Browsing by Author "Akesen, Burak"
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Item Akut spinal yaralanmanın tedavisinde riluzol, metilprednisolon ve bu iki ilacın kombinasyonunun spinal dekompresyona etkisinin in vivo sıçan modelinde karşılaştırılması(Bursa Uludağ Üniversitesi, 2022) Önder, Cem; Akesen, Burak; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.Amaç: Çalışmamızda amaç riluzol, MPS ve iki ilacın kombinasyonun akut spinal travma oluşturulmuş bir sıçan modelinde medikal tedavi etkinliğinin elektrofizyolojik ve histopatolojik olarak belirlenmesi ve karşılaştırılmasıdır. Gereç ve Yöntem: Çalışmamızda 59 adet sıçan kontrol, riluzol, MPS ve riluzol + MPS olmak üzere 4 gruba ayrılmıştır. Akut spinal travma, sıçanlara laminektomi uygulanıp epidural aralıkta ilerletilen embolektomi kateterinin şişirilmesi yöntemiyle yaratılmış ve denekler 7 gün boyunca izlenmiştir. Medikal tedavi uygulanmış, nöromonitörizasyon ile elektrofizyolojik kayıt yapılmış ve gruplar arası amplitüd–latans değerleri karşılaştırılmıştır. 7 gün sonunda denekler sakrifiye edilmiş ve gruplar arası histopatolojik inceleme ve karşılaştırma yapılmıştır. Bulgular: İstatistiksel olarak deney prosedürünün benzer akut spinal travma yaratması ve deneklerin elektrofizyolojik olarak homojen olması test edilmiştir. Spinal kord hasarı gerçekleştirilmesi sonrası alınan amplitüd ve latans değerlerinin farklılığı açısından anlamlı bir ilişki gözlenmemiştir. İlaç üstünlükleri de karşılaştırılmış ve amplitüd açısından riluzol tedavi grubu amplitüd değerinde en fazla artışı sağlamasına rağmen, hiçbir tedavinin kontrol grubuna göre anlamlı bir iyileşme sağlamadığı görülmüştür. Tedavi gruplarının birbirlerine üstünlüklerine bakıldığında ise riluzol ve riluzol + MPS tedavi gruplarınn, MPS tedavi grubuna göre amplitüdde anlamlı olarak daha fazla iyileşme sağladığı gözlenmiştir. Latans açısından, hiçbir tedavinin kontrol grubuna göre ve birbirlerine göre anlamlı bir iyileşme sağlamadığı görülmüştür. Son olarak histopatolojik inceleme, alınan medulla spinalis kesitlerinde kavitasyon alanı hesabına dayanarak yapılmış ve riluzol tedavi grubunda, kontrol grubuna ve MPS tedavi grubuna göre anlamlı olarak daha az kavitasyon alanı olduğu görülmüştür. Bunlara karşılık MPS ve riluzol + MPS tedavi gruplarının kontrol grubuna göre anlamlı bir fark sağlamadığı gözlenmiştir. Sonuç: Akut spinal yaralanmada klasik MPS tedavisinin fayda göstermediği görülmektedir. Elektrofizyolojik sonuçlara anlamlı düzeyde etki etmemesine rağmen histopatolojik iyileşme olarak riluzolün kendini kanıtladığı düşünülmektedir.Item Approach to supracondylar humerus fractures with neurovascular compromise in children(Türk Ortopedi Travmatoloji Derneği, 2013-04-03) Aksakal, Murat; Ermutlu, Cenk; Sarısözen, Bartu; Akesen, Burak; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; AAH-9833-2021; ABI-7283-2020; 55890736200; 23102160500Objective: The aim of this study was to evaluate neurovascular compromise in childhood Gartland Type 3 supracondylar humerus fractures (SHFs), identify the factors correlated with increased need of open reduction and compare the clinical outcome of anterior open reduction with that of closed reduction. Methods: The study included 65 patients (46 male, 19 female; mean age: 7.03 years, range: 1 to 14 years) treated surgically for SCH fracture between January 2002 and June 2008. Fractures underwent closed reduction with percutaneous pinning when possible. Open reduction was performed when adequate reduction via the closed technique failed or vascular compromise were indications for open reduction. Patient demographics, physical examination findings, adequacy of reduction, functional and cosmetic outcomes were assessed. Results: During the antecubital approach, vascular pathology was noted in all patients with signs of vascular compromise at physical examination. Half of these patients underwent vascular intervention. Closed reduction failed in 93% of patients with concomitant edema, ecchymosis and dimple sign. Of these, the median nerve was trapped between the bone fragments in 4 patients with normal neurological examinations. Functional and cosmetic results of open reduction were similar to closed reduction (p>0.05). Conclusion: Closed reduction should not be forced in cases with marked edema, ecchymosis, dimple sign, and absence of radial pulse. The anterior approach is the surgical approach of choice due to direct visualization of neurovascular bundle and availability of neurovascular intervention by extending the same approach.Publication Bilateral bi-level erector spinae plane blocks in scoliosis surgery: A retrospective comparative study(Türk Ortopedi Travmatoloji, 2022-09-01) Akesen, Selcan; Güler, Saltuk Buğra; Akesen, Burak; AKESEN, SELCAN; GÜLER, ABDULKERİM SALTUKBUĞRA; AKESEN, BURAK; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı; 