Postmenopozal Kad›nlarda Vücut Kitle ‹ndeksinin ... - FTR Dergisi

P-359
Uzun Dönem Statin Kullan›m› Sonras›nda Eflzamanl›, Spontan, Bilateral
Kuadriceps Tendon Rüptürü, Tamir ve Rehabilitasyonu: Olgu Sunumu
Evrim Coflkun Çelik 1, Mehmet U¤ur Özbaydar 2, Demet Ofluo¤lu 1,
Emre Demirçay 2
1Baflkent Üniversitesi T›p Fakültesi ‹stanbul Sa¤l›k Uygulama ve Araflt›rma Merkezi
Fiziksel T›p ve Rehabilitasyon Anabilim Dal›, Ankara
2Baflkent Üniversitesi T›p Fakültesi ‹stanbul Sa¤l›k Uygulama ve
Araflt›rma Merkezi Ortopedi Anabilim Dal›, Ankara
Eflzamanl›, spontan bilateral kuadriceps tendon rüptürü, s›kl›kla kronik bir hastal›¤a efllik eden
(kronik böbrek yetmezli¤i, hiperparatirodizm, diyabetes mellitus, gut gibi.. ) veya baz› ilaçlar›n
(anabolik steroid, steroid, siprofloksasin, quinolone gibi) kullan›m› sonucu oluflan nadir bir
yaralanma türüdür.
OLGU: Merdiven ç›karken ikinci basamakta aniden dizlerinde bir gevfleme ile yere düflen 56
yafl›nda erkek hasta, her iki dizinde a¤r› ve yürüyememe yak›nmas› ile hastanemize baflvurdu.
Yap›lan muayenesinde her iki suprapatellar bölgede boflluk görüldü. Dizlerini aktif ekstansiyona
getiremedi¤i tespit edildi. Çekilen MR da her iki dizde kuadriceps tendon y›rt›¤› tespit edildi.
Özgeçmiflinde Hipertansiyon ve 14 y›l önce olan abdominal anevrizma rüptürü operasyonu
oldu¤u ö¤renildi. Antihipertansif ilaç d›fl›nda profilaksi amaçl› 14 y›ld›r statin kullanmaktayd›.
Yaralanman›n 3. günü hasta operasyona al›nd›. Operasyon sonras› her iki diz ekstansiyonda
aç› ayarl› diz breysi uyguland›. ‹kinci hafta a¤›rl›k vermeden breys tam ekstansiyonda mobilizasyona
baflland›. Breysin aç›lar› fleksiyonda 10 derece ve ekstansiyonda 0 derece olarak
ayarland›. Üçüncü hafta pasif diz ekstansiyonu ve aktif diz fleksiyon egzersizlerine baflland›
Alt›nc› hafta tam a¤›rl›k verilerek breysle yürüme baflland› ve quadriceps güçlendirme egzersizlerine
geçildi. ‹kinci ay›n sonunda breys kullan›m› b›rak›ld›. Sol diz 100, sa¤ diz 110 derece
fleksiyon ve tam ekstansiyon sa¤lanarak hastaya ev egzersiz program› düzenlendi.
SONUÇ: Bilateral eflzamanl›, spontan kuadriseps tendon rüptürü mobilizasyonu, günlük
yaflam aktiviteleri ve yaflam kalitesini olumsuz etkileyen, nadir rastlanan bir durumdur. Bu
vakada uzun süreli statin kullan›m› öyküsü olup, bilateral eflzamanl›, spontan kuadriseps tendon
rüptürünün bu durum ile iliflkili¤i oldu¤unu düflünmekteyiz.
Anahtar Kelimeler: Eflzamanl› spontan bilateral kuadriseps tendon rüptürü, rehabilitasyon,
statin
P-360
Travmatik Beyin Yaralanmas› ile Beyin Tümörü olan Hastalar›n
Rehabilitasyon Sonuçlar›n›n Karfl›laflt›r›lmas›
Gülbüz Samut 1, Oya Özdemir 2, Emre Esen 1, Fatma ‹nan›c› 1, Zafer Hasçelik 1
1 Hacettepe Üniversitesi T›p Fakültesi Fiziksel T›p ve Rehabilitasyon Anabilim Dal›, Ankara
2 Hacettepe Üniversitesi Kastamonu T›p Fakültesi Fiziksel T›p ve Rehabilitasyon
Anabilim Dal›, Ankara
AMAÇ: Travmatik beyin yaralanmas› (TBY) edinsel beyin hasar›n›n en s›k karfl›lafl›lan sebeplerinden
biridir ve bafla gelen herhangi bir darbe sonucu oluflan beyin hasar› olarak tan›mlanmaktad›r.
