Gazi ZORER, A. Erdem BAGATUR, Ahmet DOĞAN, Tayyar ÜNLÜ

Paralitik pes planovalgusta Dennyson-Fulford subtalar ekstra-artiküler artrodezi ve ayak diziliminin değerlendirilmesi

Amaç: Paralitik pes planovalgus deformitesi olan hastalarda Dennyson-Fulford tekniğiyle uygulanan subtalar ekstra-artiküler artrodez sonuçlan ve bu tekniğin ayak dizilimini yeniden sağlamadaki başarısı değerlendirildi. Çalışma planı: Paralitik pes planovalgusu olan 12 hastanın (5 kız, 7 erkek; ört. yaş 97.5 ay; dağılım 79-138 ay) 19 ayağına, Dennyson-Fulford tekniğiyle subtalar ekstra-artiküler artrodez uygulandı. Etiyoloji beş hastada poliomiyelit, beş hastada serebral felç, iki hastada meningomiyelosel idi. Hastaların yedisinde deformite iki taraflıydı; diğer hastaların dördünde sağ, birinde sol ayakta deformite vardı. İki taraflı deformite olan altı olgunun iki ayağı aynı seansta ameliyat edildi. Sonuçlar klinik ve radyolojik olarak ayrı ayrı değerlendirildi. Ameliyat sonrası takip süresi ortalama 35.8 ay (dağılım 7-82 ay) idi. Sonuçlar: Tüm olgularda yeterli ve zamanında kaynama sağlandı. Klinik olarak, 19 ayağın 10'unda (%52) iyi, sekizinde (%42) orta, birinde (%6) kötü sonuç alındı. Rad-yolojik olarak, beş ayakta (%26) iyi, 12 ayakta (%64) orta, iki ayakta (%10) kötü sonuç elde edildi. Hiçbir ayakta psödoartroz bulgusu ya da komşu eklem artrozu görülmedi. Sadece iki olguda vida sklerozu görüldü; bunlardan birinde (l mm'yi aşan skleroz) sonucun kötü olduğu saptandı. Çıkarımlar: Nöromusküler hastalığı olan çocuklarda sık görülen pes planovalgus deformitesinin cerrahi tedavisinde Dennyson-Fulford subtalar ekstra-artiküler artrodez tekniği ile başarılı fonksiyonel ve radyolojik sonuçlar alınmaktadır.

Anahtar Kelimeler:

Kalkaneus, Beyin felci, Ayak deformitesi, edinsel, Düztabanlık, Meningomiyelosel, Çocuk felci, Artrodez, Kemik vidaları, Kırık tespiti, internal, Nakil, otolog

Dennyson-Fulford subtalar extra-articular arthrodesis in the treatment of paralytic pes planovalgus and its value in the alignment of the foot

Objectives: We evaluated the results of Dennyson-Fulford subtalar extra-articular arthrodesis performed in patients with paralytic planovalgus deformity and its success in realignment of the foot. Methods: Dennyson-Fulford subtalar extra-articular arthrodesis was performed in 19 feet of 12 patients (5 girls, 7 boys; mean age 97.5 months; range 79-138 months) with paralytic planovalgus deformity. The underlying causes were poliomyelitis (n=5), cerebral palsy (n=5), and meningomyelocele (n=2). Seven patients had bilateral involvement; the remaining deformities were on the right in four patients, and on the left in one patient. Simultaneous operations were performed in six patients with bilateral deformity. The results were assessed both clinically and radiologically. The mean follow-up was 35.8 months (range 7 to 82 months). Results: Union was achieved in all patients within sufficient degree and time. Clinical results were good in 10 feet (52%), moderate in eight feet (42%), and poor in one foot (6%). Radiological results were good in five feet (26%), moderate in 12 feet (64%), and poor in two feet (10%). None of the patients developed pseudoarthrosis or arthrosis of the neighboring joints. Sclerosis was observed around the screws in two patients, in one of whom sclerosis of more than 1 mm was associated with a poor clinical and radiologic outcome. Conclusion: Successful functional and radiologic results are obtained by Dennyson-Fulford subtalar extra-articular arthrodesis in the surgical treatment of paralytic planovalgus deformity in children with neuromuscular disorders.

Keywords:

Calcaneus, Cerebral Palsy, Foot Deformities, Acquired, Flatfoot, Meningomyelocele, Poliomyelitis, Arthrodesis, Bone Screws, Fracture Fixation, Internal, Transplantation, Autologous,

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