Kısmi aşil tendosu rupturunun onarımında 3-loop pulley tekniği ve temas yüzeyi arttırılmış Kessler yönteminin tavşan modelinde karşılaştırılması
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Date
2013
Authors
İnan, Kıvanç
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Publisher
Uludağ Üniversitesi
Abstract
Veteriner ve beşeri hekimlikte tendo yaralanmaları ve özellikle aşil tendosunun kısmi rupturları ile sıklıkla karşılaşılmaktadır. Veteriner hekimlikte, tendo onarımını takiben; tekrar kopmalar, uzun süreli immobilizasyona bağlı kas atrofisi ve kontraktürleri veya dejeneratif artiritis gibi komplikasyonlarla karşılaşılma olasılığı yüksektir. Bunların önlenmesi ve daha başarılı bir iyileşmenin elde edilebilmesi için, immobilizasyon süresini kısaltmaya olanak sağlayacak, dayanımı yüksek onarım tekniklerine ihtiyaç duyulmaktadır. Aşil tendosu onarımında geleneksel bir yöntem olan “3 Loop Pulley” (3LP) yönteminin, daha önce fleksor tendo onarımında kullanılmış olan “Temas Yüzeyi Arttırılmış Kessler” (TYAK) yöntemiyle kıyaslandığı çalışmamızda; 54 adet, dişi, 8 aylık, 3,0-3,5 kg ağırlığında Yeni Zelanda tavşanı kullanıldı. Altı gruba ayrılan deneklerde gastrocnemius tendosu ensize edildi. Birinci, 3. ve 5. gruplar 3LP; 2., 4., ve 6. gruplar ise TYAK yöntemiyle onarıldı. İn vitro ayağı oluşturan 1. ve 2. grupların, biyomekaniksel değerlendirilmesi yapıldı. İn vivo bölümü oluşturan diğer gruplarda ise, 3 hafta süresince immobilizasyon sağlandı. Üçüncü ve 5. gruplar 4. hafta, 4. ve 6. gruplar ise 8. hafta sonunda ötenazi edilerek, morfolojik, biyomekaniksel ve histopatolojik olarak değerlendirildi. Biyomekaniksel değerlendirme; tendo onarım hattında 2 mm aralık ve tam kopmanın oluştuğu değerlerin ölçülmesi ile yapıldı. Histopatolojik incelemede ise; ekstrasellüler matriksin yapısı, hücrelerin dağılımı, hücre çekirdeğinin morfolojisi, tamir dokusunun organizasyonu, nedbe dokusunun yapısı, defekt bölgesindeki vaskülarizasyon ve yangı şiddeti gibi parametreler kullanıldı. Morfolojik incelemelerle adezyon açısından 3LP yönteminin üstünlüğü görülürken, histopatolojik değerlendirmede TYAK yönteminin iyileşme sonuçları daha iyiydi. Biyomekaniksel inceleme sonucunda ise; 3LP yönteminin aralık oluşumuna daha dayanıklı olduğu, ancak 8. hafta sonunda TYAK yönteminin kopmaya karşı direncinin daha fazla olduğu görüldü. Sonuç olarak, TYAK yönteminin veteriner sahada kısmi aşil tendosu rupturlarının onarımında kullanılabileceği saptanmıştır.
In both veterinary and human medicine, tendon injuries and particularly partial Achilles tendon ruptures are commonly observed. In veterinary medicine, postoperative complications such as re-ruptures, muscle atrophy and contractures or degenerative arthritis induced by longterm immobilization are commonly seen. In order to prevent these complications and to achieve more optimal healing, high strength repair techniques enabling shortened immobilization durations are needed. In our study, we used 54 female, 8 months old, New Zealand rabbits weighing 3.0-3.5 kgs to compare the traditional 3 Loop Pulley (3LP) method with Contact Surface Increased Kessler (CSIK) method which has previously been used to repair flexor tendon ruptures. Rabbits were divided into six groups and gastrocnemius tendons were lacerated. Tendons of the animals in groups 1, 3 and 5 were repaired with 3LP method. CSIK method was used to repair the ruptures in groups 2, 4 and 6. On the in vitro part of the research, groups 1 and 2 were evaluated biomechanically. The rest of the groups composed the in vivo part of the research and in these groups, immobilization was achieved for a period of 3 weeks. Groups 3 and 5 were euthanized at the end of week 4, and in groups 4 and 6 euthanasia was performed at the end of week 8. All in vivo groups were evaluated morphologically, biomechanically and histopathologically. Biomechanical evaluation was performed by measuring the resistance when 2 mm gap formation and total rupture occurred. On histopathological evaluation, parameters like extracellular matrix structure, distribution of cells, morphology of nucleus, organization of repaired tissue, scar tissue structure, vascularization, and severity of inflammation were investigated. Morphological investigations showed superiority of the 3LP method in terms of adhesion. At histopathological evaluation, however, CSIK method yielded better healing results. Biomechanically, 3LP method was more durable against gap formation but at the end of the 8 weeks CSIK method showed a higher resistance to total rupture. As a conclusion, we found that CSIK technique can be used in veterinary practice to repair the partial Achilles tendon rupture pathologies.
In both veterinary and human medicine, tendon injuries and particularly partial Achilles tendon ruptures are commonly observed. In veterinary medicine, postoperative complications such as re-ruptures, muscle atrophy and contractures or degenerative arthritis induced by longterm immobilization are commonly seen. In order to prevent these complications and to achieve more optimal healing, high strength repair techniques enabling shortened immobilization durations are needed. In our study, we used 54 female, 8 months old, New Zealand rabbits weighing 3.0-3.5 kgs to compare the traditional 3 Loop Pulley (3LP) method with Contact Surface Increased Kessler (CSIK) method which has previously been used to repair flexor tendon ruptures. Rabbits were divided into six groups and gastrocnemius tendons were lacerated. Tendons of the animals in groups 1, 3 and 5 were repaired with 3LP method. CSIK method was used to repair the ruptures in groups 2, 4 and 6. On the in vitro part of the research, groups 1 and 2 were evaluated biomechanically. The rest of the groups composed the in vivo part of the research and in these groups, immobilization was achieved for a period of 3 weeks. Groups 3 and 5 were euthanized at the end of week 4, and in groups 4 and 6 euthanasia was performed at the end of week 8. All in vivo groups were evaluated morphologically, biomechanically and histopathologically. Biomechanical evaluation was performed by measuring the resistance when 2 mm gap formation and total rupture occurred. On histopathological evaluation, parameters like extracellular matrix structure, distribution of cells, morphology of nucleus, organization of repaired tissue, scar tissue structure, vascularization, and severity of inflammation were investigated. Morphological investigations showed superiority of the 3LP method in terms of adhesion. At histopathological evaluation, however, CSIK method yielded better healing results. Biomechanically, 3LP method was more durable against gap formation but at the end of the 8 weeks CSIK method showed a higher resistance to total rupture. As a conclusion, we found that CSIK technique can be used in veterinary practice to repair the partial Achilles tendon rupture pathologies.
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Keywords
Tavşan, Gastrocnemius tendosu, Kısmi aşil tendosu rupturu, Tendo dikişi, Rabbit, Gastrocnemius tendon, Partial achilles tendon rupture, Tendon suture
Citation
İnan, K. (2013). Kısmi aşil tendosu rupturunun onarımında 3-loop pulley tekniği ve temas yüzeyi arttırılmış Kessler yönteminin tavşan modelinde karşılaştırılması. Yayınlanmamış doktora tezi. Uludağ Üniversitesi Sağlık Bilimleri Enstitüsü.