Results of combined split transfer of tibialis anterior tendon and intramuscular lengthening of tibialis posterior tendon for foot varus deformity because of cerabral palsy

Yıl 2014, Cilt: 21 Sayı: 1, 1 - 6, 12.03.2014

H. Yener Erken , Davud Yasmin Halil Burç , İbrahim Akmaz Ahmet Kıral

Öz

Results of combined split transfer of tibialis anterior tendon and intramuscular lengthening of tibialisposterior tendon for foot varus deformity because of cerabral palsyAim: The aim of the study is represent 3 years follow-up results after split transfer of tibialis anterior tendonand intramuscular lengthening of tibialis posterior tendon together for foot varus deformity due to cerabralpalsy. Patients and Method: Twelve patients who have foot varus deformity due to cerebral palsy wereincluded in the study between 2008-2012 prospectively. Mean age was 8.1. Secondary to combined splittransfer of tibialis anterior tendon and intramuscular lengthening of tibialis posterior tendon percutaneousachilles lengthening for 9 patients and open achilles lengthening for 2 patients were applied simultaneously.Functions and clinical results were evaluated according to AOFAS (American Orthopaedic Foot and AnkleSociety) score and Kling et al scoring system respectively. Results: Mean follow-up was 29.3 months. Accordingto Kling et al score 7 patients were excellent, 4 were good and 1 were poor. Patients with excelent and goodresults had platigrade posture. Operated 17 feet at 12 patients had mean preop and last follow-up AOFASscore were 35.8 and 81.4 respectively. The diffence was statistically significant (p=0.023). Discussion: Combined split transfer of tibialis anterior tendon and intramuscular lengthening of tibialis posterior tendon methodhas found as an effective technique for dynamic varus foot deformity of cerebral palsy during both stanceand swing phase of gait

Anahtar Kelimeler

Cerebral palsy, tibialis anterior tendon, tibialis posterior tendon, split transfer

SEREBRAL PALSİ'YE BAĞLI AYAK VARUS DEFORMİTELERİNDE KOMBİNE TİBİALİS ANTERİOR TENDONU SPLİT TRANSFERİ VE TİBİALİS POSTERİOR TENDONU'NUN İNTRAMUSKÜLER UZATILMASI SONUÇLARI

Öz

Amaç: Bu çalışmanın amacı Serebral Palsi'ye bağlı gelişen ayak varus deformitelerinin tedavisinde kombine olarak Tibialis Anterior Tendonu split transferin ve Tibialis Posterior Tendonu İntramüsküler uzatma yönteminin 3 yıllık takip sonuçlarını bildirmektir.
Hastalar ve Yöntem: 2008-2012 arasında serebral palsi'ye bağlı ayak varus deformitesi olan 12 hasta prospektif olarak değerlendirildi. Hastaların ortalama yaşı 8,1 idi. Kombine anterior tibial tendon split transferi ve posterior tibial tendonun intramüsküler uzamasına ek olarak aynı seansta 11 hastanın, 9'una aşil tendona perkütan , 2'sine açık uzatma uygulandı. Ayrıca 4 hastada harmstring ve 1 hastada fleksör hallucis longus ve fleksör digitorum longus uzatıldı. Hastaların fonksiyonları operasyon öncesi ve sonrası AOFAS (American Orthopaedic Foot and Ankle Society) skorları ile değerlendirildi. Klinik sonuçların değerlendirilmesinde Kling ve ark. tariflediği sınıflandırma kullanıldı.
Sonuçlar: Hastalar ortalama 29.3 ay takip edildi. Kling sınıflamasına göre 12 hastanın 7'sinde mükemmel, 4'ünde iyi, 1'inde sonuçlar kötü olarak değerlendirildi. Mükemmel ve iyi sonuç elde edilen hastalarda plantigrad basma elde edildi. Oniki hastanın cerrahi uyguladığımız 17 ayağının işlem öncesi ortalama AOFAS skoru 35.8 iken son takiplerinde ortalama 81.4 olarak bulundu. Aradaki fark istatistiksel olarak anlamlı bulundu (p=0.023).
Tartışma: Yürümenin hem duruş, hem salınım fazında serebral palsi'ye bağlı dinamik varus deformitesi olanlarında kombine olarak tibialis anterior split transferi ve tibialis posteriorun intramüsküler uzatılması tekniği literatürde belirtildiği gibi çalışmamızda da efektif bir metod olarak bulunmuştur.

Anahtar Kelimeler

Serebral palsi, tibialis anterior tendon, tibialis posterior tendon, split transfer

Kaynakça

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