{"id":2072,"date":"2020-02-05T00:00:00","date_gmt":"2020-02-04T21:00:00","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdus\/2020\/02\/05\/literatur-ozetleri-radius-basi-cikigi-olan-cocuklarda-dirsek-arka-yag-yastigi-ultrason-bulgulari\/"},"modified":"2022-03-02T16:41:25","modified_gmt":"2022-03-02T13:41:25","slug":"literatur-ozetleri-radius-basi-cikigi-olan-cocuklarda-dirsek-arka-yag-yastigi-ultrason-bulgulari","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/tatdus\/2020\/02\/05\/literatur-ozetleri-radius-basi-cikigi-olan-cocuklarda-dirsek-arka-yag-yastigi-ultrason-bulgulari\/","title":{"rendered":"Literat\u00fcr \u00d6zetleri – Radius Ba\u015f\u0131 \u00c7\u0131k\u0131\u011f\u0131 Olan \u00c7ocuklarda Dirsek Arka Ya\u011f Yast\u0131\u011f\u0131 Ultrason Bulgular\u0131"},"content":{"rendered":"\r\n

Giri\u015f<\/strong><\/h3>\r\n\r\n\r\n\r\n

3 ya\u015f\u0131nda \u00e7ocuk yak\u0131n\u0131 taraf\u0131ndan kol a\u011fr\u0131s\u0131 ve kolunu kullanmamas\u0131 sebebi ile acil servise getirilir. Radius ba\u015f\u0131 \u00e7\u0131k\u0131\u011f\u0131 (RB\u00c7, dad\u0131 dirse\u011fi) olabilece\u011fini zaten tahmin edebiliyoruz. Muhtemelen koldan \u00e7ekme sonucunda olu\u015fmu\u015f bir mekanizma, d\u00fc\u015fme yok \u00e7arpma yok\u2026 Maalesef yak\u0131nlar\u0131ndan bu kadar net anamnez alamad\u0131\u011f\u0131m\u0131z bir hasta grubu da mevcut; \u00e7ocu\u011fun elinin konumundan, hareketsizli\u011finden ve travma bulgusu olmamas\u0131ndan muhtemelen \u00e7\u0131k\u0131k dedi\u011fimiz, grafi \u00e7ekme konusunda arada kald\u0131\u011f\u0131m\u0131z hasta grubu. Ultrason bize ne katar? sorusunun cevab\u0131 bu \u00e7al\u0131\u015fma ile aranmaya \u00e7al\u0131\u015f\u0131lm\u0131\u015f.\u00a0<\/p>\r\n\r\n\r\n\r\n

\"\"<\/figure>\r\n\r\n\r\n\r\n

Method<\/strong><\/h3>\r\n\r\n\r\n\r\n

\u00c7al\u0131\u015fma prospektif, g\u00f6zlemsel bir \u00e7al\u0131\u015fma, 1 Ocak 2011 – 31 May\u0131s 2012 tarihleri aras\u0131nda kentsel bir \u00e7ocuk acilinde yap\u0131lm\u0131\u015f. Hastalar\u0131 \u00f6nce deneyimli bir hekim de\u011ferlendirmi\u015f ve red\u00fcksiyon ihtiyac\u0131 oldu\u011funu d\u00fc\u015f\u00fcnd\u00fc\u011f\u00fc dad\u0131 dirse\u011fi olgular\u0131n\u0131 \u00e7al\u0131\u015fmaya alm\u0131\u015f. Grafi \u00e7ekilme ihtiyac\u0131 olan travmalar d\u0131\u015flanm\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n

\u015eimdi gelelim as\u0131l konuya, asl\u0131nda anular ligament ve radius ba\u015f\u0131n\u0131n konumuna ultrason ile bak\u0131p \u00e7\u0131k\u0131k tan\u0131s\u0131n\u0131 koyabiliyoruz ama USG ile tan\u0131mak biraz zor. \u00c7al\u0131\u015fmada bu sebeple dad\u0131 dirse\u011fi olan hastalarda posterior ya\u011f yast\u0131k\u00e7\u0131\u011f\u0131 (PYY) ve lipohemartroz (LH) var olup olmamas\u0131na bak\u0131lm\u0131\u015f. Usg uygulay\u0131c\u0131lara 1 saat e\u011fitim verdikten sonra \u00e7al\u0131\u015fmaya ba\u015flanm\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n

\u00c7al\u0131\u015fmada Sonosite Micromaxx ultrason ile lineer prop kullan\u0131lm\u0131\u015f. Primer acil servis hekimleri taraf\u0131ndan ultrason ger\u00e7ekle\u015ftirilmi\u015f. Dirsek 90 derece fleksiyonda ekstans\u00f6r y\u00fczden ultrason ger\u00e7ekle\u015ftirilmi\u015f. (\u015eekil 1) Transvers ve longit\u00fcdinal g\u00f6r\u00fcnt\u00fcleri de\u011ferlendirilmi\u015f.<\/p>\r\n\r\n\r\n\r\n

