Diz çevresi deformiteleri tedavisinde Taylor spatial frame’in etkinliği

Yıl 2013, Cilt: 47 Sayı: 2, 86 - 90, 26.04.2013

Sami Sokucu Ozgur Karakoyun Yavuz Arikan Metin Kucukkaya Yavuz Kabukcuoglu

Öz

Amaç: Bu çalışmanın amacı Taylor spatial frame (TSF) ile diz çevresi deformitelerinin tamamen düzeltilip düzeltilemeyeceğini ve diz çevresi deformitelerinde TSF uygulamasının kolay ve güvenli bir tedavi şekli olup olmadığını belirlemekti.
Çalışma planı: Diz eklemi çevresinde deformitesi olan ve TSF ile tedavi edilen 37 hastanın (ortalama yaş: 23, dağılım: 10-58) 50 alt ekstremitesi geriye dönük olarak değerlendirildi. Bu ekstremitelerin 33 tanesinde tibial, 17’sinde femoral deformiteler mevcuttu. Tüm hastalara operasyon öncesi standart ön-arka, lateral grafiler çekildi ve ayakta çekilen boy grafilerinde ölçümleri yapıldı. Ayakta çekilen boy grafilerinde mekanik aks sapması, bacak boyu eşitsizliği, lateral femoral distal açı (LFDA) ve medial proksimal tibial açı (MPTA) ölçümleri yapıldı. Tüm ölçümler eksternal fiksatör çıkarıldıktan sonra tekrarlandı.
Bulgular: TSF ile geçirilen ortalama süre 20.3 (dağılım: 4-36) hafta idi. Eksternal fiksatörün çıkarılmasından sonraki ortalama takip süresi 32 (dağılım: 15-54) ay olarak bulundu. Tüm deformiteler TSF ile tam olarak tedavi edildi İki vaka dışndaki tüm olgularda konsolidasyon sağlandı; bu 2 olguda kemik greftine ihtiyaç duyuldu.
Çıkarımlar: Sonuç olarak, diz çevresindeki translasyon ve rotasyon ile komplike olmuş büyük deformitelerde TSF’nin güvenli ve etkin bir tedavi yöntemi olduğunu düşünmekteyiz.

Anahtar Kelimeler

Deformite; diz; Taylor spatial frame; tedavi.

Efficacy of the Taylor spatial frame in the treatment of deformities around the knee

Öz

Objective: The aim of this study was to determine whether the Taylor spatial frame (TSF) can precisely correct deformities around the knee and whether application of TSF is easy and safe for treatment of the deformities around the knee.
Methods: This study included 50 retrospectively reviewed limbs of 37 patients (mean age: 23 years, range: 10 to 58 years) with deformity around the knee joint treated using the TSF. Thirty-three limbs had tibial and 17 femoral deformities. Preoperative standard anteroposterior, lateral radiographs and standing orthoroentgenographic measurements were taken for each patient. Mechanical axis deviation (MAD), leg-length discrepancy (LLD) and lateral femoral distal angle (LDFA) and medial proximal tibial angle (MPTA) were measured from standing orthoroentgenographics. All measurements were repeated after external fixator removal.
Results: The frame was applied for an average of 20.3 (range: 4 to 36) weeks. Mean follow-up time following removal of external fixator was 32 (range: 15 to 54) months. An effective and accurate correction was achieved in all cases. Solid bone consolidation was obtained in all but two cases which underwent bone grafting.
Conclusion: Taylor spatial frame appears to be a safe and effective method for the gradual correction of the complex translational and rotational deformities around the knee.

Anahtar Kelimeler

Deformity, knee, Taylor spatial frame, treatment

Kaynakça

• Tetsworth K, Paley D. Malalignment and degenerative arthropathy. Orthop Clin North Am 1994;25:367-77.
• Feldman DS, Shin SS, Madan S, Koval KJ. Correction of Tibial malunion and nonunion with six-axis analysis deformity correction using the Taylor Spatial Frame. J Orthop Trauma 2003;17:549-54.
• Naqui SZ, Thiryayi W, Foster A, Tselentakis G, Evans M, Day JB. Correction of simple and complex pediatric deformi- ties using the Taylor-Spatial Frame. J Pediatr Orthop 2008; 28:640-7.
• Manner HM, Huebl M, Radler C, Ganger R, Petje G, Grill F. Accuracy of complex lower-limb deformity correction with external fixation: a comparison of the Taylor Spatial Frame with the Ilizarov ring fixator. J Child Orthop 2007;1: 55-61.
• Rozbruch SR, Helfet DL, Blyakher A. Distraction of hyper- trophic nonunion of tibia with deformity using Ilizarov/ Taylor Spatial Frame. Report of two cases. Arch Orthop Trauma Surg 2002;122:295-8.
• Marangoz S, Feldman DS, Sala DA, Hyman JE, Vitale MG. Femoral deformity correction in children and young adults using Taylor Spatial Frame. Clin Orthop Relat Res 2008; 466:3018-24.
• Rozbruch SR, Segal K, Ilizarov S, Fragomen AT, Ilizarov G. Does the Taylor Spatial Frame accurately correct tibial deformities? Clin Orthop Relat Res 2010;468:1352-61.
• Ilizarov GA. Transosseous osteosynthesis. New York: Springer Verlag; 1992. p. 287-543.
• Eidelman M, Bialik V, Katzman A. Correction of deformities in children using the Taylor spatial frame. J Pediatr Orthop B 2006;15:387-95.
• Saleh M, Royston S. Management of nonunion of fractures by distraction with correction of angulation and shortening. J Bone Joint Surg Br 1996;78:105-9.
• Rogers MJ, McFadyen I, Livingstone JA, Monsell F, Jackson M, Atkins RM. Computer hexapod assisted orthopaedic sur- gery (CHAOS) in the correction of long bone fracture and deformity. J Orthop Trauma 2007;21:337-42.
• Sluga M, Pfeiffer M, Kotz R, Nehrer S. Lower limb defor- mities in children: two-stage correction using the Taylor spatial frame. J Pediatr Orthop B 2003;12:123-8.
• Fadel M, Hosny G. The Taylor spatial frame for deformity correction in the lower limbs. Int Orthop 2005;29:125-9.
• Ganger R, Radler C, Speigner B, Grill F. Correction of post- traumatic lower limb deformities using the Taylor spatial frame. Int Orthop 2010;34:723-30.
• Nakase T, Kitano M, Kawai H, Ueda T, Higuchi C, Hamada M, et al. Distraction osteogenesis for correction of three-dimensional deformities with shortening of lower limbs by Taylor Spatial Frame. Arch Orthop Trauma Surg 2009;129:1197-201.
• Bar-On E, Weigl DM, Becker T, Katz K. Treatment of severe early onset Blount’s disease by an intra-articular and a meta- physeal osteotomy using the Taylor Spatial Frame. J Child Orthop 2008;2:457-61.