Diz osteoartriti ile ayak bileği ve ayak yapıları arasındaki ilişkinin radyografi/MR görüntüleme ile incelenmesi
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Dosyalar
Tarih
2023
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/embargoedAccess
Özet
Kıkırdak dejenerasyonu ile karakterize osteoartritten diz eklemi sıklıkla etkilenmektedir. Diz osteoartrit hastalarındaki dejeneratif değişiklikler, kapalı kinetik zincir aktivitesi içinde birlikte görev yaptığı ayağın mekanik uyum ve fonksiyonunu etkileyebileceği gibi ayak deformiteleri de diz osteoartritinde etki sahibidir. Bu çalışmada diz osteoartritli bireylerin ayak-ayak bileği yapıları klinik, radyografik ve MRG ile değerlendirilerek diz osteoartriti ile ayak kompleksi arasındaki bağlantının tespit edilmesi amaçlandı. Çalışmaya Necmettin Erbakan Üniversitesi Fizik Tedavi ve Rehabilitasyon kliniğine diz ağrısı şikayetiyle başvuran, 40-69 yaş aralığında, 101 birey dahil edildi. Bireylerden demografik bilgiler elde edildi. Klinik muayene sırasında demografik bilgiler elde edildi ve ayak postür indeksi ile ayak pozisyonu belirlendi. Radyolojik muayene ile diz osteoartriti Kellgren Lawrence skalasına göre derecelendirildi ve ayak radyografilerinden ayak açı ölçümleri alındı. Ayak MRG ile ayakta karşılaşılan patolojiler raporlandı ve MRG görüntülerinden ayak bileği eklemini kateden tendonların kesit alanları ölçüldü. Yaş grubu, eğitim ve meslek parametrelerinde cinsiyetler arasındaki fark anlamlı bulundu (p<0,05). Düşük eğitim seviyesi, diz fleksiyonunu gerektiren meslekler, yüksek vücut kitle indeksi ve kadın olmak diz osteoartriti için risk teşkil ettiği tespit edildi. Ayak postür indeksi ile değerlendirilen diz osteoartritli hastaların sıklıkla nötral ayak postürüne sahip olduğu saptandı. On iki farklı açı ile değerlendirilen radyografilerde sadece talokalkaneal açı verilerine göre hastaların çoğunun ayak pronasyonuna işaret eden valgus deformitesi görüldü. Diğer açılara göre ise klinik değerlendirmeye benzer şekilde ayakların çoğunun nötral pozisyonda olduğu belirlendi. Tibialis anterior ve tibialis posterior kesit alanlarının proksimalden distale doğru azaldığı, flexor hallucis longus, fibularis longus, fibularis brevis ve tendo calcaneus kesit alanlarının ise genel olarak arttığı gözlendi. Tendo calcaneus kesit alanı kadınlarda, tüm yaş gruplarında, hafif simetrik ve ağır asimetrik diz osteoartritli hastalarda, nötral ayaklarda sağ tarafta daha kalındı. Diğer tendon kesitleri ile ilgili farklılıklar saptansa da bu farklılıklar tutarlı ve anlamlı değildi. Diz osteoartritli hastalarda plantar topuk kalınlığı, 1,78 cm olarak tespit edildi. Tedavi edilmediğinde osteoartrit insidansını artıran bazı dejenerasyonların (subkondral ödem, meduller ödem, kemik iliği ödemi, osteokondral lezyon, kistik dejeneratif değişiklik) MRG'de raporlandığı gözlendi. Aynı zamanda osteoartritli bireylerde sinus tarsi sendromu (%13,09), epin kalkanei (%26,19), tarsal koalisyon (%26,78), tenosinovit (%33,33) ve ligament dejenerasyonları (%28,57) tespit edildi. Tenosinovitin çoğunlukla tibialis posterior, flexor hallucis longus, fibularis brevis ve fibularis longus'un tendonlarını tuttuğu gözlendi. Ligament dejenerasyonunda çoğunlukla ligamentum talofibulare anterior ve ligamentum deltoideum'da kalınlaşma ve/veya zedelenme tespit edildi. Diz osteoartritli hastaların ayakları nötral pozisyonda olmasına rağmen, diz-ayak ilişkisinden kaynaklı olarak, patolojiye daha yatkındır. Diz osteoartritli bireylerde oluşan ya da oluşabilecek ayak deformitelerine dikkat çekilmesinin, dizdeki osteoartrit seyrini yavaşlatacağı, ayakta ve dizde sekonder bir problemin oluşmasına engel olacağı kanaatindeyiz. Diz osteoartritli hastaların tedavi protokollerine karar vermeden önce ayak kompleksinin de değerlendirilmesi ile tedavi başarısı da artacaktır.