0000-0002-9518-541X; 0000-0002-4324-4844; 0000-0002-8679-6008; ADT-9515-2022; AAH-9833-2021; ELR-9087-2022Objective: This study aimed to compare the effect of the ultrasound (US) guided erector spinae plane block (ESPB) on pain scores, opioid requirement, patient satisfaction, and the length of hospital stay with standard analgesia methods following scoliosis surgery.Methods: Twenty-seven patients (17 females, 10 males; mean age = 15.59 +/- 3.24 years) who underwent scoliosis surgery with preoperative bilateral bilevel US- guided ESPB were the sample group, and the remaining 30 patients (20 females, 10 males; mean age = 15.57 +/- 2.75 years) without ESPB were the control group. Bilateral bilevel injection ESPB was performed at two levels (T4 and T10). Postoperative pain scores, morphine consumption, patient satisfaction scores, and the number of patients requiring rescue analgesia were recorded. A visual analog scale (VAS) was used to score postoperative pain.Results: VAS at rest and when mobile, as well as postoperative cumulative morphine consumption in the first postoperative 24 h, was significantly lower in the ESPB group. Thirteen patients in the control group but no in the ESPB group required rescue analgesics in the postoperative period. Both the time to the requirement of the initial dose of PCA and patient satisfaction scores were significantly higher in the ESPB group (P < 0.001 for both).Conclusion: Given the need for improved recovery of the patients, ESPB seems to be an essential analgesic technique that may reduce both opioid consumption and the severity of the pain, thus increasing the satisfaction of the patients and decreasing the length of hospital stay.Item Comparative results of percutaneous cannulated screws, dynamic compression type plate and screw for the treatment of femoral neck fractures(Türk Travma ve Acil Cerrahi Dergisi, 2012-01) Kaplan, Tolga; Akesen, Burak; Demirağ, Burak; Bilgen, Sadık; Durak, Kemal; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; AAI-1638-2021; AAH-9833-2021; 23102160500; 56019156900; 15061239900; 6602850051BACKGROUND The purpose of this study was to compare the period of union, functional outcomes and complications of patients with femoral neck fracture treated with percutaneous cannulated screws versus dynamic hip screw (DHS). METHODS Sixty-six patients with femoral neck fracture were treated with percutaneous cannulated screws (n=33) or with DHS (n=33) between August 1999 and October 2003. Functional outcome was measured using Harris Hip Score, and period of union, amount of bleeding and complications were also recorded. RESULTS The period of union and functional outcomes were not different between the two groups. Risk of avascular necrosis (AVN) was associated mainly with the grade of fracture displacement. In the percutaneous cannulated screw group, duration of surgery was shorter and blood loss was less than in the other group. CONCLUSION There was no superiority between cannulated screws and DHS according to union times and functional results. Risk of AVN is related to the degree of displacement. However, a prospective randomized study is needed to determine the outcome of each technique for patients suffering similar displacement rates.Publication Comparing the trajectory accuracy of pedicle screws placed with a free-hand technique and a three-dimensional computed tomography-assisted navigation system in spine surgery: A retrospective study(İstanbul Üniversitesi, 2023-02-28) Çetiner, Eyyup; Akesen, Selcan; Bilgin, Yücel; Önder, Cem; Güler, Saltuk Buğra; Akesen, Burak; AKESEN, SELCAN; BİLGİN, YÜCEL; Güler, Saltuk Buğra; AKESEN, BURAK; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; ELR-9087-2022; IAI-7796-2023; ADT-9515-2022; AAH-9833-2021Objective: We evaluated a free-hand technique and a three-di-mensional computerized tomography (3D-CT)-assisted naviga-tion technique, which are pedicle screw placement techniques used in spinal surgery, regarding screw placement and reliability.Material and Method: A total of 1664 screws in 73 patients with spinal deformities who underwent spinal instrumentation using pedicle screws were evaluated in this study. Forty patients were in the free-hand technique group, and 33 patients were in the 3D-CT-assisted navigation technique group. The placement and reliability of pedicle screws in all patients were evaluated using the Gertzbein-Robbins classification using CT images taken in the postoperative period.Result: There were no significant differences found regarding age, body mass index (BMI), sex (female or male), or deformity (scoliosis or kyphosis) (p>0.05). When the pedicle screws were evaluated in terms of transverse penetration, the 3D-CT-assisted navigation technique was determined Grade A (89.6%), as was the free-hand technique (76.5%), but the 3D-CT-assisted navi-gation technique was statistically more