Total diz protezi ameliyatı sırasında kullanılan midvastus ve medial parapatellar açılımların erken dönemde diz bölgesi kas ve tendonları üzerine etkisinin shear-wave elastografi ile değerlendirilmesi
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Tarih
2021
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Selçuk Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
AMAÇ Total diz artroplastisi yapılan hastalarda kullanılan Midvastus ve Medial Parapatellar açılımların preop, postop 3.hafta ve postop 6.haftadaki kuadriseps tendonu, rektus femoris, vastus medialis ve vastus lateralis kaslarının sertliklerini ve değişimlerini Shear Wave USG Elastografi tekniği ile değerlendirerek bu iki farklı cerrahi açılımın klinik sonuçlara olan etkisini araştırmaktır. MATERYAL ve METOD Selçuk Üniversitesi Tıp Fakültesi Hastanesi otomasyon sisteminden 2016-2020 yılları arasındaki veriler retrospektif olarak taranarak gonartroza bağlı diz artroplastisi yapılmış hastalara ulaşıldı. Hastalar içinden preop, postop 3. hafta ve postop 6. hafta elastografi verileri olan, midvastus açılım yapılmış 20 hasta medialparapatellar açılım yapılmış 20 hasta olmak üzere 40 hasta çalışmaya dahil edildi. Hastaların preop, postop 3. Hafta ve postop 6.hafta opere dizlerinin USG-Elastografi ölçümleri değerlendirmeye alındı. Bunun yanında yine hastaların VAS ağrı skorları ile HSS skorları değerlendirmeye alındı. Hastane otomasyon sisteminden hastaların preop ve postop ap ve lateral diz grafilerine ulaşıldı. Sonuçların istatistiksel incelemesi için İBM SPSS Statistics Versiyon 22 kullanıldı. BULGULAR Çalışmaya dahil edilen 40 hastanın 32 tanesi kadın 8 tanesi erkekti. Hastaların 25 tanesi sağ diz 15 tanesi sol dizlerinden total diz protezi ameliyatı geçirmişlerdi. Hastaların yaş aralığı 53 ile 79 arasında değişmekte ve ortalama yaşın 63,75 olduğu görüldü. Hastalarımızın preop ve postop HSS ile VAS skorları değerlendirmesinde istatistiksel olarak anlamlı bir fark görülmemiştir. MV yapılan 1 hastada tibial komponentin varus dizilimde olduğu görüldü. Preop, postop 3.hafta ve postop 6.hafta SWE değerlendirme sonucunda kuadriseps kasının post-operatif 3. hafta kPa (p=0.015) değeri midvastus açılımda istatistiksel olarak anlamlı farklılık göstermiştir. Bunun yanında rektus femoris, vastus medialis ve vastus lateralis kaslarının preop, postop 3.hafta ve postop 6.hafta SWE ile değerlendirmesinde gruplar arasında istatistiksel olarak anlamlı bir farklılık olmadığı anlaşılmıştır. TARTIŞMA SWE kullanılarak ortopedik cerrahi pratikte çeşitli kas ve tendonların sertliklerini ve iyileşmelerini gösteren pek çok çalışma mevcuttur. Total diz artoplastisindeki cerrahi açılımlar sonucu kas ve tendonları SWE ile inceleyen daha önce herhangi bir çalışma mevcut değildir. Bu çalışma diz artroplastisi sırasında kullanılan iki farklı cerrahi açılımın diz bölgesindeki kuadriseps tendonu, rektus femoris, vastus laterali, vastus medialis kaslarının nasıl etkilendiğini gösteren ilk klinik çalışmadır. İlerde yapılacak benzer çalışmalar için örnek olabileceğini ve bulunan verilerin kullanılabileceğini düşünmekteyiz. Her ne kadar istatiksel olarak anlamlı farklılıklar saptanmasa da MV açılımın erken post operatif dönemde sayısal olarak pre operatif değerlere daha yakın sayısal sonuçlar göstermesi bu açılımın MPP açılıma tercih edilebilirliğini düşündürmektedir. ÇIKARIMLAR Bu çalışmada her ne kadar tüm istatistikler göz önüne alındığında medial parapatellar ve midvastus açılımlar arasında istatistiksel olarak anlamlı bir fark oluşmadığı görülsede, midvastus açılımın preop değerlerinin post-operatif 3.haftadaki kuadriseps tendon değerlerine yakın olması, postop dönemde kuadriseps tendonun bu açılımda daha az etkilendiği görülmüş ve uygun hastalarda midvastus açılımla daha iyi sonuçlar verebileceği düşünülmüştür.
