İhmal edilmiş yetişkin çarpık ayak deformitesinin tedavisinde tek seansta yapılan üçlü artrodez ve posteromedial gevşetmenin orta dönem sonuçları

Yıl 2015, Cilt: 49 Sayı: 2, 175 - 183, 22.05.2015

Orhan Akinci Yavuz Akalin

https://doi.org/10.3944/AOTT.2015.13.0019

Öz

Amaç: İhmal edilmiş çarpık ayak deformitelerinde aynı seansta uygulanan posteromedial gevşetme ve üçlü artrodezin orta dönem sonuçlarını literatür eşliğinde değerlendirmek.

Çalışma planı: On bir hastanın (4 kadın, 7 erkek; ortalama yaş 26, dağılım [15–50]) 15 ayağına aynı seansta posteromediyal gevşetme ve üçlü artrodez uygulandı. Tüm hastalara U çivisi ile internal fiksasyon yapıldı. Klinik değerlendirmede AOFAS (American Orthopaedic Foot and Ankle Society) tarafından tanımlanan ayak bileği-ard ayak klinik skorlaması kullanıldı. Radyolojik değerlendirme, ön arka ve yan çekilen grafiler üzerinde talokalkaneal ile talus-1.metatars açılarının ölçümleri ile yapıldı. Ortalama izlem 7.5 yıldı (dağılım, 6–11).

Bulgular: Ameliyat öncesi ortalama 39 (dağılım, 15–52) olan AOFAS skoru, son değerlendirmede 88 (dağılım, 76–94) olarak bulundu (p<0.0001). AOFAS skorlaması ile birlikte fonksiyonel ve kozmetik değerlendirmeler göz önüne alındığında sonuçlar, 15 ayağın dokuzunda çok iyi, beşinde iyi ve birinde orta olarak bulundu. Son kontrollerde radyolojik değerlerin normal fizyolojik sınırlarda olduğu görüldü. Ameliyat öncesi ile ameliyat sonrası arasında anlamlı klinik ve radyolojik düzelme elde edildi. Ortalama kaynama zamanı 12.4 (dağılım 7–36) hafta idi. Psödoartroza hiçbir hastada rastlanmazken iki hastada kaynama gecikmesi, bir hastada da talusta avasküler nekroz gelişti. Ameliyat öncesi dönemde hastaların beşinde ayakbileğinde değişik derecelerde dejeneratif değişiklikler vardı. Son kontrollerde dokuz hastanın farklı eklemlerinde ve farklı derecelerde dejeneratif değişikliklerin geliştiği görüldü.

Çıkarımlar: İhmal edilmiş idyopatik çarpık ayak deformitelerinde tek seansta uygulanan posteromedial gevşetme ile birlikte üçlü artrodezin fonksiyonel ve kozmetik sonuç elde etmede etkili bir yöntem olduğu görüşündeyiz.

 

Anahtar Kelimeler

İhmal edilmiş çarpık ayak; posteromedial gevşetme; üçlü artrodez.

Medium-term results of single-stage posteromedial release and triple arthrodesis in treatment of neglected clubfoot deformity in adults

Öz

Objective: This study aimed to evaluate the implementation, in a single session, of both massive posteromedial release and triple arthrodesis for rigid neglected clubfoot deformities in adult patients, and its effects on clinical and radiological results.

Methods: The procedures were performed in one session on 15 feet of 11 patients [7 male, 4 female; mean age 26 (range: 15 to 50)]. Staples were used for fixation in all patients. For clinical assessment, the AOFAS (American Orthopaedic Foot and Ankle Society) ankle- hindfoot scale was used.

Anteroposterior/lateral side talocalcaneal and talus-1st metatarsal angles were used as radiographic parameters. The mean follow-up was 7.5 years (range: 6 to 11).

Results: The mean AOFAS score rose from a preoperative 39 (range: 15 to 52) to 88 (range: 76 to 94) in the final follow up (p<0.0001). Among the 15 feet, 9 were evaluated as excellent, 5 as good, and 1 as fair. Significant clinical improvement was obtained between preoperative and postoperative surgical periods (p<0.05). Significant improvements were observed in radiographic parameters (p<0.0001).

At final follow-up, radiographic values were within normal physiological limits. Average union time was 12.4 (range: 7 to 36) weeks. While pseudoarthrosis was not observed in any patients, delayed union developed in 2 cases, and talus avascular necrosis in 1. In the preoperative period, 5 patients had various degrees of degenerative changes. Nine patients developed degenerative changes in different joints and of different degrees.

Conclusion: The authors believe that massive soft tissue release and triple arthrodesis performed in a single session yields satisfactory results cosmetically and functionally in neglected clubfoot cases with severe deformities.

Anahtar Kelimeler

Neglected clubfoot, posteromedial release, triple arthrodesis

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