reliable (p<0.001). When the pedicle screws were evaluated in terms of anterior penetra-tion, both the 3D-CT-assisted navigation technique (92.5%) and the free-hand technique (82.9%) were determined Grade A, but the 3D-CT-assisted navigation technique was statistically more reliable (p<0.001).Conclusion: According to our studys results, the 3D-CT-assist-ed navigation technique is more reliable than the free-hand technique in surgeries involving spine deformities for pedicle screw insertion.Publication Comparison of efficacy between the genicular nerve block and the popliteal artery and the capsule of the posterior knee (IPACK) block for total knee replacement surgery: A prospective randomized controlled study(Türkiye Ortopedi Travmatoloji, 2021-03-01) Akesen, Selcan; Akesen, Burak; Atıcı, Teoman; Gurbet, Alp; Ermutlu, Cenk; Özyalçın, Ali; AKESEN, SELCAN; AKESEN, BURAK; ATICI, TEOMAN; GURBET, ALP; ERMUTLU, CENK; ÖZYALÇIN, ALİ; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı; 0000-0002-3396-3407; 0000-0002-6503-8232; JHR-5447-2023; AEQ-5464-2022; ELR-9087-2022; AAH-9833-2021; A-5095-2018; A-7994-2018Objective: The aim of this study was to compare the efficacy of popliteal artery and the capsule of the posterior knee (IPACK) block and genicular nerve block on postoperative pain scores, the need for rescue analgesics, range of motion (ROM), walking distance, and perioperative monitorization variables in patients undergoing total knee replacement (TKR) surgery.Methods: Sixty American Society of Anesthesiologists (ASA) physical status I-III patients were enrolled in this study and then were randomly assigned into three groups: the IPACK block group (17 female, 3 male; mean age=67.5 +/- 1.4 years), genicular nerve block (16 female, 4 male; mean age=68 +/- 1.76 years), and the control group (13 female, 7 male; mean age=63 +/- 1.67years). All the patients underwent TKR under spinal anesthesia. The visual analog scale (VAS) score, mobility, pre- and intra-operative monitorization of systolic and diastolic holding area, non-invasive blood pressure, heart rate, and SPO 2 were compared between the groups.Results: Patients in the IPACK and genicular block groups had a significantly lower visual analogous scale (VAS) at postoperative 4 hours (p<0.01), 8h (p<0.01), 12h (p<0.01), and 24h (p<0.05). VAS score was significantly lower in the genicular block group at the postoperative 4h (5.5 +/- 0.55) and 8h (5.0 +/- 0.53) in the mobile state compared to the IPACK (8.0 +/- 0.47 and 8.0 +/- 0.43, respectively) and the control group (9.5 +/- 0.20; 10 +/- 0.28, respectively) (p<0.01). The use of patient-controlled-analgesia (PCA) devices and button push count for analgesics demand were significantly lower in the genicular block group on the immediate postoperative period (p<0.01 at the postoperative 0 to 4 h). The total consumption of morphine equivalents on the postoperative day 0 was significantly lower in the genicular block group (p<0.01, and p<0.001 for IPACK and control groups, respectively). The degree of flexion was significantly higher in the genicular block group at the postoperative 12h compared to the IPACK and the control group (p<0.001). The length of hospital stay was significantly lower in the genicular block group compared to the IPACK and the control group (p<0.05 for both variables).Conclusion: IPACK and genicular blocks both are effective in improving patient comfort during and after TKR surgery and reducing the potential need for systemic analgesic and opioids. The genicular block seems to be a promising technique that can offer improved pain management in the immediate and early postoperative period without adverse effects on systemic and motor variables.Item Comparison of hemiarthroplasty and total hip arthroplasty in elderly patients with displaced femoral neck fractures(Sage Puplications, 2018-03-21) Barışhan, Fatih Canşah; Akesen, Burak; Atıcı, Teoman; Durak, Kemal; Bilgen, Muhammed Sadık; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; 0000-0003-0599-6874; A-5095-2018; AAH-9833-2021; 57203059363; 23102160500; 7801647288; 6602850051; 35723877700Objective This study was performed to compare the clinical and radiological outcomes of displaced femoral neck fractures (FNFs) treated with either hemiarthroplasty or total hip arthroplasty (THA) in elderly patients. Morbidity and mortality were also evaluated. Methods Twenty-two patients who underwent hemiarthroplasty and 16 patients who underwent THA for treatment of Garden type 3-4 FNFs from 2012 to 2015 were enrolled in this study. All patients were >65 years of age. Cox regression analysis was performed for mortality evaluation. Results The postoperative blood loss volume, decrease in the hemoglobin level, and transfusion rate were significantly higher in the THA group. The univariate mortality risk was higher in patients with a Charlson comorbidity