Ahmet DOĞAN, Mehmet ALBAYRAK, Fatih UĞUR, Gazi ZORER

Rijit ayak deformitelerinde üçlü artrodez uygulamaları ve internal fiksasyonun klinik ve radyografik sonuçlara etkisi

Amaç: Rijit ayak deformitelerinde üçlü artrodez uygulamaları değerlendirildi ve internal fiksasyonun klinik ve radyografik sonuçlar üzerindeki etkisi araştırıldı. Çalışma planı: Yirmi altı hastanın (12 kadın, 14 erkek; ort. yaş 27; dağılım 13-55) 30 ayağına klasik üçlü artrodez uygulandı. On hastanın 12 ayağına üçlü artrodezle birlikte bir veya daha fazla Kirschner teli kullanılarak geçici internal fiksasyon yapıldı. Klinik değerlendirmede AOFAS (American Orthopaedic Foot and Ankle Society) ayak bileği-arka ayak skorlaması ve Angus-Cowell skorlaması kullanıldı. Radyografik değerlendirmede, ön-arka ve yan talokalkaneal ve talus-birinci metatars açıları kullanıldı. Ortalama takip süresi 80.3 aydı (dağılım 30-140 ay). Sonuçlar: Ameliyat öncesinde ortalama 39.3 (dağılım 16-59) olan AOFAS skoru son izlemde 90.8 (71-94) bulundu. Angus-Cowell ölçütlerine göre, 19 ayakta (%63.3) iyi, sekizinde (%26.7) orta, üçünde (%10) kötü sonuç elde edildi. Her iki klinik skorlamada da, tedavi öncesine göre anlamlı klinik düzelme elde edildi (p

Anahtar Kelimeler:

Ameliyat sonrası komplikasyonlar, Hastalık ciddiyet indeksi, İnternal fiksatörler, Tedavi sonucu, Ayak deformitesi, Artrodez

Triple arthrodesis in rigid foot deformities and the effect of internal fixation on clinical and radiographic results

Objectives: We evaluated the results of triple arthrodesis in rigid foot deformities and assessed the effect of internal fixation on clinical and radiographic results. Methods: Thirty feet of 26 patients (12 females, 14 males; mean age 27 years; range 13 to 55 years) were treated with classic triple arthrodesis. Ten patients (12 feet) underwent temporary internal fixation with one or more Kirschner wires. Clinical evaluations were made with the use of both AOFAS (American Orthopaedic Foot and Ankle Society) and Angus- Cowell ankle-hindfoot scoring systems. Anteroposterior and lateral talocalcaneal and talus-first metatarsal angles were used as radiographic parameters. The mean follow-up period was 80.3 months (range 30 to 140 months). Results: The mean AOFAS score increased from a preoperative 39.3 (range 16 to 59) to postoperative 90.8 (range 71 to 94). According to the Angus-Cowell criteria, the results were good in 19 feet (63.3%), fair in eight feet (26.7%), and poor in three feet (10%). Clinical improvement was statistically significant according to both scoring systems (p<0.05). Radiographically, all the angular values were within normal limits both in the early postoperative period and at the last follow-up (p<0.05). Pseudoarthrosis was detected in four feet (13.3%) and degeneration of the ankle and naviculocuneiform joints was detected in 12 feet (40%) and 17 feet (56.7%), respectively. Internal fixation had no significant effect on pseudoarthrosis, residual or recurrent deformity, and the degree of degeneration (p>0.05). Conclusion: Triple arthrodesis is a good alternative for functional and cosmetic improvement in foot deformities. Although internal fixation seems to have no significant effect, the use of a temporary fixation material may contribute to maintenance of reduction and surface contact.

Keywords:

Postoperative Complications, Severity of Illness Index, Internal Fixators, Treatment Outcome, Foot Deformities, Arthrodesis,

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