Beyin tümörleri de edinsel beyin hasarlar›ndan biri olup semptom ve bulgular ile
prognoz aç›s›ndan TBY ile benzerlik gösterebilir. Biz bu çal›flmada TBY ve primer beyin
tümörü olan hastalar›n fonksiyonel durumlar›n› ve yat›fl sürelerini karfl›laflt›rmay› amaçlad›k.
GEREÇ-YÖNTEM: Çal›flmaya 2005-2010 y›llar› aras›nda servisimizde yatarak rehabilitasyon
uygulanm›fl olan 19 TBY geçiren hasta ile 16 primer beyin tümörü olan hasta al›nd›. Hastalar›n
fonksiyonel durumu karfl›laflt›rmak amac›yla fonksiyonel ba¤›ms›zl›k ölçe¤i (FBÖ) kullan›ld›.
BULGULAR: TBY geçiren hastalar›n yafl ortalamas› 37,1±18,4 y›l olarak belirlendi ve sadece 2’si
kad›nd›. Beyin tümörü olan hastalar›n ortalama yafl› ise 50,8±16,7 y›l olup TBY geçirenlere
göre belirgin yüksekti (p=0,022). Beyin tümörü olanlar 6 kad›n, 10 erkek hastadan oluflmaktayd›.
Tan› tarihinden yat›fla kadar geçen ortalama süre TBY grubu için 15,0±19,8 (medyan,
10,0) ay, beyin tümörü grubu için 16,7±27,5 (medyan, 5,5) ay olarak saptand›. Ortalama yat›fl
süreleri ise TBY ve beyin tümörü hastalar›nda s›ras›yla 29,5±15,2 ve 27,2±19,4 gündü. ‹ki grup
aras›nda hastal›k süresi ve hastanede yat›fl süresi bak›m›ndan istatistiksel olarak anlaml› bir
fark mevcut de¤ildi. Yat›fl ve ç›k›fl s›ras›nda, TBY ve beyin tümörü olan hastalar›n FBÖ motor
ve kognitif skorlar› birbirine benzerdi. Rehabilitasyon program› sonucunda toplam FBÖ skorlar›nda
oluflan farklar; TBY grubunda 8,8±12,8 (medyan, 6,0), beyin tümörü grubunda
12,2±19,3 (medyan, 3,5) olarak hesapland›. Her iki grubun fonksiyonel kazan›m› aras›nda belirgin
bir fark gözlenmedi (p=0,987). Ayr›ca, hastalar›n yat›fl-ç›k›fl toplam FBÖ skorlardaki fark
ile hastalar›n yafl›, hastal›k süresi ve yat›fl FBÖ kognitif skorlar› aras›nda herhangi bir iliflki
olmad›¤› tespit edildi.
SONUÇ: Bu çal›flman›n sonucunda, her ne kadar farkl› prognozlara sahip görünseler de,
tedavinin bafllang›c›nda benzer motor ve kognitif fonksiyonlara sahip olan bu iki hasta
grubunun, rehabilitasyon klini¤inde benzer yat›fl sürelerinde elde ettikleri kazan›mlar›n birbirine
benzer oldu¤u gözlenmifltir.
Anahtar Kelimeler: Travmatik beyin yaralanmas›, beyin tümörü, rehabilitasyon,
fonksiyonel sonuç
331
23. Ulusal Fiziksel T›p ve Rehabilitasyon Kongresi / 23 rd National Physical Medicine & Rehabilitation Congress
Türk Fiz Rehab Derg 2011:57Özel Say›; 1-334 /Turk J Phys Med Rehab 2011:57Suppl; 1-334
P-359
Simultaneous and Spontaneous Bilateral Quadriceps Tendons
Rupture Related with Long-Term Statin Use, Treatment and
Rehabilitation: Case Report
Evrim Coflkun Çelik 1, Mehmet U¤ur Özbaydar 2, Demet Ofluo¤lu 1,
Emre Demirçay 2
1 Baskent Universit Faculty of Medicine Physical Medicine and Rehabilitation Department,
Istanbul Application and Research Hospital, Ankara
2 Baskent University Faculty of Medicine Department of Orthopedics and Traumatology
Istanbul Application and Research Hospital, Ankara
Simultaneous and spontaneous bilateral quadriceps tendons rupture is an uncommon injury
mostly seen in patients with chronic diseases such as renal failure, hyperparathyroidism,
diabetes mellitus, gout, or after usage of some drugs such as corticosteroids, anabolic
steroids, ciprofloxacin, quinolone.
