Metin KÜÇÜKKAYA, Özgür KARAKOYUN, Raffi ARMAĞAN, Ünal KUZGUN

Kompleks alt ekstremite deformitelerinin Ilizarov-Taylor uzaysal çerçeve ile düzeltilmesi

Amaç: Bu çalışmada Taylor uzaysal çerçevenin (Smith & Nephew, Memphis, TN, ABD) kompleks alt ekstremite deformitelerinin tedavisindeki etkinliği incelendi. Çalışma planı: Taylor uzaysal çerçeve (TSF) 25 hastanın (12 kadın, 13 erkek; ort. yaş 17) 29 kemik segmentinde kullanıldı. Uygulama nedenleri, doğuştan deformite (n=12), raşitizm sekeli (n=6), fiz hasarı (n=4), sert psödoartoz (n=3), kötü pozisyonda kaynama (n=3) ve diz septik artrit sekeli (n=1) idi. Uygulamaların 15’i tibia, dokuzu femur, dördü ayak, biri de dize yönelik yapıldı. Beş TSF uygulaması osteomisiz, diğerleri osteotomili yapıldı. Altı olguda TSF ile deformite akut olarak düzeltildikten sonra ameliyat sırasında internal osteosentez uygulanarak fiksatör çıkartıldı. Akut düzeltme yapılan altı olguda “kronik program” ile, geri kalan olgularda “önce halkalar yöntemi” ile tedrici düzeltme yapıldı. Hastaların takip süresi 8-42 ay arasında (ort. 29 ay) değişmekteydi. Sonuçlar: Düzeltme uygulanan 13 tibia ve beş femur segmentinde eksternal fiksatör süresi ortalama 24.5 hafta (dağılım 18-37 hafta) idi. Bütün olgularda mekanik eksen normal sınırlar içerisine gelene kadar düzeltme yapıldı. Psödoartoz nedeniyle TSF uygulanan üç olgu da dahil, osteotomi yapılan olguların hepsinde tam konsolidasyon elde edildi. Ayak deformitelerinin hepsinde plantigrad ayak elde edildi. Diz fleksiyon kontraktürü ve posterior subluksasyonu osteotomisiz olarak düzeltilen bir olguda nüks görüldü. Çıkarımlar: Veriler doğru hesaplanır ve doğru kullanılırsa, psödoartrozların ve özellikle translasyon ve rotasyon ile komplike olmuş deformitelerin tedavisinde TSF mükemmel düzelme sağlayabilen güvenli ve pratik bir sistemdir.

Anahtar Kelimeler:

Eksternal fiksatörler, Osteogenez, distraksiyon, Hipertrofi, Femur, Ilizarov tekniği, Osteotomi

Correction of complex lower extremity deformities with the use of the Ilizarov-Taylor spatial frame

Objectives: We evaluated the effectiveness of the Taylor spatial frame (Smith & Nephew, Memphis, TN, USA) in the treatment of complex lower extremity deformities. Methods: The Taylor spatial frame (TSF) was applied to 29 bone segments of 25 patients (12 females, 13 males; mean age 17 years). Indications for the TSF were congenital disorders (n=12), rickets (n=6), physeal injuries (n=4), stiff nonunions (n=3), malunions (n=3), and sequela from septic arthritis of the knee (n=1). Applications involved the tibia (n=15), femur (n=9), foot (n=4), and knee (n=1) with (n=24) or without (n=5) osteotomies. Following acute correction with the use of the TSF and internal osteosynthesis by plating or nailing, the fixator was removed in six cases. The chronic mode was used in six cases who underwent acute correction. The remaining deformities were gradually corrected using the “total residual mode”. The follow-up period ranged from eight months to 42 months (mean 29 months). Results: The mean duration of external fixator was 24.5 weeks (range 18 to 37 weeks) in 13 tibial and five femoral segments. In all cases, correction was applied until the mechanical axis reached normal limits. Complete consolidation was achieved in all osteotomized segments, including three cases of nonunion. A plantigrade foot was obtained in all foot deformities. Recurrence was seen in one case in which knee contracture and subluxation were treated with soft tissue distraction without osteotomy. Conclusion: The Taylor spatial frame is a safe and practical method with excellent results in the treatment of nonunions and deformities complicated especially by translation and rotation providing correct clinical data are derived and used.

Keywords:

External Fixators, Osteogenesis, Distraction, Hypertrophy, Femur, Ilizarov Technique, Osteotomy,

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