Aşil tendonunun uzatılmasında yeni bir teknik: Subkutan Z-uzatma
Loading...
Files
Date
2010
Authors
Danış, Muhammed Mutlu
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Çalışmada ayaktaki ekinus deformitesinin cerrahi tedavisinde bugüne kadar kullanılagelmiş aşil tendonu uzatma tekniklerinden farklı, yeni bir teknik olan Aşil tendonunun subkutan Z-uzatma ile uzatılması yöntemi değerlendirilerek, klasik açık uzatma tekniği ile arasında biyomekanik ve histolojik olarak farklılıklar olup olmadığının ortaya konması amaçlandı.Yirmi tavşanın sol aşil tendonlarına açık Z-uzatma ve dikişle onarım, sağ aşil tendonlarına ise subkutan Z-uzatma yapıldı. Üçüncü hafta sonunda hayvanların sağ ve sol aşil tendonları kalkaneus ile birlikte, kas-tendon bileşkesi bozulmadan çıkarıldı. On tavşanın 20 tendonu biyomekanik değerlendirme için, 9 tavşanın 18 tendonu histopatolojik çalışma için kullanıldı. Mekanik germe cihazı ile elde edilen kuvvet-uzama grafikleri üzerinde her bir tendonun maksimum kopma kuvveti ve tendon sertliği hesaplandı. Histopatolojik incelemede iyileşme bölgesinden uzunlamasına alınan örnekler boyanıp incelenerek toplam tendon puanları belirlendi.Gruplarda uygulanan iki farklı tendon uzatma tekniğinin birbirlerine bir üstünlüklerinin bulunmadığı belirlendi. Biyomekanik olarak subkutan grupta daha yüksek olmasına karşın maksimum kopma kuvveti ve tendon sertliği değerleri arasında fark saptanmadı (p=0.68, p=0.68). Histolojik olarak toplam tendon puanları açısından iki grup arasında fark yoktu (p=0.19).Subkutan Z-uzatma tekniği, tendonda kontrollü uzatmaya izin vermesi, küçük kesiler kullanılarak yapılması ve tendona dikiş uygulanmaması gibi avantajları yanında yeterli bir iyileşme de sağladığından klinik uygulamalarda güvenle kullanılabilir.
This study aimed to compare the outcomes of subcutaneous Z-lengthening of Achilles tendon, which has come into use recently, and the conventional open lengthening technique, using histological and biomechanical evaluation.The open Z-lengthening technique with suturing was performed on the left leg Achilles tendon of 20 New Zealand rabbits and subcutaneous Z-lengthening was performed on the right Achilles tendon of the animals. After 3 weeks all the Achilles tendons were harvested lengthwise between the calcaneus and the muscle-tendon junction. For histological evaluation, 20 tendons of 10 rabbits were used and for biomechanical evaluation, 18 tendons of 9 rabbits. Maximum force to failure and tendon stiffness were calculated using a mechanical tension meter and force-elongation curve. In the histopathological examination, by staining and examining longitudinal samples taken from the healing area, the total tendon scores were determined.No superior advantage was determined between the two different tendon lengthening techniques which were applied to the groups. Although the subcutaneous group were higher biomechanically, no difference was determined between the failure force and tendon stiffness values (p=0.68, p=0.68). Histologically there was no difference between the total tendon scores of the two groups (p=0.19).The subcutaneous Z-lengthening technique, besides having the advantages of allowing for controlled lengthening of the tendon, using a small incision and not requiring suturing in the tendon, provides sufficient recovery and can thus be safely used in clinical practice.
This study aimed to compare the outcomes of subcutaneous Z-lengthening of Achilles tendon, which has come into use recently, and the conventional open lengthening technique, using histological and biomechanical evaluation.The open Z-lengthening technique with suturing was performed on the left leg Achilles tendon of 20 New Zealand rabbits and subcutaneous Z-lengthening was performed on the right Achilles tendon of the animals. After 3 weeks all the Achilles tendons were harvested lengthwise between the calcaneus and the muscle-tendon junction. For histological evaluation, 20 tendons of 10 rabbits were used and for biomechanical evaluation, 18 tendons of 9 rabbits. Maximum force to failure and tendon stiffness were calculated using a mechanical tension meter and force-elongation curve. In the histopathological examination, by staining and examining longitudinal samples taken from the healing area, the total tendon scores were determined.No superior advantage was determined between the two different tendon lengthening techniques which were applied to the groups. Although the subcutaneous group were higher biomechanically, no difference was determined between the failure force and tendon stiffness values (p=0.68, p=0.68). Histologically there was no difference between the total tendon scores of the two groups (p=0.19).The subcutaneous Z-lengthening technique, besides having the advantages of allowing for controlled lengthening of the tendon, using a small incision and not requiring suturing in the tendon, provides sufficient recovery and can thus be safely used in clinical practice.
Description
Keywords
Aşil tendonu uzatılması, Ekinus deformitesi, Tavşanlar, Biyomekanik, Achilles tendon lengthening, Equinus deformity, Rabbits, Biomechanics
Citation
Danış, M. M. (2010). Aşil tendonunun uzatılmasında yeni bir teknik: Subkutan Z-uzatma. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.