OBJECTIVE To demonstrate the stiffness and changes of the quadriceps tendon, rectus femoris, vastus medialis and vastus lateralis muscles in the preop, post-op 3rd and post-op 6th weeks of the Midvastus and Medial Parapatellar approaches used in patients undergoing total knee arthroplasty and to evaluate the clinical implications of these two approaches with using Shear Wave USG Elastography MATERIAL AND METHOD The data between the years 2016-2020 were retrospectively retrieved from the hospital digital automation system of Selçuk University School of Medicine, and patients who had knee arthroplasty due to gonarthrosis were reached. Among the patients listed, 40 patients, including 20 patients with medial parapatellar approach and 20 patients with midvastus approach with elastography data present at preop, postop 3 weeks and postop 6 weeks were included in the study. The USG-Elastography measurements of the operated knees of the patients preoperatively, postop 3 weeks and postop 6 weeks were evaluated. In addition, the patients' VAS pain scores and HSS scores were also evaluated. Preop and postop ap and lateral knee radiographs of the patients were accessed from the hospital digital automation system. IBM SPSS Statistics Version 22 was used for statistical analysis of the results. RESULTS Of the 40 patients in the study, 32 were women and 8 were men. 25 of the patients were operated on the right knee and 15 of them were operated on the left knee. The patients ranged from regarding age 53 to 79, and the mean age was 63.75. There was no statistically significant difference in the preop and postop HSS and VAS scores of our patients. In one patient who underwent MV, the tibial component was observed to be in varus alignment. As a result of the SWE evaluation at the preop, post-op 3 and post-op 6 weeks, the postoperative 3rd week kPa (p = 0.015) value of the quadriceps muscle showed a statistically significant difference in midvastus approach. However, it was understood that there was no significant difference between the groups in the evaluation of rectus femoris, vastus medialis and vastus lateralis muscles with SWE in the preop, postop 3 weeks and postop 6 weeks. DISCUSSION There are many studies showing the stiffness and healing of various muscles and tendons in orthopaedic surgery practice using SWE. There is no previous study examining muscles and tendons with SWE as a result of surgical approaches in total knee arthroplasty. This is the first clinical study showing how two different surgical approaches used during knee arthroplasty affect the quadriceps tendon, rectus femoris, vastus lateral and vastus medialis muscles in the knee. We think that it can be a source of inspiration for similar studies to be done in the future and that the data found can be used. Although statistically significant differences were not detected, the fact that the MV approach showed quantitative results closer to pre-operative values in the early postoperative period suggests that this approach may be preferable to the MPP approach. CONCLUSION In this study, although it was observed that there was no statistically significant difference between the medial parapatellar and midvastus approach when all statistics were taken into consideration, midvastus approach was thought to give better results in suitable patients in the light of the preop values of the midvastus approach were close to the quadriceps tendon values in the postoperative 3rd week and the quadriceps tendon was less affected in this approach in the postop period.
OBJECTIVE To demonstrate the stiffness and changes of the quadriceps tendon, rectus femoris, vastus medialis and vastus lateralis muscles in the preop, post-op 3rd and post-op 6th weeks of the Midvastus and Medial Parapatellar approaches used in patients undergoing total knee arthroplasty and to evaluate the clinical implications of these two approaches with using Shear Wave USG Elastography MATERIAL AND METHOD The data between the years 2016-2020 were retrospectively retrieved from the hospital digital automation system of Selçuk University School of Medicine, and patients who had knee arthroplasty due to gonarthrosis were reached. Among the patients listed, 40 patients, including 20 patients with medial parapatellar approach and 20 patients with midvastus approach with elastography data present at preop, postop 3 weeks and postop 6 weeks were included in the study. The USG-Elastography measurements of the operated knees of the patients preoperatively, postop 3 weeks and postop 6 weeks were evaluated. In addition, the patients' VAS pain scores and HSS scores were also evaluated. Preop and postop ap and lateral knee radiographs of the patients were accessed from the hospital digital automation system. IBM SPSS Statistics Version 22 was used for statistical analysis of the results. RESULTS Of the 40 patients in the study, 32 were women and 8 were men. 25 of the patients were operated on the right knee and 15 of them were operated on the left knee. The patients ranged from regarding age 53 to 79, and the mean age was 63.75. There was no statistically significant difference in the preop and postop HSS and VAS scores of our patients. In one patient who underwent MV, the tibial component was observed to be in varus alignment. As a result of the SWE evaluation at the preop, post-op 3 and post-op 6 weeks, the postoperative 3rd week kPa (p = 0.015) value of the quadriceps muscle showed a statistically significant difference in midvastus approach. However, it was understood that there was no significant difference between the groups in the evaluation of rectus femoris, vastus medialis and vastus lateralis muscles with SWE in the preop, postop 3 weeks and postop 6 weeks. DISCUSSION There are many studies showing the stiffness and healing of various muscles and tendons in orthopaedic surgery practice using SWE. There is no previous study examining muscles and tendons with SWE as a result of surgical approaches in total knee arthroplasty. This is the first clinical study showing how two different surgical approaches used during knee arthroplasty affect the quadriceps tendon, rectus femoris, vastus lateral and vastus medialis muscles in the knee. We think that it can be a source of inspiration for similar studies to be done in the future and that the data found can be used. Although statistically significant differences were not detected, the fact that the MV approach showed quantitative results closer to pre-operative values in the early postoperative period suggests that this approach may be preferable to the MPP approach. CONCLUSION In this study, although it was observed that there was no statistically significant difference between the medial parapatellar and midvastus approach when all statistics were taken into consideration, midvastus approach was thought to give better results in suitable patients in the light of the preop values of the midvastus approach were close to the quadriceps tendon values in the postoperative 3rd week and the quadriceps tendon was less affected in this approach in the postop period.
Açıklama
Anahtar Kelimeler
Diz Protezi, Shear Wave Elastografi, Medial Parapatellar, Midvastus, Knee Prosthesis, Shear Wave Elastography
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Sert, M. (2021). Total diz protezi ameliyatı sırasında kullanılan midvastus ve medial parapatellar açılımların erken dönemde diz bölgesi kas ve tendonları üzerine etkisinin shear-wave elastografi ile değerlendirilmesi. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya.
