain. Bourne MH, Hazel WA, Scott SG, Sim FH, eds. Mayo Clinic Proceedings: Elsevier, Rochester, 1988.
30. 30. Aksahin E, Karasoy I, Hapa O, Dogan Ö, Duran S, Yüksel H. Does the change in the mass of parapatellar muscle influence the patellofemoral kinematics in the sagittal plane following the surgical treatment of tibial shaft fractures? Injury 2013; 44:S26.
31. 31. Aksahin E, Aktekin CN, Kocadal O, Duran S, Gunay C, Kaya D, Hapa O, Pepe M. Sagittal plane tilting deformity of the patellofemoral joint: A new concept in patients with chondromalacia patella. Knee Surgery, Sports Traumatology, Arthroscopy 2017; 25(10):3038-45.