The knee joint is frequently affected by osteoarthritis, which is characterized by cartilage degeneration. Degenerative changes in knee osteoarthritis patients can affect the mechanical adaptation and function of the foot with which it works together in closed kinetic chain activity, and foot deformities also have an effect on knee osteoarthritis. This study, it was aimed to determine the connection between knee osteoarthritis and foot complex by evaluating the foot-ankle structures of individuals with knee osteoarthritis with clinical, radiographic, and MRI. 101 individuals, aged between 40-69 years, who applied to the Necmettin Erbakan University Physiotherapy and Rehabilitation Clinic with knee pain were included in the study. Demographic information was obtained from individuals. Demographic information was obtained during clinical examination and foot position was determined by foot posture index. Knee osteoarthritis was graded according to the Kellgren-Lawrence scale by radiological examination, and foot angle measurements were taken from foot radiographs. Pathologies encountered in the foot were reported with foot MRI, and cross-sectional areas of tendons traversing the ankle joint were measured from MRI images. There was a significant difference between genders in age group, education, and occupation parameters (p<0.05). It was determined that low education level, occupations requiring knee flexion, high body mass index, and being female pose a risk for knee osteoarthritis. It was found that patients with knee osteoarthritis evaluated with the foot posture index often had a neutral foot posture. In radiographs evaluated with twelve different angles, valgus deformity indicating foot pronation was seen in most of the patients according to only talocalcaneal angle data. According to other aspects, it was determined that most of the feet were in the neutral position, similar to the clinical evaluation. It was observed that the cross-sectional areas of tibialis anterior and tibialis posterior decreased from proximal to distal, while the cross-sectional areas of flexor hallucis longus, fibularis longus, fibularis brevis, and tendo calcaneus generally increased. The cross-sectional area of the tendon calcaneus was thicker on the right side in neutral feet in women, in all age groups, and in patients with mildly symmetrical and severely asymmetrical osteoarthritis. Although there were differences related to other tendon sections, these differences were not consistent and significant. The plantar heel thickness in patients with knee osteoarthritis was 1.78 cm. It was observed that some degenerations (subchondral edema, medullary edema, bone marrow edema, osteochondral lesion, cystic degenerative change) that increase the incidence of osteoarthritis if untreated, were reported in MRI. At the same time, sinus tarsi syndrome (13.09%), epine calcanei (26.19%), tarsal coalition (26.78%), tenosynovitis (33.33%), and ligament degenerations (28%, 57) was detected. It was observed that tenosynovitis mainly affected the tendons of the tibialis posterior, flexor hallucis longus, fibularis brevis, and fibularis longus. In ligament degeneration, thickening and/or injury were detected mostly in the anterior talofibular ligament and deltoid ligament. Although the feet of patients with knee osteoarthritis are in a neutral position, they are more prone to pathology due to the knee-foot relationship. We believe that drawing attention to foot deformities that occur or may occur in individuals with knee osteoarthritis will slow down the course of osteoarthritis in the knee and prevent the occurrence of a secondary problem in the foot and knee. Before deciding on the treatment protocols for patients with knee osteoarthritis, evaluation of the foot complex will increase the success of the treatment.
