Ulus Travma Acil Cerrahi Derg. 2012; 18(1): 11-17 | DOI: 10.5505/tjtes.2012.95530

Fleksör tendon onarým sonrasý, tekrarlayan hyaluronik asit enjeksiyonlarýnýn, peritendinöz adezyon üzerine etkisi: Randomize plasebo kontrollü klinik ön çalýþma

Güzin Yeþim Özgenel¹, Abdullah Etöz^2
1Uludað Üniversitesi Týp Fakültesi, Plastik, Rekonstrüktif ve Estetik Cerrahi Anabilim Dalý, El Cerrahisi Bilim Dalý, Bursa, Türkiye
²Ýnegöl Devlet Hastanesi, Plastik Cerrahi, Ýnegöl, Türkiye

AMAÇ
Bu çalýþmada, zon-II fleksör tendon onarýmlarýndan sonra, iki haftalýk süre içerisinde enjekte edilen 3 doz hyaluronik asit (HA) enjeksiyonunun plaseboya (salin) karþý etkinliði araþtýrýldý.
GEREÇ VE YÖNTEM
Çalýþmaya Ýkinci parmak izole zon-II fleksör tendon hasarlanmasý olan 22 hasta dahil edildi. Tenorafi öncesi, parmaklar randomize olarak iki gruba ayrýldý; 11 parmakta tenorafi çevresine 3 doz HA enjekte edilirken, ayný þekilde salin enjekte edilen 11 parmak da plasebo grubunu oluþturdu. Birinci doz tenorafi sýrasýnda verildi ve ilave 2 doz 1 hafta ara ile enjekte edildi. Operasyon sonrasý Kleinert rehabilitasyon protokolü uygulandý. Eklem hareket açýklýðý, 3. hafta, 3. ay ve uzun dönemde total aktif ve pasif eklem açýklýðý ölçülerek deðerlendirildi. Fonksiyonel sonuç, Strickland sýnýflandýrmasýna göre belirlendi.
BULGULAR
Üçüncü haftada eklem hareket açýklýðý açýsýndan iki grup arasýnda bir fark tespit edilmedi. Ancak, 3. ay ve uzun dönemde, eklem hareket açýklýðýnda, HA enjekte edilen parmaklarda plasebo grubuna göre anlamlý derecede iyileþme olduðu gözlendi.
SONUÇ
Bu plasebo kontrollü ön çalýþmada, mükerrer HA enjeksiyonlarýnýn, primer tendon onarýmýnda, muhtemelen adezyon azaltýcý etkisine baðlý olarak, klinik sonuçlarý iyileþtirebildiði ileri sürülmektedir.

Anahtar Kelimeler: Adezyon önleme, hyaluronik asit; tendon adezyonlarý; tendon onarýmý.

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Effects of repetitive injections of hyaluronic acid on peritendinous adhesions after flexor tendon repair: a preliminary randomized, placebo-controlled clinical trial

Güzin Yeþim Özgenel¹, Abdullah Etöz^2
1Department Of Plastic, Reconstructive And Aesthetic Surgery, Division Of Hand Surgery, Uludag University Medical School, Bursa, Turkey
²Plastic Surgery, Social Security Hospital, Inegöl, Turkey

BACKGROUND
The aim of this study was to investigate the efficacy of three injections of hyaluronic acid (HA) versus placebo (saline) over a two-week period on functional outcomes after zone-II flexor tendon repairs.
METHODS
Twenty-two patients with isolated zone-II flexor tendon injury of the index fingers were included in this study. Before tenorrhaphy, fingers were randomly divided into two groups; 11 were treated with three injections of HA around the tenorrhaphy site and 11 served as a placebo group and were treated with saline in the same way. The first dose was given at the time of tenorrhaphy and two additional doses were given at one-week intervals. A Kleinert rehabilitation protocol was employed postoperatively. Range of motion was assessed with total active and passive movement evaluation systems at 3 weeks, 3 months and long-term. Functional outcome was evaluated using the Strickland classification.
RESULTS
There were no differences between the two groups in terms of range of motion at 3 weeks. However, at 3 months and long-term, a significant improvement was observed in fingers treated with HA compared to placebo.
CONCLUSION
This preliminary placebo-controlled study suggests that repetitive injections of HA can improve clinical outcomes presumably due to the effect on decreasing adhesions in primary tendon repairs.

Keywords: Adhesion prevention, hyaluronic acid; tendon adhesions; tendon repair

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