Research Article
Serebral palsi hastalarında iyatrojenik pes kalkaneus deformitesinin tedavisinin erken dönem sonuçları
Abstract
GİRİŞ ve AMAÇ: Serebral palside ekin kontraktürü
çoğunlukla aşil tendonu uzatma prosedürleri ile tedavi edilmektedir. Bu
işlemlerin en önemli komplikasyonu ise tendonun aşırı uzatılmasına bağlı
gelişen ve yürümeyi olumsuz etkileyen pes kalkaneus deformitesidir. Bu çalışma
ile serebral palsi tanılı hastalarda gelişen iyatrojenik pes kalkaneus
deformitesinin tibialis anterior ve peroneus brevis tendon transferleri ile
tedavisinin etkinliğini belirlemek amaçlanmıştır.
YÖNTEM ve GEREÇLER: Çalışmaya ortalama yaşları 11,5 olan
8 çocuk (14 ayak) dahil edilmiştir. Ameliyat öncesi ve sonrası kaba motor
fonksiyon sınıflama sistemi (GMFCS) seviyeleri, ayak bileği eklem hareketleri
ve kas gücü değerlendirmeleri yapılmıştır. Ameliyat sonrası ayrıca plantar
fleksiyon tork gücü de bakılmıştır.
BULGULAR: Ortalama 43 aylık (25-90 ay) takip sonunda
ameliyat öncesinde plantar fleksiyonu olmayan hastalarda ortalama 10,1 derece
aktif plantar fleksiyon elde edilmiştir. Tork değerleri ise 90°/sn ve 120°/sn
açısal hızlarda 14,6 ve 8,7 N/m olarak ölçülmüştür.
TATRIŞMA VE SONUÇ: Serebral palsi hastası çocuklarda
gastroknemius-soleus kompleksinin aşırı uzatılmasına bağlı gelişen pes
kalkaneus deformitesinin yeni bir teknik olarak tibialis anterior ve peroneus
brevis tendonlarının aşil tendonuna transferleri ile plantar fleksiyon gücünde
ve GMFCS seviyelerinde anlamlı iyileşme elde edilmiştir.
Keywords
References
- 1. Lofterød B, Terjesen T. Local and distant effects of isolated calf muscle lengthening in children with cerebral palsy and equinus gait. J Child Orthop. 2008;2:55-61.2. Lyon R, Liu X, Schwab J, et al. Kinematic and kinetic evaluation of the ankle joint before and after tendo achilles lengthening in patients with spastic diplegia. J Pediatr Orthop. 2005;25:479-483.3. Segal LS, Thomas SE, Mazur JM, et al. Calcaneal gait in spastic diplegia after heel cord lengthening: a study with gait analysis. J Pediatr Orthop. 1989;9:697-701.4. Dillin W, Samilson RL. Calcaneus deformity in cerebral palsy. Foot Ankle 1983;4:167-70.5. Rethlefsen SA, Blumstein G, Kay RM, et al. Prevalence of specific gait abnormalities in children with cerebral palsy revisited: influence of age, prior surgery, and Gross Motor Function Classification System level. Dev Med Child Neurol. 2017;59:79-88.6. Kasser JR, MacEwen GD. Examination of the cerebral palsy patient with foot and ankle problems. Foot Ankle 1983;4:135-144.7. Sutherland DH, Cooper L. The pathomechanics of progressive crouch gait in spastic diplegia. Orthop Clin North Am. 1978;9:143-154.8. Provelengios S, Papavasiliou KA, Kyrkos MJ, et al. The role of pantalar arthrodesis in the treatment of paralytic foot deformities. A long-term follow-up study. J Bone Joint Surg Am. 2009;91:575-583.9. Waugh TR, Wagner J, Stinchfield FE. An evaluation of pantalar arthrodesis. A follow-up study of one hundred and sixteen operations. J Bone Joint Surg Am. 1965;47:1315-1322.10. Aids to the investigation of peripheral nerve injuries. Medical Research Council: Nerve Injuries Research Committee. Brain 2010:1;3:2838-2844.11. Palisano R, Rosenbaum P, Walter S, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997:39:214-223.12. Borton DC, Walker K, Pirpiris M, et al. Isolated calf lengthening in cerebral palsy. Outcome analysis of risk factors. J Bone Joint Surg. (Br) 2001;83B:364–370.13. Yngve DA, Chambers C. Vulpius and Z-lengthening. J Pediatr Orthop. 1996;16:759–764.14. Colmeley, JA. Elmslie’s operation for the calcaneus foot. J Bone Joint Surg. (Br) 1953;35:46-49.15. Evans, D. Calcaneo-valgus deformity. J Bone Joint Surg. (Br) 1975;57:270 -278.16. Faraj AA. Review of Elmslie's triple arthrodesis for post-polio pes calcaneovalgus deformity. J Foot Ankle Surg. 1995;34:319-321.17. Sharrard WJW. Affection of the lower motor neuron. In: Sharrard WJW, editor. Paediatric orthopaedics and fractures. Oxford: Blackwell Scientific 3rd ed; 1993:880-881.18. Wenz W, Bruckner T, Akbar M. Complete tendon transfer and inverse Lambrinudi arthrodesis: preliminary results of a new technique for the treatment of paralytic pes calcaneus. Foot Ankle Int. 2008;29:683-9.19. Pandy, AC, Pandy S, Vinod P. Calcaneal osteotomy and tendon sling for the management of calcaneus deformity. J Bone Joint Surg. 1989:71:1192-201.
