Total diz artroplastisinde ve tibial dizilimde ekstansör hallusis longus tendonunun distal referans noktası olarak kullanılması

Öz

Amaç:Bu çalışmada, total diz artroplastisinde (TDA) kanal dışı kılavuz sistemlerinde ekstansör hallusis longus (EHL) tendonu ve ikinci metatars referanslı tekniklerin tibial dizilimin üzerindeki etkilerinin karşılaştırılması amaçlandı.

Çalışma planı: Çalışmada 2004 ve 2008 yılları arasında primer TDA yapılmış 79 hastaya ait 100 radyografi incelendi. Hastalar ameliyat sırasında kullanılan distal anatomik referans noktasına göre gruplandırıldılar. EHL referanslı teknik (ERT) grubunda ortalama yaşı 68.3 (dağılım: 56-82) olan 36 hasta yer alırken, ikinci metatars referanslı teknik (MRT) grubundaki 43 hastanın yaş ortalaması 70.2 (dağılım: 54-78) idi. ERT grubunda 47, MRT grubunda 53 komponent yer almaktaydı. Tibial komponentlerin frontal dizilimleri ölçüldü. 90±2° derecelik açılanmalar normal kabul edilirken bu değerin üzerindekiler ‘varus’, altındakiler ise ‘valgus’ olarak işaretlendi.

Bulgular: Ortalama frontal dizilim MRT ve ERT gruplarında, sırası ile, 88.57° ve 89.17° idi. ERT grubunda normal aralıktaki tibial komponentlerin sayısı anlamlı olarak fazlayken (p=0.017) , varus dizilimli komponent sayısı anlamlı olarak düşüktü (p=0.024). İki grup arasında valgus dizilimli normal dağılım dışı değerler açısından anlamlı bir farklılık görülmedi (p=1.000).

Çıkarımlar: Ekstansör hallusis longus tendonunun kullanımı tibial komponentin koronal plandaki dizilimini iyileştirmektedir. EHL tendonu kılavuz dışı sistemlerle güvenle kullanılabilecek bir anatomik referans noktasıdır.

Anahtar Kelimeler

• Anatomik referans noktası; ekstansör hallusis longus tendonu; kanal içi kılavuz; koronal tibial dizilim; total diz artroplastisi.

The extensor hallucis longus tendon as the distal reference point in total knee arthroplasty and tibial alignment

Öz

Objective:The aim of this study was to compare the effects on tibial alignment of the use of the extensor hallucis longus (EHL) tendon with the use of the 2nd metatarsal as a reference in total knee arthroplasty (TKA) using the extramedullary technique.

Methods: The study evaluated 100 postoperative radiographs of 79 patients who underwent primary TKA between 2004 and 2008. Patients were grouped according to the distal anatomical landmark used during surgery. There were 36 patients (mean age: 68.3 years, range: 56 to 82 years) in the EHL-referenced (ERT) group and 43 patients (mean age: 70.2 years, range: 54 to 78 years) in the 2nd metatarsal-referenced (MRT) group. There were 47 components in the ERT group and 53 in the MRT group. Frontal alignments of the tibial components were measured. Angles of 90±2° were accepted as the normal boundaries while those above that value were labeled as ‘varus’ and those below as ‘valgus’.

Results: Average frontal alignment was 88.57° in the MRT group and 89.17° in the ERT group. The number of tibial components in the normal range was significantly higher (p=0.017) and the number of varus-oriented components significantly lower (p=0.024) in the ERT group. There were no significant differences in valgus-oriented outliers between groups (p=1.000).

Conclusion: The use of the EHL tendon as a reference improves coronal tibial alignment. The EHL is a reliable anatomical landmark to use with extramedullary guide systems.

Anahtar Kelimeler

• Anatomical landmark
• coronal tibial alignment
• extensor hallucis longus tendon
• extramedullary guide
• total knee arthroplasty

Kaynakça

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