score of >4, American Society of Anesthesiologists score of >2, Singh index of <3, and postoperative hospitalization of >1 week. Conclusion This study revealed no significant difference in the short-term clinical and radiological results between cementless hemiarthroplasty and THA in elderly patients with displaced FNFs. However, morbidity and mortality were associated with the presence of additional systemic diseases. THA is the preferred surgical technique in patients with displaced FNFs and low comorbidities.Item The comparison of the negative effect of autoclaving and pasteurization on bone healing(Türk Ortopedi ve Travmatoloji Derneği, 2010) Vural, Recep; Akesen, Burak; Karakayalı, Mehmet; Yalçınkaya, Ülviye; Aydınlı, Ufuk; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Patoloji Anabilim Dalı.; AAH-9833-2021; AAH-8924-2021; 16318100900; 23102160500; 8630188700; 6508300295; 6602800134Objectives: The aim of this study was to compare the effects of autoclaving and pasteurization on bone healing. Methods: Twenty-five full-grown male rabbits were included in the study; all 25 had bone blocks resected and reimplanted. In group 1, bone blocks were autoclaved; in group 2, bone blocks were pasteurized; and in group 3 (controls), resected bone blocks were reimplanted without sterilization. Results: Heiple scores of the proximal parts of the fusion surfaces in group 1, group 2, and group 3 were 12.8 +/- 0.4, 6.8 +/- 1.2, and 10.2 +/- 1.9, respectively. Heiple scores of the distal parts of the fusion surfaces in group I, group 2, and group 3 were 10.8 +/- 0.8, 6.0 +/- 1.1, and 9.8 +/- 1.5, respectively. Differences in radiologic scores were not statistically significant between the groups for proximal or distal fusion surfaces at 3 and 6 weeks. Conclusion: In conclusion, pasteurization has a less negative effect on bone healing than autoclaving, and can be considered for bone sterilization in certain circumstances.Item The comparison of the results after spinal fusion with or without iliac screw insertion in the treatment of neuromuscular scoliosis(Türkiye Ortepedi Travmatoloji Derneği, 2017-12-12) Akesen, Burak; Atıcı, Teoman; Eken, Gökay; Ulusaloğlu, Armağan Can; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; AAH-9833-2021; AAD-6003-2022; A-5095-2018; 23102160500; 7801647288; 57195109967; 57203977748Introduction: Neuromuscular scoliosis leads to a wide range of spinal disorders which disturb the musculoskeletal system. The aim of this study is to compare the clinical and radiological results of posterior spinal fusion with and without extending the instrumentation to iliac bones in treatment of neuromuscular scoliosis. Methods: Medical records and radiographies of 36 patients with neuromuscular scoliosis who underwent posterior instrumentation between 2011 and 2015 were reviewed. Age and body mass index at time of surgery, underlying diagnosis, gender, postoperative infection rates, perioperative and postoperative blood transfusion, duration of surgery, complication rates were identified for each patient retrospectively. SF-36 physical questionnaire was applied to all patients. Surgery was performed in each patient and included posterior spinal fusion with pedicle screws from the proximal thoracic spine (T2 or T3) to S1 (Group A) or extension of distal instrumentation to pelvis by bilateral iliac screws (Group B). Results: A total of 23 patients in group A were compared with 13 patients in group B. Median age was 14 (9-38) years for group A and 16 (12-25) years for group B. Median follow-up period was 20 (12-66) months. Preoperative median Cobb angles were 66 degrees and 60 degrees and postoperative Cobb values were 33 degrees and 31 degrees in group A and B respectively. Median Cobb angle reduction was 40 degrees and 34 degrees for group A and B. We are able to see in this study that the usage of illiac screws do not increase implant failure and help achieve better functional results. Conclusion: This study shows that the extention of instrumentation to the pelvis with illiac screws can be beneficial in terms of functional and complicational incidences.Item Comparison of two techniques in hemivertebra resection: transpedicular eggshell osteotomy versus standard anterior-posterior approach(Springernature, 2006-03-29) Aydınlı, Ufuk; Öztürk, Çaǧatay; Temiz, Aytun; Akesen, Burak; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedik Cerrahi Anabilim Dalı.; 0000-0003-3133-206X; S-6686-2019; AAH-9833-2021; 6602800134; 8230555600; 6701549831; 23102160500Hemivertebrae are the most frequent cause of congenital scoliosis. They have growth potential similar to normal vertebra, creating wedge-shaped deformity that progresses during further spinal growth. This study aims to compare the interventions for hemivertebrae resections in congenital scoliosis by posterior transpedicular eggshell osteotomy approach