Hasan ÖZKAN, Zekeriya ÖZTEMUR, S. Gündüz TEZEREN, Hayati ÖZTÜRK, Okay BULUT

Pes ekinovarusta Turco operasyonun değerlendirilmesi

Amaç. Pes ekinovarus (PEV) tanısı ile 84 hasta Turco operasyonu ile Ocak 1990-Aralık 2003 tarihleri arasında kliniğimizde tedavi edildi. Bunlardan son kontrolleri yapılabilen 25 olgunun 39 ayağı, operasyon başarımızın değerlendirilmesi ve başarısızlık nedenlerini belirlemek için, klinik ve radyolojik olarak değerlendirildi. Yöntem. Bu çalışmada PEV'li 25 hastanın (15 erkek, 10 kız; ort. Operasyon yaşı 20,2 ay; dağılım 4 ay-6 yaş) 39 ayağı değerlendirildi. Olguların tümüne Turco'nun tariflediği posteromedial serbestleştirme ameliyatı yapıldı. Değerlendirme; görünüş, fonksiyon ve hareket sırasında ağrı gibi parametreler içeren Green-Lloyd Roberts kriterlerine göre yapıldı. Bulgular. 8 ayakta (%21) çok iyi, 13 ayakta iyi (%33), 18 ayakta (%46) ise kötü sonuç görüldü. Çok iyi ve iyi sonuçlar başarılı, kötü sonuçlar başarısız kabul edildi. Takipte nüks nedeniyle 5 ayağa kemiksel ameliyat, 4 ayağa ise yumuşak doku ameliyatı yapıldı. Komplikasyon olarak 8 subtalar varus (%21), 5 kavus (%13), 5 medial longitudinal ark çökmesi (%13), 5 tekne ayak deformitesi (%13), 5 navikular subluksasyon (%13), 2 kalkaneoküboid subluksasyon (%5) gözlendi. Sonuç. Elde ettiğimiz veriler ışığında; operasyon zamanlamasının ve erken operasyonun, yöntemi titizlikle uygulama koşulu ile PEV deformitesini düzeltmede oldukça önemli bulundu. Sonuçlar nüks önlenmesinden kaçınmak için post-operatif takibin, breys ve ters kalıp bot uygulamalarının ve aile işbirliğinin önemini gösterdi.

Evaluation of Turco’s operation in pes equinovarus

Aim. Eighty-four patients with pes equinovarus (PEV) have undergone Turco operation between January 1990-December 2003. Twenty-five patients (39 feet) of them came to control examination were reviewed clinically and radiologically to evaluate our operation success and to determine the causes of failure. Method. This study included 39 feet of 25 patients (15 boys, 10 girls; mean operation age 20.2 months; range 4 months to 6 years) with PEV. Assessment was made upon Green-Lloyd Roberts' strict clinical criteria; including appearance, function and degree of pain during activity. Results. The results were excellent in 8 feet (20%), good in 13 feet (33 %), and poor in 18 feet (47 %). Excellent and good results were accepted as satisfactory results. Poor results are accepted as unsatisfactory results. Our complications were subtalar varus in 8 cases (20%), cavus in 5 cases (13%), defective medial longitudinal arc (13%), rocker bottom in 5 cases (13%), navicular subluctation in 5 cases (13%), calcaneocuboid subluctation in 2 cases (5%). Conclusion. We propose that, operation timing proved important in correcting idiopathic PEV deformities, provided that type details of the technique are strictly adhered to. The results also suggest the role of post-operative follow and brace application in order to avoid relapses along with the importance of increasing patients' compliance through family education.

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