FARKLI EVRELERDE DİZ OSTEOARTRİTİ OLAN HASTALARDA AYAK VE AYAK BİLEĞİ DEĞERLENDİRİLMESİ

Year 2020, , 463 - 470, 25.12.2020

Merve Karapınar , Ferdi Başkurt , Zeliha Başkurt , Meric Unal

https://doi.org/10.17343/sdutfd.704497

Abstract

Giriş: Ayak ve ayak bileği profili alt ekstremitenin mekanik dizilimini ve dinamik fonksiyonunu, özellikle diz eklemi mekaniğini değiştirmektedir. Farklı derecelerde diz osteoartriti (OA) olan hastalarda; ayak ve ayak bileği duruşundaki değişiklikleri belirlemek tedavi yaklaşımları açısından oldukça önemlidir. Bu çalışmanın amacı, Kellgren-Lawrence (K-L) ’a göre farklı derecelerde medial kompartman diz OA olan hastaların ayak ve ayak bileği profilindeki değişiklikleri ve etkilenimleri değerlendirmektir.
Yöntem: Tüm hastaların OA evresi, ağırlık taşıyarak çekilen ön-arka ve yan diz radyografilerine göre K-L derecelendirme sistemi kullanılarak belirlendi. Western Ontario ve Mc Master Üniversitesi Osteoartrit İndeksi, hastaların osteoartrite bağlı ağrılarını ve fonksiyonel durumlarını değerlendirmek için kullanıldı. Ayak ve ayak bileği profilinin ve fonksiyonelliklerinin belirlenmesinde Ayak Postür İndeksi (APİ) ve Amerikan Ortopedik Ayak ve Ayak Bileği Derneği Ayak Bileği (AOFAS)-Arka Ayak ve Orta Ayak ölçekleri kullanıldı. Hastaların ayak ağrısı şiddeti görsel analog skala, ayağa özgü sağlıkla ilişkili yaşam kalitesi ise Manchester-Oxford Ayak Anketi kullanılarak değerlendirildi.
Sonuç: Çalışmamıza yaş ortalaması 57,12±12,2 yıl olan toplam 112 hasta dahil edilmiştir. Diz OA şiddetine göre sınıflandırılan hastaların %24’ü Evre 0-1, %24’ü Evre 2, %29’u Evre 3 ve %23’ü Evre 4 grubunu oluşturmuştur. Hastaların ayak değerlendirmesinde kullanılan APİ sonuçlarına göre hastaların %18,4’ü supinasyonda, %42,5’i nötralde ve %39,1’i pronasyonda olarak değerlendirildi. Ayrıca hastaların radyolojik olarak OA şiddeti arttıkça ayak pronasyonu da artmıştır (p <0,005). Diz OA şiddeti Evre 0-1 ve 2 olan hastaların; AOFAS-Arka Ayak, Orta Ayak skorları ve ayak ağrıları diz OA Evre 3 ve 4 olan hastalara göre yüksek bulunurken MOAA puanları daha düşük bulunmuştur (p <0,001).
Tartışma: Çalışmamız farklı evrelerde medial kompartman diz OA şiddeti olan hastaların ayak ve ayak bileği profilinin farklı derecelerde etkilendiğini göstermektedir. Bu yüzden hastalığın ilerlemesindeki risk faktörleri ve uygun tedavi yaklaşımlarının belirlenmesinde mutlaka ayak-ayak bileğinin kapsamlı değerlendirilmesi yapılmalıdır.

Keywords

Ayak, Ayak Bileği, Diz Osteoartriti

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