CASE: A 56 year-old healthy man suddenly felt both knees give way on the second step while
climbing the stairs and collapsed suddenly. He was admitted to the hospital with the
complaints of pain and inability to walk. In the physical examination, gaps in the both
suprapatellar areas were seen. He was unable to extend his legs actively. Magnetic resonance
images of both knees revealed complete rupture of quadriceps tendons. In his medical
history, he reported hypertension and an abdominal aorta aneurysm operation 14 years ago.
He has been using statins for prophylaxis of atherosclerosis since this operation. Also he had
been using an antihypertensive drug. Surgical treatment of both quadriceps tendons was
performed 3 days after the injury. After the operation, braces were performed while knees
were at full extension. Fort he next two weeks after the operation, the patient remained
non-weight bearing while knees were at full extension into the casts, the degree of the braces
were adjusted 10 degrees in flexion and 0 degree in extension. In the third week, active knee
flexion exercises and passive knee extension exercises were done. At the sixth week after the
operation, the patient could walk with full weight-bearing and started the quadriceps
strengthening exercises. In the second month of operation he stopped using braces. When
100 degree flexion for the left knee, 110 degree flexion for the right knee and full extension
were achieved, an exercise program at home was set for the patient.
CONCLUSION: Bilateral simultaneous and spontaneous quadriceps tendon rupture which
negatively affect mobility, daily activity and quality of life is a rare condition. We suggest that
long term statin use should be taken into consideration as a risk factor for spontaneous and
simultaneous bilateral quadriceps tendons rupture.
Keywords: Simultaneous and spontaneous bilateral quadriceps tendons rupture,
rehabilitation, statin
P-360
Comparison of Rehabilitation Outcomes in Patients with Traumatic
Brain Injury and Brain Tumor
Gülbüz Samut 1, Oya Özdemir 2, Emre Esen 1, Fatma ‹nan›c› 1, Zafer Hasçelik 1
1 Hacettepe University Medical School Department of Physical Medicine and
Rehabilitation, Ankara
2 Hacettepe University Kastamonu Medical School Department of Physical
Medicine and Rehabilitation, Ankara
OBJECTIVE: Traumatic brain injury (TBI) is one of the most common causes of acquired brain
injury and defined as the damage of the brain caused by external forces applied to the head.
Brain tumor -another cause of acquired brain injury- may lead to similar symptoms, clinical
findings and prognosis with TBI. In this study, we aimed to compare the functional status and
length of stay in patients with TBI and primary brain tumor.
MATERIALS-METHODS: Nineteen patients with TBI and 16 patients with a primary brain
tumor who received inpatient rehabilitation between 2005 and 2010 were included in the
study. Functional Independence Measure (FIM) scale was used for the comparison of the
patients’ functional status.
RESULTS: The mean age of the patients with TBI was 37.1±18.4 years and only two of them
were female. The mean age of the patients with a brain tumor was 50.8±16.7 years which was
significantly higher than the TBI group (p=0.022). Six of the patients with a brain tumor were
female and 10 were male. The interval between the date of diagnosis and hospitalization was
determined as 15.0±19.8 months (median, 10.0) in the TBI group and 16.7±27.5 months
(median, 5.5) in the brain tumor group. The mean of length of stay for the TBI and brain
tumor groups were 29.5±15.2 and 27.2±19.4 days, respectively. There was no statistically
significant difference between two groups in disease duration and length of stay. At
admission and at discharge, motor and cognitive FIM scores were similar in both groups. The
change in total FIM scores after the rehabilitation program were calculated as 8.8±12.8
(median, 6.0) for the TBI group and 12.2±19.3 (median, 3.5) for the brain tumor group. Any
significant differences in functional gain between the two groups were not found (p=0.987).
Furthermore, it was demonstrated that there were no relationships between the change in
total FIM scores and age, disease duration and admission cognitive FIM scores.
CONCLUSION: Although it seems like they have different prognosis, the patients with TBI and
brain tumor who had similar motor and cognitive function at the beginning of rehabilitation
program have shown similar functional gain in similar periods of hospitalization.
Keywords: Traumatic brain injury, brain tumor, rehabilitation, functional outcome