ISSN: 1309 - 3843 E-ISSN: 1307 - 7384
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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
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.
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.
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