Öz
Aim. Eighty-four patients with pes equinovarus (PEV) have undergone Turco operation between
January 1990-December 2003. Twenty-five patients (39 feet) of them came to control examination
were reviewed clinically and radiologically to evaluate our operation success and to determine the
causes of failure. Method. This study included 39 feet of 25 patients (15 boys, 10 girls; mean
operation age 20.2 months; range 4 months to 6 years) with PEV. Assessment was made upon
Green-Lloyd Roberts’ strict clinical criteria; including appearance, function and degree of pain
during activity. Results. The results were excellent in 8 feet (20%), good in 13 feet (33 %), and
poor in 18 feet (47 %). Excellent and good results were accepted as satisfactory results. Poor
results are accepted as unsatisfactory results. Our complications were subtalar varus in 8 cases
(20%), cavus in 5 cases (13%), defective medial longitudinal arc (13%), rocker bottom in 5 cases
(13%), navicular subluctation in 5 cases (13%), calcaneocuboid subluctation in 2 cases (5%).
Conclusion. We propose that, operation timing proved important in correcting idiopathic PEV
deformities, provided that type details of the technique are strictly adhered to. The results also
suggest the role of post-operative follow and brace application in order to avoid relapses along
with the importance of increasing patients’ compliance through family education.
Anahtar Kelimeler
Kaynakça
- Andrade M, Banholtz JS, Amos CI. Segregation analysis of idiopatic talipes equinovarus in a Texan population. Am J Med Genet 1998; 79: 57-102.
- Lapunzina P, Camelo J I, Rittler M, Castilla EE Risk of congenital anomalies in large for gestational age infants. J Pediatr 2002; 140: 200-4.
- Santos-Alvarez I, Martos-Rodriguez A, Delgado-Baezo E. Retinoic acid and risk factors for club foot. Cell Tissues Organs 2003; 173: 217-26.
- Ahmet M, Ahmet N, Khan KM, Umar M. Sensory hypoinnervation in club foot. J Bone Joint Surg Br 2004; 86: 1163-9.
- Coleman SS. Complex foot deformities in children.Lea and Febiger 112-132, 1983, Philadelphia
- Böhm Z. Complex foot deformities in children. 2nd ed. 23-42, Williams &Wilkins, Philadelphia, 1983.
- Jangid S, Khan SA. Freeman-Sheldon Syndrome. Indian Pediatr. 2005; 42:717
- Phillips S, Hemmady S, Thomas P, O Doherty D. Kabuki syndrome presenting with congenital talipes equinovarus. J Ped Orthop B 2005; 14: 285-6.
- Kite JH. Nonoperative treatment of congenital clubfoot. Clin Orthop Relat Res 1972; 84. 29-38.
- Bleck EE. Club foot. Dev Med Child Neurol 1993; 35: 927-31.
- Yalçın S. Pes Ekinovarus: Ponsetti yöntemi ile tedavi. Avrupa Tıp Kitapçılık; s: 3-9. 2003.
- Turco VJ. Surgical correction of the resistant clubfoot. One–stage posteromedial release with internal fixation: a preliminary report .J Bone Joint Surg. Am 1971; 53: 477-97.
- Ponseti IV, Campos S. Observation on pathogenesis and treatment of congenital clubfoot. Clin Ortop Relat Res 1972; 84: 50-60.
- Turco V.J.: Resistant congenital clubfoot. One-stage posteromedial release with internal fixation. A follow-up report of a fifteen-year experience. J Bone Joint Surg. Am 1979; 61: 805-14.
- Green AD, Lloyd-Roberts GC. The results of early posterior in resistant clubfeet. A long term review. J Bone Joint Surg Br 1985; 67: 588-93.
- Levin MN, Kuo KN, Harris GF, Matesi DV. Posteromedial release for idiopathic talipes equinovarus. A long-term follow-up study. Clin Orthop Relat Res 1989; 242: 265-8.
