ORIJINAL ARAÅžTIRMA
Primer Diz Osteoartriti Hastalarında Radyolojik Evreleme ile Postural Stabilite, Fonksiyon, İzokinetik Değerlendirmeler Arasındaki İlişkinin Değerlendirilmesi
The Evalua on of Rela on Between Radiological Grading and Postural Stability, Func on, Isokine c Measurements in Pa ents with Primary Knee Osteoarthri s
Received Date : 25 Jun 2018
Accepted Date : 15 Oct 2018
Pınar DORUK ANALANa
aFiziksel Tıp ve Rehabilitasyon Kliniği, Başkent Üniversitesi Adana Dr. Turgut Noyan Uygulama ve Araştırma Merkezi, Adana, TÜRKİYE
Doi: 10.31609/jpmrs.2018-61951 - Makale Dili: TR
J PMR Sci 2019;22(1):7-15
ÖZET
Amaç: Primer diz osteoartritli (OA) hastalarda radyolojik evrelemenin ağrı, fonksiyon, izokinetik değerlendirme ve postural stabiliteye olan etkilerinin değerlendirilmesidir. Gereç ve Yöntemler: Amerikan Romatoloji Derneği kriterlerine göre primer diz OA tanısı alan 110 kadın hasta çalışmaya dahil edildi. Hastaların ön-arka ve yan diz grafileri değerlendirildi. Bu grafiler üzerinden Kellgren-Lawrence (K/L) diz OA evrelemesi yapıldı. Çalışmaya K/L diz OA evrelemesine göre evre 2 ve evre 3 olan hastalar dâhil edildi. Hastalar K/L diz OA evrelemesine göre K/L evre 2 (Grup 1) ve K/L evre 3 (Grup 2) olmak üzere iki gruba ayrıldı. Kesin osteofit ve eklem aralığında şüpheli daralma K/L evre 2 olarak kabul edildi. K/L evre 3 ise orta derecede çok sayıda osteofit, eklem aralığında kesin daralma, skleroz olarak belirlendi. Çalışmanın sonuç parametreleri vizüel analog skala (VAS), WOMAC OA ve Lequesne indeksleri, Tetrax postüral stabilite testi, izokinetik kas parametreleri olarak belirlendi. Hastaların ağrı, tutukluk ve günlük yaşam aktiviteleri değerlendirmeleri VAS, WOMAC ve Lequesne indeksleri ile karşılaştırıldı. Denge ve postüral stabilite karşılaştırmaları Tetrax İnteraktif Denge Sistemi ile gerçekleştirildi. Kas kuvveti karşılaştırmaları için Biodex System 3 Pro izokinetik dinamometre cihazı kullanıldı. Bulgular: Çalışmaya alınan hastaların yaş ortalaması Grup 1’de 57,12 ±8,34 yıl ve Grup 2’de 62,38±8,23 yıl bulundu. Gruplar arasında yaş, beden kitle indeksi, hastalık süresi değerleri benzer idi. Gruplar arasında VAS, Lequesne indeksi, WOMAC tutukluk alt grupları arasında istatistiksel olarak anlamlı fark bulunmadı. WOMAC’ın toplam skoru ile ağrı ve günlük yaşam aktivitesi altskorları ise K/L evre 3 hastalarda daha yüksek saptandı. İzokinetik değerlendirmeler içinde yer alan 60°/sn ve 180°/sn hızlarındaki kuadriseps pik tork değerleri, hamstring/kuadriseps agonist/antagonist oranlarında fark belirlenmedi. Gruplar arasında düşme riski ve postüral stabilite değerleri açısından fark saptanmadı. Sonuç: Primer diz OA’nde K/L evre 2 ve 3 olan hastaların fonksiyon ve tutuklukları arasında fark bulunmamaktadır. Ağrı ve günlük yaşam aktivitesi değerlendirmeleri ise ölçülen yönteme göre değişmektedir. K/L evre 2 ve 3 kategorisi arasında postüral stabilite ve izokinetik kas değerlendirmeleri arasında fark saptanmamıştır.
Anahtar Kelimeler: Primer diz osteoartriti; radyolojik evreleme; izokinetik kas testi; postüral stabilite
ABSTRACT
Objective: The aim of this study is to evaluate the effects of radiologic grading on pain, function, isokinetic measurement and postural stability in patients with primary knee osteoarthritis (OA). Material and Methods: Total 110 women patients with primary knee OA diagnosis according to American College of Rheumatology criteria were included in the study. The patients’ anteroposterior and lateral views of the knee radiographs were evaluated. Kellgren-Lawrence (K/L) grading system was used based on these radiographs. Patients with K/L grade 2 and K/L grade 3 knee OA were included to the study. Patients were divided to two groups as Kellgren-Lawrence (K/L) grade 2 ( Group 1) and K/L grade 3 ( Group 2) according to K/L OA grading system. K/L grade 2 was accepted as small osteophytes with possible narrowing of the joint space. K/L grade 3 was determined as the multipl, moderately sized osteophytes,sclerosis,with definite joint space narrowing. Outcome parameters of the study were determined as visual analog scale (VAS), WOMAC OA and Lequesne index, Tetrax postural stability testing, and isokinetic muscle parameters. Evaluation of pain, stiffness and daily living activities of patients were compared by using VAS,WOMAC ve Lequesne indexes. Balance and postural stability comparisons were evaluated by using Tetrax Interactive Balance System. Biodex System 3 Pro Isokinetic dynamometer were used for the muscle strength comparisons. Results: The mean age of the patients in the study was found 57.12±8.34 years in group 1 and 62.38±8.23 years in group 2. Age, body mass index, disease duration parameters were similar among groups. There was not any significant difference between goups on VAS, Lequesne index, stiffness subgroup of WOMAC. Pain, activities of daily living subgroups and total score of WOMAC were higher in patients with K/L grade 3. The quadriceps peak torque measurements at 60°/sc and 180°/sc rates, hamstring/quadriceps agonist/antagonist ratios which are within the isokinetic evaluations were not found different. There were no significant difference on falling risk and postural stability measurements among groups. Conclusion: There are no difference on function and stiffness of patients with primary knee OA according to K/L grade 2 and 3. Pain and activity of daily living may vary according to evaluation method. There are no difference on isokinetic muscle measurements and postural stability evaluations among the K/L grade 2 and 3.
Keywords: Primary knee osteoarthritis; radiologic grading; isokinetic muscle testing; postural stability
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