‹nmeli Hastalarda Yaflflam Kalitesini Etkileyen ... - FTR Dergisi

177
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-046
Dorsal Spinal Ligamentum Flavum Ossifikasyonuna Ba¤l› Miyelopati
Geliflimi: Olgu Sunumu
Hidayet Sar›, Nurettin ‹rem Örnek, Kerem Gün, Murat Uluda¤,
Tu¤çe Özekli M›s›rl›o¤lu, Ülkü Akar›rmak
‹stanbul Üniversitesi Cerrahpafla T›p Fakültesi Fiziksel T›p ve
Rehabilitasyon Anabilim Dal›, ‹stanbul
Omurgada ligamentum flavum ossifikasyonu omurilik kompresyonuna neden olan, özellikle
Japon toplumunda bildirilmifl ancak di¤er ›rklarda da görülebilen nadir bir hastal›kt›r. Di¤er
omurga patolojileri ile karfl›laflt›r›ld›¤›nda sessiz klinik bafllang›ç, yavafl seyir nedeniyle tan›
konmas› genellikle gecikir. Hastal›¤›n etyolojik nedenleri tam olarak ayd›nlanmam›fl olsa da
genetik yatk›nl›k, travma, enflamasyon, diabetes mellitus (DM) ve beslenme faktörleri
üzerinde daha çok durulmaktad›r. Erken tan› için manyetik rezonans görüntüleme (MRG) ve
bilgisayarl› tomografinin ön plana ç›kt›¤› patolojik sürecin erken dönemlerinde korseleme,
fizik tedavi, egzersiz ve günlük yaflam aktivitelerinin düzenlenmesi yeterli olabilmektedir.
Ancak ileri vakalarda, her zaman yeterli cevap al›namasa da, cerrahi giriflim kaç›n›lmazd›r.
K›rk befl yafl›nda bir kad›n mekanik karakterde bel-bacak a¤r›s› ile ayakta durma ve yol
yürümekle bacaklarda ilerleyici güçsüzlük ile klini¤imize baflvurdu. Spinal MRG’de dorsal
spinal ligamentum flavumun ossifikasyonuna sekonder miyelopati geliflti¤i saptanm›fl ve bu
konuda önce konservatif tedavi olarak korseleme, fizik tedavi ve rehabilitasyon uygulanm›flt›r.
Sonuç olarak ligamentum flavum ossifikasyonu sonucu dorsal miyelopati geliflebilir. Bu
durum sadece Japon toplumunda görülen bir durum olmay›p ülkemizde de ortaya ç›kabilecek
bir durumdur. Bizim olgumuzda etyolojik bir faktör olarak DM saptanm›flt›r. Buna göre DM
omurgada ve di¤er eklemlerde diffüz idiopatik iskeletal hiperostoz d›fl›nda, ligamentum
flavum ossifikasyonuna da sebep olabilir.
Anahtar Kelimeler: Diabetes mellitus, dorsal miyelopati, dorsal spinal ligamentum flavum
ossifikasyonu
P-047
Fiziksel T›p ve Rehabilitasyon Klini¤inde Bölgesel Kas ‹skelet Sistemi A¤r›s›
Nedeniyle Yatan Hastalarda Anksiyete ve Depresyon
Hasan Toktafl, Deniz Çiftçi, Sevda fiahin, Özlem Solak,
Ümit Dündar, Vural Kavuncu
Afyon Kocatepe Üniversitesi T›p Fakültesi Fiziksel T›p ve
Rehabilitasyon Anabilim Dal›, Afyonkarahisar
AMAÇ: Kas iskelet sistemi a¤r›l› sendromlar› nedeniyle Fiziksel T›p ve Rehabilitasyon klini¤inde
yatarak tedavi alan hastalarda anksiyete ve depresyon düzeylerinin araflt›r›lmas›
GEREÇ-YÖNTEM: Fiziksel T›p ve Rehabilitasyon klini¤inde yatarak tedavi alm›fl olan hastalar›n
kay›tlar› retrospektif olarak de¤erlendirildi. ‹nflamatuar romatizmal hastal›klar ve rehabilitasyon
hastalar› (ortopedik, nörolojik v.b) de¤erlendirmeye al›nmad›. Sadece kas iskelet sistemi
a¤r›l› lezyonu nedeniyle yat›r›lm›fl olan, derin ›s›t›c›+yüzeyel ›s›t›c›+analjezik ak›m+egzersiz
ve medikal tedavi olarak steroid olmayan antienflamatuar ilaç ve/veya parasetamol ve/veya
kas gevfletici ilaç alm›fl olan hastalar de¤erlendirmeye al›nd›. Hastalar›n kendi doldurduklar›
Hastane Anksiyete ve Depresyon (HAD) ölçekleri de¤erlendirildi.
BULGULAR: Toplam 34 hasta (14 erkek, 20 kad›n) de¤erlendirildi. Hastalar›n yafl
ortalamas›:58,15 (38-82) olarak hesapland›. Ortalama yat›fl süresi: 13,88 gündü (4-24). Hastalar;
13 diz, 9 boyun, 5 bel, 4 omuz, 2 kalça, 1 ayak bile¤i bölgesi patolojisi nedeniyle yat›r›lm›flt›.
