GÜLTEKİN ATALAN, METE CİHAN, İBRAHİM DEMİRKAN, MAHMUT SÖZMEN

Surgical treatment of musculus gastrocnemius tendon rupture by use of tensor fascia lata autograft: An experimental study on rabbit model

Çalışmada, tensor fasya latanın m. gastrocnemius tendon rupturunda bir greft materyali olarak kullanılıp kullanılamayacağının araştırılması amaçlandı. Çalışma 12 sağlıklı beyaz tavşan üzerinde yürütüldü. Fasia lata (FL) greftinin elde edilmesi amacıyla femurun kranio-lateral bölgesi üzerinde 5 cm uzunluğunda eliptik bir deri ensizyonu yapıldı. 4x3 cm büyüklüğünde FL kesiti greft amacıyla izole edildi. Her bir tavşandan genel anestezi eşliğinde 2 cm uzunluğunda m. gastrocnemius tendon kesiti tuber calcaneusdan 1 cm proksimal yönde olmak üzere kesilip uzaklaştırılmak suretiyle defekt oluşturuldu. Fasia lata greft i gastrocnemius tendosunun distal ve proksimal segmentinden l cm mesafeden başlamak üzere PDS iplikle locking loop dikiş tekniği kullanılarak kapatıldı. Tavşanlar, yaklaşık 10 hafta operasyona tabi tutulan bacağı kullanma yönündeki fonksiyonlarının tespit amacıyla gözlendi. Postoperatif olarak 10. haftada kontrast radyografi ve histolojik muayeneler FL'nin bütünlüğünü saptamak amacıyla yapıldı. Tüm tavşanlar postoperatif olarak 3. günden sonra belirgin bir topallık gösterdi. 15 günde hiç bir topallık belirtisi gözlenmedi. Kontrast radyografik muayeneler tendon ve implante edilen materyal arasında başarılı bir kaynaşmanın olduğunu gösterdi. 12 tavşanın 8'i nekroskopik ve mikroskobik muayene için uyutulurken, diğer 4 tavşan ise fonksiyonel yürüyüş durumlanm gözlemlemek için bir yıl gözetim altında tutuldu. Nekroskopide, m. gastrocnemius tendosuncla oluşturulan defektin yumuşak yeni bir doku tarafından doldurulduğu görüldü. 10. haftada yapılan mikroskobik muayeneler defektin immature konnektif doku üremesiyle dolduğu ve olgun tendodakine benzer longitudinal bir yapı arzettiği saptandı. Tendon fibril demetlerinin erken ko-krimping özelliği longitudinal yönde alman örneklerde barizdi. Sonuç olarak, klinik, radyolojik ve histopatolojik incelemeler FL greft implantasyonunun tendon iyileşmesinde faydalı bir model olduğunu ortaya çıkardı.

Anahtar Kelimeler:

hayvan deneyleri, tavşan, tendonlar, rüptür (Veterinerlik), cerrahi işlemler, otogreft

Gastroknemius tendo rupturunun tensor fasya lata otogrefti kullanımıyla operatif sağaltımı:Tavşanlarda deneysel bir çalışma

The aim of this study was to investigate whether the fascia lata (FL) could be used as a graft material for the repairing of large detect of m. gastrocnemius tendon. Twelve healthy adult white rabbits were included to the study. A curved skin incision about 5 cm in length was made over the lateral aspect of the cranio-lateral region of femur to harvest FL. 4x3 cm in size of FL was bluntly separated and harvested. 2 cm piece of the m. gastrocnemius tendon was cut and removed from each rabbit at the level of 1 cm proximal of tuber calcaneus under general anaesthesia. Fascia lata graft was covered around the tendon starting 1 cm both distal and proximal to the transection sites of the m. gastocnemius tendon and sutured by locking loop suture pattern with PDS. Rabbits were evaluated up to 10 weeks for disfiguration and functional limb usage. At 10 weeks postoperatively, contrast radiographie and histological examination were carried out to reveal the survival of FL. All rabbits showed a significant lameness following three days postoperatively but no sign of lameness were observed at the day of 15. Contrast radiographie examination indicated a satisfactory union between the implanted material and the tendon ends. At 10 weeks, 8 of the 12 rabbits were euthanasied. Remaining 4 rabbits were observed for their functional status up to one year. In gross examinations of the euthanasied rabbits, the gap was filled in by a firm and smooth new tissue formation. Microscopic examination at 10 weeks showed that the defect was filled with immature fibrous connective tissue proliferation and occasional vascularity in which collagen fibers tended to be oriented longitudinally as in mature tendon. Early co-crimping of tendon fiber bundles was apparent on longitudinal sections. In conclusion, clinical, radiological and histopathological examinations revealed that implantation of the FL graft was a useful model of tendon healing without any complications.

Keywords:

animal experiments, rabbits, tendons, rupture (Veterinary science), surgical operations, autografts,

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