Year 2018,
Volume: 11 Issue: 3, 223 - 228, 28.09.2018
Abstract
References
- 1. Lofterød B, Terjesen T. Local and distant effects of isolated calf muscle lengthening in children with cerebral palsy and equinus gait. J Child Orthop. 2008;2:55-61.2. Lyon R, Liu X, Schwab J, et al. Kinematic and kinetic evaluation of the ankle joint before and after tendo achilles lengthening in patients with spastic diplegia. J Pediatr Orthop. 2005;25:479-483.3. Segal LS, Thomas SE, Mazur JM, et al. Calcaneal gait in spastic diplegia after heel cord lengthening: a study with gait analysis. J Pediatr Orthop. 1989;9:697-701.4. Dillin W, Samilson RL. Calcaneus deformity in cerebral palsy. Foot Ankle 1983;4:167-70.5. Rethlefsen SA, Blumstein G, Kay RM, et al. Prevalence of specific gait abnormalities in children with cerebral palsy revisited: influence of age, prior surgery, and Gross Motor Function Classification System level. Dev Med Child Neurol. 2017;59:79-88.6. Kasser JR, MacEwen GD. Examination of the cerebral palsy patient with foot and ankle problems. Foot Ankle 1983;4:135-144.7. Sutherland DH, Cooper L. The pathomechanics of progressive crouch gait in spastic diplegia. Orthop Clin North Am. 1978;9:143-154.8. Provelengios S, Papavasiliou KA, Kyrkos MJ, et al. The role of pantalar arthrodesis in the treatment of paralytic foot deformities. A long-term follow-up study. J Bone Joint Surg Am. 2009;91:575-583.9. Waugh TR, Wagner J, Stinchfield FE. An evaluation of pantalar arthrodesis. A follow-up study of one hundred and sixteen operations. J Bone Joint Surg Am. 1965;47:1315-1322.10. Aids to the investigation of peripheral nerve injuries. Medical Research Council: Nerve Injuries Research Committee. Brain 2010:1;3:2838-2844.11. Palisano R, Rosenbaum P, Walter S, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997:39:214-223.12. Borton DC, Walker K, Pirpiris M, et al. Isolated calf lengthening in cerebral palsy. Outcome analysis of risk factors. J Bone Joint Surg. (Br) 2001;83B:364–370.13. Yngve DA, Chambers C. Vulpius and Z-lengthening. J Pediatr Orthop. 1996;16:759–764.14. Colmeley, JA. Elmslie’s operation for the calcaneus foot. J Bone Joint Surg. (Br) 1953;35:46-49.15. Evans, D. Calcaneo-valgus deformity. J Bone Joint Surg. (Br) 1975;57:270 -278.16. Faraj AA. Review of Elmslie's triple arthrodesis for post-polio pes calcaneovalgus deformity. J Foot Ankle Surg. 1995;34:319-321.17. Sharrard WJW. Affection of the lower motor neuron. In: Sharrard WJW, editor. Paediatric orthopaedics and fractures. Oxford: Blackwell Scientific 3rd ed; 1993:880-881.18. Wenz W, Bruckner T, Akbar M. Complete tendon transfer and inverse Lambrinudi arthrodesis: preliminary results of a new technique for the treatment of paralytic pes calcaneus. Foot Ankle Int. 2008;29:683-9.19. Pandy, AC, Pandy S, Vinod P. Calcaneal osteotomy and tendon sling for the management of calcaneus deformity. J Bone Joint Surg. 1989:71:1192-201.
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Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Article |
| Authors | |
| Publication Date | September 28, 2018 |
| Submission Date | March 9, 2018 |
| Acceptance Date | April 18, 2018 |
| Published in Issue | Year 2018 Volume: 11 Issue: 3 |
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