H. Yener ERKEN, Davud YASMİN, Halil BURÇ, İbrahim AKMAZ, Ahmet KIRAL

Serebral palsi'ye bağlı ayak varus deformitelerinde kombine tibialis anterior tendonu split transferi ve tibialis posterior tendonu'nun intramusküler uzatılması sonuçları

Amaç: Bu çalışmanın amacı Serebral Palsi'ye bağlı gelişen ayak varus deformitelerinin tedavisinde kombine olarak Tibialis Anterior Tendonu split transferin ve Tibialis Posterior Tendonu intramüsküler uzatma yönteminin yıllık takip sonuçlarını bildirmektir. Hastalar ve Yöntem: 2008-2012 arasında serebral palsi'ye bağlı ayak varus deformitesi olan 12 hasta prospektif olarak değerlendirildi. Hastaların ortalama yaşı 8,1 idi. Kombine anterior tibial tendon split transferi ve posterior tibial tendonun intramüsküler uzamasına ek olarak aynı seansta 11 hastanın, 9'una aşil tendona perkütan 2'sine açık uzatma uygulandı. Ayrıca hastada harmstring ve hastada fleksör hallucis longus ve fleksör digitorum longus uzatıldı. Hastaların fonksiyonları operasyon öncesi ve sonrası AOFAS (American Orthopaedic Foot and Ankle Society) skorları ile değerlendirildi. Klinik sonuçların değerlendirilmesinde Kling ve ark. tariflediği sınıflandırma kullanıldı. Sonuçlar: Hastalar ortalama 29.3 ay takip edildi. Kling sınıflamasına göre 12 hastanın 7'sinde mükemmel, 4'ünde iyi, 1'inde sonuçlar kötü olarak değerlendirildi. Mükemmel ve iyi sonuç elde edilen hastalarda plantigrad basma elde edildi. Oniki hastanın cerrahi uyguladığımız 17 ayağının işlem öncesi ortalama AOFAS skoru 35.8 iken son takiplerinde ortalama 81.4 olarak bulundu. Aradaki fark istatistiksel olarak anlamlı bulundu (p=0.023). Tartışma: Yürümenin hem duruş, hem salınım fazında serebral palsi'ye bağlı dinamik varus deformitesi olanlarında kombine olarak tibialis anterior split transferi ve tibialis posteriorun intramüsküler uzatılması tekniği literatürde belirtildiği gibi çalışmamızda da efektif bir metod olarak bulunmuştur.

Results of combined split transfer of tibialis anterior tendon and intramuscular lengthening of tibialis posterior tendon for foot varus deformity because of cerabral palsy

Aim: The aim of the study is represent years follow--up results after split transfer of tibialis anterior tendon and intramuscular lengthening of tibialis posterior tendon together for foot varus deformity due to cerabral palsy. Patients and Method: Twelve patients who have foot varus deformity due to cerebral palsy were included in the study between 2008-2012 prospectively. Mean age was 8.1. Secondary to combined split transfer of tibialis anterior tendon and intramuscular lengthening of tibialis posterior tendon percutaneous achilles lengthening for patients and open achilles lengthening for patients were applied simultaneously. Functions and clinical results were evaluated according to AOFAS (American Orthopaedic Foot and Ankle Society) score and Kling et al scoring system respectively. Results: Mean follow-up was 29.3 months. According to Kling et al score patients were excellent, were good and were poor. Patients with excelent and good results had platigrade posture. Operated 17 feet at 12 patients had mean preop and last follow-up AOFAS score were 35.8 and 81.4 respectively. The diffence was statistically significant (p=0.023). Discussion: Combined split transfer of tibialis anterior tendon and intramuscular lengthening of tibialis posterior tendon method has found as an effective technique for dynamic varus foot deformity of cerebral palsy during both stance and swing phase of gait

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