- Ponsetti MD. Treatment of congenital clubfoot. J Bone Joint Surg Am 1992; 74: 448-54
- Main BJ, Crider RJ, Polk M, Lloyd-Roberts GC, Swann M, Kamdar BA. The results of early operation in talipes equinovarus. A preliminary report. J Bone Joint Surg Br 1977; 5983; 337-41.
- Handelsman JE. The surgical treatment of clubfoot in later childhood. Orthopaedic Surgery and Traumatology. Congenital clubfoot C. Surgical treatment in later childhood. New York American Elsevier 1973; 767-8.
- Reimann I, Becker-Andersen H. Early surgical treatment of congenital clubfoot. Clin Orthop Relat Res 1974; 102: 200-06.
- Schwering L, Ruppert R, Reichelt A. Aplasia of the posterior tibial arter in a child with idiopathic clubfoot. Orthopedics 2003; 325: 437-38.
- Kolban M, Kolodziej S, Radomski S, Zacha S. Classification of results of treatment of congenital clubfoot. Chir Narzadow Ruchu Ortop. Pol 2001; 66: 517-22.
- Tachdjian M.D.: Congenital talipes equinovarus. Tachdjian Pediatric Orthopaedics. W.B Saunders 2nd edition, Philadelphia 1990, 2428-557.
- Atlar D, Lehman W.B, Grant A.P: Complications in clubfoot surgery. Orthop Rev 1991; 20: 233-9.
- Kolodziej L, Kolban M, Zacha S. Long-term results of posteromedial release for the treatment of congenital clubfoot. Chir Narzadow Ruchu Ortop Pol 2001; 66: 191-7.
- Karski T, Tarczynska M, Ostrowski J, Madej J, Drelich M. Postero-medial release in surgical treatment of congenital clubfeet: a comment to Turco’s method based on personal experience. Chir Narzadow Ruchu Orthop. Pol 2001; 66: 275-84.
- Simon GW. Complete subtalar release in clubfeet. Part II-Comprasion with less extensive procedures. J Bone Joint Surg Am 1985; 67: 1056-67.
- Kranicz J, Than P, Kustos T. Long-term results of the operative treatment of clubfoot: a representative study. Orthopedics 1998; 21: 669-74.
- DePuy J, Drehnan JC. Correction of idiopatic clubfoot. A comparison of results of early versus delayed posteromedial release. J Pediatr Orthop1989; 9: 44-8.
- Tareco J, Sala DA, Scher DM, Lehman WB, Feldman DS. Percutaneous fixation in clubfoot surgery: a radiographic and gait study. J Pediatr Orthop B. 2002; 11; 139-42.
- Widman RF, Do TT, Burk SW. Radical soft-tissue release of the artrogrypotic clubfoot. J Pediatr Orthop B. 2005; 14: 111-15.
- Yamamoto H, Furuya K. Treatment of congenital clubfoot with a modified Denis Browne splint. J Bone Joint Surg Br 1990; 72: 460-63.
- Hoque MF, Udin N, Sultana S. Operative management of rigid congenital club feet in Bangladesh. Int. Orthop 2001; 25: 260-2.
- Ege Rıdvan: Ayak ve ayak Bileği Sorunları: Bizim Büro Basımevi, Ankara. Bölüm 1997;9: 188-9.
- Simbak N, Razak M. Residual deformity following surgical treatment of congenital talipes equinovarus. Med J Malaysia 1998; 115-20.
