Ahmet DOĞAN, Onat ÜZÜMCÜGİL, Merter YALÇINKAYA, Gazi ZORER

Doğuştan çarpık ayak cerrahi tedavisinde abdüktör hallusis tendon gevşetmesinin cerrahi sonrası adduktus deformitesi üzerine etkisi

Amaç: Doğuştan çarpık ayak deformitesinin cerrahi tedavisinde abdüktör hallusis (AH) tendon gevşetmesinin cerrahi sonrası adduktus deformitesi üzerine etkisi araştırıldı. Çalışma planı: Çalışmaya doğuştan çarpık ayak deformitesi olan 35 hasta alındı. On üç hastada (grup 1, 21 ayak) klasik tam subtalar gevşetme ameliyatı uygulandı. Yirmi iki hastada (grup 2, 31 ayak) ise ek olarak AH kası tamamıyla plantara sıyrıldı ve distal tendinöz kısmından kesildi. Ortalama yaş grup 1’de 19.4 ay (dağılım 13-39 ay), grup 2’de ise 13.5 ay (dağılım 11-25 ay) idi. Ortalama takip süresi grup 1’de 55.5 ay (dağılım 36-77 ay), grup 2’de 24.7 ay (dağılım 10-37 ay) idi. Ön-arka talus-birinci metatars açısı ve kalkaneoküboid ilişki ameliyat öncesi, ameliyat sonrası erken dönem ve son takip radyografilerinde değerlendirilirken, ön-arka navikülometatarsal açı ve ön-arka talonaviküler ilişki son takip radyografilerinde değerlendirildi. Sonuçlar: Ameliyattan sonra erken dönemde iki grupta da ön-arka talus-birinci metatars açısında anlamlı düzelme görüldü (p0.05). Bu açı erken dönem ve son kontrolde iki grup arasında anlamlı fark göstermedi (p>0.05). Ön-arka navikülometatarsal açı grup 1’de 95.3 derece, grup 2’de 96.7 derece bulundu. Ön-arka navikülometatarsal açı ve ön-arka talonaviküler subluksasyon iki grupta benzer bulundu (p>0.05). Kalkaneoküboid ilişki her iki grupta da ameliyat sonrası erken dönem ve son kontrollerde anlamlı düzelme gösterirken, bu açıdan gruplar arasında fark yoktu (p>0.05). Çıkarımlar: Doğuştan çarpık ayak deformitesinin cerrahi tedavisinde AH kasının serbestleştirilmesi, cerrahi sonrası adduktus deformitesi oranını etkilememektedir.

Anahtar Kelimeler:

Süt çocuğu, Çarpık ayak, Çocuk, okul öncesi, Ortopedik işlemler, Ayak deformitesi, doğuştan

The effect of abductor hallucis tendon release on residual adductus deformity in the surgical treatment of congenital clubfoot

Objectives: We evaluated the effect of abductor hallucis (AH) tendon release on residual adductus deformity in the surgical treatment of congenital clubfoot. Methods: The study included 35 patients with congenital clubfoot. Thirteen patients (group 1, 21 feet) underwent classical complete subtalar release, while 22 patients (group 2, 31 feet) underwent the same treatment combined with AH muscle release by stripping it plantarward and transecting it distally. The mean age was 19.4 months (range 13 to 39 months) in group 1, and 13.5 months (range 11 to 25 months) in group 2. The mean follow-up period was 55.5 months (range 36 to 77 months) in group 1, and 24.7 months (range 10 to 37 months) in group 2. Radiographic assessments were made on preoperative, early postoperative, and final radiographs for the anteroposterior talo-first metatarsal angle and calcaneocuboid relationship, and for the anteroposterior naviculometatarsal angle and talonavicular relationship on final radiographs. Results: Both groups showed significant improvement in the anteroposterior talo-first metatarsal angle in the early postoperative period (p0.05). The anteroposterior naviculometatarsal angle was 95.3 degrees in group 1, and 96.7 degrees in group 2. The anteroposterior naviculometatarsal angle and talonavicular subluxation were similar in the two groups (p>0.05). The early and late postoperative calcaneocuboid relationship showed significant improvement in both groups, without a significant difference between the groups (p>0.05). Conclusion: It seems that release of the AH muscle does not affect the incidence of postsurgical residual adduction deformity in the surgical treatment of congenital clubfoot

Keywords:

Infant, Clubfoot, Child, Preschool, Orthopedic Procedures, Foot Deformities, Congenital,

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