Efficiency of Primary End-to-End Open Repair in the Acute Achilles Tendon Ruptures

Year 2009, Volume: 3 Issue: 2, 104 - 109, 26.07.2009

Durmus Ali Ocguder

Abstract

In this study we evaluated the results of 31 patients (28 male, 3 female mean age 41; range 26-66) who underwent primary surgical end-to-end repair for acute achilles tendon ruptures. The causes of the repair were sportic activities in 21 patients (%67.7), car accident in 2 patients (%6.4), spraining and falling in 7 patients (%2.5), sharp agent injury in 1 patient. All patients had unilateral and traumatic rupture of the achilles tendon. 18 patients (%58) had right achilles tendon ruptures, 13 patients (%42) had left achilles tendon ruptures. All of the patients were operated and cast applied urgently. The follow-up period ranged from 24 months to 70 months (mean 44.6 months). The patients who were immobilized for 6 to 8 weeks underwent standardized progressive postoperative rehabilitation program. At the end of the follow-up, patients were evaluated according to Percy /Co-nochie criteria: 14 patients (%45) showed excellent, 10 patients (%32) good, 6 patients (%19) moderate and 1 patient (%3.2) failure resuts. No patient had rerupture, skin necrosis, deep infection and sinus formation. In 4 patients (% 13) who were treated with oral antibiotics showed superficial wound infection and in 1 patient (3.2) who was treated conservatively showed partial rupture recurrence. Consequently, there isn’t consensus in the treatment of achilles tendon ruptures at the present time. Many surgical methods have been defined from primary end-to-end repair methods to very complicated surgical method of facial augmentation technique. We believe that end-to-end repair technique in acute achille tendon ruptures has sufficient functional results

Keywords

chilles tendon ruptures/ injury/surgery, end-to-end repair, augmentation, surgery

Akut Aşil Tendon Rüptürlerinde Primer Uç-Uca Açık Tamirin Etkinliği

Abstract

Akut aşil tendon rüptürü nedeniyle uç-uca açık tamiri yapılan 31 hastanın (28 erkek, 3 kadın; ort. yaş 41; dağılım 26-66) sonuçları bu çalışmada incelenmiştir. Rüptür nedeni 21 hastada (%67.7) sportif aktivite, 7 hastada (%22.5) düşme-burkulma, 2 hastada (%6.4) trafik kazası, 1 hastada (%3.2) ise kesici alet yaralanmasıydı. Hastaların tamamında tek taraflı aşil tendon rüptürü mevcut idi. 18 hastada (%58) sağ aşil tendonu,13 hastada (%42) ise sol aşil tendonu rüptüre idi. Hastaların hiçbirisinde ek ortopedik patoloji yoktu. Hastalara görüldükleri ilk anda uzun bacak atel uygulandı ve sonrasında ameliyat edildiler. Ameliyat sonrası altı-sekiz hafta immobilizasyon uygulanan hastalara aşamalı ve standart bir rehabilitasyon programı uygulandı. Hastalar yaklaşık 24 ay ile 70 ay arasında takip edildiler (ortalama 44.6 ay). Takipler sonunda hastalar Percy/Conochie kriterlerine göre değerlendirildi, buna göre 14 hastada (%45) çok iyi, 10 hastada (%32) iyi, 6 hastada (%19) orta, 1 hastada (%3.2) ise kötü sonuç elde edildi. Hiçbir hastamızda komplet rerüptür, cilt nekrozu, sinus formasyonu, derin yumuşak doku enfeksiyonu gibi komplikasyonlara rastlanılmadı. Bir hastamızda (%3.2) tedavinin dördüncü ayında parsiyel rerüptür gelişti ve konservatif yöntemlerle tedavi edildi. Yine 4 hastamızda (%13) yüzeyel cilt enfeksiyonu gelişti ve bir hasta dışında oral antibiyotik tedavisi ile tedavileri yapıldı. Sonuç olarak aşil tendon yırtıklannın tedavisinde günümüzde hala ortak bir görüş birliği yoktur. Primer uç-uca tamir yöntemlerinden çeşitli tendon ve fasyaların augmentasyonlarıyla yapılan çok komplike ameliyat tekniklerine kadar bir çok yöntem tarif edilmiştir. Biz akut aşil tendon rüptürlerinde uç-uca tamir tekniğinin başarılı sonuçlar ortaya koyduğuna inanmaktayız.

Dr. D. Ali ÖÇGÜDER,
Dr. Erkan AKGÜN,
Dr. Murat DEMİRDÖGEN,
Dr. Tolga TOLUNAY,
Dr. Hasan OĞUR,
Dr. Bülent BEKTAŞER

Keywords

Aşil tendon rüptürü/ yaralanma/ cerrahi; uçuca tamir, augmentasyon, cerrahi

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