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    The results of rehabilitaion on motor and functional improvement of the spineal tuberculosis
    (2004) Nas, Kemal; Kemaloǧlu, Mustafa Serdar; Çevik, Remzi; Ceviz, Adnan; Necmioǧlu, Serdar; Bükte, Yaşar; Coşut, Abdülkadir; Şenyeǧit, Abdurraham; Gür, Ali; Saraç, Ayşegül Jale; Özkan, Ümit; Kırbaş, Gökhan; 0000-0001-9680-6268
    Objectives. - To evaluate the result of rehabilitation on motor and functional improvement in spinal tuberculosis. Methods. - Prospective case study. Data were collected from 47 patients with spinal tuberculosis medically and/or surgically treated, and rehabilitated over a period of 6 months, after spinal decompression and fusion. The main outcome measures were motor development of the patients was evaluated at the beginning, in the 1st week, in the 3rd month, and in the 6th month. Functional development of the patients was evaluated at the beginning and in the 6th month. Functional assessment was made according to Modified Barthel Index (MBI), and motor examination was make according to American Spinal Injury Association (ASIA). Results. - The study population consisted of 47 patients (22 males and 25 females) mean age 37.9 ± 18.3 years (range 5-76 years). The most common site of spinal tuberculosis was the thoracic region. Localized back pain, paraparesis, sensory dysfunction and fever were typical clinical manifestations. Surgical management was performed as anterior or posterior drainage of abscess and/or stabilization of the spine. The rehabilitation program was performed in all patients during the preoperative, early postoperative and late postoperative 6th month periods. Muscle-strengthening exercises on necessary localization such as pectoral, abdominal, lower extremities, truncal and sacrospinal extansors were started for the rehabilitation. The motor score for the lower limbs and the MBI scores for activities of daily living (ADL) and mobility improved significantly ( P < 0.001). The self-care and mobility categories of the MBI on admission were 14.8% severely dependent and 10.6% independent. However, at the end of the rehabilitation program, 4.2% were severely dependent and 70.2% independent. Conclusion. - Early diagnosis and appropriate medical and/or surgical treatment together with a rehabilitation program will improve the life quality of patients with spinal tuberculosis.
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    Valgus angulation osteotomy in secondary treatment of femoral neck fractures
    (2004) Necmioǧlu, Serdar; Subaşı, Mehmet; Kayıkçı, Cuma; Tüzüner, Tolga
    Fourteen patients who were operated on by various techniques for collum femoris fracture, between the years 1992 and 1998 were treated by valgus angulation osteotomy for non-union of the fracture. The average age of the patients was 45.2 years (range, 22–58 years). The osteotomy line was healed for all patients and the mean healing period was 3.6 months (range, 2.8 to 6.4 months). The nonunion of the femoral neck and the delay in uniting healed except for in one patient, and the healing period was found to be 5.8 months (range, 4.8–11 months). Including the 12 cases that had avascular necrosis at several preoperative degrees, five patients developed postoperative degenerative arthritis. During follow-ups, while the average score in the first year was 89.7, it was 85.7 in the last examination, accounting for 4% failure. For younger patients under the age of 60 who were treated with internal fixation, however nonunion, it is appropriate to perform angulation osteotomy, which is the rescuing operation, without regard to the feeding position of the head. We believe that this process will allow the union of the femoral head and, at most, lengthen the period for transition to prosthesis.