Gonartroz tedavisinde hareketli unikompartmantal diz artroplastisi, açık kama ve dome tipi yüksek tibial osteotomi seçeneklerinin değerlendirilmesi

Öz

Amaç: Gonartroz tedavisinde uygulanan hareketli unikompartmantal diz artroplastisi, açık kama ve dome tipi yüksek tibial osteotomi yöntemleri hasta memnuniyeti, yaşam kalitesi ve fonksiyonel sonuçlar açısından retrospektif olarak karşılaştırmayı amaçladık.

Çalışma planı: 2003-2010 yılları arasında 235 hastanın 255 dizi medial kompartman artrozu nedeniyle ameliyat edildi. Unikompartmantal diz artroplastisi (UDP), kilitli plakla açık kama yüksek tibial osteotomi (YTO) ve sirküler eksternal fiksatörle kubbe tipi YTO olmak üzere üç tip cerrahi tedavi gerçekleştirildi. İlk grupta 94 hastanın 109 dizine Oxford UDP uygulandı. İkinci grupta 36 hastanın 36 dizine İlizarovla kubbe tipi YTO yapıldı. Üçüncü grupta ise 52 hastanın 57 dizine kilitli plakla açık kama YTO yapıldı. Grupların fonksiyonel skorlarının karşılaştırılmasında SF-36 ve HSS diz skorları kullanıldı.

Bulgular: Her üç tedavi grubunda da ameliyat öncesi ve ameliyat sonrası değerler karşılaştırıldığında SF-36’nın tüm alt parametreleri (fiziksel fonksiyon, fiziksel rol, ağrı, genel sağlık, vitalite, sosyal fonksiyon, emosyonel rol ve mental sağlık) ve HSS skorlarında anlamlı değişiklikler saptandı. İkinci grupta mekanik aks sapmasında ortalama 38 mm, femoro-tibial aksta ortalama 11.7° ve medial proksimal tibial açıda ortalama 6.2° düzeltme elde edildi. Üçüncü grupta ise; mekanik aks sapmasında ortalama 28 mm, femoro-tibial aksta ortalama 9.7° ve medial proksimal tibial açıda ortalama 5.6° düzeltme elde edildi. Tüm tedavi seçeneklerinin tatmin edici sonuçlarının olduğu görüldü.

Çıkarımlar: UDP grubunda sosyal fonksiyon ve mental sağlık açısından ameliyat sonrası iyi sonuçlar elde edilmiş ve hastaların rehabilitasyonu ve önceki yaşam aktivitelerine geri dönmeleri daha erken sağlanmıştır.

 

DOI: 10.3944/AOTT.2015.14.0320

Bu özet, makalenin henüz redaksiyonu tamamlanmamış haline aittir ve bilgi verme amaçlıdır. Yayın aşamasında değişiklik gösterebilir.

Anahtar Kelimeler

• Yüksek tibial osteotomi; medial osteoartrit; unikompartmantal diz artroplastisi.

Evaluation of mobile bearing unicompartmental knee arthroplasty, opening wedge, and dome-type high tibial osteotomies for knee arthritis

Abstract

Objective: Three methods of surgery used in the treatment of knee osteoarthritis (OA) are mobile bearing unicompartmental knee arthroplasty (Oxford UKA), opening wedge high tibial osteotomy (HTO), and dome-type HTO. This article aimed to retrospectively compare these three methods in terms of outcomes for health status, patient satisfaction, and function.
Methods: Between 2003 and 2010, 255 knees of 235 patients underwent operations for medial knee OA. Three types of surgery were performed. Group 1 consisted of 109 knees of 94 patients who underwent Oxford UKA. Group 2 was made up of 36 knees of 36 patients who underwent HTO using circular external fixation, and Group 3 comprised 57 knees of 52 patients on whom opening wedge type HTO using locking plate fixation was performed. SF-36 and HSS knee scores were used to compare the functional outcomes among groups.
Results: Statistically significant differences were found between the preoperative and postoperative measures in all 3 of the treatment groups for physical function, physical role, pain, general health, vitality, social function, emotional role, and mental health according to SF-36 and HSS scores. In the 2nd group, the average correction of the mechanical axis deviation (MAD) was 38 mm with 11.7º along the femorotibial axis and 6.2º along the medial proximal tibial angle (MPTA). In the 3rd group, the average correction in the MAD was 28 mm with 9.7º along the femorotibial axis and 5.6º along the MPTA. All 3 of the treatment alternatives were observed to be sufficient. Satisfactory postoperative results were achieved in the UKA group in terms of social function and mental health, and the patients were able to achieve early rehabilitation and return to their previous life activities.
Conclusion: UKA is the ideal option for patients who wish for the earliest possible return to social and recreational activities.

Keywords

• High tibial osteotomy
• medial osteoarthritis
• unicompartmental knee arthroplasty

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