\"\"<\/figure>\r\n\r\n\r\n\r\n

\u015eekil 1: Normal\u00a0PYY ve LH g\u00f6r\u00fcnt\u00fcleri<\/em><\/p>\r\n\r\n\r\n\r\n

Sonu\u00e7lar<\/strong><\/h3>\r\n\r\n\r\n\r\n

Manevra yapmadan \u00f6nce ilk bak\u0131da ultrason bulgular\u0131 kay\u0131t edilmi\u015f ve toplam 42 hasta \u00e7al\u0131\u015fmaya (ort. 22 ayl\u0131k ) al\u0131nm\u0131\u015f.\u00a0 Sonras\u0131nda hastalar telefon ile aranarak red\u00fcksiyon ba\u015far\u0131s\u0131 de\u011ferlendirilmi\u015f.<\/p>\r\n\r\n\r\n\r\n

Gelelim ka\u00e7 hastada PYY ya da LH saptanm\u0131\u015f. \u00c7al\u0131\u015fmada 35 hastan\u0131n (35\/42, 83%; 95% (CI), 69%\u201392%) dirsek ultrasonunda PYY ya da LH saptanmam\u0131\u015f. 6 hastada (14%; 95% CI 6%\u201328%) PYY ve 2 hastada (5%; 95% CI, 0.5%\u201317%) LH saptanm\u0131\u015f. 1 \u00e7ocukta her iki bulgu birden tespit edilmi\u015f.<\/p>\r\n\r\n\r\n\r\n

\"\"<\/figure>\r\n\r\n\r\n\r\n

\u015eekil 2: Patolojik PYY ve LH g\u00f6r\u00fcnt\u00fcleri<\/em><\/p>\r\n\r\n\r\n\r\n

Semptom zaman\u0131 veya red\u00fcksiyon denemesi say\u0131s\u0131 ile pozitif ultrason bulgular\u0131 aras\u0131nda bir korelasyon g\u00f6zlenmemi\u015f.<\/p>\r\n\r\n\r\n\r\n

27 hastada (%64) supinasyon-fleksiyon, 4 hastada (%10) hiperpronasyon yap\u0131lm\u0131\u015f. 6 (%14) hastada supinasyon-fleksiyon ve hiperpronasyon denenmi\u015f, 5 hasta (%12) ise kendili\u011finden acil serviste red\u00fckte olmu\u015f. 31 (%74) hastaya tek sefer red\u00fcksiyon yap\u0131lm\u0131\u015f, 7 (%17) hastaya tekrarlayan red\u00fcksiyon denenmi\u015f. T\u00fcm hastalarda, acil serviste radius ba\u015f\u0131 \u00e7\u0131k\u0131\u011f\u0131 red\u00fcksiyonu teyit edilmi\u015f.\u00a0<\/p>\r\n\r\n\r\n\r\n

36 hasta i\u00e7in telefon ile takip yap\u0131labilmi\u015f ve sonraki g\u00fcnlerde bu hastalarda k\u0131r\u0131k veya komplikasyon olmad\u0131\u011f\u0131 teyit edilmi\u015f. Pozitif ultrason bulgular\u0131 olan t\u00fcm hastalara ula\u015f\u0131labilmi\u015f ve asemptomatik olduklar\u0131 \u00f6\u011frenilmi\u015f.<\/p>\r\n\r\n\r\n\r\n

\u00c7al\u0131\u015fmadaki hastalar\u0131n \u00e7o\u011funda normal ultrason bulgular\u0131 g\u00f6zlenmi\u015f olmas\u0131na ra\u011fmen 7 (%17) hastada artm\u0131\u015f ya\u011f yast\u0131k\u00e7\u0131\u011f\u0131 ve lipohemartroz g\u00f6r\u00fclm\u00fc\u015f. \u00a0\u00a0<\/p>\r\n\r\n\r\n\r\n

Ba\u015fka bir odaklanm\u0131\u015f ultrason \u00e7al\u0131\u015fmas\u0131nda artm\u0131\u015f arka ya\u011f yast\u0131k\u00e7\u0131\u011f\u0131 ve lipohemartrozun \u00e7ocuklarda dirsek k\u0131r\u0131klar\u0131nda %98 oran\u0131nda sensitivitesi oldu\u011fu g\u00f6sterilmi\u015f, negatif bulgular\u0131n ise k\u0131r\u0131k olma ihtimalini azaltt\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015f. Bu sebeple negatif ultrason bulgular\u0131 \u00f6zellikle mekanizmas\u0131 bilinmeyen ancak hareketsiz dirsek ile gelen \u00e7ocuklarda klinisyenin frakt\u00fcr olma ihtimalini azaltarak radius ba\u015f\u0131 \u00e7\u0131k\u0131\u011f\u0131 olarak ek g\u00f6r\u00fcnt\u00fcleme yapmadan tedavi etmesini destekleyebilir.<\/p>\r\n\r\n\r\n\r\n

