Peritendinöz fibrotik yapışıklıkların önlenmesinde emilebilen bariyer kullanımı /
Yazar: AYTUN TEMİZ
Danışman: PROF. DR. HÜSEYİN TUFAN KALELİ
Uludağ Üniversitesi / Tıp Fakültesi / Ortopedi ve Travmatoloji Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2003
Konu: Ortopedi ve Travmatoloji = Orthopedics and Traumatology

Özet:
Tendon cerrahisi sonrasi geliyen fibrotik yapiyikliklar fonksiyonel sonuglari etkileyen en onemli faktorlerden biridir. Bu yapiyikliklarin onlenmesinde mekanik veya kimyasal yontemler kullanilmaktadir. Mekanik yontemlerde, iyileyme surecinde tendon ve peritendinoz dokular arasindaki fiziksel temas azaltilarak fibrotik doku invazyonu onlenmektedir. galiymamizda emilebilen bariyerin, peritendindz yapiyikliklarin dnlenmesindeki etkinligi incelendi.

Yirmi ug adet diri ratin her iki ayil tendonuna tarn kat tenotomi uygulandi. Deneklerin tumunde tenotomi standart sutur materyali ve teknigi kullanilarak onarildi. Sag taraf ayil tendonlari etrafina adezyon bariyeri uygulandi (Grup 1). Sol taraf ayil tendonlari ise kontrol grubu olarak kullanildi (Grup 2). Fonksiyonel sonuglarin degerlendirilmesi amaciyla deneklerin i§Iem oncesi ve iylem sonrasi ayak izlerinden elde edilen dIgum degerleri karyilaytirildi. Denekler sakrifiye edilerek her iki ayil tendonu peritendinoz adezyon, yabanci cisim tipi enflamatuar reaksiyon geliyimi ve tendon iyileymesi agisindan degerlendirildi.

Deneysel iylem oncesi ve sonrasi ayak izi olgum degerleri karyilaytirildiginda, adezyon bariyeri uygulanmayan tarafta anlamli fark tespit edildi. Histolojik incelemede adezyon bariyeri uygulanan grupta peritendinoz adezyon geliyiminin daha az ve tendon iyileymesinin daha iyi oldugu
saptandi.

Sonuç olarak seluloz yapidaki, emilebilen bariyerin, peritendinoz yapiyikliklarin onlenmesinde etkili oldugu kanisindayiz.

Anahtar kelimeler: Peritendinoz yapiyiklik, Mekanik bariyer

Abstract:
Adhesion formatian is one of the most important factor affects the functional results of tendon surgery. Prevention of adhesion formatian has been attempted via mechanical or chemical methods. In mechanical methods, fibrotic tissue invasion is prevented by limiting contact between the tendon and surraunding tissues. The aim of this study is to evaluate that the effect of bioabsorbable barrier on prevention of peritendinous adhesion formation.


Complete tenotomy was performed on achilles tendons of both hind paws in twenty-three female rats. All of the tenotomies were sutured using the standart sutur material and technique. In all of right hind paws, adhesion barrier was wrapped arround the repaired tendon (Group 1). The left hi nd paws were used as control group (Group 2). For the functional evaluation, walking tracks of all of the animals were recorded before and after the procedure and were compared. All of the animals were sacrified and peritendinous adhesion formation, foreign body type inflammatuar reaction and tendon healing were evaluated.


When the walking tracks measurement were compared between before and after the procedure for each hindpaw, signifıcant difference was estimated for the control group that were not performed adhesion barrier. Histologically the level of peritendinous adhesion formatian was lower and tendon healing was better in group 1.


We concluded that bioabsorbable cellulose barrier is an effective material for prevention of peritendinous adhesion formation.


Key words: Peritendinous adhesion, mechanical barrier