FİZİK TEDAVİ UYGULANAN GONARTROZLU HASTALARDA İNTRAARTİKULER SODYUM-HYALURONANIN ETKİLERİ / THE EFFECTS OF INTRA-ARTICULAR SOOIUM-HYALURONAN IN PATIENTS WITH GONARTHROSIS TREATED WITH PHYSICIAL THERAPY

Yıl 2002, Cilt: 4 Sayı: 1, 0 - 0, 20.02.2010

Fazile Hatipoğlu Şiraz Çoğalgil Lale Cerrahoğlu

Öz

Bu 9all~ma, fizik tedavi uygulanan gonartrozlu hastalara intra-artikuler olarak verilen sodyum hiyaluronanm
etkilerini ara~tmnak amac/yla yaplldl. Amenkan Romatoloii Ko/eii Diz Osteoartriti tam ktiterlerine gore
gonartroz tamsl konan 40 hasta fizik tedavi programma almdl. Daha sonra hasta/ar rastgele se9i/erek 20'~er
ki~ilik iki gruba aynldl. I. gruba yalmzca fizik tedavi uygulamp kontrol grubu olarak almdl. II. gruba ise fizik
tedavi ile birJikte tedavinin 1., 7., ve 14. gunlerinde intra-artikuler sodyum hyaluronan veri/di.
Deger/endirme krilerleti olarak tedaviden once ve tedavi slrasmda 7., 14., ve 21. gunlerde; istirahatte agn,
gece agnsl, dirence kaf§1 ago, palpasyonla agn ve yurumek/e agn degerleri, sabah tutuklugu suresi, eklem
hareket apklJ[jl dl'lumleri, kuadriseps kasl a{wl1k kaldmna gucu, eklem ve uyluk gevresi dl9umleri, 15 metre
yuriime zamam, diz 'l6kme, 'lome/me, merdiven 91kma ve inme gibi gunlUk ya~am aktiviteleti ve fonksiyonel
klSltianma proWi kullamldl. Ayoca ek/emde effuzyon varl/gl da degerlendirildi.
Tedavi sonrasmda her iki gruptaki agn degerleri, sabah tutuklugu suresi, kuadriseps kasl a{wlJk ka/dlrma
gucu, 15 metre yuriime zamam, merdiven pkma ve inme aktiviteleri ile fonksiyonel kls/tlanma profilinde r;ok
an/amll (p<O. 00 1), diz 'lokme ve 'lome/me aktivitelerinde anlamll (p<0.01) iyi/e~meler elde edildi. Eklem
'levresi ve uyluk gevresi ol9umlerindeki iyile~meler ise anlamslzdl (p>0.05). Diz eklemlerinde hareket klsltlilig/
ve effuzyonu bulunan vaka say/sl az ol1:lugundan bu parametre/er istatistiksel olarak degerlendirilemedi.
Iki grup kaf§lla~t/(/ldlgmda; istirahatte ag(/, gece ag(/sl ve yurumekle agn degerleri ile fonksiyonel klsltlanma
profilinde meydana gelen iyile§me, II. grupta I. gruba g6re daha anlamllyd/. (slfas/yla p<0.01, p<O.05, p<O.01,
p<0.05). Ancak diger kJinik parametrelerde iki grup arasmda anlamll fark bufunamadl (p>O.05).
Sonu9 olarak, gonartrozda intra-artikuler sodyum hyaluronanm ozellikle agnnm azaltllmasl ve fonksiyonel
klsltllll{Jm duzeltilmesinde etkili ve guvenli bir yontem oldugu, bu nedenle klasik fizik tedavi programl
uygulanan gonartrozlu hastalara fizik tedavi lie birlikte intra-artikUler sodyum hyaluronan verilmesinin faydall
olaeagl kamsma vanldl.

Anahtar Kelimeler: Sodyum-Hyaluronan, Gonartroz, Fizik tedavi

 

SUMMARY
This study vas performed to determine the effects of intra-articular Sodium-Hyaluronate in patient with
gonarthritis that had pyhsicial therapy. A physical therapy programme was performed in forty patients that
diagnosed as gonarthritis according to American Collage of Rheumatology criteria. And then patients were
allocated randomly to two parellel groups of equal size. First group was received only physicial therapy and
re~arded as control group. Intra-articular Sodium-Hyaluronate was administered to the second group on the
15
, t h
, and 14th days in addition to them.
Evaluation criten'a at baseline and at t h
, 14th and 21th were rest pain, night pain, pain underload, touch pain
and walking pain, the duration of morning stiffness, range of motion measurements, power of lifting mass of
quadn'ceps muscle, the measurement ofjoint and thigh ring size, 15 meters walking time, daily living activities
such as kneeling, squatting, going up stairs, going down stairs and sickness impact profile. The presence of
joint effusion was also evaluated.
After teratmem in both groups, there were very significant improvements in pain score, morning stiffness, the
power of lifting mass of quadriceps muscle, 15 meters walking time, going up stairs and going down stairs,
and sickness impack profile (p<0.001). There were also significant improvements in kneeling and squatting
activities (p<0.01). There was no significant improvement in the measurement of joint and thigh ring size
(p>0.05). The measurements of range of motion and presence of ioint effusion were not able to evaluated
because the number of the patients that had limited joint movements and joint effusion was not enough.
In comparing the two groups the improvements in rest pain, night pain, walking pain and sickness impact
profile were more significant in second group according to first group (respectively p<0.01, p<0.05, p<0.01,
p<0.05). But there was no significant difference in other clinicaf parameters between two groups (p>0.05).
It was concluted that intra-articular Sodium-Hyaluronate is an effective and safe method in gonarthritis
especially in decreasing the pain and improving sickness impact profile. Sodium-Hyaluronate may therefore
be a useful additional therapy for the patients with gonartrosis treated with physical therapy

Key Words: Sodium-Hyaluronan, Gonarthrosis, Physical Therapy