Araştırma Çıktıları
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Item Selection of distal fusion level in terms of distal junctional kyphosis in Scheuermann kyphosis. A comparison of 3 methods(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2018-01-01) Dikici, Fatih; Akgul, Turgut; Sariyilmaz, Kerim; Korkmaz, Murat; Ozkunt, Okan; Sar, Cuneyt; Domanic, UnsalObjective: The aim of this study was to investigate the effect of distal fusion level selection on the distal junctional kyphosis (DJK) in Scheuermann kyphosis (SK) patients who underwent posterior fusion. Methods: Thirty-nine SK patients who underwent posterior fusion with a minimum follow-up of 3 years were retrospectively evaluated. According to the distal fusion level, patients were divided into 3 groups. Group SItem Postoperative mechanical alignment analysis of total knee replacement patients operated with 3D printed patient specific instruments: A Prospective Cohort Study(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2019-01-01) Gemalmaz, Halil Can; Sariyilmaz, Kerim; Ozkunt, Okan; Sungur, Mustafa; Kaya, Ibrahim; Dikici, FatihObjective: Total knee replacement (TKR) is a surgical treatment for final stage gonarthrosis. The lifespan of the prosthetic implants used in TKR surgery is a major interest for the orthopaedic research community. Previously, proper implant alignment of the implants has been advocated for longevity of the TKR surgery. Recently, patient-specific (PSI) instruments have been proposed to improve the mechanical alignment of the TKR by permitting better implant positioning over conventional TKR surgery. The aim of this study is to compare the mechanical alignment results of patients operated with PSIs and conventional instruments. Methods: Two groups of 20 patients chosen in a quasi-random manner have been compared in this study. In the first group femoral distal and tibial osteotomies were made by a PSI which was produced by the patients' computed tomography scans. All osteotomies in the control group were made with the TKR set's routine instruments by conventional means. Patients' preoperative and postoperative mechanical femorotibal angles (mFTA), femoral coronal angles (FCA), tibial coronal angles (TCA) were measured and the number of outliers which showed more than 3 degrees of malalignment were counted in both groups for comparison. Results: The average postoperative mFTA was found to be 2.09 degrees for the PSI group and in was found to be 2.84 degrees for the control which was not statistically significant. The comparison of postoperative FCA and TCA also did not show significant difference between the groups. The number of outliers showing more than 3 degrees of malalignment per group were found to be 1 out of 20 (5\%) for the PSI group and 7 out of 20 (35\%) for the control which was statistically significant. Conclusion: In this study patient-specific instrumentation provided significantly better mechanical alignment compared to conventional TKR for the frequency of outlier cases with malalignment beyond 3 degrees. PSI proved no significant difference when the groups were compared for mFTA, FCA and TCA. Our findings support that PSI may improve TKR alignment by improving the ratio of the outlier patients with marked malalignment. (C) 2019 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V.Item Autologous segmental tibia bone transfer in the treatment of distal tibia Gustilo-Anderson type-III open fracture: A case report(ELSEVIER SCI LTD, 2016-01-01) Demirel, Mehmet; Akgul, Turgut; Polat, Gokhan; Cakmak, Mehmet Fevzi; Dikici, FatihINTRODUCTION: We present the results of a two-stage reconstruction performed with autologous segmental tibia bone transfer on a distal tibia Gustilo-Anderson type-IIIC open fracture in this paper. Our aim is to discuss the results of this surgery, potential failures and complications in our procedures, and ways to protect against osteolysis. PRESENTATION OF CASE: A 20-year-old male who has undergone surgery in our clinic for a Gustilo-Anderson type-III open fracture of the left tibia using autologous tibia segmental bone transfer. The first operation consisted of removing the exposed bony fragment and placing it in the abdominal wall. Fifty days after the first operation, an intramedullary nailing operation was performed using the autologous bone fragment kept in the abdominal wall. Before the final procedure, we assessed the viability of the bone fragment using scintigraphy as well as the paprika sign was observed on the fragment during operation. Patient was seen in follow-up every three weeks to evaluate for successful osteosynthesisItem Analysing the change of sagittal balance in patients with Lenke 5 idiopathic scoliosis(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2017-01-01) Ozkunt, Okan; Karademir, Gokhan; Sariyilmaz, Kerim; Gemalmaz, Halil Can; Dikici, Fatih; Domanic, UnsalObjective: The aim of this study was to evaluate preoperative and postoperative spinopelvic parameters and the influence of lowest