FUAT BİLGİLİ, İLKE ALİ GÜRSES, Ufuk ÖZKAYA, Özcan GAYRETLİ, Atilla Sancar PARMAKSIZOĞLU, Ayşin KALE ÇETİNER

Periasetabuler osteotomilerde medial girişimle uygulanan iskiyal ve pubik osteotomiler: Anatomik bir çalışma

Amaç: Bu çal›flman›n amac› Bernese periasetabuler osteotomisindeki iskiyum ve pubis osteotomilerinin anatomik referans noktalar›n›n saptanmas›, bu noktalar›n çevre nörovasküler yap›lara mesafelerinin öl- çülmesi ve bu osteotomilerin medial giriflimle görerek yap›l›p yap›lamayaca¤›n›n belirlenmesiydi. Çal›flma plan›: Çal›flmada formaldehit ile tespit edilmifl 10 adet kadavran›n 20 hemipelvisi kullan›ld›. Kalçaya, medial cerrahi yaklafl›mla adduktor longus ve pektineus kaslar› aras›ndan girilerek obturator ar- ter ve sinir görülerek korundu. Subperiostal olarak ortaya koyulan üst pübik ramusta anterior obturator tüberkülün ön s›n›r› ve obturator sulkusun tepe noktas›n›n obturator krestteki izdüflümü pübik kemik osteotomisi hatt›ndaki iki nokta olarak belirlendi. ‹skiyal kemikte posterior obturator tüberkülün alt s›n›r› ile iskiyadik spinan›n tepe noktas›n› birlefltiren çizgi ostetomi hatt› olarak tan›mland›. ‹skiyum osteoto- misinin pudendal nörovasküler yap›lara olan mesafesini ölçmek amac›yla posterior diseksiyon yap›ld›. Tüm ölçümler dijital kompas kullan›larak gerçeklefltirildi. Bulgular: Obturator sulkusun obturator sinire uzakl›¤› ortalama 15.3 (da¤›l›m: 8.1-30.5) mm olarak bulundu. Anterior obturator tüberkülün obturator sinire uzakl›¤› ortalama 19.5 (da¤›l›m: 27.1-49.5) mm, obturator artere ise 38.5 mm (da¤›l›m: 29.4-51.1) mm idi. ‹skiyum osteotomisinin pudendal nö- rovasküler yap›lara uzakl›¤› ise ortalama 13.6 (da¤›l›m: 11.2-17.6) mm bulundu. Ç›kar›mlar: Pubis ostetomi hatt›n› oluflturan anterior obturator tüberkül ve obturator krest ile poste- rior obturator tüberkülün alt s›n›r›na (iskiyum osteotomisinin bafllang›ç noktas›) Bernese periasetabu- ler osteotomisinde medialden yap›lan giriflimle görerek, güvenli bir flekilde ulafl›labilmektedir.

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