The knee joint is frequently affected by osteoarthritis, which is characterized by cartilage degeneration. Degenerative changes in knee osteoarthritis patients can affect the mechanical adaptation and function of the foot with which it works together in closed kinetic chain activity, and foot deformities also have an effect on knee osteoarthritis. This study, it was aimed to determine the connection between knee osteoarthritis and foot complex by evaluating the foot-ankle structures of individuals with knee osteoarthritis with clinical, radiographic, and MRI. 101 individuals, aged between 40-69 years, who applied to the Necmettin Erbakan University Physiotherapy and Rehabilitation Clinic with knee pain were included in the study. Demographic information was obtained from individuals. Demographic information was obtained during clinical examination and foot position was determined by foot posture index. Knee osteoarthritis was graded according to the Kellgren-Lawrence scale by radiological examination, and foot angle measurements were taken from foot radiographs. Pathologies encountered in the foot were reported with foot MRI, and cross-sectional areas of tendons traversing the ankle joint were measured from MRI images. There was a significant difference between genders in age group, education, and occupation parameters (p<0.05). It was determined that low education level, occupations requiring knee flexion, high body mass index, and being female pose a risk for knee osteoarthritis. It was found that patients with knee osteoarthritis evaluated with the foot posture index often had a neutral foot posture. In radiographs evaluated with twelve different angles, valgus deformity indicating foot pronation was seen in most of the patients according to only talocalcaneal angle data. According to other aspects, it was determined that most of the feet were in the neutral position, similar to the clinical evaluation. It was observed that the cross-sectional areas of tibialis anterior and tibialis posterior decreased from proximal to distal, while the cross-sectional areas of flexor hallucis longus, fibularis longus, fibularis brevis, and tendo calcaneus generally increased. The cross-sectional area of the tendon calcaneus was thicker on the right side in neutral feet in women, in all age groups, and in patients with mildly symmetrical and severely asymmetrical osteoarthritis. Although there were differences related to other tendon sections, these differences were not consistent and significant. The plantar heel thickness in patients with knee osteoarthritis was 1.78 cm. It was observed that some degenerations (subchondral edema, medullary edema, bone marrow edema, osteochondral lesion, cystic degenerative change) that increase the incidence of osteoarthritis if untreated, were reported in MRI. At the same time, sinus tarsi syndrome (13.09%), epine calcanei (26.19%), tarsal coalition (26.78%), tenosynovitis (33.33%), and ligament degenerations (28%, 57) was detected. It was observed that tenosynovitis mainly affected the tendons of the tibialis posterior, flexor hallucis longus, fibularis brevis, and fibularis longus. In ligament degeneration, thickening and/or injury were detected mostly in the anterior talofibular ligament and deltoid ligament. Although the feet of patients with knee osteoarthritis are in a neutral position, they are more prone to pathology due to the knee-foot relationship. We believe that drawing attention to foot deformities that occur or may occur in individuals with knee osteoarthritis will slow down the course of osteoarthritis in the knee and prevent the occurrence of a secondary problem in the foot and knee. Before deciding on the treatment protocols for patients with knee osteoarthritis, evaluation of the foot complex will increase the success of the treatment.
Açıklama
Doktora Tezi
Anahtar Kelimeler
Ayak Açıları, Ayak Postür İndeksi, Diz Osteoartriti, Plantar Topuk Kalınlığı, Tendon Kesit Alanları, Angles of Foot, Foot Posture Index, Knee Osteoarthritis, Plantar Heel Thichness, Cross-sectional Areas of Tendon
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Yağmurkaya, Ü. (2023). Diz osteoartriti ile ayak bileği ve ayak yapıları arasındaki ilişkinin radyografi/MR görüntüleme ile incelenmesi. (Yayımlanmamış doktora tezi). Necmettin Erbakan Üniversitesi, Sağlık Bilimleri Enstitüsü Anatomi Anabilim Dalı, Konya.
