Yıl: 2008 Cilt: 19 Sayı: 3 Sayfa Aralığı: 233 - 293 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Adölesan idiopatik skolyoz cerrahi tedavisinde korreksiyon ve enstrümantasyon teknikleri

Öz:
İdiopatik skolyozun cerrahi tedavisinde son 20 yıl içinde önemli gelişmeler olmuş, hastalığın üç boyutlu patolojisi daha iyi anlaşıldıktan sonra, çoklu çengel ve tranpediküler vidaları kullanan modern segmenter sistemler kullanılmaya başlanmıştır. İdiopatik skolyoz tedavisinde, köşe taşı olan Harrington Rod sisteminin temel olarak kullandığı düzeltici kuvvet, gerdirme (distraksiyon) idi. Yeni geliştirilen 3. jenerasyon sistemlerden Dünya çapında en çok popüler olanı, bir devrim niteliğinde bir gelişme olarak görülen Cotrel Dubousset enstrümantasyon sistemiydi. Bu sistem, düzeltici manevra olarak derotasyon adı verilen manevrayı kullanıyor ve stratejik omurlara konulan çengel ve vidalara, eğriliğe uyacak şekilde eğilerek yerleştirilen rodun, eğriliğin konkav tarafına döndürülmesi işlemi ile skolyotik eğriliğin düzeltilmesine dayanıyordu. CD sistemi ve modifikasyonlarına ait yüksek düzeltme oranları bildiren yayınların yapılmasına rağmen, sistemin gövde dengesi üzerinde olumsuz etkilerinin de olduğuna dair çalışmalar yapılmıştır. 1990’ların başında bu problemleri elimine etmek üzere eğriliğin orta hatta çekilmesi yani translasyon adı verilen düzeltici manevrayı kullanan ISOLA, USS gibi sistemler kulanılmaya başlanmıştır. 2000 yılından bu yana, idiopatik skolyozun cerrahi tedavisinde 3. jenerasyon modern sistemlerin birer birer piyasadan kaybolduğu ve yeni bir gelişmenin yaşanmadığı yıllara girilmiştir. Bu yıllarda tüm bu sistemlerin uzun dönem sonuçları, hastaların tedaviden tatmin düzeyleri yayınlanmaya başlanmıştır. Bu yıllarda, ayrıca Harms ve arkadaşlarının geliştirdiği tüm seviyelere vida tespiti, Benli ve arkadaşlarının rapor ettikleri translasyon ve derotasyonu kombine kullanan güçlendirilmiş korreksiyon girişimlerine ait çalışmalar da yayınlanmıştır. Bir süredir bir duraklama içine girdiği izlenen idiopatik skolyozun cerrahi korreksiyonu konusunda önümüzdeki yıllar yeni gelişmelere gebedir.
Anahtar Kelime: Skolyoz Ortopedik işlemler Ameliyat sonrası dönem Osteogenez, distraksiyon Omurilik eğrilikleri enstrümantasyon

Konular: Cerrahi

Correction and instrumentation techniques in surgical treatment of adolescent idiopathic scoliosis

Öz:
Many important developments occured in idiopatic scoliosis surgery at last 20 years, as modern segmenter systems with multipl hook and transpedicular screws were used after understanding the three dimentional pathology of the disease. The main correction force in Harrington rod system which was the "corner stone" of treatmant of idiopathic scoliosis was distraction. The most popular one of the 3rd generation systems in the world was Cotrel Dubousset instrumentation system. This system was using derotation maneuver as correction force and it was correcting the curve with turning the rod that was bent and placed similar to curve to the concave site of the curve. Although there were several articles that reported high correction rates with CD system and its modifications, some studies reported that it had negative effects on body equilibrium. At early 1990’s, new systems as ISOLA and USS were started to use to transvers the curve to midline to eliminate this problem. Since 2000, the 3rd generation modern systems disappeared from the market, and there was not any new developments occured. At these years, articles about the long term results and satisfaction rates of the patients published. Additionally, some articles about all segment screw fixation described by Harms et al., and stronger correction occured by combination and translation described by Benli et al. published at these years. Despite unproductive period of surgical correction of idiopathic scoliosis for recent years, new developments will be expected.
Anahtar Kelime: instrumentation Scoliosis Orthopedic Procedures Postoperative Period Osteogenesis, Distraction Spinal Curvatures

Konular: Cerrahi
Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık
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APA BENLİ İ, KAYA A (2008). Adölesan idiopatik skolyoz cerrahi tedavisinde korreksiyon ve enstrümantasyon teknikleri. , 233 - 293.
Chicago BENLİ İ. Teoman,KAYA Alper Adölesan idiopatik skolyoz cerrahi tedavisinde korreksiyon ve enstrümantasyon teknikleri. (2008): 233 - 293.
MLA BENLİ İ. Teoman,KAYA Alper Adölesan idiopatik skolyoz cerrahi tedavisinde korreksiyon ve enstrümantasyon teknikleri. , 2008, ss.233 - 293.
AMA BENLİ İ,KAYA A Adölesan idiopatik skolyoz cerrahi tedavisinde korreksiyon ve enstrümantasyon teknikleri. . 2008; 233 - 293.
Vancouver BENLİ İ,KAYA A Adölesan idiopatik skolyoz cerrahi tedavisinde korreksiyon ve enstrümantasyon teknikleri. . 2008; 233 - 293.
IEEE BENLİ İ,KAYA A "Adölesan idiopatik skolyoz cerrahi tedavisinde korreksiyon ve enstrümantasyon teknikleri." , ss.233 - 293, 2008.
ISNAD BENLİ, İ. Teoman - KAYA, Alper. "Adölesan idiopatik skolyoz cerrahi tedavisinde korreksiyon ve enstrümantasyon teknikleri". (2008), 233-293.
APA BENLİ İ, KAYA A (2008). Adölesan idiopatik skolyoz cerrahi tedavisinde korreksiyon ve enstrümantasyon teknikleri. Journal of Turkish Spinal Surgery, 19(3), 233 - 293.
Chicago BENLİ İ. Teoman,KAYA Alper Adölesan idiopatik skolyoz cerrahi tedavisinde korreksiyon ve enstrümantasyon teknikleri. Journal of Turkish Spinal Surgery 19, no.3 (2008): 233 - 293.
MLA BENLİ İ. Teoman,KAYA Alper Adölesan idiopatik skolyoz cerrahi tedavisinde korreksiyon ve enstrümantasyon teknikleri. Journal of Turkish Spinal Surgery, vol.19, no.3, 2008, ss.233 - 293.
AMA BENLİ İ,KAYA A Adölesan idiopatik skolyoz cerrahi tedavisinde korreksiyon ve enstrümantasyon teknikleri. Journal of Turkish Spinal Surgery. 2008; 19(3): 233 - 293.
Vancouver BENLİ İ,KAYA A Adölesan idiopatik skolyoz cerrahi tedavisinde korreksiyon ve enstrümantasyon teknikleri. Journal of Turkish Spinal Surgery. 2008; 19(3): 233 - 293.
IEEE BENLİ İ,KAYA A "Adölesan idiopatik skolyoz cerrahi tedavisinde korreksiyon ve enstrümantasyon teknikleri." Journal of Turkish Spinal Surgery, 19, ss.233 - 293, 2008.
ISNAD BENLİ, İ. Teoman - KAYA, Alper. "Adölesan idiopatik skolyoz cerrahi tedavisinde korreksiyon ve enstrümantasyon teknikleri". Journal of Turkish Spinal Surgery 19/3 (2008), 233-293.