Ara\u015ft\u0131rmac\u0131lar acil servise geli\u015f s\u00fcresi uzayan veya \u00e7oklu red\u00fcksiyon denemesi yap\u0131lan hastalarda pozitif ultrason bulgular\u0131 g\u00f6receklerini d\u00fc\u015f\u00fcnmelerine ra\u011fmen sonu\u00e7lar arada bir korelasyon olmad\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015f. Rabiner ve arkada\u015flar\u0131n\u0131n 2013\u2019te yapt\u0131\u011f\u0131 bir \u00e7al\u0131\u015fmada dirsek k\u0131r\u0131\u011f\u0131 olan hastalarda ultrason bulgular\u0131 incelenmi\u015f ve 18 hastadan 3\u2019\u00fcnde anormal ultrason bulgular\u0131 olmas\u0131na ra\u011fmen son tan\u0131 radius ba\u015f\u0131 \u00e7\u0131k\u0131\u011f\u0131 olarak tespit edilmi\u015f. O zamanki sonu\u00e7lar bu \u00e7al\u0131\u015fmadakiler ile benzerlik g\u00f6stermektedir. Sonu\u00e7 olarak radius ba\u015f\u0131 \u00e7\u0131k\u0131\u011f\u0131 olan hastalar\u0131n bir k\u0131sm\u0131nda anormal dirsek ultrason bulgular\u0131 g\u00f6r\u00fclebilmektedir.<\/p>\r\n\r\n\r\n\r\n

Odaklanm\u0131\u015f dirsek ultrasonu mekanizmas\u0131 tam bilinmeyen \u00e7ocuk dirsek yaralanmalar\u0131nda klinik karars\u0131zl\u0131k durumlar\u0131nda klinisyene radiografi konusunda yol g\u00f6sterici olabilir. Bu tarz vakalarda hastalara gereksiz radyografi \u00e7ekilmesini azaltalabilir.<\/p>\r\n\r\n\r\n\r\n

\u00c7al\u0131\u015fma prospektif olarak dizayn edildi\u011fi i\u00e7in hasta say\u0131s\u0131 az ve ek olarak \u00e7al\u0131\u015fmaya sadece klinik olarak radius ba\u015f\u0131 \u00e7\u0131k\u0131\u011f\u0131 tan\u0131s\u0131 alm\u0131\u015f hastalar ve klinisyenin direkt olarak red\u00fcksiyonu deneyecek kadar tan\u0131s\u0131ndan emin oldu\u011fu hastalar dahil edilmi\u015ftir. Tan\u0131s\u0131ndan emin olunmayan veya red\u00fcksiyon \u00f6ncesi grafi \u00e7ekilen hastalar \u00e7al\u0131\u015fmaya dahil edilmemi\u015flerdir. Takipte herhangi bir komplikasyon izlenmemesine ra\u011fmen bir di\u011fer k\u0131s\u0131tlay\u0131c\u0131 durum ise red\u00fcksiyon ba\u015far\u0131s\u0131 klinik olarak etkilenmi\u015f dirse\u011fin spontan olarak yeniden kullan\u0131labiliyor olmas\u0131 olarak belirlenmi\u015ftir.<\/p>\r\n\r\n\r\n\r\n

\u00d6zet olarak \u00e7al\u0131\u015fmada 42 hastadan 7\u2019sinde LH veya PYY saptanm\u0131\u015f. Bu \u00e7al\u0131\u015fma ile PYY ve LH’ nin g\u00f6r\u00fclmemesi \u00e7\u0131k\u0131k tan\u0131s\u0131n\u0131 destekledi\u011fi belirtilmi\u015f. LH ve PYY\u2019nin az bir oranda dad\u0131 dirse\u011fi hastalar\u0131nda da g\u00f6r\u00fclebilece\u011fi vurgulanm\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n\r\n\r\n

DOI:<\/strong>10.1097\/PEC.0000000000000420<\/a><\/p>\r\n","protected":false},"excerpt":{"rendered":"

Giri\u015f 3 ya\u015f\u0131nda \u00e7ocuk yak\u0131n\u0131 taraf\u0131ndan kol a\u011fr\u0131s\u0131 ve kolunu kullanmamas\u0131 sebebi ile acil servise getirilir. Radius ba\u015f\u0131 \u00e7\u0131k\u0131\u011f\u0131 (RB\u00c7, dad\u0131 dirse\u011fi)…<\/p>\n","protected":false},"author":1205,"featured_media":2076,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[19,12],"tags":[38,65],"class_list":["post-2072","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-literatur-ozetleri-surekli-yayinlar","category-surekli-yayinlar","tag-dadi-dirsegi","tag-kas-iskelet-usg"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2072","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/users\/1205"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/comments?post=2072"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2072\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media\/2076"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media?parent=2072"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/categories?post=2072"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/tags?post=2072"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}