only and with combined anterior and posterior approach. Ten patients who underwent hemivertebra resection between 1995 and 2002 were evaluated by retrospective charts and radiographic views. Mean follow-up time was 32 months (range 12-48). Except one patient, all were female and mean age at surgery was 7 years (range 3-13). Transpedicular eggshell osteotomy was performed in five patients (group I) and by combined anterior and posterior approach in five patients (group II). All patients had a single non-incarcerated hemivertebra and the locations of the hemivertebra were Th7, Th8, Th11, Th12, L2 in group I and Th7, Th10, L1, L4, L5 in group II. The average operation time was 3 h in group I and 6 h in group II (P < 0.05). The number of instrumented vertebrae was 4 for group I and 6 for group II. The mean blood loss during the operation for groups I and II was 354 and 500 cc, respectively (P < 0.05). The mean Cobb angle was measured as 37 degrees before surgery, 18 degrees after surgery and 21 degrees at the latest follow-up for group I; 32 degrees, 14 degrees and 17 degrees for group II. The correction ratio was 51% in group I and 56% (P > 0.05). The loss of correction was 8% in group I and 9% in group II (P > 0.05). No intra-operative complications were noted and no implant failure was verified at the final radiographic evaluations. Transpedicular eggshell osteotomy is a technique that should be considered for older patients who have congenital scoliosis with multiplanar spinal abnormalities. It is a technically demanding procedure that provides an effective correction in selected patients.Item Evaluation of intraarticular collagenase, TIMP-1, and TNF-α levels before and after anterior cruciate ligament reconstruction(Türk Ortopedi ve Travmatoloji Birliği Derneği, 2009) Akesen, Burak; Demirağ, Burak; Budak, Ferah; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Mikrobiyoloji Anabilim Dalı.; AAH-9833-2021; F-4657-2014; 23102160500; 56019156900; 6701913697Objectives: We investigated intra-articular levels of collagenase, which presumably promotes bone-tendon healing, and collagenase mediators involved in its production (tumor necrosis factor-alpha, TNF-alpha) and inhibition (TIMP-1 enzyme) in patients following anterior cruciate ligament (ACL) reconstruction. Methods: The study included 16 patients (15 males, 1 female; mean age 27 years; range 17 to 40 years) who underwent arthrocentesis due to effusion that developed following reconstruction of isolated ACL injuries. Intra-articular levels of collagenase, TNF-alpha, and TIMP-1 were measured using appropriate activity assay and immunoassay kits in synovial fluid samples obtained intraoperatively and during arthrocentesis. The mean time from ACL injury to surgical repair was 21 +/- 10 months (range 1 to 72 months). Arthrocentesis was performed in a mean of 18 hours (range 12 to 36 hours) following ACL repair. Results: Measurements in synovial fluid samples obtained intra- and postoperatively yielded 1.49 +/- 0.06 ng/ml and 1.45 +/- 0.05 ng/ml for collagenase, 12 +/- 5 ng/ml and 22 +/- 9.5 ng/ml for TIMP-1, and 10.4 +/- 7.1 pr/ml and 14.11 +/- 6.1 pr/ml for TNF-alpha, respectively. Postoperative changes in the levels of collagenase (p=0.098) and TNF-alpha (p=0.069) were not significant, whereas increase in the TIMP-1 level was significant (p=0.026). Conclusion: This study showed elevated levels of TNF-alpha, collagenase, and TIMP-1 due to the presence of ruptured ACL. Our findings showed how these levels changed in the acute postoperative period.Item İleri yaş deplase femur boyun kırıklarının tedavisinde hemiartroplasti ve total kalça artroplastisinin karşılaştırılması(Uludağ Üniversitesi, 2017) Barışhan, Fatih Canşah; Akesen, Burak; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.Amaç: Çimentosuz hemiartroplasti yada total kalça artroplastisi (TKA) ile tedavi edilen ileri yaş deplase femur boyun kırıklı (FBK) olgularda klinik ve radyolojik sonuçların karşılaştırılması ve seçilen tedavi yönteminin morbidite ve mortalite üzerine etkisinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Deplase FBK nedeniyle çimentosuz hemiartroplasti (Grup I) ya da TKA (Grup II) uygulanılmış ileri yaşta (>65) hastalar geriye dönük değerlendirildi. Cinsiyet, ASA skoru, ek hastalık sayısı, travma-kırık tipi, Sportorno indeksi, ameliyat sırası-sonrası kanama- transfüzyon miktarı, hemoglobin düşmesi, ameliyat süresi, yatış süresi, izlemlerdeki Harris kalça puanı, radyolojik değişiklikler, Barthel aktivite skoru, gelişen komplikasyonlar ve Carlson komobidite indeksi ile ilişkisi ve erken dönem ve son izlemlerdeki mortalite oranları gruplar arası karşılaştırıldı. Bulgular: Grup I'deki 22 olgunun yaş ortalaması 76.9 yıl (65-88) ve ameliyat sonrası izlem süresi ortalama 31 ay (16-47) iken Grup II'deki 16 olguda bu değerler 73.6 yıl (65-90) ve 30.5 aydı (16-48) (p>0.05). Grup