Ilker Sarikaya, Muharrem Inan, Ali Seker

Semitendinozus ve gastroknemius tenotomileriserebral palside diz fleksiyon kontraktürününasıl etkiler?

Amaç: Artmış hamstring spastisitesine bağlı diz fleksiyon kontraktürü serebral palside (SP) en sık rastlanan diz deformitesidir. Bu çalışmada amacımız spastik SP’de semitendinozus ve gastroknemius tenotomileri sonucunda popliteal açıda meydana gelen iyileşme ve cerrahi başarıyı etkileyen faktörleri değerlendirmektir.Çalışma planı: Çalışmaya 19 kız, 25 erkek hasta dahil edildi. Yaş ortalaması 8.1 (4-14) yıldı. 50 semi¬tendinozuz ve 28 gastroknemius tenotomisi uygulandı. Çalışmaya sadece SP tanısı olan, semitendino¬zus ve/veya gastrocnemius tenotomi ihtiyacı olan hastalar dahil edildirken daha önce etkilenen tarafta hamstring veya gastrocnemius cerrahisi geçiren hastalar dahil edilmedi. Popliteal açı işlem öncesi ve sonrasında genel anestezi altında hasta sırtüstü yatarken kalça 90º fleksiyonda ve karşı ekstremite eks¬tansiyonda tutulurken ölçüldü. Hastalar ayriyeten yedi yaşından küçük veya büyük olmalarına göre de gruplara ayrıldı.Bulgular: Cerrahi öncesi ortalama popliteal açı semitendinosus grubunda 47.7°, gastroknemius gru¬bunda 50.9° idi. Bu gruplarda tenotomi sonrası popliteal açıdaki ortalam düşüş sırası ile 14.5° ve 6.0° oldu. Semitendinosus grubundaki yedi yaşından küçük çocuklarda popliteal açıdaki düzelme yaklaşık %34, yedi yaş ve üzerindekilerde ise %28 olarak hesaplandı.Çıkarımlar: Sonuç olarak semitendinozus ve gastroknemius tenotomileri spastik SP’de popliteal açıda sırasıyla %30.8’lik ve %11.3’lük düzelme sağlamaktadır. Bu bulguların ortopedik cerrahlara spastik SP’de diz fleksiyon kontraktürünün tedavi planlaması hususunda yardımcı olacağına inanıyoruz.

Anahtar Kelimeler:

Serebral palsi; gastroknemius; popliteal açı; semitendinozus; tenotomi.

Improvement of popliteal angle with semitendinosus or gastrocnemius tenotomies in children with cerebral palsy

Objective: The aim of this study was to determine the efficacy of semitendinosus and gastrocnemius tenotomies on popliteal angle presenting knee flexion spasticity in children with cerebral palsy (CP).Methods: The study included 44 patients (25 males, 19 females; mean age: 8.1 years, range: 4 to 14 years) with spastic CP who underwent surgery for knee flexion spasticity. A total of 78 semitendinosus tenotomies and 28 associated gastrocnemius tenotomies were performed. Popliteal angle was measured under general anesthesia before and after surgery. Patients were divided into groups according to age (younger and older than 7 years), severity of deformity and type of CP.Results: Mean popliteal angles decreased by 14.3º (30.1%) following semitendinosus tenotomy and by 6.1º (12%) following gastrocnemius tenotomy (p=0.0001). The change in popliteal angle was not statistically significant according to age, severity of flexion spasticity, and type of CP palsy. There was a significant difference following gastrocnemius tenotomy between groups with a popliteal angle of greater or lesser than 50º (p=0.0001).Conclusion: Semitendinosus and gastrocnemius tenotomies improved popliteal angle by 30.1% and 12%, respectively. Age, preoperative popliteal angle or anatomical disease classification did not a significantly affect popliteal angle.

Keywords:

Cerebral palsy, gastrocnemius, popliteal angle, semitendinosus tenotomy,

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