OLGU SUNUMLARI
Travmatik Diz Eklem Sertliğinde Ultrason ve Periferik Sinir Bloğu Eşliğinde Hidrodiseksiyon
Ultrasound-Guided Hydrodissection Combined with Peripheral Nerve Block for the Treatment of Post-Traumatic Knee Stiffness
Received Date : 02 Apr 2019
Accepted Date : 14 Oct 2019
Available Online : 20 Jan 2020
Merve ÖRÜCÜ ATARa, Eda GÜRÇAYa, Yasin DEMİRa, Özlem KÖROĞLUa,
Kutay TEZELa, Evren YAŞARa
aUniversity of Health Sciences, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, TURKEY
Doi: 10.31609/jpmrs.2019-66307 - Makale Dili: EN
J PMR Sci. 2020;23(1):51-4
ÖZET
Diz sertliği diz yaralanmasının önemli bir komplikasyonudur
ve sıklıkla doğal ambulasyonu etkiler. Burada femur kırığı sonrası diz
sertliği olan ve sonrasında diz cerrahisi ve ultrason eşliğinde hidrodiseksiyonun
uygulandığı 29 yaşındaki erkek olguyu sunmaktayız. Hastanın
hikayesinde femur kırığı sonrası açık reduksiyon, internal
fiksasyon ve popliteal bölgedeki doku defekti için greft cerrahisi mevcuttu.
2 ay süreyle uygulanan eklem hareket açıklığı (EHA), germe ve
güçlendirme egzersizlerinden oluşan fizik tedavi programına ve akabinde
uygulanan artroskopik gevşetmeye rağmen sol diz kısıtlılığı
devam etti. Fibrotik dokulara ultrason eşliğinde hidrodiseksiyon haftada
bir kez toplamda 4 kez uygulandı. Hastaya EHA, germe ve güçlendirme
egzersizlerinden oluşan toplam 20 seans tedavi uygulandı.
Diz fleksiyonu 60°’den 70°’ye, ekstansiyonu -35°’den -15°’ye gelişti.
Bu vaka diz travması/cerrahisi sonrası gelişen eklem sertliğinin tedavisinde
periferik blokla birlikte uygulanan ultrason eşliğinde hidrodiseksiyonun
minimal invaziv ve güvenli bir yöntem olduğunu
göstermektedir.
Anahtar Kelimeler: Diz; sertlik; hidrodiseksiyon; ultrason; cerrahi
ABSTRACT
Knee stiffness is an important complication of knee injury
and commonly affects natural ambulation. We demonstrated a case
of 29-year old male who presented with knee stiffness following femur
fracture and knee surgery and underwent ultrasound-guided hydrodissection
into the fibrotic tissues. The patient’s history revealed an open
reduction internal fixation surgery after femur fracture and graft surgery
for the tissue defect in the popliteal region. Although the patient had a
2-month physical therapy program including range of motion (ROM),
stretching and strengthening exercises, and underwent arthroscopic
lysis of adhesions after while, the left knee ROM continued to be seriously
limited. Ultrasound-guided hydrodissection procedure around fibrotic
tissues and common peroneal nerve block were performed once
a week, 4 times in total. The patient underwent a total of 20 training
sessions including ROM, stretching and strengthening exercises. The
improvement of the knee flexion from 60° to 70° and extension from -
35° to -15° were detected. This case report demonstrates that ultrasound-
guided hydrodissection combined with peripheral block is a
minimally invasive and a safe method in the treatment of patients with
joint stiffness after knee trauma/surgery.
Keywords: Knee; stiffness; hydrodissection; ultrasound; surgery
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