Klinik Araştırma
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Efficiency of Primary End-to-End Open Repair in the Acute Achilles Tendon Ruptures

Yıl 2009, Cilt: 3 Sayı: 2, 104 - 109, 26.07.2009

Durmus Ali Ocguder

Öz

In this study we evaluated the results of 31 patients (28 male, 3 female mean age 41; range 26-66) who underwent primary surgical end-to-end repair for acute achilles tendon ruptures. The causes of the repair were sportic activities in 21 patients (%67.7), car accident in 2 patients (%6.4), spraining and falling in 7 patients (%2.5), sharp agent injury in 1 patient. All patients had unilateral and traumatic rupture of the achilles tendon. 18 patients (%58) had right achilles tendon ruptures, 13 patients (%42) had left achilles tendon ruptures. All of the patients were operated and cast applied urgently. The follow-up period ranged from 24 months to 70 months (mean 44.6 months). The patients who were immobilized for 6 to 8 weeks underwent standardized progressive postoperative rehabilitation program. At the end of the follow-up, patients were evaluated according to Percy /Co-nochie criteria: 14 patients (%45) showed excellent, 10 patients (%32) good, 6 patients (%19) moderate and 1 patient (%3.2) failure resuts. No patient had rerupture, skin necrosis, deep infection and sinus formation. In 4 patients (% 13) who were treated with oral antibiotics showed superficial wound infection and in 1 patient (3.2) who was treated conservatively showed partial rupture recurrence. Consequently, there isn’t consensus in the treatment of achilles tendon ruptures at the present time. Many surgical methods have been defined from primary end-to-end repair methods to very complicated surgical method of facial augmentation technique. We believe that end-to-end repair technique in acute achille tendon ruptures has sufficient functional results

Anahtar Kelimeler

chilles tendon ruptures/ injury/surgery end-to-end repair augmentation surgery

Kaynakça

  • 1. Akgün U ,Erol B,Karahan M.Akut aşil tendonu yırtıklarında Krackow yöntemiyle primer tamir ve plantaris tendonu güçlendirmenin uzun dönem sonuçları. Açta Orthop Ttraumatol Turc 2006;40(3):228-33.
  • 2. Bhandari M, Guyatt GH, Siddiqui F, Morrow F, Buse J, et al.Treatment of acute Achilles ten- don ruptures: a systematic overview and 5 metaanalysis. Clin Orthop Relat Res 2002; 400:190-200.
  • 3. Robet B,Smith Lea and Lyman.Non-surgical treatment of tendo achillis rupture. J Bone Joint Surg (Am) 1972;54:1398-407.
  • 4. Lui TH. Fixation of tendo Achilles avulsion fracture. Foot And Ankle Surg 2009;15:58-61
  • 5. Mafulh N.Ruptur of the achilles tendon .J Bone Joint Surg [Am] 1999;81:1019-36.
  • 6. Nistor L. Surgical and non-surgical treatment of Achilles tendon rupture .A prospective randomized study. J Bone Joint Surg [Am] 1981, 63:394-9.
  • 7. Moller M,Movin T,Granhed H,Lind K,Faxen H.et al.Acute rupture of tendon Achilles .A prospective randomized study of comparision between surgical and non-surgical treatment.J Bone Joint Surg [Br] 2001 ;83:843-8.
  • 8. Buchgraber A, Passler HH. Percutaneus repair of Achilles tendon ruptire: immobilization versus functional postoperative treatment. Clin Orthop Relat Res1997;341:113-22.
  • 9. Kakiuchi M.A combined open and percutaneus technique for repair of tendo Achilhs ;comparnson with open repair. .J Bone Joint surg[Br] 1995;77:60-3.
  • 10. Aktas S,Kocaoğlu B,Nalbantoğlu U,Seyhan M, Güven 0. End-to-end versus augmented repair in the treatment of acute Achilles tendon ruptures.J Foot Ankle Surg 2007;46(5):336-40.
  • 11. Abraham E,Pankovich AM.Neglected rupture of the achilles tendon.Treatment by V-Y tendinous flap.J Bone J Surg (Am) 1975;57:253-55.
  • 12. .Winter E, Weisw K, Weller S, Ambachar T. Surgical repair of Achilles tendon rupture; Comparison of surgical with conservative treatment. Arch Orthop Trauma Surg 1998; 117:364-67.
  • 13. McComis GP, Nawoczenski DA, DeHaven KE. Functional bracing for rupture of the Achilles tendon.Clinical results and analysis of ground-reaction forces and temporal data.J Bone Joint Surg[Am]1997;79:1799-80.
  • 14. Lo IKY,Kirkley A.Nonweiler B.Kumbhare DA.Rotating clinical curriculum:Operative versus nonoperative treatment of acute achilles tendon ruptures:A quantitative review.Clin J Sport Med 1997;7(3):207-11.
  • 15. Wills CA .Washburn S.Caiozzo V,Prietto CA.Achilles tendon rupture.Clin Orthop Relat Res 1986;207:16-163.
  • 16. Vega J, Cabestany JM, Golano P, Perez-Carro L. Endoscopic treatment for chronic Achilles tendinopathy. Foot and Ankle Surg 2008;14:204-10.
  • 17. Lui TH. Surgical tip:Repair of acute Achille rupture with Krackow suture through a 1.5 cm medial wound. Foot Ankle Surg 2009; 371:1-4.
  • 18. Miskulin M, Miskulin A, Klobucar H, Kuvalja S. Neglected rupture of the Achilles tendon treated with Peroneus Brevis transfers functional assessment of 5 cases. J Foot Ankle Surg 2005 ;44(1)49-56.
  • 19. Gerdes MH, Brown TD, Bell AL, Baker JA, Levson M, et al. A flap augmentation technique for Achilles tendon repair; Postoperative strenght and functional outcome. Clin Orthop Relat Res 1992;280:241-6.
  • 20. Yel M, emik R, Arazi M, Öğün CT. Akut aşıl tendon rüptürlerinde cerrahi tedavi sonuçları. Acta Orthop Traumatol Turc 1999;33:313-6.
  • 21. Cetti R. Ruptured achilles tendon preliminary results of a new treatment. J Sport Med (Br) 1988;22(1):6-8.

