Türker ÖZKAN, Serdar TUNCER, KAHRAMAN ÖZTÜRK, Atakan AYDIN, Safiye ÖZKAN

Düşük ayak deformitesinin posterior tibial tendon transferi ile düzeltilmesi

Amaç: Düşük ayağın cerrahi tedavisinde posterior tibial tendonun ayak bileği önünde felçli tendonlara transferi, sadece felç olmuş kasların işlevini restore etmekle kalmamakta, aynı zamanda ayağın medialindeki deforme edici kuvveti de ortadan kaldırmaktadır. Çalışmamızda düşük ayak nedeniyle posterior tibial tendon transferi uygulanan olgular değerlendirildi. Çalışma planı: Düşük ayak sorunu nedeniyle posterior tibial tendon transferi yapılan 41 hasta (24 erkek, 17 kadın; ort. yaş 32; dağılım 11-73) çalışmaya alındı. Olgularda ortalama paralizi süresi 51.5 aydı (dağılım 4-240 ay). Ameliyat öncesi düşük ayak açısı ortalama 30.9° (dağılım 15°-55°) idi. Posterior tibial tendonu, insersiyon noktasından ayırılıp kruris orta hatta proksimale, sonra da sirkumtibial yoldan ayak dorsaline taşınarak iki dala ayırıldı. Dallardan biri anterior tibial tendona, diğeri de ekstansör hallusis longus, ekstansör digitorum longus ve peroneus tertius tendonlarına transfer edilerek tespit yapıldı. Tendon transferi sonuçları Carayon ve ark.nın ölçütlerine göre değerlendirildi. Ortalama takip süresi 107.9 ay (dağılım 12-254 ay) idi. Sonuçlar: Ameliyat sonrası aktif dorsifleksiyon açısı ortalama 7.6°, plantar fleksiyon açısı 21.8°, iki açının toplamı 30.4° bulundu. Sonuçlar altı ayakta (%14.6) mükemmel, 23 ayakta (%56.1) iyi, yedi ayakta (%17.1) orta, beş ayakta (%12.2) kötü idi. Çıkarımlar: Düşük ayakta posterior tibial tendon transferi ile, ayakta aktif dorsifleksiyonun yeniden kazandırılmasında ve parmakların fleksiyon deformitesini önlemekte oldukça başarılı sonuçlar elde edilmektedir.

Anahtar Kelimeler:

Çarpık ayak, Ayak bileği eklemi, Ayak deformitesi, edinsel, Tendon transferi, Peroneal sinir

Surgical restoration of drop foot deformity with tibialis posterior tendon transfer

Objectives: The transfer of the tibialis posterior tendon to the paralysed tendons on the anterior aspect of the ankle not only restores the function of the paralyzed muscles, but also removes the deforming force on the medial aspect of the foot. In this study, we evaluated patients who underwent tibialis posterior tendon transfer for the treatment of drop foot. Methods: The study included 41 patients (24 males, 17 females; mean age 32 years; range 11 to 73 years) who underwent tibialis posterior tendon transfer for drop foot. The mean duration of paralysis was 51.5 months (range 4 to 240 months). The mean preoperative drop foot angle was 30.9° (range 15 to 55 degrees). The tibialis posterior tendon was first detached from its insertion and carried proximally on the crural midline, then transferred to the dorsum of the foot through the circumtibial route, where it was split into two parts. One strip was attached to the tibialis anterior tendon, and the other to the extensor hallucis longus, extensor digitorum longus, and peroneus tertius tendons. The results were evaluated according the criteria of Carayon et al. The mean follow-up was 107.9 months (range 12 to 254 months). Results: The mean postoperative active dorsiflexion was 7.6°, plantar flexion was 21.8°, and their sum was 30.4°. The results were excellent in six feet (14.6%), good in 23 feet (56.1%), moderate in seven feet (17.1%), and poor in five feet (12.2%). Conclusion: Tibialis posterior tendon transfer in drop foot yields highly successful results in the restoration of active dorsiflexion and prevention of flexion deformity in the toes.

Keywords:

Clubfoot, Ankle Joint, Foot Deformities, Acquired, Tendon Transfer, Peroneal Nerve,

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