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

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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-054
Spontan Diz Osteonekrozu (SPONK): Konservatif Tedavi ile
‹yileflen Üç Kad›n Olgu
Murat Uluda¤, Sibel Süzen, Farid Radwan, fians›n Tüzün
‹stanbul Üniversitesi Cerrahpafla T›p Fakültesi Fiziksel T›p ve Rehabilitasyon Anabilim Dal›, ‹stanbul
Osteonekroz (ON) kemik ve kemik ili¤inin hücresel ölümü olarak tan›mlanmaktad›r. ON en s›k
femur bafl›nda olmak üzere daha sonra diz ve humerus bafl›nda görülmektedir. ON gerçek
insidans› bilinmemekle birlikte tüm ON olgular›n›n %10’unu oluflturdu¤una inan›lmaktad›r.
Spontan diz osteonekrozu (SPONK), daha genç yafllarda da görülebilmesine ra¤men genellikle
55 yafl üzerindeki hastalarda diz a¤r›s›na neden olan bir hastal›kt›r. Genellikle bir kondili
etkiler ve artritik de¤iflikliklere sebep olur. Kemik ve kemik ili¤inin ölümü olarak bilinmesine
ra¤men son yap›lan çal›flmalar spontan diz osteonekrozunun hikaye, klinik süreç ve kemik
tutulumu bak›m›ndan gerçek osteonekrozdan farkl› oldu¤unu göstermifltir. Gerçek
osteonekroz genellikle 40 yafl alt› hastalarda görülüp birkaç eklem ve kondili tutar.
Kortikosteroid kullan›m›, travma, alkol ba¤›ml›l›¤›, menisektomi sonras›, orak hücreli anemi,
Gaucher hastal›¤›, SLE, renal transplantasyon, romatolojik hastal›klar, Caisson hastal›¤› ve
baz› kronik inflamatuvar hastal›klar ile iliflkilidir. SPONK ise genellikle dizin medial kondilini
etkiler. S›kl›kla tek tarafl›d›r. Daha yafll› hastalarda görülmekle birlikte herhangi bir risk faktörü
ile iliflkili de¤ildir. SPONK kad›nlarda erkeklere göre 3 kat daha fazla görülür.
Spontan osteonekroz tedavisi konservatif ve cerrahi olarak iki bafll›kta incelenebilir.
Konservatif tedavi genellikle erken dönemde ve femur kondilinin %40’dan az›n›n tutuldu¤u
olgularda yararl› olabilir. Tek tarafl› fliddetli diz a¤r›s› ve gece a¤r›s› ile baflvuran, manyetik
rezonans görüntüleme ile SPONK tan›s› konulan 53, 54 ve 58 yafl›nda 3 kad›n olgumuzu
sunuyoruz. Hastalar›m›z analjezik ve steroid olmayan antiinflamatuvar ilaçlar, infraruj, ultrason
ve TENS’i içeren fizik tedavi uygulamalar› ve kuadriseps kuvvetlendirme egzersizleri ile
flikayetlerinde tama yak›n iyileflme göstermifllerdir. Hareketle artan ve dinlenmekle
geçmeyen ve gece a¤r›s›n›n efllik etti¤i ani bafllang›çl› fliddetli diz a¤r›s›nda SPONK ak›lda
tutulmal›d›r.
Anahtar Kelimeler: Diz, osteonekroz, sponk, spontan
P-055
Posterior Longitudinal Ligament Ossifikasyonu
(Japon Hastal›¤›): Olgu Sunumu
Nesrin Çeflmeli, Cem Erçal›k, Tayfun Özdemir, Tiraje Tuncer, Bülent Bütün
Akdeniz Üniversitesi T›p Fakültesi Fiziksel T›p ve Rehabilitasyon Anabilim Dal›, Antalya
Posterior longitudinal ligament ossifikasyonu; servikal kord ve sinir köklerine bas› yapmas›na
sekonder nörolojik semptomlara sebep olan nadir bir hastal›kt›r. ‹lk kez Tsukimoto taraf›ndan
1960 y›l›nda bildirilmifltir ve Japon populasyonda daha s›k görülmesi nedeniyle ‘‘Japon
Hastal›¤› ’’ olarak tan›mlanm›flt›r. Klinik olarak asemptomatik, nörolojik defisit olmadan boyun
ve omuz a¤r›s› fleklinde, radikülopati bulgular› ile veya myelopati bulgular› ile seyredebilir.Yafl
aral›¤› 31 ile 81 olmakla pik insidens yafl› 64’tür. Etyolojisi tam bilinmemekle birlikte genetik ve
çevresel faktörler rol almaktad›r.
Yaklafl›k 2 y›ld›r hareketle artan fliddetli boyun a¤r›s› yak›nmas› ile klini¤imize baflvuran 65
yafl›nda bayan hastan›n fizik muayenesinde servikal hareketleri tüm yönlerde a¤r›l› ve minimal
k›s›tl›yd›, servikal paravertebral spazm› mevcuttu. Nörolojik muayenesi normaldi.
