Bekler, Halil İbrahim | Rosenwasser, Melvin P. | Akılına, Yelena | Bulut, Güven

Other | 2010 | Acta Orthopaedica et Traumatologica Turcica44 ( 2 ) , pp.157 - 161

Amaç: Otolog ven greftleri periferik arter köprüleme (bypass) işlemlerinde kullanılmaktadır. Greftin aniden arteryel kan basıncına maruz kalması, ven duvar basıncında artışa yol açarak greftte aşırı gerilmeye ve akımda değişikliklere neden olur. Vendeki aşırı gerilmeye sıklıkla anastomozda sızıntı, trombüs oluşumu ve akım kaybı eşlik eder. Bu çalışmada, sıçan modelinde arter köprülemede kullanılan ven greftlerine eriyebilir kolajen örtü uygulamasının grefti koruyucu etkisi araştırıldı. Çalışma planı: Çalışmada, ağırlıkları 250-350 gr arasında değişen, Sprague-Dawley cinsi 22 dişi sıçan kullanıldı. Sıçanlar çalışma (n15) ve kontrol ( . . .n7) grupları olarak rastgele iki gruba ayrıldı. Tüm sıçanlarda, sol femoral venden 10 mm’lik bir segment greft olarak alınarak sağ femoral arter kesisi ven greftiyle onarıldı. Kontrol grubunda başka bir işlem uygulanmadı. Çalışma grubunda onarım tamamlandıktan sonra, ven grefti uygun uzunlukta bir kolajen örtü (Neurawrap Nerve Protector) ile sarıldı ve ven grefti etrafında bir tüp oluşturacak şekilde dikildi. İşlem sonunda kanama yoğunluğu ve süresi ile damar açıklığı kaydedildi. Proksimal ve distal arter segmentleri Doppler ultrasonografi ile incelendi. Tüm gözlem ve ölçümler ameliyattan 1 ve 2 saat sonra tekrarlandı. İkinci saatin sonunda tüm sıçanlar kurban edilerek, arteryel bölümleri ile birlikte ven greftleri histolojik çalışma için çıkarıldı. Sonuçlar: Kontrol grubunda, damar klemplerinin çıkarılmasından sonra tüm ven greftlerinde ani şişme gözlendi. Bu gruptaki tüm deneklerde, anastomoz hattında 1-3 dakika süren kanamayı greftlerin balonlaşması izledi. Çalışma grubunda ise hiçbir ven greftinde şişme ve balonlaşma görülmedi. Bu grupta 11 örnekte herhangi bir kanama görülmezken, diğer dördünde kanama zamanı 1 dakikanın altındaydı. Kontrol grubunda, iki saat sonra yedi greftin sadece biri açıktı, biri daha 3. dakikada tıkandı. Çalışma grubunda ise greftlerin tümü açıktı, hiç tromboz gelişmedi. Doppler incelemede ortalama kan akım hızı kontrol grubunda 0. saatte proksimal arterde 0.930.33 cm/sn, distal arterde 0.730.44 cm/sn ölçüldü. Çalışma grubunda, proksimal ve distal arter kan akımı hızları 0, 1 ve 2 saat sonunda sırasıyla 0.450.27 ve 0.460.22 cm/sn, 0.400.22 ve 0.620.40 cm/sn, 0.550.22 ve 0.640.37 cm/sn idi. Çıkarımlar: Ven greftlerinde aşırı gerilmenin dışarıdan örtü desteğiyle önlenmesi, anastomoz sızıntısını azaltır, intimal mediayı korur, akımın devamını sağlar, tromboz oluşumunu azaltır ve greftin açık kalmasını sağlar. Objectives: Autologous interpositional vein grafts are used in peripheral arterial bypass procedures. Sudden exposure of vein grafts to arterial blood pressure is associated with increased wall tension leading to overdistension of the graft and changes in flow patterns. Overdistension of vein grafts often results in anastomotic leaks, thrombosis, and loss of patency. This study was designed to evaluate the use of a biodegradable collagen cover as a means of preventing overdistension of venous bypass grafts in a rat model. Methods: Twenty-two Sprague-Dawley female rats weighing 250-350 g were randomly assigned to two groups: study group (n 15) and control group (n7). In all the rats, a 10-mm segment of the left femoral vein was harvested and used as a graft in repair of a right femoral artery injury. Following this procedure, control rats remained untreated. After completion of the femoral artery repair in the study group, the graft was wrapped with a collagen cover of appropriate length (NeuraWrap Nerve Protector) and sutured to form a tube around the vein graft. At the end of the procedure, the intensity and duration of bleeding, and vessel patency were recorded and the proximal and distal arterial segments were examined by Doppler ultrasonography. All observations and measurements were repeated at 1 and 2 hours after surgery. After the second hour, all the rats were sacrificed and vein graft samples with the arterial portions were removed for histological study. Results: After removal of the vascular clamps of the control group, a sudden distension was observed in all the vein grafts. In this group, bleeding at the anastomosis site lasted for 1 to 3 minutes and was followed by ballooning of the grafts. In the study group, however, none of the samples exhibited distension and ballooning. There was no bleeding in 11 samples at all, and bleeding time was less than one minute in the remaining four samples. In the control group, only one graft was patent at two hours, one of the grafts was occluded after only three minutes. In the study group, all the grafts were patent and no thrombosis was noted. The mean blood flow velocity of the control group measured at 0 hour by Doppler ultrasonography was 0.93±0.33 cm/sec in the proximal artery, and 0.73±0.44 cm/sec in the distal artery. The mean blood flow velocities in the proximal and distal arteries of the study group were as follows, respectively: at 0 hour: 0.45±0.27 and 0.46±0.22 cm/sec; at 1 hour: 0.40±0.22 and 0.62±0.40 cm/sec; and at 2 hours: 0.55±0.22 and 0.64±0.37 cm/sec. Conclusion: Prevention of overdistension of vein grafts with the use of an external cover decreases anastomotic leaks, protects the intimal media, maintains blood flow, reduces the incidence of thrombosis, and thus provides a higher patency rate Daha fazlası Daha az