I ve Grup II klinik ve radyolojik sonuçlarda fark tespit edilmedi (p>0.05). Grup I'de Harris puanı ortalama 83.9 (75-97) ve Grup II'de 83.3 (71-93) idi (p>0.05). Grup II de kanama ve transfüzyon miktarı daha fazla idi (p<0.05). Komplikasyon ve morbidite oranları ise benzerdi (p>0.05). Mortalite oranları Grup I ve Grup II için sırasıyla 1. ayda %4.5 ve %6.3 ilen son izlemlerde %18.2 ve %25 idi (p>0.05). Sonuç: İleri yaşta gelişen deplase FBK'nın çimentosuz hemiartroplasti ve TKA ile tedavisinin kısa dönem klinik ve radyolojik sonuçları benzerdir. Mortalite ve morbidite oranları ek sistemik hastalıkların varlığıyla ilişkilidir.Item Iliosacral fixation after type-1 hemipelvectomy: A novel technique(Acta Medica Belgica, 2012-06) Şerifoğlu, Rasim; Aydınlı, Ufuk; Akesen, Burak; Yalçınkaya, Ulviye; Hakyemez, Bahattin; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Patoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0001-8729-4715; 0000-0002-8679-6008; 0000-0002-2097-7842; 0000-0002-3425-0740; CEM-8094-2022; AAI-2318-2021; AAH-8924-2021; AAH-9833-2021; 6602800134; 23102160500; 55257709100; 6602527239Involvement of the iliac bone and a sacroiliac joint with malignant tumours is not uncommon, treatment is difficult due to the anatomy of the pelvis. Resection of the tumour mass must be extensive in order to achieve safe margins, but this may lead to instability and poor results. We present a new technique for reconstruction after resection of the iliac bone and sacroiliac joint including a sacral ala, and we present two illustrative cases, with 2 years follow-up. Following en bloc resection of a chondrosarcoma in the iliac bone, two or three polyaxial pedicle screws were placed transversly into the sacrum. Two polyaxial pedicle screws were also inserted into the remaining pubic and ischial bone respectively. After completion of the construct with rods, a cortical strut graft from the ipsilateral fibula was placed between the rods. Next a split mesh was placed around the implants and was filled with 60 cc bone chips allografts. Both patients were mobilized with crutches and partial weight bearing for 4 weeks and then fullweight bearing. After two years follow-up, they were ambulatory without external support and their radiological results remained satisfactory. This technique for reconstruction after type I pelvic resection is advantageous in that it saves mobile lumbar segments.Item Interobserver reliability in evaluation of pedicle screw positions inserted with a modified technique(Acta Medica Belgica, 2007-08) Özer, Özgür; Öztürk, Çaǧatay; Akesen, Burak; Aydınlı, Ufuk; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedik Cerrahi Anabilim Dalı.; 0000-0003-3133-206X; AAH-9833-2021; S-6686-2019; 8230556100; 8230555600; 23102160500; 6602800134The aim of this study was to evaluate a new technique for insertion of pedicle screws. The position of the screws was assessed on postoperative plain radiographs and computed tomography (CT) scans, and the interobserver reliability in evaluation of the pedicle screw positions was studied. The technique was applied to insert 201 pedicle screws in 27 patients with various spine conditions. The positions of the screws were evaluated blindly by two independent orthopaedic surgeons and two independent radiologists. Interobserver reliability was evaluated separately for analysis of plain radiographs and CT scans, as well as for the different spinal segments and for the different spine conditions treated. The rate of malpositioned screws was between 6.5% and 32.8% in plain radiographs and between 3.5% and 6.5% in CT scans according to the different observers. In plain radiographs, the rates of malpositioned screws in the upper thoracic, lower thoracic and lumbosacral spine segments were between 3.8%-39.6%, 10.0%-36.3%, 4.4%-23.5%, respectively. In CT scans, the rates of malpositioned screws in the upper thoracic, lower thoracic and lumbosacral spine segments were between 3.8%-13.2%, 2.5%-8.8%, and 0%, respectively. Interobserver reliability was found to be poor in radiographs and fair in CT scans. The technique used for insertion of pedicle screws was found to be simple and reproducible. Assessment of the screw positions with only plain radiographs was not found reliable. A detailed and standard classification system should be developed in order to improve interobserver reliability in assessing the positions of the screws.Item Lomber interbody füzyon cerrahisinde kafes kullanımı ile kafes şeklinde allogreft kullanımının klinik ve radyolojik olarak karşılaştırılması(Bursa Uludağ Üniversitesi, 2023) Altun, Sefa; Akesen, Burak; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.Amaç: Bu çalışmada, lomber interbody füzyon cerrahisinde kafes kullanımı ile kafes şeklinde allogreft kullanımının klinik ve radyolojik sonuçlarının karşılaştırılması amaçlandı. Gereç ve Yöntem: Çalışmada