instrumented vertebrae on sagittal parameters in Lenke 5 Adolescent Idiopathic Scoliosis (AIS) patients. Methods: A total of 42 patients (37 females, 5 malesItem Surgical Approach Algorithm in the Treatment of Lumbar and Thoracolumbar Pyogenic Spondylodiscitis(TURKISH NEUROSURGICAL SOC, 2022-01-01) Akgul, Turgut; Bayram, Serkan; Korkmaz, Murat; Karalar, Sahin; Dikici, Fatih; Sar, CuneytAIM: To reveal the efficiency of our surgical approach algorithm in patients with thoracolumbar pyogenic spondylodiscitis based on the involvement of anatomical structure. MATERIAL and METHODS: Data of patients who underwent debridement or stabilization surgery for thoracolumbar pyogenic spondylodiscitis from January 2012 to December 2018 were reviewed. Lumbar and thoracolumbar spondylodiscitis was classified into four stages based on anatomical involvement. Infection was limited in the disc space, which had not spread to the endplate in stage 1 and progressed as two-level corpus involvement of >1/2 of vertebral corpus bony destruction or as failed treatment in stage 4. Neurological function was evaluated using Frankel's grading postoperatively. Functional outcomes were categorized according to the Kirkaldy-Willis criteria. RESULTS: The study included 39 patients, with a mean age of 58.2 years. Of these patients, 10, 12, 13, and 4 had stages 1, 2, 3, and 4 spondylodiscitis, respectively. The mean follow-up period was 60.2 (12-184) months. All patients with stages 1 and 2 spondylodiscitis had grade E injuryItem Posterior Approach Alone Versus Combined Anterior and Posterior Approach in the Management of Vertebral Tuberculosis(TURKISH NEUROSURGICAL SOC, 2019-01-01) Demirel, Mehmet; Akgul, Turgut; Pehlivanoglu, Tuna; Karademir, Gokhan; Bayram, Serkan; Dikici, Fatih; Sar, CuneytAIM: To compare posterior surgery alone versus combined anterior and posterior surgery for the management of spinal tuberculosis. MATERIAL and METHODS: Data from 31 consecutive patients who underwent surgery for spinal tuberculosis were analyzed retrospectively. Patients were divided into two groups as group A (posterior surgery alone) or group B (combined anterior and posterior surgery), and groups were compared in terms of invasiveness of the procedure, spinal deformity, fusion, neurological status, and postoperative complications. RESULTS: Group A included 16 patients (mean age: 56 years, range: 29-75) with a mean follow-up period of 29 months (range 12-60) while group B included 15 patients (mean age: 60 years, range: 35-73) with a mean follow-up period of 28 months (range 12-60). Procedurally, average operation time and mean length of hospitalization were shorter, and mean blood loss was lower in group A (p<0.05) compared to group B. Postoperative bone fusion took significantly (p<0.05) longer time in group A (10.5 +/- 2.1 months)than in group B (9.3 +/- 3.1 months), and all patients with a neurological deficit recovered completely during the postoperative period. No significant differences were observed between two groups with respect to postoperative complications (p>0.05). CONCLUSION: Combined anterior-posterior surgery may not be required for treating vertebral tuberculosis as posterior surgery alone appears to be sufficient.Item Investigation of efficacy of treatment in spinal cord injury: Erythropoietin versus methylprednisolone(SAGE PUBLICATIONS INC, 2017-01-01) Ozkunt, Okan; Sariyilmaz, Kerim; Gemalmaz, Halil Can; Gurgen, Seren Gulsen; Yener, Ulas; Dikici, FatihBackground: Investigation of the expression of platelet-derived growth factor (PDGF)-beta and glial fibrillary acidic protein (GFAP) in rats with spinal cord injury as a marker of neurologic recovery between groups treated with erythropoietin (EPO) and methylprednisolone (MP). Methods: Thirty adult female rats were randomly divided into three even groups. A laminectomy was applied to thoracic ninth vertebra and contusion injury was induced by extradural application of an aneurysm clip. Group 1 rats received one-time intrathecal administration of normal saline, group 2 rats received MP, and group 3 rats received EPO. Motor neurological function was evaluated by the Basso, Beattie, and Bresnahan (BBB) locomotor rating scale. Thirty days after the surgery, T8-10 segments of the spinal cords were extracted and the immunohistochemical assay revealed the number of PDGF-beta- and GFAP-positive cells. Results: Evaluation of the last control animal showed that BBB score in the EPO group showed an increase from 1 to 12 (p < 0.05). The immunohistochemical assay revealed that the number of PDGF-beta- and GFAP-positive cells was significantly higher in EPO group (p = 0.000) when compared to MP and control groups. After studying the effect of PDGF-beta expression on the locomotor function, we determined that PDGF-beta expression and locomotor function after a spinal injury has a strong relationship (p < 0.05). Conclusion: EPO seems to better increase the expression of PDGF-beta, thus produce better results in locomotor functions when compared to MP.