Modifiye lapidus prosedürünün uzun dönem sonuçları

Amaç: Çalışmamızda 2004-2012 yılları arasında Modifye Lapidus prosedürü uyguladığımız 67 hastayı restrospektif olarak değerlendirdik.Gereç ve Yöntemler: Hastaların 61’I Kadın,6’sı erkekti. Hastaların ortalama yaşı 51’di .Hastaların ortalama takip süresi yaklaşık 10yıl’dı (6-14 yıl). Hastaların klinik muayenesiyle birlikte ameliyat öncesi ,ameliyat sonrası en son takipte basarak çekilmiş ayak grafileri alınmıştır.Bu grafilerde intermetatarsal açı (İMA),halluks abduktus açısı (HAV) ve tibial sesamoid pozisyonu (TSP) değerlendirildi. Bulgular: Hastalarımızda İMA ve HAA’da sırasıyla 9.6⁰ ve 21.4⁰ ortalama düzelme sağlandı. İMA ve HAA’da ameliyat öncesi ve ameliyat sonrası radyografilerde istatiksel olarak anlamlı bir fark mevcuttu (p<0.001).Kaynamama nedeniyle revize ettiğimiz bir hastamız hariç hiçbirisinde greft kullanmadık.Komplikasyon olarak 4 hastamızda kaynamama,2 hastamızda kaynamama,3 hastamızda intraoperative kılavuz teli kırılması,2 hastamızda vida kırılması,5 hastamızda yüzeysel enfeksiyon,1 hastamızda FHL rüptürüyle karşılaştık.Takiplerde hiçbir hastamızda halluks valgus rekürrensiyle karşılaşmadık. Sonuç: Biz Modifiye Lapidus artrodezi 1. sıra hipermobilitesiyle birlikte olan halluks valguslarda ve ciddi halluks valguslarda kullanabileceğimiz ve kuvvetli düzeltme sağlayabileceğimiz bir prosedür olduğu kanaatine vardık.

Anahtar Kelimeler:

halluks valgus, lapidus, hipermobilite, 1st tarsometatarsal artrodez

Long term results of modified lapidus procedure

Aim: In this study we presented a review of 67 Modified Lapidus procedure performed between 2004 and 2012.Material and Methods: There were 61 females and 6 males. The mean age of patients was 51 years. The average follow-up was 10 years (6-14 years).The patients were evaluated preoperatively,postoperatively and last follow up using standard weight bearing radiographs and clinical examination.The radiographs were evaluated for intermetatarsal angle (IMA),hallux abductus angle (HAA) and tibial sesamoid position (TSP).Results: The mean improvement at IMA and HAA was respectively 9.6⁰ and 21.4⁰.There was statically significant difference at IMA and HAA preoperatively and postoperatively (p<0.001).We didn’t use graft for any patients except one patient which was revised for nonunion.Complications include delayed union (n=4),nonunion (2),intraoperative guide wire breakage (n=3),screw breakage (n=2),superficial infection (n=5),FHL rupture (n=1).There were no recurrences of hallux valgus at follow up.Conclusion: Modified Lapidus procedure is both a predictable and durable procedure for the powerful correction for severe hallux valgus and first ray hypermobility.

Keywords:

hallux valgus, lapidus, hypermobility, 1st tarsometatarsal arthrodesis,

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