Total diz artroplastisinde insizyon kapatılırken diz pozisyonunun, postoperatif ağrı ve fonksiyona etkisi

Amaç Literatürde total diz artroplastisi (TDA) sırasında inzisyonun hangi pozisyonda kapatılması gerektiği konusunda fikir birliği yoktur. İnsizyon bölgesindeki gerginlik, hematom oluşması aynı zamanda ekstensör mekanizmanın uyumsuz kapatılmasının erken dönemde kötü fonksiyonel sonuçlar doğurabileceği bildirilmiştir. Bu çalışmada TDA sırasında dizin tam fleksiyon pozisyonunda insizyonun kapatılması ile tam ekstansiyon pozisyonda kapatılmasının, postoperatif ağrı ve fonksiyona olan etkisini araştırmayı amaçladık. Gereç ve Yöntemler İleri derece gonartroz nedeniyle TDA operasyonu planlanan 61 hasta çalışmaya dahil edildi. TDA sırasından insizyonu diz maksimum fleksiyon pozisyonundayken sütüre edilen 30 hasta Grup 1 olarak, tam ekstansiyon pozisyonunda sütüre edilen 31 hasta Grup 2 olarak belirlendi. Gruplar arasında (1) hastaların demografik özellikleri (yaş, kilo, beden kitle indeksi (BKİ)) (2) preop, postop 1. hafta, postop 2. hafta eklem hareket açıklığı değerleri ve ağrı skorları karşılaştırıldı. Bulgular Gruplar arasında ağrı değerleri açısından preoperatif dönemde anlamlı bir fark yoktur. Postop 1. haftada eklem hareket açıklığı ve ağrı skorları Grup 1’de anlamlı oranda düşüktür (p<0,001). 6. hafta incelendiğinde gruplar arasında anlamlı bir fark görülmemektedir. Sonuç TDA da insizyonun hangi pozisyonda kapatılacağı konusunda fikir birliği yoktur. Ancak literatürde ve bu çalışmada görüldüğü gibi fleksiyon pozisyonunda gerçekleştirilen onarımların fonksiyonel sonuçlarının erken dönemde daha iyi olduğu düşüncesindeyiz.

Anahtar Kelimeler:

Diz replasman artroplastisi, Hareket açıklığı, Eklem, Rehabilitasyon

The effect of wound closure position in total knee arthroplasty on postoperative pain and function

Aim After total knee arthroplasty (TKA), there are publications showing the importance of soft tissue balance in pain control and functional results. In existing publications there is no consensus on which position should be the insicion closed. In this study, we aimed to investigate the effect of the incision closure in the full flexion position or in full extension position during TKA and the effect on postoperative pain and function. Materials and MethodsA total of 61 patients who were scheduled for TKA operation due to severe gonarthrosis were included in the study. Thirty patients who were sutured while the knee was in the maximum flexion position in the incision of the TKA sequence were identified as Group1, and 31 patients sutured in the full extension position were determined as Group 2. Demographic characteristics (age, weight, body mass index (BMI)) of the patients. preop, postoperative 1st week, postoperative 2nd week motion range and pain scores were compared between the groups.ResultsThere was no significant difference between the groups in terms of VAS values in the preoperative period. In the 1st week postoperative range of motion and pain scores were significantly lower in Group 1 (p <0.001). No significant difference was observed between the groups at the 6th week.Conclusion There is no consensus on which position the incision will be closed in TKA. However, in the literature and as seen in the present study, we think that the functional results of the repairs performed in the flexion position are better in the early period.

Keywords:

Knee Replacement Arthroplasty, Range of Motion, Articular, Rehabilitation,

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