Laboratuar tetkiklerinde patolojik bulgu saptanmad›. Servikal grafide dejeneratif de¤ifliklikler
izlendi, posterior ligament kalsifikasyonu net izlenemedi. Servikal vertebra BT C3-4
düzeyinde genifl tabanl› santral-sa¤ parasantral protrude disk hernisi ve posterior longitudinal
ligamentte belirgin ossifikasyon, C4-5 düzeyinde genifl tabanl› posterior santral disk
hernisi ve posterior longitudinal ligamentte belirgin ossifikasyon, C5-6 diffüz bulging disk ve
posterior longitudinal ligamentte belirgin ossifikasyon izlendi. Nörolojik defisit bulunmayan
sadece a¤r› yak›nmas› olan hastaya servikal bölgeye ultrason (1,5 W/cm2 ), infraruj ve TENS ile
servikal bölgeye yönelik eklem hareket aç›kl›¤› ve izometrik kuvvetlendirme egzersizleri
uyguland›. A¤r› yak›nmalar› azalan hastaya günlük yaflam aktiviteleri s›ras›nda dikkat etmesi
gereken noktalar ö¤retilerek poliklinik takibine al›nd›.
Posterior longitudinal ligament ossifikasyonu (Japon hastal›¤›); nadir görülen bir hastal›k
olmas›na ra¤men kronik boyun a¤r›s› ve servikal radikülopati, myelopati varl›¤›nda ay›r›c›
tan›da düflünülmesi gereken bir hastal›k oldu¤unu vurgulamak amac›yla bu olgu sunulmufltur.
Anahtar Kelimeler: Boyun a¤r›s›, ossifikasyon, posterior longitudinal ligament
P-054
Spontaneous Osteonecrosis Of The Knee (SPONK):
Three Female Patients Improved With Conservative Treatment
Murat Uluda¤, Sibel Süzen, Farid Radwan, fians›n Tüzün
Istanbul University Cerrahpafla Medical Faculty Physical
Medicine and Rehabilitation Department, Istanbul
Osteonecrosis (ON) is defined as ischemic death of the cellular constituents of bone and bone
marrow. ON is found most commonly in the femoral head, followed by knee and humeral
head. The true incidence of ON is unknown, but involvement of the knee is believed to
account for approximately 10% of all cases. Spontaneous osteonecrosis of the knee (SPONK)
is generally seen in patients over 55 year old and causes knee pain. It usually affects
one condyle and causes degenerative changes. Although it is known as bone and bone
marrow death, recent studies revealed that in terms of history, clinical outcome and bone
involvement, knee osteonecrosis differs from true osteonecrosis. True osteonecrosis is
generally seen in patients under 40 years old, affecting more than one joint and condyle. It
is associated with many conditions like corticosteroid use, trauma, alcohol abuse, after
meniscectomy operation, Sickle cell anemia, Gaucher’s disease, SLE, renal transplantation,
rheumatologic diseases, Caisson’s disease and some inflammatory diseases. SPONK
generally affects the medial condyle of the knee. It is frequently seen unilaterally. It is seen
in older patients and it is not associated with any risk factors. It is 3 times more common in
women. Treatment of spontaneous osteonecrosis can be divided into conservative
treatment and surgical treatment. Conservative treatment is beneficial for patients with
earlier stages of the disease and with condyle involvement less than 40%.
We reported 53, 54 and 58-year-old three women with unilateral severe knee pain and night
pain who was diagnosed as SPONK with magnetic resonance imaging. Their complaints
relieved with analgesics, non-steroidal anti-inflammatory drugs, physical therapy including
infrared, ultrasound and TENS and quadriceps isometric exercises. SPONK should be kept in
mind if there is a sudden and severe knee pain accompanied by night pain and it is not
improving with rest.
Keywords: Knee, osteonecrosis, sponk, spontaneous
P-055
Ossification of The Posterior Longitudinal Ligament
(The Japanese Disease): A Case Report
Nesrin Çeflmeli, Cem Erçal›k, Tayfun Özdemir, Tiraje Tuncer, Bülent Bütün
Akdeniz University Physical Medicine and Rehabilitation, Antalya
Ossification of the posterior longitudinal ligament is an uncommon disorder that is often
associated with neurological symptoms secondary to compression of the cervical spinal cord
or nerve roots. First case of the disease was reported by Tsukimoto in 1960. Since it is common
particularly in Japanese population, It was defined as 'the Japanese disease'. Disease
can proceed clinically asymptomatic, in the form of neck and shoulder pain without neurological
deficit, or can proceed with the findings of radiculopathy or myelopathy. The age
range is 31 to 81 years, with the peak incidence of 64 years. Genetic and environmental factors
have been implicated in the etiology of the ossification of the posterior longitudinal ligament,
but the cause remains unknown.
65-year-old female patient was admitted to our clinic with severe neck pain which increases
with movement for approximately the last two years. Physical examination findings were as
follows: Her cervical movements in all directions werepainful and minimally limited, cervical
paravertebral spasm was present. Neurological examination was normal. Pathologic findings
were not determined in routine laboratory tests. Degenerative changes were observed in cervical
spine radiography, but calcification of posterior ligament was not observed clearly.
Cervical spine CT scan showed that disc herniations and ossification of posterior longitudinal
ligament at the levels of C3-C4, C4-C5, C5-C6.
As the pain was the only complain and there was no neurologic deficit, infrared, ultrasound
(1.5 W/cm 2 ), TENS were appliedto the cervical region. Cervical range of motion and isometric
strengthening exercises were performed. Pain complaint of the patient reduced. The
patient was trained about the important points to pay attention during daily activities and
was followed up in outpatient clinic.
Although ossification of the posterior longitudinal ligament is a rare disease, when chronic
neck pain and cervical radiculopathy or myelopathy are present it should be considered in
the differential diagnosis of a disease. In order to emphasize that this case is presented.
Keywords: Neck pain, ossification, posterior longitudinal ligament