Kahraman ÖZTÜRK, Emre ORHUN, Oğuz POLATKAN, Selma POLATKAN

Fleksör pollisis longus tendonunun erken dönemde primer onarımı: Uzun dönem sonuçlar

Amaç: Modifiye Kessler yöntemi ve çevresel epitenon dikişle erken dönemde primer olarak onarılan izole fleksör pollisis longus (FPL) tendon yaralanmalarının uzun dönem sonuçlan değerlendirildi. Çalışma planı: Otuz hastanın (10 kadın, 20 erkek; ort. yaş 26; dağılım 4-52) başparmağı, ilk dört zone'da FPL tendon kesişi nedeniyle primer-uç-uca onarım tekniğiyle tedavi edildi. On altı olguda sol, 14'ünde sağ başparmakta tendon kesişi vardı. Yaralanma yeri bir başparmakta zone I, 15'inde zone II, dokuzunda zone III, beşinde zone IV idi. Yirmi beş hastaya yaralanmadan sonraki birkaç saat içinde, beşine ise 1-34 gün içinde müdahale edildi. Yirmi üç başparmakta tendon kesişine eşlik eden arter ve sinir yaralanmaları aynı seansta tamir edildi. Hastalara modifiye Duran yöntemine göre rehabilitasyon programı uygulandı. Fonksiyonel değerlendirme Buck-Gramcko sistemine göre yapıldı. Ortalama izlem süresi 34 ay (dağılım 5-71 ay) idi. Sonuçlar: Buck-Gramcko sistemine göre yapılan değerlendirmede, 17 başparmakta (%56.6) mükemmel, beş baş parmakta (%16.6) iyi, beş başparmakta (% 16.6) orta, üç başparmakta (%9.9) kötü sonuç elde edildi. İkinci zone'da mükemmel ve iyi sonuç %73.3, üçüncü zone'da %88.8 oldu. Yalnızca FPL tendon kesişi olan hastalarla, tendon kesişine damar ve sinir yaralanmasının eşlik ettiği hastalar arasında fonksiyonel bakımdan bir fark bulunmadı. Çıkarımlar: Başparmak FPL tendon kesilerinin, eşlik eden damar ve sinir yaralanmalanyla birlikte erken dönemde primer uçuca tamir edilmesi ve özenli rehabilitasyonuyla çok iyi fonksiyonel sonuçlar elde edilmektedir.

Anahtar Kelimeler:

El baş parmağı, Tendon yaralanmaları, Hareket açıklığı, eklem, El parmağı yaralanmaları, Dikiş teknikleri

Long-term results of early primary repair of flexor pollicis longus tendon injuries

Objectives: We evaluated the long-term results of early primary repair of flexor pollicis longus (FPL) tendon injuries with the modified Kessler method and circumferential sutures. Methods: Thirty patients (10 females, 20 males; mean age 26 years; range 4 to 52 years) were treated primarily with end-to-end anastomosis for FPL tendon injuries at the level of zone I to W. Injuries were in the left thumb in 16 patients and in the right thumb in 14 patients. They were localized in zone I in one patient, zone n in 15 patients, zone IU in nine patients, and zone IV in five patents. Twenty-five patients were treated within the first few hours after injury, while five patients were treated within a period ranging from 1 to 34 days. Associated digital artery and nerve injuries in 23 patients were treated during the same session. A rehabilitation program was implemented according to the modified Duran method. Functional evalua-tions were made according to the Buck-Gramcko system. The mean follow-up was 34 months (range 5 to 71 months). Results: Functional results were excellent in 17 patients (56.6%), good in five patients (16.6%), fair in five patients (16.6%), and poor in three patients (9.9%). Excellent and good results accounted for 73.3% and 88.8% in zone II and zone III injuries, respectively. No significant differences existed between functional results obtained from patients with and without associated neurovascular injuries. Conclusions: Early primary end-to-end repair followed by an appropriate rehabilitation program yields very good functional results in patients with FPL tendon injuries, whether or not they are associated with neurovascular injuries.

Keywords:

Thumb, Tendon Injuries, Range of Motion, Articular, Finger Injuries, Suture Techniques,

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