Sever, Celalettin | Uygur, Fatih | Külahçı, Yalçın | Torun, Gamze Köse | Urhan, Muammer | Küçükodacı, Zafer | Çaycı, Tuncer

Other | 2010 | Acta Orthopaedica et Traumatologica Turcica44 ( 5 ) , pp.403 - 409

Amac: Bu deneysel calışmanın amacı hidroksiapatit (HA) seramik bloklarına mezenkimal kok hucre, vaskuler pedikul ve hiperbarik oksijen tedavisi (HBOT) uygulanarak, sıcanlarda vaskularize kemik prefabrikasyonunun gercekleştirilmesidir. Calışma planı: Calışmada 45 adet erkek Sprague-Dawley sıcan, her birinde 15 sıcan olan uc gruba ayrıldı. Tum gruplarda HA seramikleri yuzeyel inferior epigastrik arter ve ven ile pedikulize edildi. Grup 2’de HA seramiklerinin icine mezenkimal kok hucre implantasyonu yapıldı. Grup 3’te ise hem mezenkimal kok hucre hem de HBOT uygulandı. Yeni kemik oluşumu ve neovaskularizasyon varlı.ı ve derecesi radyol . . .ojik, mikroanjiografik, sintigrafik, biyokimyasal ve histomorfometrik yontemler ile de.erlendirildi. Sonuclar: Neovaskularizasyon ve yeni kemik oluşumu en fazla, mezenkimal kok hucre implantasyonu yapılan ve takiben HBOT uygulanan Grup 3’te goruldu. Cıkarımlar: HBOT, neovaskularizasyon ve yeni kemik oluşumunu artırır, bu nedenle vaskulerize kemik greftlerinin optimal ve hızlı kemik prefabrikasyonunu sa.layabilir. using the interconnected porous coralline hydroxyapatite ceramic by combining vascular bundle implantation, mesenchymal stem cells, and hyperbaric oxygen therapy (HBOT) administration in a rat model. Methods: Forty-five male Sprague-Dawley rats were divided into three groups, each containing 15 rats. The hydroxyapatite ceramics were vascularized by the superficial inferior epigastric artery and vein in all groups. These vessels passed through the hole of the hydroxyapatite blocks. In Group 2, mesenchymal stem cells were administered into the hydroxyapatite. In Group 3, both mesenchymal stem cells and HBOT were administered. The presence and density of any new bone formation and neovascularization were evaluated by radiography, microangiography, scintigraphy, biochemical analysis, and histomorphometry. Results: Neovascularization and bone formation were significantly greater in Group 3, in which both mesenchymal stem cells and HBOT were applied, than the other groups. Conclusion: HBOT enhances neovascularization and osteogenesis, thus HBOT can provide optimal and faster prefabrication of a vascularized bone graft Daha fazlası Daha az