Hastalar›n ortalama a¤r› süreleri 45,76 ayd› (2-240). Hastalar›n tedavi öncesi (TÖ) VAS
de¤erleri ortalamas› 6,74 (2-10), tedavi sonras› (TS) VAS de¤erleri ortalamas› 2,68 (0-8)
bulundu. HAD TÖ anksiyete skorlar› ortalamas› 8,12 (1-17), HAD TS anksiyete skorlar› ortalamas›
ise 7,24 (1-15) bulundu. HAD TÖ depresyon skorlar› ortalamas› 6,21 (1-12), HAD TS
depresyon skorlar› ortalamas› ise 7,06 (0-17) bulundu. TÖ 11, TS ise 8 hastan›n anksiyete
puanlar› kesme s›n›r›n›n üzerinde bulundu. TÖ 15, TS ise 21 hastan›n depresyon puanlar›
kesme s›n›r›n›n üzerinde bulundu
SONUÇ: Bölgesel kas iskelet sistemi a¤r›lar› nedeniyle yatarak tedavi gören ve duygudurumunu
etkileyecek herhangi bir ilaç almayan hastalarda anksiyete ve depresyon bulgular›na rastlanabilir.
Hastalar›n a¤r› düzeylerinde belirgin azalma saptansa bile, depresyon skorlar›nda
azalma görülmeyebilir. Hatta bu durum anksiyete skorlar› azalm›fl olmas›na ra¤men görülebilir.
Bölgesel kas iskelet sistemi a¤r›s› nedeniyle yatarak fizik tedavi almakta olan hastalar
depresyon yönünden de de¤erlendirilmelidir. Kronik a¤r›lar›n tedavisinde hasta bir bütün
olarak de¤erlendirilmeli ve sadece a¤r›ya odaklan›lmamal›d›r
Anahtar Kelimeler: Fizik tedavi, anksiyete, depresyon
P-046
Myelopathy Due to Dorsal Spinal Ligamentum Flavum Ossification:
Case Report
Hidayet Sar›, Nurettin ‹rem Örnek, Kerem Gün, Murat Uluda¤,
Tu¤çe Özekli M›s›rl›o¤lu, Ülkü Akar›rmak
Istanbul University Cerrahpasa School of Medicine
Department of Physical Medicine and Rehabilitation, Istanbul
Ossification of the ligamentum flavum of the spine (OLF) is a rare disease causing spinal cord
compression that has been especially reported in Japanese population. However it can be
also seen in the other races. The diagnosis is usually delayed because of OLF has an insidious
clinical onset compared to other pathologies of the spine. Although etiology of the disease
is not completely clarified, it emphasized the genetic predisposition, trauma, inflammation,
diabetes mellitus (DM), and dietary factors. Magnetic Resonance Imaging (MRI) and
Computerized Tomography (CT) might use for early diagnosis. Although surgical intervention
should be performed in severe cases, conservative treatment applications such as corset,
physical therapy, exercise, and regulation of activities of daily living may be sufficient.
45 year old female patient was admitted to our outpatient clinic with progressive leg weakness,
low back and leg pain with mechanical characteristics.
Spinal MRI revealed the development of the dorsal spinal myelopathy secondary to ligamentum
flavum ossification. Firstly, conservative treatment methods such as corset and physical
therapy and rehabilitation were applied.
In conclusion, dorsal myelopathy can develop due to ligamentum flavum ossification.
This situation is not only seen in Japanese society, it may also occur in our country.
OLF in the spine is not only associated with Diffuse Idiopathic Skeletal Hyperostosis ("DISH"
or Forestier Disease), but it may also occur associated with DM as in our case.
Keywords: Diabetes mellitus, dorsal myelopathy, dorsal spinal ligamentum flavum ossification
P-047
Anxiety and Depression in Hospitalized Patients Admitted to Physical
Medicine and Rehabilitation Clinic with Regional Musculoskletal Pain
Hasan Toktafl, Deniz Çiftçi, Sevda fiahin, Özlem Solak,
Ümit Dündar, Vural Kavuncu
Afyon Kocatepe University Faculty of Medicine, Department of
Physical Medicine and Rehabilitation, Afyonkarahisar
OBJECTIVE: To investigate anxiety and depression in patients with musculoskeletal pain
syndromes (MPS) who were hospitalized in Physical Medicine and Rehabilitation clinic.
MATERIALS-METHODS: The data of hospitalized patients with regional MPS were evaluated
retrospectively. Patients with inflammatory rheumatic diseases and attendants of
rehabilitation programs (orthopedic, neurologic etc.) were not evaluated. Patients with
regional MPS and who underwent deep heating+superficial heating+ analgesic medication
was enrolled in the study. Patient taking any drug (opioid analgesics, antidepressants etc.)
other than nonsteroidal antirheumatic drugs and paracetamol were excluded. Hospital
Anxiety and Depression Inventory (HAD) was used to investigate anxiety and depression.
Pain intensity was evaluated with visual analog scale (VAS).
RESULTS: Thirty-four (14 men, 20 women) patients were evaluated. Mean age was 58,15
(38-82). The mean duration of hospitalization was 13.88 day (4-24). Thirteen patients had a
knee problem, 9 patients had neck problems, 5 patients had low back problem, 4 patients
had a shoulder problem, 2 patients had a hip problem and 1 patient had an ankle problem.
Mean pain duration was 45,76 month (4-420). Mean VAS score before the treatment (BT) was
6.74 (2-10) and after the treatment (AT) 2.68 (0-8). Mean HAD anxiety score BT was 8.12
(1-17) and AT was 7.24 (1-15). Mean HAD depression score BT was 6.21 (1-12) and AT was 7.06
(0-17). HAD anxiety scores were higher than the cut off point in 11 patients BT and in 8
patients AT. HAD depression scores were higher than the cut off point in 15 patients BT and
in 21 patients AT.
CONCLUSION: Symptoms of anxiety and depression can be observed in any hospitalized
patient doesn’t take drugs affecting mood. Pain intensity and anxiety were decreased
however depression scores may not be improved. Depression should be kept in mind in
patients with musculoskeletal pain syndromes. During the treatment of chronic pain patients,
the patients should be evaluated globally and the practitioners should not focus only to
decrease pain.
Keywords: Physical therapy, anxiety, depression