Operativno liječenje rerupture Ahilove tetive

master's thesis

• Title (english): Surgical treatment of Achilles tendon re-rupture
• Author: Kristijan Vrdoljak
• Mentor: Mario Starešinić (mentor)
• Committee member: Božidar Šebečić (predsjednik povjerenstva)
• Committee member: Anko Antabak (član povjerenstva)
• Committee member: Mario Starešinić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Načini liječenja rupture pa tako i rerupture Ahilove tetive mogu se općenito klasificirati pod otvorene operativne zahvate, perkutane operativne i neoperativne metode. U literaturi ne postoje jasne definicije pojmova perkutani i minimalno invazivni popravak. Logički se to dvoje može razlikovati prema vizualizaciji apozicije krajeva tetive tijekom procesa popravka. Kod minimalno invazivnog popravka krajevi tetive mogu se vidjeti spojeni kroz mali rez iako se sami šavovi mogu provući kroz ubodne rezove s obje strane tetive. Za razliku, u perkutanom popravku, krajevi tetiva možda se neće izravno vidjeti, ali se mogu vizualizirati ultrazvukom i endoskopijom. Zbog velikih varijacija u kirurškim tehnikama za popravak puknute ahilove tetive, gotovo je nemoguće istaknuti koja metoda daje najbolji ukupni ishod. Otvoreni pristup je metoda izbora kod sportaša, mladih ljudi i pacijenata s kroničnim rupturama, jer im je potrebna rekonstruktivna kirurgija kako bi što ranije vratili funkciju na višoj razini odnosno vratili funkciju nakon određenog vremena. U kirurške tehnike koje su se pokazale metodom izbora u slučaju ponovljene rupture Ahilove tetive ubrajaju se prijenos tetive peroneus brevisa za rupture s defektom manjim od 6 cm te rekonstrukcija slobodnim ipsilateralnim transplantatom tetive semitendinozusa s fiksacijom interferentnim vijkom za rupture s defektom većim od 6 cm. Također, razvija se i metoda kombinirane biološke augmentacije uz kirurško liječenje.

Abstract (english)

Treatment methods for rupture and rerupture of the Achilles tendon can generally be classified under open surgical procedures, percutaneous operative and non-operative methods. There are no clear definitions of the terms percutaneous and minimally invasive repair in the literature. Logically, the two can be distinguished by visualizing the apposition of the tendon ends during the repair process. In minimally invasive repairs, the ends of the tendon can be seen joined through a small incision although the sutures themselves can be passed through stab incisions on either side of the tendon. In contrast, in a percutaneous repair, the ends of the tendons may not be directly seen, but can be visualized by ultrasound and endoscopy. Because of the wide variation in surgical techniques for the repair of a ruptured Achilles tendon, it is almost impossible to single out which method provides the best overall outcome. The open approach is the method of choice for athletes, young people and patients with chronic ruptures, because they need reconstructive surgery in order to restore function to a higher level as soon as possible, or to restore function after a certain time. Surgical techniques that have proven to be the method of choice in the case of repeated rupture of the Achilles tendon include transfer of the peroneus brevis tendon for rupture with a defect less than 6 cm and reconstruction with a free ipsilateral semitendinosus tendon graft with interference screw fixation for rupture with a defect larger than 6 cm. Also, a method of combined biological augmentation with surgical treatment is being developed.

• Keywords: reruptura Ahilove tetive; rekonstrukcija Ahilove tetive; ruptura Ahilove tetive; prijenos tetive peroneus brevisa; rekonstrukcija slobodnim transplantatom tetive semitendinozusa
• Keywords (english): Achilles tendon rerupture; Achilles tendon reconstruction; Achilles tendon rupture; peroneus brevis tendon transfer; semitendinosus tendon reconstruction with a free graft
• Language: croatian
• URN:NBN: urn:nbn:hr:105:017877
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-11-02 11:57:22