Coşkunsu, Dilber | Tunay, Volga Bayrakcı | Akgün, Işık

Article | 2010 | Acta Orthopaedica et Traumatologica Turcica44 ( 6 ) , pp.458 - 463

Amaç: Bu çalışmada Türk ortopedik cerrahlar tarafından yapılan ön çapraz bağ (ÖÇB) tamirinde kullanılan son cerrahi teknikler ve rehabilitasyon protokolleri bildirilerek, sonuçları “ÖÇB Çalışma Grubu” ile karşılaştırıldı. Çalışma planı: Cerrahi yöntemleri, cerrahinin önkoşulları, cerrahi sonrası rutin uygulamalar, rehabilitasyon yaklaşımları ve spora dönüşle ilgili bilgi almak üzere 16 sorudan oluşan bir anket hazırlanarak, yılda 25 ve üzeri ÖÇB tamiri yapan 55 ortopedik cerraha e-posta yolu ile gönderildi. Sonuçlar: Anketin yanıtlanma oranı %70.9 (n39) idi. Ondokuz cerrah (%48.7) sadece hamstring tendon (HT) grefti, dört cerrah (%1 . . .0.3) sadece patellar tendon (PT) grefti, 16 cerrah (%41) hem HT hem de PT grefti kullanmakta idi. Hem HT hem de PT greft kullanan 16 cerrahtan dördünün (%18.8) iki greft tipi için ayrı rehabilitasyon protokolleri vardı. Spesifik aktivitelere başlama zamanları karşılaştırıldığında iki greft tipi için verilen cevaplar arasında istatistiksel olarak anlamlı fark yoktu (p0.05). Rehabilitasyon protokolleri “ÖÇB Çalışma Grubu”nun son verileri ile benzerlik göstermekte idi. Türk cerrahlar ve “ÖÇB Çalışma Grubu” arasında sürekli pasif hareket (continuous passive motion, CPM) cihazı ve postoperatif breys kullanımı açısından fark vardı. Cerrahi sonrası breys ve CPM cihazı kullanımı Türkiye’de daha yaygındı. Çıkarımlar: Türk ortopedik cerrahların HT ve PT greft ile yaptıkları ÖÇB tamirinin cerrahi sonrası yaklaşımı çok az farklılık göstermektedir. Türk ortopedik cerrahlardan elde edilen veriler “ÖÇB Çalışma Grubu” güncel yaklaşımları ile benzerlik göstermektedir. Objectives: This study aims to determine the current approaches to surgical techniques and rehabilitation protocols used in anterior cruciate ligament (ACL) reconstruction performed by Turkish orthopedic surgeons and to compare their results with the data of “ACL Study Group”. Methods: A questionnaire consisting of 16 questions on surgical techniques, preoperative prerequisites, routine postoperative applications, rehabilitation approaches, and return to sport following ACL reconstruction was sent via e-mail to the 55 orthopedic surgeons performing annually 25 or more ACL reconstructions. Results: Response rate to questionnaire was 70.9% (n39). Nineteen surgeons (48.7%) regularly performed only hamstring tendon (HT) graft, and four surgeons (10.3%) performed only patellar tendon (PT) graft, while 16 surgeons (41%) performed both HT and PT grafts. Three (18.8%) of the 16 surgeons who performed both HT and PT grafts had individual rehabilitation protocols for the two graft types. No statistically significant difference was found between the responses for two graft types in terms of the starting times for specific activities (p>0.05). Rehabilitation protocols were similar to the current data of “ACL Study Group”. The use of a postoperative brace and continuous passive motion (CPM) was different between Turkish surgeons and “ACL Study Group”. The CPM and postoperative brace use was more common in Turkey. Conclusion: There are only a few differences in the postoperative approach of ACL reconstruction with HT and PT grafts performed by Turkish orthopedic surgeons. The data obtained from the Turkish orthopedic surgeons showed similarities with the “ACL Study Group” current approache Daha fazlası Daha az

Sever, C. | Uygur, F. | Külahçi, Y. | Torun Köse, G. | Urhan, M. | Küçükodaci, Z. | Çayci, T.