lomber interbody füzyon cerrahisi uygulanan ve füzyon amacıyla kafes ( PEEK- Polietereterketon ) kullanılan 30 hasta ile kafes şeklinde allogreft kullanılan hastaların sonuçları prospektif olarak karşılaştırıldı. Hastaların klinik değerlendirmesinde Visual Analog Skala (VAS) ve Oswestry Disabilite İndeksi (ODI) kullanıldı. Radyolojik olarak interbody füzyonu değerlendirmek amacıyla postoperatif 1. Yılda çekilen bilgisayarlı tomografilerde ‘Brantigan’ sınıflaması kullanıldı. Hastalarda radyolojik olarak preop ve takiplerde pelvik parametreler ( PI: Pelvik İnsidans, PT: Pelvik Tilt, SS: Sakral Slop ), disk yükseklik indeksi, disk yüksekliği ve rejyonel lordoz açıları değerlendirildi. Radyolojik veriler 2 radyoloji 1 ortopedi hekimi tarafından değerlendirildi ve istatistiki veriler korelasyon analizleri yapılarak kaydedildi. Bulgular: Kafes şeklinde allogreft kullanılan hastaların preop VAS skorları ortalaması 9,1 iken 1.yıl kontrollerinde 2,87 ye gerilediği görülmüştür. Yine allogreft grubunda preop ortalama 48,87 olan olan ODI skorunun 1.yıldaortalama 18,53 e gerilediği görülmüştür. PEEK kafes grubunda preop VAS skoru ortalama 8,8 den 3,97’ ye ODI skoru 42,13 ten 24,87’ye gerilemiştir. Allogreft grubunda VAS ve ODI skorlarındaki değişim daha iyi bulunmuştur (p=0,002,p=0,012). Postoperatif 1. yılda allogreft grubunda %80, PEEK kafes grubunda %70oranında radyolojik füzyon tespit edilmiştir. Brantigan sınıflamasına göre gruplar arası intervertebral füzyon değerlendirmesinde istatistiksel olarak anlamlı bir fark görülmemiştir (p=0,301). PEEK kafes kullanılan hastaların 2 (%6,6) tanesinde vertebra korpusuna migrasyon görülürken allogreft grubunda migrasyon görülmemiştir. Sonuç: Lomber interbody füzyon cerrahisinde, PEEK kafes ve ve kafes şeklinde allogreft kullanımı füzyon açısından benzer radyolojik sonuçlar sağlamaktadır. Fakat allogreft kullanımı postoperatif 1.yılda daha iyi klinik sonuçlar sağlamıştır. Bu bulgular, klinik uygulamada kafes şeklinde allogreft kullanımının benzer füzyon oranları ve daha iyi klinik sonuçlarla tercih edilebileceğini göstermektedir.Item Long-term outcome after surgical treatment of thoracolumbar fractures versus a control group of healthy volunteers(Acta Medica Belgica, 2011-02) Yaray, Osman; Akesen, Burak; Aydınlı, Ufuk; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; AAH-9833-2021; 36538242000; 23102160500; 6602800134The authors conducted a retrospective study on the long term outcome (+/-9 years) after instrumentation for thoracolumbar fractures. This study is probably unique in that it compares the surgical group with a control group of healthy volunteers, rather than with a group of conservatively treated Patients. All classical outcome measures were used : ODI, RMDQ, VASSS, VAS, Denis Pain scale, SF-36 Bodily Pain, SF-12 Bodily Pain, the remaining SF-36 and SF-12 scores, and the Denis Work Scale. As expected, the large majority of the scores was better in the healthy group. The difference was significant, except as far as the SF-tests were concerned.Item Long-term outcome of unreamed intramedullary nails in femur diaphyseal fractures(Türk Travma ve Acil Cerrahi Derneği, 2012-03) Özdemir, Bülent; Akesen, Burak; Demirağ, Burak; Bilgen, Muhammed Sadık; Durak, Kemal; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; AAH-9833-2021; 7004168959; 23102160500; 56019156900; 35723877700; 6602850051BACKGROUND: We evaluated the results of patients with traumatic femur diaphyseal fracture who had undergone biologic fixation with unreamed intramedullary nailing. METHODS: Twenty-five adults with 29 traumatic femur diaphyseal fractures who had undergone unreamed intramedullary nailing at Uludag University School of Medicine, Department of Orthopedics and Traumatology were included in the study between January 1997 and December 2007. Gender, age, cause of injury, fracture type, operation length, time lapse till surgery, blood loss, fluoroscopy duration, early and late complications, time until union, and functional results were noted. Functional results were evaluated with Klemm-Borner and Thoresen systems and Short Form (SF)-36 health survey questions. RESULTS: The mean follow-up of the patients was 65.1 +/- 31.6 months (26-138). There was no statistically significant difference between operation length, blood loss and time until union of simple and complex fractures (p>0.05). Furthermore, the SF-36 questionnaire revealed no statistically significant difference between pain scores (p>0.05). CONCLUSION: Sparing of the endosteal and periosteal circulation, low infection and high union rates, and good functional outcomes of unreamed intramedullary nailing fixation make it the treatment of choice for simple and comminuted fractures of the femur shaft, especially for multi-trauma patients and patients with cardiopulmonary comorbidities.Item Magnetically controlled growing rod in 13 