Akut Aşil Tendon Rüptürlerinde Primer Uç-Uca Açık Tamirin Etkinliği

Yıl 2009, Cilt: 3 Sayı: 2, 104 - 109, 26.07.2009

Durmus Ali Ocguder

Öz

Akut aşil tendon rüptürü nedeniyle uç-uca açık tamiri yapılan 31 hastanın (28 erkek, 3 kadın; ort. yaş 41; dağılım 26-66) sonuçları bu çalışmada incelenmiştir. Rüptür nedeni 21 hastada (%67.7) sportif aktivite, 7 hastada (%22.5) düşme-burkulma, 2 hastada (%6.4) trafik kazası, 1 hastada (%3.2) ise kesici alet yaralanmasıydı. Hastaların tamamında tek taraflı aşil tendon rüptürü mevcut idi. 18 hastada (%58) sağ aşil tendonu,13 hastada (%42) ise sol aşil tendonu rüptüre idi. Hastaların hiçbirisinde ek ortopedik patoloji yoktu. Hastalara görüldükleri ilk anda uzun bacak atel uygulandı ve sonrasında ameliyat edildiler. Ameliyat sonrası altı-sekiz hafta immobilizasyon uygulanan hastalara aşamalı ve standart bir rehabilitasyon programı uygulandı. Hastalar yaklaşık 24 ay ile 70 ay arasında takip edildiler (ortalama 44.6 ay). Takipler sonunda hastalar Percy/Conochie kriterlerine göre değerlendirildi, buna göre 14 hastada (%45) çok iyi, 10 hastada (%32) iyi, 6 hastada (%19) orta, 1 hastada (%3.2) ise kötü sonuç elde edildi. Hiçbir hastamızda komplet rerüptür, cilt nekrozu, sinus formasyonu, derin yumuşak doku enfeksiyonu gibi komplikasyonlara rastlanılmadı. Bir hastamızda (%3.2) tedavinin dördüncü ayında parsiyel rerüptür gelişti ve konservatif yöntemlerle tedavi edildi. Yine 4 hastamızda (%13) yüzeyel cilt enfeksiyonu gelişti ve bir hasta dışında oral antibiyotik tedavisi ile tedavileri yapıldı. Sonuç olarak aşil tendon yırtıklannın tedavisinde günümüzde hala ortak bir görüş birliği yoktur. Primer uç-uca tamir yöntemlerinden çeşitli tendon ve fasyaların augmentasyonlarıyla yapılan çok komplike ameliyat tekniklerine kadar bir çok yöntem tarif edilmiştir. Biz akut aşil tendon rüptürlerinde uç-uca tamir tekniğinin başarılı sonuçlar ortaya koyduğuna inanmaktayız.