Article | 2010 | Acta Orthopaedica et Traumatologica Turcica44 ( 5 ) , pp.403 - 409

Objectives: This experimental study aimed to create a prefabricated vascularized bone graft using the interconnected porous coralline hydroxyapatite ceramic by combining vascular bundle implantation, mesenchymal stem cells, and hyperbaric oxygen therapy (HBOT) administration in a rat model. Methods: Forty-five male Sprague-Dawley rats were divided into three groups, each containing 15 rats. The hydroxyapatite ceramics were vascularized by the superficial inferior epigastric artery and vein in all groups. These vessels passed through the hole of the hydroxyapatite blocks. In Group 2, mesenchymal stem cells were administered into the . . .hydroxyapatite. In Group 3, both mesenchymal stem cells and HBOT were administered. The presence and density of any new bone formation and neovascularization were evaluated by radiography, microangiography, scintigraphy, biochemical analysis, and histomorphometry. Results: Neovascularization and bone formation were significantly greater in Group 3, in which both mesenchymal stem cells and HBOT were applied, than the other groups. Conclusion: HBOT enhances neovascularization and osteogenesis, thus HBOT can provide optimal and faster prefabrication of a vascularized bone graft. © 2010 Turkish Association of Orthopaedics and Traumatology Daha fazlası Daha az

Atay, Evren Fehmi | Güven, Melih | Altıntaş, Faik | Kadıoğlu, Barış | Ceviz, Emrah | İpek, Serdar

Article | 2010 | Acta Orthopaedica et Traumatologica Turcica44 ( 4 ) , pp.306 - 312

Amaç: Bu çal›flmada kalça ve diz artroplastisinde ameliyat sonras› uygulanan ototransfüzyon yönteminin allojenik kan transfüzyonu ihtiyac›n› önlemedeki etkinliinin deerlendirilmesi amaçlanm›flt›r. Çal›flma plan›: Total kalça ve diz artroplastisi uygulanm›fl 74 hasta (77 artroplasti giriflimi) ça- l›flma ve kontrol gruplar›na randomize edilerek prospektif olarak deerlendirildi. Diz grubunda (39 hasta; 30 kad›n, 9 erkek; ortalama yafl 66.6) standart yaklafl›mla turnike kontrolünde çimen- tolu, kalça grubundaysa (35 hasta; 24 kad›n, 11 erkek; ortalama yafl 59.3) posterolateral yakla- fl›mla çimentosuz artroplasti uyguland›. Hiçbir hast . . .aya ameliyat öncesinde ve s›ras›nda allojenik kan transfüzyonu yap›lmad›. Çal›flma gruplar›ndaki hastalarda ameliyat sonras› 4. saatte cerrahi sahada biriken kan ototransfüzyon seti ile transfüze edildi. Kalça ve diz çal›flma gruplar›nda or- talama ototransfüzyon miktarlar› s›ras›yla 413 mL ve 480 mL idi. Banka kan› transfüzyonu; he- moglobin 8 gr/dL’nin, hematokrit ise %25’in alt›nda olduu ve klinik olarak anemi bulgular›n›n efllik ettii hastalarda uyguland›. Sonuçlar: Çal›flma ve kontrol gruplar› aras›nda ameliyat öncesi ve sonras› hemoglobin-hematok- rit deerlerinde istatistiksel anlaml› fark yoktu. Diz hastalar›nda çal›flma grubunda 1 (%5), kon- trol grubunda 8 (%38) (p0.01); kalça hastalar›nda ise çal›flma grubunda 9 (%53), kontrol gru- bunda 15 (%79) hastada (p0.044) banka kan› transfüzyonu yap›ld›. Çal›flma gruplar›nda alloje- nik transfüzyon miktar› kontrol gruplar›na göre anlaml› olarak düflüktü (diz grubu p0.008, kal- ça grubu p0.048). Ç›kar›mlar: Diz ve kalça artroplastisinde ototransfüzyon yöntemiyle diz artroplastisinde daha belirgin olmak üzere allojenik kan transfüzyonu ihtiyac› ve transfüzyon miktar› azalmaktad›r Daha fazlası Daha az

Bekler, H.I. | Rosenwasser, M.P. | Akilina, Y. | Bulut, G.

