Fadel NAİM, Aykın ŞİMŞEK, SERKAN SİPAHİOĞLU, Erdinç ESEN, GÖKHAN ÇAKMAK

Aşil tendon yırtıklarında cerrahi tedavi sonuçlarının yürüme analizi ve kas gücü ölçümüyle değerlendirilmesi

Amaç: Aşil tendonu yırtığı nedeniyle cerrahi tedavi uygulanan hastalarda uzun dönem sonuçlar değerlendirildi. Çalışma planı: Aşil tendonu yırtığı nedeniyle 15:erkek hastaya (ort. yaş 39.5; dağılım 28-58) cerrahi tedavi uygulandı. Bir olgu dışında, tüm yaralanmalar aktif spor yaparken oluşmuştu. On bir hasta travmadan sonra bir hafta içinde ameliyat edildi. Ameliyattan dört hafta sonra alçı sonlandırılarak dorsifleksiyona izin vermeyen polietilen "splint uygulandı. Kısmi yük vermeye dördüncü haftadan itibaren başlandı. Hastalar Thermann ve ark.nın skorlama sistemiyle objektif ve sübjektif olarak değerlendirildi. İzokinetik dinamometre ile kas gücü ölçüldü ve yürüme analizi yapıldı. Sonuçlar sağlam ayaklardan elde edilen verilerle karşılaştırıldı. Ortalama izlem süresi 16.8 ay (dağılım 8-48 ay) idi. Sonuçlar: Yedi hasta (%46.7) hiç ağrı olmadığını, altı hasta (%40) ağır, bir hasta (%67) orta ağır, bir hasta (%67) da hafif antrenman sırasında ağrı olduğunu belirtti. Dokuz hastada (%60) güç azalması hiç olmadı. Yedi hasta (%46.7) yaralanma öncesindeki aktivite düzeyine ulaştı. Sübjektif değerlendirmede, 12 hasta (%80) uygulanan tedavinin çok iyi veya iyi oldu¬ğunu belirtti. Objektif ölçümlerde ameliyatlı taraf, karşı taraf¬tan ortalama 0.43 cm incelmiş bulundu. Sonuçlar dokuz hastada (%60) çok iyi veya iyi, dördünde (%26.7) orta, ikisinde (%133) kötü idi. Bir hastada yüzeyel enfeksiyon ve yara iyileşmesi sorunu izlendi. İzokinetik ölçümlerde zirve torkta azalma, toplam işte ise artma gözlendi. Yürüme analizinde dorsifleksiyon veya plantar fleksiyon farkı ile önayakta yer tepkimesi kuvveti farkı arasında anlamlı ilişki bulunmadı. Çıkarımlar: Aşil tendonu yırtılmalarında erken uygulanan cerrahi tedavi, kısa süreli immobilizasyon ile birlikte iyi sonuç vermekte, uzun dönemde hasta memnuniyeti yüksek olmaktadır.

Anahtar Kelimeler:

Cerrahi işlemler, operatif, Aşil tendon, Tendon yaralanmaları, Yırtık

Evaluation of the surgical results of achilles tendon ruptures by gait analysis and isokinetic muscle strength measurements

Objectives: We evaluated the long-term results of surgical treatment of Achilles tendon ruptures. Methods: Fifteen male patients (mean age 39.5 years; range 28 to 58 y^rs) underwent surgery for Achilles tendon ruptures. All the rupftires but one occurred during sport recreations. Eleven patients were treated within the first week of trauma. After surgery, a cast was applied for four weeks, after which it was switched to a polyethylene splint that did not allow dorsiflexion. Partial weight bearing was allowed in the fourth postoperative week. Subjective and objective evaluations were made according to the system by Thermann et al. Muscle strength was measured by an isokinetic dinamometer and gait analysis was performed. Data from the healthy sides were used for comparisons. The mean follow-up was 16.8 months (range 8 to 48 months). Results: Seven patients (46.7%) had no pain, while six patients (40%), one patient (6.7%), and one patient complained of pain during heavy, medium, and light sports activities, respectively. Muscle strength did not decrease in nine patients (60%). Seven patients (46.7%) returned to preinjury activity levels. Twelve patients (80%) evaluated the outcome as very good or good. The mean muscle atrophy on the affected side was 0.43 cm. The overall results were very good or good in nine patients (60%), moderate in four patients (26.7%), and poor in two patients (13.3%). One patient had superficial infection and delayed heal¬ing. Isokinetic measurements showed decreased peak torque, and increased total work. By gait analysis, no significant relationship was found between the dorsiflexion and plantar flexion difference and forefoot ground reaction forces. Conclusion: Early surgical treatment of Achilles tendon ruptures followed by a shorter immobilization period is associated with satisfactory results, and in the long-term, with a higher rate of patient satisfaction.

Keywords:

Surgical Procedures, Operative, Achilles Tendon, Tendon Injuries, Rupture,

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