Öz
Pes ekinovarus (PEV) tanısı ile 84 hasta Turco operasyonu ile Ocak 1990-Aralık 2003 tarihleri arasında kliniğimizde tedavi edildi. Bunlardan son kontrolleri yapılabilen 25 olgunun 39 ayağı, operasyon başarımızın değerlendirilmesi ve başarısızlık nedenlerini belirlemek için, klinik ve radyolojik olarak değerlendirildi. Yöntem. Bu çalışmada PEV'li 25 hastanın (15 erkek, 10 kız; ort. Operasyon yaşı 20,2 ay; dağılım 4 ay-6 yaş) 39 ayağı değerlendirildi. Olguların tümüne Turco'nun tariflediği posteromedial serbestleştirme ameliyatı yapıldı. Değerlendirme; görünüş, fonksiyon ve hareket sırasında ağrı gibi parametreler içeren Green-Lloyd Roberts kriterlerine göre yapıldı. Bulgular. 8 ayakta (%21) çok iyi, 13 ayakta iyi (%33), 18 ayakta (%46) ise kötü sonuç görüldü. Çok iyi ve iyi sonuçlar başarılı, kötü sonuçlar başarısız kabul edildi. Takipte nüks nedeniyle 5 ayağa kemiksel ameliyat, 4 ayağa ise yumuşak doku ameliyatı yapıldı. Komplikasyon olarak 8 subtalar varus (%21), 5 kavus (%13), 5 medial longitudinal ark çökmesi (%13), 5 tekne ayak deformitesi (%13), 5 navikular subluksasyon (%13), 2 kalkaneoküboid subluksasyon (%5) gözlendi. Sonuç. Elde ettiğimiz veriler ışığında; operasyon zamanlamasının ve erken operasyonun, yöntemi titizlikle uygulama koşulu ile PEV deformitesini düzeltmede oldukça önemli bulundu. Sonuçlar nüks önlenmesinden kaçınmak için post-operatif takibin, breys ve ters kalıp bot uygulamalarının ve aile işbirliğinin önemini gösterdi.
Anahtar Kelimeler
Kaynakça
- Andrade M, Banholtz JS, Amos CI. Segregation analysis of idiopatic talipes equinovarus in a Texan population. Am J Med Genet 1998; 79: 57-102.
- Lapunzina P, Camelo J I, Rittler M, Castilla EE Risk of congenital anomalies in large for gestational age infants. J Pediatr 2002; 140: 200-4.
- Santos-Alvarez I, Martos-Rodriguez A, Delgado-Baezo E. Retinoic acid and risk factors for club foot. Cell Tissues Organs 2003; 173: 217-26.
- Ahmet M, Ahmet N, Khan KM, Umar M. Sensory hypoinnervation in club foot. J Bone Joint Surg Br 2004; 86: 1163-9.
- Coleman SS. Complex foot deformities in children.Lea and Febiger 112-132, 1983, Philadelphia
- Böhm Z. Complex foot deformities in children. 2nd ed. 23-42, Williams &Wilkins, Philadelphia, 1983.
- Jangid S, Khan SA. Freeman-Sheldon Syndrome. Indian Pediatr. 2005; 42:717
- Phillips S, Hemmady S, Thomas P, O Doherty D. Kabuki syndrome presenting with congenital talipes equinovarus. J Ped Orthop B 2005; 14: 285-6.
- Kite JH. Nonoperative treatment of congenital clubfoot. Clin Orthop Relat Res 1972; 84. 29-38.
- Bleck EE. Club foot. Dev Med Child Neurol 1993; 35: 927-31.
- Yalçın S. Pes Ekinovarus: Ponsetti yöntemi ile tedavi. Avrupa Tıp Kitapçılık; s: 3-9. 2003.
- Turco VJ. Surgical correction of the resistant clubfoot. One–stage posteromedial release with internal fixation: a preliminary report .J Bone Joint Surg. Am 1971; 53: 477-97.
- Ponseti IV, Campos S. Observation on pathogenesis and treatment of congenital clubfoot. Clin Ortop Relat Res 1972; 84: 50-60.
- Turco V.J.: Resistant congenital clubfoot. One-stage posteromedial release with internal fixation. A follow-up report of a fifteen-year experience. J Bone Joint Surg. Am 1979; 61: 805-14.