patients with early-onset scoliosis and spinal improvement(Türkiye Ortepedi Travmatoloji Derneği, 2017-12-11) Akesen, Burak; Ulusaloğlu, Armağan Can; Atıcı, Teoman; İpek, Enver; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; 0000-0001-6205-1207; A-5095-2018; AAH-9833-2021; AAD-6003-2022; 23102160500; 57203977748; 7801647288; 57203989518Objective: The aim of this study was to examine the use of magnetically controlled growing rods as a method of providing spinal improvement while preventing thoracic insufficiency in patients with early-onset scoliosis (EOS). Methods: Of a total of 13 patients, 4 patients underwent a dual magnetic rod implantation, while 9 patients had a single magnetic rod procedure. The study group comprised 12 (93%) female and 1 (7%) male patients. Six patients (46%) had an idiopathic form of scoliosis, in 4 (30%) it was congenital, and in 3 (23%) it was neuromuscular scoliosis. The patients' Cobb angles, thoracic kyphosis, T1 -T12 and T1-S1 distance prior to and following the treatment were compared. Results: The mean Cobb angle before surgery was 53.78(0), whereas it decreased to 39.29(0) postoperatively (p < 0.001). The mean thoracic kyphosis angle was 40(0) before and 29.79(0) after surgery (p < 0.001). The mean T1 -S1 distance was 32.14 cm before and 36.36 cm after surgery (p < 0.001). The mean T1-T12 distance was 18.69 cm before and 20.64 cm after surgery (p < 0.001). Conclusion: The use of magnetic rods is an effective method of EOS treatment. It allows for spinal growth while managing the progression of the scoliosis. (C) 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V.Item Omurga kırıklı hastalarda görsel analog skala omurga skoru Türkçe versiyonunun geçerliliği(Türk Ortopedi ve Travmatoloji Birliği Derneği, 2011) Yaray, Osman; Akesen, Burak; Ocaklıoǧlu, Gökhan; Aydınlı, Ufuk; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; AAH-9833-2021; 36538242000; 23102160500; 53983054000; 6602800134Objective: The visual analog scale spine score (VASSS) is a valid and reliable instrument for outcome assessment of patients with thoracic and lumbar spine fractures. The aim of this study was to prepare a Turkish version of the VASSS and to validate its use for assessing treatment outcomes in Turkish patients with spinal trauma. Methods: The German version of the VASSS was blindly and independently translated into Turkish by three translators and modified by a team. Fifty patients who had been surgically treated for thoracic or lumbar fracture and a group of 50 healthy controls were evaluated using the VASSS, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and Short Form 36 (SF-36). The Cronbach's alpha was performed to test the internal consistency of the score. Results: The Cronbach's alpha coefficient was calculated as 0.965 in the overall assessment of the scale. Criterion validity measured by comparing the VASSS responses with the results of ODI, RMDQ, and SF-36 physical component (for ODI r=0.881, p<0.001; for RMDQ r=0.882, p<0.001; for SF-36 r=0.824, p<0.001). Construct validity tested by factor analysis yielded a factorial structure of the questionnaire with 64.7% of cumulative percentage of explained variance, and Turkish version of the VASSS showed a similar structure than the original version. Conclusion: The Turkish version of the VASSS is a reliable and valid instrument to assess the outcome in patients with thoracic or lumbar spinal fractures in the Turkish population.Item Osteosarkom: Olgu sunumu(Uludağ Üniversitesi, 2012-05-15) Aydınlı, Ufuk; Akesen, Burak; Küçükalp, Abdullah; Yalçınkaya, Ulviye; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.Osteosarkom 20 yaş altı görülen en sık malign kemik tümörüdür. Ergenlik döneminde görülme sıklığı pik yapar. Cerrahi ve kemoterapi ile tedavi edilir. Preoperatif kemoterapi sonrası eksize edilen tümör yerine genelde bio-uyumlu metal protezler kullanılmaktadır. Bazen kemik greftleri veya hastanın kendi kemiği de, dış ortamda yüksek doz radyasyon uygulanıp, otoklavize edilip veya pastorize edilip tekrar kullanılabilmektedir. Bu yazıda sunulan olgu 24 yaşında erkek hastadır. Hastanın temel şikayetleri sağ uylukta ağrı ve kitle olup yapılan biyopsi sonrası hastaya osteosarkom tanısı konuldu. Hastaya ameliyat öncesi kemoterapi uygulandı ve daha sonra total olarak rezeke edilen femur diafizinde önce kabaca tümör dokularından mekanik olarak temizlendi daha sonra pastörisazyona tabi tutuldu ve tekrar yerine konan parça intramedüller çivi ile tespit edildi. Kaynama sağlanması için hastada proksimal ve distal osteotomi hatlarına damar pediküllü kot grefti kullanıldı. Postoperatif üçüncü yılında lokal yada sistemik nükse rastlanmadı. Pastorizasyon ile rezeke edilen kemiğin otogreft olarak kullanıldığı; amputasyona ve tümör protezine ihtiyaç duyulmadan osteosarkom tedavisinde rutin uygulamanın dışında olan olgumuzu sunuyoruz.