Opere kalkaneus kırıkları sonrası bel ağrısı görülme sıklığı
Küçük Resim Yok
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Kalkaneus kırıkları tüm ayak ve ayak bileği kırıklarının %4'ünü oluşturken, yer değiştirmiş eklem içi kırıklar, tüm kalkaneus kırıklarının %60 ila %70'ini oluşturur. Bu tip eklem içi kırıklarının cerrahi tedavisi son derece yaygındır. Klinik deneyimlerimiz sonucunda açık redüksiyon internal fiksasyon (ARİF) ile tedavisi yapılmış hastalarda kırık sonrası süreçte bel ağrısı ile başvuruların sık olduğu tespit edilmiştir. Yaptığımız literatür araştırmalarında kalkaneus cerrahisi sonrası bel ağrısının görülme sıklığı ile ilgili yapılmış çalışmaya rastlanamamıştır. Çalışma ameliyat edilmiş kalkaneus kırıkları sonrası oluşabilecek bel ağrısı sıklığını ve bel ağrısını etkileyen risk faktörlerini saptamak, fizyoterapi gerekliliğini önceden belirleyebilmek, fizyoterapi tedavilerine katkı sağlamak, bu sayede yaşanan sosyo-ekonomik kayıpların artmasının önüne geçebilmek ve literatürdeki boşluğu kapatabilmek amacıyla planlanmıştır. Bu amaçla 2020-2016 yılları arasında tek taraflı ameliyat edilmiş kalkaneus kırığı olan 31 (27 erkek, 4 kadın) hasta çalışmaya dâhil edilmiştir. Yaşam kalitesini değerlendirmek amacıyla kısa form SF-36, bel ağrısında fonksiyon kaybının derecesini değerlendirmek için Oswestry Özürlülük İndeksi (OÖİ), ağrı, fonksiyon ve arka ayak dizilimini değerlendirmek amacıyla Amerikan Ortopedik Ayak-Ayak Bileği Derneği Skoru (AOFAS) kullanılmıştır. Sanders kırık sınıflaması ile kırık derecesi, yaralı ve sağlam uzva ait pedobarografik ölçümlerde tek ayak üstünde denge, yürüme zamanı, subtalar eklem fleksibilitesi (STEF), statik ve dinamik ölçümlerde Ark İndeks (Aİ) yöntemi ile ayak şekli, eklem hareket açıklığı (EHA) ölçümleri, maksimal izometrik kas kuvveti ölçümleri yapılmıştır. İstatistiksel analizlerde IBM SPSS Statistics 25.0 kullanılmıştır. Çalışmanın güven aralığı %95, anlamlılık düzeyi p<0.05 kabul edilmiştir. Bel ağrısı görülme oranı %71 olarak bulunmuştur. Bel ağrısı kırık oluşumunu takiben 6. aydan itibaren görülmeye başlanmıştır. Bel ağrısı ile ilişkisi bulunan ölçümler tek ayak üstünde denge zamanı, ayak, ayak bileğine ait EHA ölçümlerinden aktif ve pasif plantar fleksiyon, inversiyon, kalçaya ait aktif ve pasif internal, eksternal rotasyon, kas kuvvet ölçümlerinden ayak eversiyon kuvvetidir. Bu ölçümlerin hepsinde yaralı tarafa ait değerler sağlam tarafa göre istatistiksel olarak anlamlı şekilde düşük bulunmuştur. AOFAS sonuçları 7 hastada iyi, 9 hastada orta ve 15 hastada kötü ve ortalaması 68,8 (±12.7)'dir. Sanders kırık sınıflamasında 17 hasta tip II, 13 hasta tip III ve 1 hasta da tip IV kırık görülmüştür. SF-36 Fiziksel işlevsellik 64,1(±18,9), SF-36 Ruhsal sağlık 52,7(±18,6)'dir. OÖİ 'de bel ağrısı önemli bir problem oluşturmuyor diyen 4, bel ağrısı yaşamımı hafifçe kısıtlıyor diyen 13, bel ağrısı yaşamımı ileri derecede kısıtlıyor diyen 3 ve bel ağrısı günlük yaşamımı tamamen kısıtlıyor diyen 2 hasta vardır. Konservatif ya da cerrahi tedavisi yapılmış tüm topuk kırıkları sonrasında çalışmamızda tespit ettiğimiz EHA, kas güçsüzlükleri ve dengede meydana gelen bozukluklar göz önünde bulundurularak uygun fizyoterapi yaklaşımları uygulanmalıdır. Bu tedavi yaklaşımları arasında mümkün olan en kısa sürede ayak ve ayak bileği hareketlerini arttırmaya yönelik eklem hareket açıklığı egzersizleri, kas kuvvetini artırmaya yönelik kuvvet egzersizleri ve hasta bağımsız olarak tam yükle başlar başlamaz denge egzersizleri reçete edilmelidir. Ayrıca yürüme sırasında vücut ağırlığının ayak lateralinden geçirilmesini önleyebilmek amacıyla hastalara uygun tabanlık kullanılmalıdır
Calcaneus fractures account for 4% of all foot and ankle fractures. Displaced intra-articular fractures account for 60% to 70% of all calcaneal fractures. Surgical treatment of this type of intra-articular fracture is extremely common. Our clinical experience revealed that patients treated with open reduction internal fixation (ORIF) were frequently admitted with low back pain during the post-fracture period. Our literature searches turned up no studies on the frequency of low back pain following calcaneal surgery. The study was designed to determine the frequency of low back pain that may occur after operated calcaneal fractures and the risk factors affecting low back pain, to determine the need for physiotherapy ahead of time, to contribute to physiotherapy treatments, to prevent an increase in socio-economic losses, and to filling a gap in the literature. For this purpose, 31 (27 men, 4 women) patients with unilateral calcaneal fractures operated between 2020 and 2016 were included in the study. The short form SF-36 was used to assess quality of life, the Oswestry Disability Index (ODI) was used to assess the degree of functional loss in low back pain, and the American Orthopedic Foot-Ankle Association Score (AOFAS) was used to assess pain, function and hindfoot alignment. Fracture degree was determined by Sanders fracture classification. Balance on one foot, walking time, subtalar joint flexibility, static and dynamic measurements were made with the Arc Index (AI) method and the foot shape was measured by pedobarographic measurements. Joint range of motion (ROM) and maximal isometric muscle strength were measured. All these measurements were made for both feet. The IBM SPSS Statistics (version 25.0) was used. 95 percent of the study's confidence interval was considered significant, whereas p 0.05 did not. While the incidence of low back pain was 71%, low back pain started to be seen from the 6th month following the fracture. Balance time on