- Green AD, Lloyd-Roberts GC. The results of early posterior in resistant clubfeet. A long term review. J Bone Joint Surg Br 1985; 67: 588-93.
- Levin MN, Kuo KN, Harris GF, Matesi DV. Posteromedial release for idiopathic talipes equinovarus. A long-term follow-up study. Clin Orthop Relat Res 1989; 242: 265-8.
- Ponsetti MD. Treatment of congenital clubfoot. J Bone Joint Surg Am 1992; 74: 448-54
- Main BJ, Crider RJ, Polk M, Lloyd-Roberts GC, Swann M, Kamdar BA. The results of early operation in talipes equinovarus. A preliminary report. J Bone Joint Surg Br 1977; 5983; 337-41.
- Handelsman JE. The surgical treatment of clubfoot in later childhood. Orthopaedic Surgery and Traumatology. Congenital clubfoot C. Surgical treatment in later childhood. New York American Elsevier 1973; 767-8.
- Reimann I, Becker-Andersen H. Early surgical treatment of congenital clubfoot. Clin Orthop Relat Res 1974; 102: 200-06.
- Schwering L, Ruppert R, Reichelt A. Aplasia of the posterior tibial arter in a child with idiopathic clubfoot. Orthopedics 2003; 325: 437-38.
- Kolban M, Kolodziej S, Radomski S, Zacha S. Classification of results of treatment of congenital clubfoot. Chir Narzadow Ruchu Ortop. Pol 2001; 66: 517-22.
- Tachdjian M.D.: Congenital talipes equinovarus. Tachdjian Pediatric Orthopaedics. W.B Saunders 2nd edition, Philadelphia 1990, 2428-557.
- Atlar D, Lehman W.B, Grant A.P: Complications in clubfoot surgery. Orthop Rev 1991; 20: 233-9.
- Kolodziej L, Kolban M, Zacha S. Long-term results of posteromedial release for the treatment of congenital clubfoot. Chir Narzadow Ruchu Ortop Pol 2001; 66: 191-7.
- Karski T, Tarczynska M, Ostrowski J, Madej J, Drelich M. Postero-medial release in surgical treatment of congenital clubfeet: a comment to Turco’s method based on personal experience. Chir Narzadow Ruchu Orthop. Pol 2001; 66: 275-84.
- Simon GW. Complete subtalar release in clubfeet. Part II-Comprasion with less extensive procedures. J Bone Joint Surg Am 1985; 67: 1056-67.
- Kranicz J, Than P, Kustos T. Long-term results of the operative treatment of clubfoot: a representative study. Orthopedics 1998; 21: 669-74.
- DePuy J, Drehnan JC. Correction of idiopatic clubfoot. A comparison of results of early versus delayed posteromedial release. J Pediatr Orthop1989; 9: 44-8.
- Tareco J, Sala DA, Scher DM, Lehman WB, Feldman DS. Percutaneous fixation in clubfoot surgery: a radiographic and gait study. J Pediatr Orthop B. 2002; 11; 139-42.
- Widman RF, Do TT, Burk SW. Radical soft-tissue release of the artrogrypotic clubfoot. J Pediatr Orthop B. 2005; 14: 111-15.
- Yamamoto H, Furuya K. Treatment of congenital clubfoot with a modified Denis Browne splint. J Bone Joint Surg Br 1990; 72: 460-63.
- Hoque MF, Udin N, Sultana S. Operative management of rigid congenital club feet in Bangladesh. Int. Orthop 2001; 25: 260-2.
- Ege Rıdvan: Ayak ve ayak Bileği Sorunları: Bizim Büro Basımevi, Ankara. Bölüm 1997;9: 188-9.
- Simbak N, Razak M. Residual deformity following surgical treatment of congenital talipes equinovarus. Med J Malaysia 1998; 115-20.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 14 Eylül 2010 |
| Yayımlandığı Sayı | Yıl 2010Cilt: 32 Sayı: 3 |