S. Sinan BİLGİN, K. Çağrı KÖSE, Sinan ADIYAMAN, MEHMET DEMİRTAŞ

Ayak bileği lezyonlarında artroskopik cerrahinin erken dönem fonksiyonel sonuçları

Amaç: Ayak bileği patolojilerinde artroskopik tedavinin erken dönemdeki fonksiyonel sonuçlan incelendi. Çalışma planı: Ayak bileği artroskopisi yapılan 32 hasta (15 kadın, 17 erkek; ört. yaş 35; dağılım 17-54) incelendi. Yirmi bir olguda talusta ostekondritis dissekans (OKD), altı olguda izole sinovit, dört olguda sıkışma sendromu, bir olguda sinovyal kondromatozis vardı. On beş hastanın sol, 17 hastanın sağ ayak bileğine girişim yapıldı. Osteokondral lezyonlar radyografik olarak BerndtHarty, artroskopik görüntüler Ferkel-Cheng sınıflamasına göre; ameliyat öncesi ve sonrası fonksiyonel durum Freiburg ayak bileği skorlama sistemiyle değerlendirildi. Ortalama izlem süresi 42 aydı (dağılım 11-84 ay). Sonuçlar: Ameliyat öncesi Freiburg skorları ortalaması 66 olan OKD'li hastaların hiçbirinde ameliyat sonrası ilk dokuz haftada skorlarda iyileşme görülmedi. Ameliyattan 3.5 ay sonraki skorlarda ise belirgin iyileşme (ört. 88) vardı. İlk dokuz haftada ortalama skor, sinovitli hastalarda 72'den 90'a, sıkışma sendromlu hastalarda 80'den 95'e yükseldi. Sinovyal kondromatozisli olguda ameliyat sonrası ikinci ayda tüm semptomlar kayboldu (skor 100). Komplikasyon olarak, bir hastada drilleme sırasında drill ucu kırıldı; bir diğer hastada ameliyat sonrasında refleks sempatik distrofi gelişti. Çıkarımlar: Ayak bileği artroskopisi, özellikle OKD, sinovit ve sıkışma sendromu olan olgularda morbiditeyi belirgin olarak azaltan, fonksiyonel iyileşmeyi hızlandıran bir tekniktir.

Anahtar Kelimeler:

Ayak bileği eklemi, Artroskopi, Manyetik rezonans görüntüleme, Subtalar eklem, Hareket açıklığı, eklem, Osteokondritis dissekans

Early functional results of arthroscopic surgery for ankle lesions

Objectives: We evaluated early functional results of arthroscopic surgery in the treatment of ankle pathologies. Methods: A total of 32 patients (17 males, 15 females; mean age 35 years; range 17 to 54 years) underwent arthroscopic surgery for ankle lesions, which included osteochondritis dissecans (n=21), synovia's (n=6), impingement syndrome (n=4), and synovial chondromatosis. Arthroscopic-surgery was performed in the left ankle in 15 patients, and in the right ankle in 17 patients. Osteochondral lesions were assessed by the Berndt-Harty, arthroscopic views by the Ferkel-Cheng classification systems. Preoperative and postoperative functional evaluations were made using the Freiburg ankle scoring system. The mean follow-up was 42 months (range 11 to 84 months). Results: There was no improvement in Freiburg scores within nine weeks in patients with osteochondritis dissecans, whose preoperative mean score was 66. However, at the end of 3.5 months, the Freiburg scores manifested a marked increase to a mean of 88. Functional scores increased from 72 to 90, and from 80 to 95 in patients with synovitis and impingement syndrome, respectively, at the end of nine weeks. The patient with synovial chondromatosis became symptom-free after two months. Complications included breakage of a drill in one patient and development of reflex sympathetic dystrophy in another. Conclusion: Arthroscopic surgery for ankle lesions decreases surgical morbidity and promotes functional improvement, especially in patients with osteochondritis dissecans, synovitis, and impingement syndrome.

Keywords:

Ankle Joint, Arthroscopy, Magnetic Resonance Imaging, Subtalar Joint, Range of Motion, Articular, Osteochondritis Dissecans,

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