Article | 2010 | Acta Orthopaedica et Traumatologica Turcica44 ( 2 ) , pp.157 - 161

Objectives: Autologous interpositional vein grafts are used in peripheral arterial bypass procedures. Sudden exposure of vein grafts to arterial blood pressure is associated with increased wall tension leading to overdistension of the graft and changes in flow patterns. Overdistension of vein grafts often results in anastomotic leaks, thrombosis, and loss of patency. This study was designed to evaluate the use of a biodegradable collagen cover as a means of preventing overdistension of venous bypass grafts in a rat model. Methods: Twenty-two Sprague-Dawley female rats weighing 250-350 g were randomly assigned to two groups: study gr . . .oup (n= 15) and control group (n=7). In all the rats, a 10-mm segment of the left femoral vein was harvested and used as a graft in repair of a right femoral artery injury. Following this procedure, control rats remained untreated. After completion of the femoral artery repair in the study group, the graft was wrapped with a collagen cover of appropriate length (NeuraWrap Nerve Protector) and sutured to form a tube around the vein graft. At the end of the procedure, the intensity and duration of bleeding, and vessel patency were recorded and the proximal and distal arterial segments were examined by Doppler ultrasonography. All observations and measurements were repeated at 1 and 2 hours after surgery. After the second hour, all the rats were sacrificed and vein graft samples with the arterial portions were removed for histological study. Results: After removal of the vascular clamps of the control group, a sudden distension was observed in all the vein grafts. In this group, bleeding at the anastomosis site lasted for 1 to 3 minutes and was followed by ballooning of the grafts. In the study group, however, none of the samples exhibited distension and ballooning. There was no bleeding in 11 samples at all, and bleeding time was less than one minute in the remaining four samples. In the control group, only one graft was patent at two hours, one of the grafts was occluded after only three minutes. In the study group, all the grafts were patent and no thrombosis was noted. The mean blood flow velocity of the control group measured at 0 hour by Doppler ultrasonography was 0.93±0.33 cm/sec in the proximal artery, and 0.73±0.44 cm/sec in the distal artery. The mean blood flow velocities in the proximal and distal arteries of the study group were as follows, respectively: at 0 hour: 0.45±0.27 and 0.46±0.22 cm/sec; at 1 hour: 0.40±0.22 and 0.62±0.40 cm/sec; and at 2 hours: 0.55±0.22 and 0.64±0.37 cm/sec. Conclusion: Prevention of overdistension of vein grafts with the use of an external cover decreases anastomotic leaks, protects the intimal media, maintains blood flow, reduces the incidence of thrombosis, and thus provides a higher patency rate. © 2010 Turkish Association of Orthopaedics and Traumatology Daha fazlası Daha az

Atay, E.F. | Güven, M. | Altintaş, F. | Kadioglu, B. | Ceviz, E. | Ipek, S.

Article | 2010 | Acta Orthopaedica et Traumatologica Turcica44 ( 4 ) , pp.306 - 312

Objectives: We aimed to evaluate the effectiveness of postoperative autotransfusion method on prevention of the need of allogeneic blood transfusion in hip and knee arthroplasty. Methods: Seventy-four patients who underwent 77 hip and knee arthroplasty operations were randomized into control and study groups, and evaluated prospectively. In the knee group (39 patients; 30 females, 9 males; mean age 66.6 years), cemented, cruciate retaining, and bicompartmental arthroplasty was performed under tourniquet control; whereas in the hip group (35 patients; 24 females, 11 males; mean age 59.3 years) cementless arthroplasty with posterolate . . .ral approach was performed. None of the patients received preoperative and intraoperative allogeneic blood transfusion. The collected blood in the surgical area was transfused with autotransfusion system to the patients in the study groups at the end of the fourth hour postoperatively. The mean amounts of autotransfused blood in hip and knee groups were 413 mL and 480 mL, respectively. Allogeneic blood transfusion was applied to the patients with hemoglobin level below 8 g/dL, hematocrit level below 25%, and clinical symptoms of anemia. Results: Preoperative and postoperative hemoglobin-hematocrit levels did not differ significantly between study and control groups. Allogeneic blood transfusion was applied to one patient (5%) in study and 8 patients (38%) in control groups during knee arthroplasty (p=0.01); whereas 9 patients (53%) in study and 15 patients (79%) in control groups received allogeneic blood transfusion during hip arthroplasty (p=0.044). The amount of allogeneic blood transfusion in study groups was significantly lower than that in control groups (p=0.008 for knee arthroplasty, p=0.048 for hip arthroplasty). Conclusion: The need and amount of allogeneic transfusion were reduced with postoperative autotransfusion in both knee and hip arthroplasty groups with greater extent in knee arthroplasty. © 2010 Turkish Association of Orthopaedics and Traumatology Daha fazlası Daha az