Durmuş Ali ÖÇGÜDER, Enes ULUYARDIMCI, Süleyman Bülent BEKTAŞER, Muhammed Nadir YALÇIN, İbrahim BOZKURT, Ahmet Şükrü SOLAK

İHMAL EDİLMİŞ AŞİL TENDON RÜPTÜRLERİNDE PRİMER ONARIM VE PLANTARİS TENDONU İLE ÖGMENTASYON TEKNİĞİNİN ORTA DÖNEM SONUÇLARI

Amaç: İhmal edilmiş Aşil tendon rüptürlerine uyguladığımız primer onarım ve plantaris tendonu ile ögmentasyon tekniğinin klinik ve fonksiyonel sonuçlarını değerlendirmek. Gereç ve yöntemler: Bu çalışmada 2011-2014 yılları arasında ihmal edilmiş Aşil tendon rüptürü nedeniyle, primer onarım ve plantaris tendonuyla ögmentasyon tekniği ile cerrahi tedavi uyguladığımız yirmi hasta retrospekti olarak incelendi. Hastalar son takiplerde klinik olarak Amerikan Ortopedik Ayak ve Ayak Bileği Topluluğu (AOFAS) arka ayak skoru, Vizüel Ağrı Skalası (VAS) skoru, baldır çevresi uzunluğu, topuk yükseltme test ve ayak bileği eklem hareket açıklığı dereceleri ile değerlendirildi. Bulgular: Yaralanma ile ameliyat arasında geçen süre ortalama 7,8 (4-16) haft olarak bulundu. Ameliyat sı- rasında tendon güdükleri arasındaki ortalama defekt miktarı 44 (30-75) mm olarak ölçüldü. Ortalama takip süresi 62 (56-84) aydı. Son takiplerde AOFAS skoru ortalaması 93,6 (86-100) olarak bulundu ve VAS skoru tüm hastalarda sıfıdı. Ortalama baldır çevresi uzunluğu, ayak bileği plantar flksiyon ve dorsiflksiyon dereceleri etkilenmemiş taraf ile karşılaştııldığında istatitisel olarak anlamlı farklılık saptanmadı (p değerleri sırasıyla 0,40-0,59-0,68). Bir hasta hariç tüm hastalar topuk yükseltme testii gerçekleştiebilmekteydi. Bir hastada antiiyoti tedavisi ile iyileşen yüzeysel cilt enfeksiyonu gözlendi. Hiçbir hastada derin ven trombozu, cilt nekrozu ve tekrar rüptür tespit edilmedi. Sonuç: İhmal edilmiş Aşil tendon rüptürlerinde, primer onarım ve plantaris tendonu ile ögmentasyon tekniği, orta dönemde, klinik ve fonksiyonel olarak başarılı sonuçlar ile ilişkilidir

Mid-Term Results of Primary Repair and Plantaris Tendon Augmentatin Technique in Neglected Achilles Tendon Rupture

Objectie: To assess clinical and functinal outcomes of primary repair and plantaris tendon augmentatintechnique employed in neglected Achilles tendon rupture.Methods: We retrospectiely reviewed 20 patints underwent surgical treatment with primary repair andplantaris tendon augmentatin technique for neglected Achilles tendon rupture between 2011 and 2014. Atthe last follow-up, the patints were clinically assessed by American Orthopedic Foot & Ankle Society (AOFAS)hindfoot score, Visual Analogue Scale (VAS) score, calf circumference, single-limb heel rise test and range ofmotin in ankle.Results: Mean tie from rupture to surgery was 7.8 weeks (range 4-16 weeks). The mean gap was 44 mm(range 30-75 mm). Mean postoperatie follow-up period was 62 months (range 56-84 months). At the lastfollow-up, mean AOFAS score was 93.6 (range 82-100) while VAS score was found as zero in all patints. Nosignifiant diffrence was detected in mean calf circumference and plantar flxion and dorsiflxion rangeof ankle between involved site and contralateral intact site (p=0.40; p=0.59 and p=0.68, respectiely). Onepatint suffred from superfiial skin infectin which was treated successfully with antiicrobial therapy.There were no cases of deep-vein thrombosis, skin necrosis, or re-rupture.Conclusion: In neglected Achilles tendon rupture, primary repair and plantaris augmentatin technique isassociated with successful clinical and functinal outcomes at mid-term.

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