Dr. D. Ali ÖÇGÜDER,
Dr. Erkan AKGÜN,
Dr. Murat DEMİRDÖGEN,
Dr. Tolga TOLUNAY,
Dr. Hasan OĞUR,
Dr. Bülent BEKTAŞER

Anahtar Kelimeler

Aşil tendon rüptürü/ yaralanma/ cerrahi; uçuca tamir augmentasyon cerrahi

Kaynakça

  • 1. Akgün U ,Erol B,Karahan M.Akut aşil tendonu yırtıklarında Krackow yöntemiyle primer tamir ve plantaris tendonu güçlendirmenin uzun dönem sonuçları. Açta Orthop Ttraumatol Turc 2006;40(3):228-33.
  • 2. Bhandari M, Guyatt GH, Siddiqui F, Morrow F, Buse J, et al.Treatment of acute Achilles ten- don ruptures: a systematic overview and 5 metaanalysis. Clin Orthop Relat Res 2002; 400:190-200.
  • 3. Robet B,Smith Lea and Lyman.Non-surgical treatment of tendo achillis rupture. J Bone Joint Surg (Am) 1972;54:1398-407.
  • 4. Lui TH. Fixation of tendo Achilles avulsion fracture. Foot And Ankle Surg 2009;15:58-61
  • 5. Mafulh N.Ruptur of the achilles tendon .J Bone Joint Surg [Am] 1999;81:1019-36.
  • 6. Nistor L. Surgical and non-surgical treatment of Achilles tendon rupture .A prospective randomized study. J Bone Joint Surg [Am] 1981, 63:394-9.
  • 7. Moller M,Movin T,Granhed H,Lind K,Faxen H.et al.Acute rupture of tendon Achilles .A prospective randomized study of comparision between surgical and non-surgical treatment.J Bone Joint Surg [Br] 2001 ;83:843-8.
  • 8. Buchgraber A, Passler HH. Percutaneus repair of Achilles tendon ruptire: immobilization versus functional postoperative treatment. Clin Orthop Relat Res1997;341:113-22.
  • 9. Kakiuchi M.A combined open and percutaneus technique for repair of tendo Achilhs ;comparnson with open repair. .J Bone Joint surg[Br] 1995;77:60-3.
  • 10. Aktas S,Kocaoğlu B,Nalbantoğlu U,Seyhan M, Güven 0. End-to-end versus augmented repair in the treatment of acute Achilles tendon ruptures.J Foot Ankle Surg 2007;46(5):336-40.
  • 11. Abraham E,Pankovich AM.Neglected rupture of the achilles tendon.Treatment by V-Y tendinous flap.J Bone J Surg (Am) 1975;57:253-55.
  • 12. .Winter E, Weisw K, Weller S, Ambachar T. Surgical repair of Achilles tendon rupture; Comparison of surgical with conservative treatment. Arch Orthop Trauma Surg 1998; 117:364-67.
  • 13. McComis GP, Nawoczenski DA, DeHaven KE. Functional bracing for rupture of the Achilles tendon.Clinical results and analysis of ground-reaction forces and temporal data.J Bone Joint Surg[Am]1997;79:1799-80.
  • 14. Lo IKY,Kirkley A.Nonweiler B.Kumbhare DA.Rotating clinical curriculum:Operative versus nonoperative treatment of acute achilles tendon ruptures:A quantitative review.Clin J Sport Med 1997;7(3):207-11.
  • 15. Wills CA .Washburn S.Caiozzo V,Prietto CA.Achilles tendon rupture.Clin Orthop Relat Res 1986;207:16-163.
  • 16. Vega J, Cabestany JM, Golano P, Perez-Carro L. Endoscopic treatment for chronic Achilles tendinopathy. Foot and Ankle Surg 2008;14:204-10.
  • 17. Lui TH. Surgical tip:Repair of acute Achille rupture with Krackow suture through a 1.5 cm medial wound. Foot Ankle Surg 2009; 371:1-4.
  • 18. Miskulin M, Miskulin A, Klobucar H, Kuvalja S. Neglected rupture of the Achilles tendon treated with Peroneus Brevis transfers functional assessment of 5 cases. J Foot Ankle Surg 2005 ;44(1)49-56.
  • 19. Gerdes MH, Brown TD, Bell AL, Baker JA, Levson M, et al. A flap augmentation technique for Achilles tendon repair; Postoperative strenght and functional outcome. Clin Orthop Relat Res 1992;280:241-6.
  • 20. Yel M, emik R, Arazi M, Öğün CT. Akut aşıl tendon rüptürlerinde cerrahi tedavi sonuçları. Acta Orthop Traumatol Turc 1999;33:313-6.
  • 21. Cetti R. Ruptured achilles tendon preliminary results of a new treatment. J Sport Med (Br) 1988;22(1):6-8.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Ortopedi
Bölüm Araştırma Makalesi
Yazarlar

Durmus Ali Ocguder

Yayımlanma Tarihi 26 Temmuz 2009
Yayımlandığı Sayı Yıl 2009 Cilt: 3 Sayı: 2

Kaynak Göster

APA Ocguder, D. A. (2009). Akut Aşil Tendon Rüptürlerinde Primer Uç-Uca Açık Tamirin Etkinliği. Türk Tıp Dergisi, 3(2), 104-109.
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