Anıl TAŞKESEN, Yüksel Uğur YARADILMIŞ, Kasım KILIÇARSLAN, Mehmet ASİLTÜRK, İsmail DEMİRKALE, Murat ALTAY

Total kalça protezi uygulanmış hastalarda anestezi tipinin ekstremite uzunluk farkına etkisi var mı?

Amaç: Total kalça artroplastisi sonrası ekstremite eşitsizliği, instabilite ve enfeksiyondan sonrası en sık hasta şikayet nedenidir. Kullanılan anestezi yöntemine göre yumuşak doku gevşemesindeki değişkenlik bacak uzunluk eşitsizliği konusunda bizi yanıltabilir. Çalışmamızda total kalça protezi ameliyatında anestezi tipinin bacak uzuma miktarına etkisini araştırdık.Gereç ve Yöntem: Çalışmamızda 2016-2017 tarihleri arasında iki farklı merkezde ameliyat edilen ve anestezi türleri farklı olan 36 primer koksartrozlu hasta retrospektif olarak değerlendirildi. Hastalar genel anestezi uygulananlar [Grup 1 (n:18)] ve rejyonel anestezi uygulananlar [Grup 2 (n:18)] olarak ayrıldı. Hastalar radyolojik olarak trokanter minör - tuberkulum iskiadikum mesafesi (T.İ.-T.M.) ile uzama miktarı, umblicus - medial malleol ölçümü ile bacak uzunluk eşitsizliği belirlendi. Fonksiyonel değerlendirme için hastalara Harris kalça skoru yapıldı.Bulgular: Ortalama takip süresi 13 ay (12-15 ay) idi. Vakaların hiçbirinde derin enfeksiyon ya da damar-sinir yaralanması görülmedi. T.İ.- T.M. mesafesine göre bakıldığında Grup 1’de 19,76 ± 9,83 mm Grup 2’de 3,2 ± 3,96 mm uzama gözlendi (p=0.000*). Hastaların 12. ay umblikus – medial malleol ölçümlerinde Grup 1 de 9 hastada ameliyat edilen bacakta uzama (<2cm) gözlenirken 9 hastada ekstremiteler eşit gözlendi. Grup 2 de 3 hastada kısalık (<1 cm), 5 hastada uzama (<1 cm), 11 hastada ise ekstremiteler eşit gözlendi. Grup 1’deki hastaların ortalama Harris Kalça Skorları 77,17±4,4, Grup 2’deki hastaların ise 78,64±5,73 olarak bulundu (p=0,410). Grup ayrımı gözlenmeksizin hastaları 12’sinde (%33) 1-10mm uzama, 4 ünden (%11) 10-20 mm bacak eşitsizliği görüldü. Harris kalça skorları bacak uzunluk farkı olmayan hastalarda 79,62, 1-10 mm hastalarda 77,41, 10-20 mm olan hastalarda 75,21 olarak bulundu (p=0,140).Sonuç: Total kalça protezinde cerrahide genel anestezi uygulaması rejyonel anesteziye göre patolojik tarafta uzamaya neden olmaktadır. Bunun nedeni genel anestezinin daha çok yumuşak doku gevşemesi yapması olduğunu düşünmekteyiz.

Anahtar Kelimeler:

total kalça protezi, bacak uzunluk eşitsizliği, genel anestezi, rejyonel anestezi

Anesthesia type have the effect of extremity length award in patients with total hip artroplasty?

Aim: Leg length discrepancy (LLD), instability and periprosthetic infection are most common reasons patient complaint after total hip replacement (THR) surgery. Degree of soft tissue release in operating room may mislead us about LLD. The objective of this study is to report the effect of the anesthesia type on leg lengthening amount.Material and Method: In this study, 36 primary coxarthrosis patients who underwent THR surgery in two different medical centers under different types of anesthesia during2016-2017 were enrolled retrospectively. Patients are divided into two groups. Group 1 (n:18) who underwent general anesthesia, group 2 (n:18) who underwent regional anesthesia. Distance between greater trochanter-ischial tuberocity (GT-IT) is measured radiologically for leg lengthening, umbilicus-medial malleolus distance is measured clinically for LLD. Harris hip score (HHS) is measured for functional scoring.Results: The average follow-up time was 13 months (12-15 months). No deep infection or neurovascular damage were seen in patients. According to GT-IT distance, leg lengthening was 19.76±9.83 mm in group 1 and 3.2±3.96 in group 2 (p:0.000*). According to 12 month umbilicus-medial malleolus distance, 9 patients experienced leg lengthening (<2cm) and 9 patients had no LLD in group 1 where 3 patients experienced leg shorthening (<1cm), 5 patients experienced leg lengthening (<1cm) and 11 patients had no LLD in group 2. Average HHS was 77.17±4.4 in group 1 where 78.64±5.73 in group 2 (p:0.410). When all patients were considered 12 patients (33%) experienced 1-10 mm lengthening, 4 patients (11%) experienced 10-20 mm lengthening. HHS was 79.62 in patients with no LLD, 77.41 in 1-10 mm LLD, 75.21 in 10-20 mm LLD (p:0.140)Conclusion: In THR surgery, leg lengthening is seen in patients whom underwent general anesthesia more than regional anesthesia patients. We think that this is because soft tissue relaxation is more significant after general anesthesia.

Keywords:

total hip artroplasty, leg length discrepancy, general anesthesia, regional anesthesia,

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