Ardayak Endoskopisi: Preoperatif Endikasyonların Perioperatif Endoskopik Bulgular ile Korelasyonu

Year 2018, Volume: 25 Issue: 1, 63 - 69, 30.03.2018

A. Meric Unal

https://doi.org/10.17343/sdutfd.391224

Abstract

Amaç: Bu çalışmanın amacı, ardayak
endoskopisi ile tedavi edilen patolojilerin değerlendirilmesi ve kombine patolojilerin
oranları ve tiplerinin saptanmasıdır. Çalışmanın bir diğer amacı ise operasyon
öncesi ve ardayak endoskopisi sırasında saptanan bulguların korelasyonudur.

Hastalar ve Metod: 2010-2015
yılları arasında ardayak endoskopisi uygulanan 77 hastanın 81 ayak bileği
değerlendirmeye alınmıştır. Tüm hastaların demografik bilgileri, preoperatif
fizik muayene ve radyolojik bulguları ve operasyon notları gözden
geçirilmiştir. Operasyon öncesi tüm hastalara standart ayak bileği fizik
muayene testleri uygulanmıştır. Yüklenmede ayak bilek ön-arka ve yan direkt
radyografileri alınmıştır. Manyetik rezonans görüntüleme, direkt radyografide
belirgin kemik sıkışması olan hastalar hariç tüm hastalara uygulanmıştır.
Ardayak endoskopisi tüm hastalara genel ya da spinal anestezi altında pron
pozisyonda van Dijk ve ark. tarafından tanımlanmış olan standart posteromedial
ve posterolateral portaller kullanılarak uygulanmıştır.

Sonuçlar: Bu olgu
serisinde en sık saptanan preoperatif endikasyonlar fleksör hallusis
longus  tendinopatisi(%27.1), semptomatik
os trigonum(%22.2) ve insersiyonel aşil tendinopatisi(%20.9) olarak
bulunmuştur. En sık saptanan endoskopik bulgular ise sırası ile fleksör
hallusis longus tendinopatisi(%33.3), semptomatik os trigonum(%19.3) ve
retrokalkaneal bursit(%16.2) olarak saptanmıştır. 16 hastada preoperatif
kombine patoloji saptanmıştır. 32 hastada ise ardayak endoskopisi sırasında
preoperatif endikasyonlara yeni bir endikasyon eklenmiştir.

Çıkarımlar: Ardayak
endoskopisinin en sık endikasyonları ayak bileği posterior sıkışma sendromu ve
aşil tendon çevresi patolojileri olarak belirtilebilir. Operasyon sırasında
saptanabilecek yeni endikasyonlar ve nadir durumlar konusunda uyanık olmak
gerekmektedir. 

Keywords

Ardayak endoskopisi, ayak bileği posterior sıkışma, endikasyonlar, aşil tendinopatisi

Hindfoot Endoscopy: Correlation of the Preoperative Indications with the Perioperative Endoscopic Findings

Abstract

Background: The aim
of this study was to review the disorders treated with hindfoot endoscopy and
investigate the detected ratio and type of combined pathologies. The second aim
was to evaluate the preoperative and peroperative findings before and at the
time of hindfoot endoscopy.

Patients and Methods: 81
hindfoot endoscopies of the 77 patients performed between 2010-2015 were
reviewed. Demographic informations, preoperative physical and radiological
findings and operative data of all patients were noted. Preoperative physical
examination for hindfoot was performed in a standart fashion for all patients. Weight-bearing
anteroposterior and lateral radiographs were taken for all patients. Magnetic
resonance imaging(MRI) was performed to all patients except obvious prescence
of bony impingement. The hindfoot endoscopy was performed to all patients at
prone position under either spinal or general anesthesia with standart
posteromedial and posterolateral portals described as Van Dijk et al.

Results: In this
case series; the most detected preoperative indications were flexor hallucis
longus tendinopathy(27.1%), symptomatic os trigonum(22.2%) as a cause of
posterior ankle impingement and insertional achilles tendinopathy(20.9%). The most
detected endoscopic findings were flexor hallucis longus
tendinopathy(33.3%),  symptomatic os
trigonum(19.3%), and retrocalcaneal bursitis(16.2%).16 patients(19.7%) had
preoperatively detected combined pathologies. In 32 patients(39.5%), a new
indication was added to preoperative indication.

Conclusion: Posterior
ankle impingement and peri-achilles pathologies are the most seen indications
for this technique. It is important that we all must aware of perioperatively
detected new indications and rare conditions.

Keywords

Hindfoot endoscopy, posterior ankle impingement, indications, posterior ankle arthroscopy, achilles tendinopathy

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