Emre ÇALIŞAL, Ertuğrul AKŞAHİN, İsmail Murad PEPE, İsmail KARASOY, Ali BİÇİMOĞLU

Antegrad Femoral Kilitli İntramedüller Çivileme Uygulanan Hastalarda Patellofemoral Eklemin Sagital Plan Değişikliklerinin Kuadriseps Kas Atrofisi ile İlişkisinin Değerlendirilmesi

Amaç: Antegrad femoral intramedüller çivileme sonrası patellofemoral eklemde gelişen sagital dizilim bozukluklarının kuadriseps kas atrofisi ile ilişkisini araştırmak. Gereç ve Yöntemler: Çalışmada ameliyat sonrası opere ekstremitede diz önü ağrısı olan 24 hastanın 9 erkek ve 15 kadın dinamik patellofemoral manyetik rezonans görüntüleme MRG sonuçları incelendi. Rotasyonel deformitesi ve horizontal planda patellofemoral dizilim bozukluğu olan hastalar çalışma dışı bırakıldı. Klinik değerlendirme, hastaların son takiplerinde Kujala patellofemoral skorlama sistemi ile yapıldı. Diz dinamik MRG çekimleri supin pozisyonda ve bilateral yapıldı. Sağlam ve opere ekstremitede patellofemoral eklem; istirahat ve belirlenen fleksiyon açılarında, P-PT patella-patellar tendon açı ölçümleri ve DP-TT distal patella-tüberositaz tibia mesafe ölçümleri ile değerlendirildi. Aynı zamanda kuadrisepsin kontraksiyonlu ve kontraksiyonsuz iken enine kesit alan ölçümleri yapıldı. Hastaların opere ve sağlam ekstremitelerindeki kuadriseps enine kesit alanı, P-PT açı ve DP-TT mesafe ölçümleri arasındaki ilişkiye bakıldı. Bulgular: Hastaların ortalama yaşı 39,7±13,9 yıl idi. Ortalama takip süreleri 40 16-64 ay idi. Hastaların kujala patellofemoral skorları ortalama 73,3±11,8 idi. Opere taraf P-PT açı değişimleri sağlam tarafa göre anlamlı olarak yüksek bulunurken, DP-TT mesafe değişimleri sağlam tarafa göre anlamlı olarak düşük bulundu. Aynı zamanda P-PT açısındaki artış ile DP-TT mesafesindeki azalmanın birbirleriyle anlamlı olduğu tespit edildi. Opere taraf kuadriseps kasının enine kesit alanının kontraksiyonlu ve kontraksiyonsuz değerleri, sağlam tarafa göre anlamlı olarak düşük bulundu. Sonuç: Antegrad femoral kilitli intramedüller çivileme sonrası diz önü ağrısı olan hastalarda, patellada gelişen sagital plan değişimleri ve kuadriseps atrofisi diğer nedenlerle beraber patellofemoral eklemin biyomekaniğini etkiler.

Anahtar Kelimeler:

Femur kırıkları, Patellofemoral eklem, Kuadriseps atrofisi

Evaluation of the Relationship between Sagittal Plan Changes of the Patellofemoral Joint with Quadriceps Muscle Atrophy in Patients Undergoing Antegrade Locked Intramedullary Femoral Nailing

Objective: The aim of the study was to analyse the relationship between sagittal plane alignment instability were excluded. All the patients were given Kujala patellofemoral clinical evaluation scores at the latest follow-up. Knee dynamic MRI was performed in the supine position and bilaterally. Patellofemoral joints were assessed by means of P-PT patellapatellar tendon angle measurements and DP-TT distal patellar-tuberosity tibia distances measured at rest and in the selected flexion angles of the operated and non-operated extremity. At the same time, cross-sectional area of quadriceps measurements were made while the tendon was contracted and not contracted. The correlation between the changes in the operated and contralateral side of the quadriceps muscle mass with the alterations in the inferior patellar pole, the tibial tubercle DP-TT distances and T patella–patellar tendon P-PT angles were analysed.Results: The mean age of all participants was 39.7±13.9 years. The mean follow-up was 40 months range 16–64 . The mean Kujala patellofemoral score was 73.3±11.8. While the mean P–PT angle in operated group was significantly higher than the values in the nonoperated group p

Keywords:

Femoral fractures, Patellofemoral joint, Quadriceps atrophy,

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