Total Diz Artroplastisi Sonrası Erken Dönemde Plantar Basınç Dağılımı Nasıl Değişir? Pilot Çalışma

Öz

Total diz artroplasti (TDA) cerrahisi sonrasında ayak tabanındaki statik ve dinamik yüklenme paternlerinin nasıl değiştiğini basınç platformu ile değerlendirmektir. Çalışmaya dahil olma kriterlerini karşılayan 10 hasta (yaş ortalaması 68.5±7.9) alındı. Değerlendirmeler cerrahi öncesinde ve cerrahi sonrası 15. günde yapıldı. Statik denge parametreleri (ayak ön-arka ve total yük dağılımları, sağ-sol ayaklardaki ağrılık taşıma oranı, basınç merkezi elips alanı ve salınım hızı) Zebris™ FDM-2 (zebris® Medical GmbH, Germany)  cihazı ile ölçülerek kaydedildi. Olguların yürüme sırasında hasta tarafta arka ayakta oluşan maksimum kuvveti, bu kuvvetin oluştuğu yürüme siklusundaki zaman yüzdesi ile orta ayak maksimum basınç değerleri anlamlı olarak azaldığı bulundu (p<0,05). Olguların ayak rotasyon dereceleri cerrahi sonrası azaldığı fakat bu azalmanın istatistiksel olarak anlamlı olmadığı görüldü. Olguların, ayakta statik duruşta, ayağa binen toplam yük, elips alanı, basınç merkezi (center of pressure (COP)) çizgi uzunluğu ve COP ortalama hızı cerrahi öncesi ve sonrası ölçüm değerleri arasında anlamlı bir fark bulunmadı (p>0,05). Hasta tarafta ayakta duruşta ön ayağa binen yük ölçüm değerleri cerrahi sonrası anlamlı olarak artarken, arka ayağa binen yük ölçüm değerleri anlamlı derecede azaldığı görüldü (p<0,05). TDA cerrahisi geçiren diz osteoartritli hastalarda cerrahi sonrası 15. günde statik duruş sırasında arka ayağa binen yük azalmış, ön ayağa binen yük artmıştır. Cerrahi öncesi ve sonrası kuvvet platformu kullanılarak yapılan değerlendirmeler, ortopedik cerrahlar için yararlı olabilir çünkü diz uyumunu düzeltmek için kullanılan TDA cerrahisi, erken dönemde yükleme parametrelerini de etkilemektedir.

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Anahtar Kelimeler

• ayak; diz osteoartriti; pedobarografi; total diz artroplastisi; yürüme analizi.

How does Plantar Pressure Distribution Change Early after Total Knee Arthroplasty? A Pilot Study

Öz

To evaluate how the static and dynamic plantar overload distribution patterns change following total knee arthroplasty (TKA) surgery using a pressure platform. Ten patients who met the inclusion criteria were included (mean age 68.5±7.9 years). Evaluations were performed prior to the surgery and on the 15th day after the surgery. Static balance parameters (anterior-posterior and total load distribution of the foot, ratio of weight bearing of the right and left foot, elliptic area of the pressure center and oscillation speed) were measured and recorded by  Zebris™ FDM-2 (Zebris® Medical GmbH, Germany) device. Maximum strength produced in the posterior foot during walking, time percent of the walking cycle produced by this strength and middle foot maximum pressure values were found to be significantly decreased (p<0,05). Rotation degrees of the foot were found to be decreased in the patients, though not statistically significant. No significant differences were found in the total weight load on the foot, elliptic area, center of pressure (COP), line length and mean COP rate during static standing between the pre-surgical and post-surgical measurement results (p>0,05). Weight load measurement values on the forefoot of the opere side during standing were found to be significantly increased following surgery, while the weight load on the rear foot was found to be significantly decreased (p<0,05).  The weight load on the rear foot and forefoot upon static stance was decreased and increased, respectively 15 days after the surgery in patients who underwent TKA surgery. The evaluations using force platform before and after surgery may be useful for orthopedic surgeons because TKA surgery used to correct knee alignment also affect loading parameters in early period.

Kaynakça

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