Halil BEKLER, TAHSİN BEYZA BEYZADEOĞLU, Alper GÖKÇE

Düşük ayak deformitesinde posterior tibial tendon transferi

Amaç: Düşük ayak deformitesi nedeniyle posterior tibial tendon (PTT) transferi uygulanan hastalar değerlendirildi. Çalışma planı: Düşük ayak deformitesi saptanan sekiz hastada (2 kadın, 6 erkek; ort. yaş 40; dağılım 15-75 yıl) PTT ayak dorsaline nakledildi. Üç hastada sol, beş hastada sağ alt ekstremitede tutulum vardı. Etyoloji altı hastada travmatik peroneal sinir yaralanması, iki hastada ise kalça ve bel cerrahisinin yol açtığı daha yüksek seviyeli sinir yaralanmalarıydı. Klinik sonuçları değerlendirirken, ilk olarak hastaların tedavi sonucuyla ilgili düşünceleri sorgulandı; daha sonra hastalar Yeap ve ark. tarafından PTT transferlerinden sonra önerilen Stanmore değerlendirme skalasına göre incelendi. Ortalama takip süresi 39 ay (dağılım 8-78 ay) idi. Sonuçlar: Stanmore skalasına göre üç hastada mükemmel, iki hastada iyi, iki hastada orta, bir hastada kötü sonuç alındı. Dört hasta durumunu mükemmel, üçü iyi, biri ise kötü olarak değerlendirdi. Kötü sonuç alınan olguda, politravma sekelli femur kırığı, asetabulum posterior kırıklı çıkığı, L3 kompresyon kırığı öyküsüyle birlikte, siyatik sinirde de en az iki seviyeli hasar vardı. Orta sonuç alınan iki hastanın birinde ameliyat sonrası yetersiz bakım nedeniyle, ayak dorsalinde transfer bölgesinde derin yangı gelişti. Kullanılmış olan dikişli ankor, bir bölüm kemik debridmanıyla birlikte çıkarıldı. Diğer hastada ise doğuştan olan spondilolistezis zemininde gelişen ve füzyon ameliyatını takiben ilerleyen ciddi paraparezi vardı. Çıkarımlar: Düşük ayak deformitesi tedavisinde PTT transferi, paraparezili ambulatuvar hastalarda dahi başarıyla uygulanabilen bir tekniktir. Bu hastalarda anterior tibial tendonun da işleme eklenmesi yararlı olabilir.

Anahtar Kelimeler:

Tedavi sonucu, Ayak deformitesi, edinsel, Tendon transferi, Peroneal nöropatiler

Tibialis posterior tendon transfer for drop foot deformity

Objectives: We evaluated tibialis posterior tendon (TPT) transfers in patients with drop foot deformity. Methods: Eight patients with drop foot deformity (2 females, 6 males; mean age 40 years; range 15 to 75 years) underwent TPT transfer to the dorsum of the foot. The deformity was on the left in three patients and on the right in five patients. Etiology was traumatic peroneal nerve injuries in six patients, and upper-level nerve injuries after hip and lumbar surgery in two patients. For clinical evaluation, the patients were questioned about the results of treatment, and the Stanmore evaluation scale was applied, which is recommended by Yeap et al. for TPT transfers. The mean follow-up period was 39 months (range 8 to 78 months). Results: According to the Stanmore scale, the results were excellent in three patients, good in two patients, fair in two patients, and poor in one patient. Subjectively, four patients defined their condition as excellent, three as good, and one as poor. One poor result was associated with polytrauma sequelae including a femoral fracture, posterior acetabular fracture-dislocation, and L3 compression fracture, accompanied by at least a two-level injury to the sciatic nerve. Of two patients with a fair result, one patient developed deep infection at the dorsum of the foot due to inadequate postoperative care and required removal of the suture anchor with partial bone debridement. The other patient had severe paraparesis associated with congenital spondylolisthesis, which aggravated following spinal fusion surgery. Conclusion: We conclude that TPT transfer is a successful technique for the treatment of drop foot even in ambulatory patients with paraparesis. Addition of tibialis anterior tendon transfer may be useful in these patients.

Keywords:

Treatment Outcome, Foot Deformities, Acquired, Tendon Transfer, Peroneal Neuropathies,

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