one foot, active and passive plantar flexion, inversion from foot and ankle ROM measurements, active and passive internal and external rotation of the hip, and foot eversion strength from muscle strength measurements were associated with low back pain. In all of these measurements, the values of the injured side were found to be statistically significantly lower than the healthy side. The AOFAS results were good in 7 patients, fair in 9 patients, and poor in 15 patients, with a mean of 68.8 (±12.7). In the Sanders fracture classification, 17 patients had type II fractures, 13 patients had type III and 1 patient had type IV fractures. SF-36 Physical functionality was 64.1(±18.9), SF-36 Mental health was 52.7(±18.6). In ODI, there are 4 patients who say that low back pain does not pose a significant problem, 13 patients who say that low back pain limits my life slightly, 3 patients who say that low back pain limits my life severely, and 2 patients who say that low back pain completely limits my daily life. After all heel fractures treated conservatively or surgically, appropriate physiotherapy approaches should be applied, taking into account the ROM, muscle weakness and balance disorders that we found in our study. Among these treatment approaches, joint range of motion exercises to increase foot and ankle movements as soon as possible, strength exercises to increase muscle strength, and balance exercises should be prescribed as soon as the patient reaches the stage where he or she can carry the whole body weight independently to the injured foot. In addition, appropriate insoles should be used for patients in order to prevent the transfer of body weight from the lateral side of the foot during walking.
Calcaneus fractures account for 4% of all foot and ankle fractures. Displaced intra-articular fractures account for 60% to 70% of all calcaneal fractures. Surgical treatment of this type of intra-articular fracture is extremely common. Our clinical experience revealed that patients treated with open reduction internal fixation (ORIF) were frequently admitted with low back pain during the post-fracture period. Our literature searches turned up no studies on the frequency of low back pain following calcaneal surgery. The study was designed to determine the frequency of low back pain that may occur after operated calcaneal fractures and the risk factors affecting low back pain, to determine the need for physiotherapy ahead of time, to contribute to physiotherapy treatments, to prevent an increase in socio-economic losses, and to filling a gap in the literature. For this purpose, 31 (27 men, 4 women) patients with unilateral calcaneal fractures operated between 2020 and 2016 were included in the study. The short form SF-36 was used to assess quality of life, the Oswestry Disability Index (ODI) was used to assess the degree of functional loss in low back pain, and the American Orthopedic Foot-Ankle Association Score (AOFAS) was used to assess pain, function and hindfoot alignment. Fracture degree was determined by Sanders fracture classification. Balance on one foot, walking time, subtalar joint flexibility, static and dynamic measurements were made with the Arc Index (AI) method and the foot shape was measured by pedobarographic measurements. Joint range of motion (ROM) and maximal isometric muscle strength were measured. All these measurements were made for both feet. The IBM SPSS Statistics (version 25.0) was used. 95 percent of the study's confidence interval was considered significant, whereas p 0.05 did not. While the incidence of low back pain was 71%, low back pain started to be seen from the 6th month following the fracture. Balance time on one foot, active and passive plantar flexion, inversion from foot and ankle ROM measurements, active and passive internal and external rotation of the hip, and foot eversion strength from muscle strength measurements were associated with low back pain. In all of these measurements, the values of the injured side were found to be statistically significantly lower than the healthy side. The AOFAS results were good in 7 patients, fair in 9 patients, and poor in 15 patients, with a mean of 68.8 (±12.7). In the Sanders fracture classification, 17 patients had type II fractures, 13 patients had type III and 1 patient had type IV fractures. SF-36 Physical functionality was 64.1(±18.9), SF-36 Mental health was 52.7(±18.6). In ODI, there are 4 patients who say that low back pain does not pose a significant problem, 13 patients who say that low back pain limits my life slightly, 3 patients who say that low back pain limits my life severely, and 2 patients who say that low back pain completely limits my daily life. After all heel fractures treated conservatively or surgically, appropriate physiotherapy approaches should be applied, taking into account the ROM, muscle weakness and balance disorders that we found in our study. Among these treatment approaches, joint range of motion exercises to increase foot and ankle movements as soon as possible, strength exercises to increase muscle strength, and balance exercises should be prescribed as soon as the patient reaches the stage where he or she can carry the whole body weight independently to the injured foot. In addition, appropriate insoles should be used for patients in order to prevent the transfer of body weight from the lateral side of the foot during walking.
Açıklama
04.04.2023 tarihine kadar kullanımı yazar tarafından kısıtlanmıştır
Anahtar Kelimeler
Fizyoterapi ve Rehabilitasyon, Physiotherapy and Rehabilitation, Ortopedi ve Travmatoloji, Orthopedics and Traumatology
