{"id":2160,"date":"2017-05-02T00:00:00","date_gmt":"2017-05-01T21:00:00","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdus\/2020\/02\/27\/pediyatrik-yas-grubunda-radius-basi-subluksasyonunun-tani-ve-yonetiminde-ultrasonografinin-destegi-olgu-serileri\/"},"modified":"2022-03-02T16:59:37","modified_gmt":"2022-03-02T13:59:37","slug":"pediyatrik-yas-grubunda-radius-basi-subluksasyonunun-tani-ve-yonetiminde-ultrasonografinin-destegi-olgu-serileri","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/tatdus\/2017\/05\/02\/pediyatrik-yas-grubunda-radius-basi-subluksasyonunun-tani-ve-yonetiminde-ultrasonografinin-destegi-olgu-serileri\/","title":{"rendered":"Pediyatrik ya\u015f grubunda radius ba\u015f\u0131 subluksasyonunun tan\u0131 ve y\u00f6netiminde ultrasonografinin deste\u011fi: olgu serileri"},"content":{"rendered":"\r\n\r\n\r\n<p>\u201cDad\u0131 dirse\u011fi\u201d olarak da bilinen radius ba\u015f\u0131 subluksasyonu (RBS) 6 ya\u015f ve \u00f6ncesi pediyatrik pop\u00fclasyonda g\u00f6r\u00fclen ortopedik bir yaralanmad\u0131r. S\u0131kl\u0131kla kolun pronasyon ve ekstansiyon pozisyonunda iken \u00e7ekilmesi ile olu\u015fur. Tan\u0131 i\u00e7in genellikle direkt grafi istenmesine gerek olmamakta ve kapal\u0131 red\u00fcksiyon tekni\u011fi ile tedavi edilmektedir. Ancak anamnezin al\u0131namad\u0131\u011f\u0131 durumlarda veya atipik semptom ve bulgular s\u00f6z konusu oldu\u011funda ultrason kullan\u0131m\u0131 tan\u0131 koymada ve hasta y\u00f6netiminde Acil Hekimine yard\u0131mc\u0131 bilgiler verecektir. <a href=\"http:\/\/dx.doi.org\/10.1016\/j.jemermed.2017.01.049\" target=\"_blank\" rel=\"noreferrer noopener\">10.1016\/j.jemermed.2017.01.049<\/a><\/p>\r\n\r\n\r\n\r\n<p><strong>Olgu 1:\u00a0<\/strong>7 ayl\u0131k k\u0131z bebek acil servise huzursuzluk, a\u011flama ve kolunu hareket ettirememe \u015fikayeti ile gelmi\u015f. Bu \u015fikayetler annesi \u00fczerini de\u011fi\u015ftirirken ba\u015flam\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n<p><strong>Olgu 2:\u00a0<\/strong>3 ya\u015f\u0131nda erkek hasta acil servise sol dirsekte a\u011fr\u0131 \u015fikayeti ile getirilmi\u015f. \u015eikayetler, babas\u0131n\u0131n hastan\u0131n d\u00fc\u015fmemesi i\u00e7in kolundan \u00e7ekmesi ile ba\u015flam\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n<p><strong>Olgu 3:<\/strong>\u00a018 ayl\u0131k erkek hasta sa\u011f kolunu hareket ettirememe \u015fikayeti ile getirilmi\u015f. Hasta yeni y\u00fcr\u00fcmeye ba\u015flam\u0131\u015f ve odada oyun oynarken a\u011flama seslerinin duyulmas\u0131 ile yan\u0131na gidilmi\u015f. Olay\u0131 g\u00f6ren bir yak\u0131n\u0131 yok.<\/p>\r\n\r\n\r\n\r\n<p><strong>ULTRASON TEKN\u0130\u011e\u0130<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Hastalar ebeveynlerinin kuca\u011f\u0131nda oturtulurken etkilenmi\u015f dirsek tam ekstansiyonda olacak \u015fekilde a\u00e7\u0131l\u0131r, lineer prob dirse\u011fin anterioruna\/fleks\u00f6r y\u00fcz\u00fcne yerle\u015ftirilir\u00a0<strong>(\u015eekil 1).<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Dirse\u011fin ultrason g\u00f6r\u00fcnt\u00fclemesinde supinat\u00f6r kas (SK) radiokapitellar eklemin anteriorunda bulunur ve anuler ligamente (AL) tutunur. AL ultrasonda \u00e7izgi \u015feklinde hiperekoik olarak g\u00f6r\u00fcl\u00fcr ve radius ba\u015f\u0131n\u0131 lateralden \u00e7evirir\u00a0<strong>(\u015eekil 2A).<\/strong>\u00a0Subluksasyon ile AL eklem aral\u0131\u011f\u0131na girince, kendisi ile beraber SK\u2019n\u0131n da bir k\u0131sm\u0131n\u0131 \u00e7eker. B\u00f6ylece patolojik hiperekoik kanca (hook) veya \u201cJ\u201d bulgusu ortaya \u00e7\u0131kar\u00a0<strong>(\u015eekil 2B).<\/strong><\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" class=\"wp-image-828\" src=\"https:\/\/tatd.org.tr\/tatdus\/wp-content\/uploads\/sites\/5\/2021\/10\/deniz-makale-sekil-1-1.png\" alt=\"\" \/>\r\n<figcaption><strong>\u015eekil 1.\u00a0<\/strong>Ultrason yap\u0131l\u0131rken hastaya verilen pozisyon. Hasta ebeveyninin kuca\u011f\u0131nda dirsek tam ekstansiyonda iken, lineer prob dirsek ekleminin anterioruna yerle\u015ftirilir\u00a0<em>(PMID:28284770)<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" class=\"wp-image-829\" src=\"https:\/\/tatd.org.tr\/tatdus\/wp-content\/uploads\/sites\/5\/2021\/10\/deniz-makale-sekil-2-1024x374.png\" alt=\"\" \/>\r\n<figcaption><strong>\u015eekil 2.\u00a0<\/strong>Dirse\u011fin ultrasonografik g\u00f6r\u00fcnt\u00fcs\u00fc.\u00a0<strong>A.<\/strong>\u00a0Dirse\u011fin normal anatomik g\u00f6r\u00fcnt\u00fcs\u00fc; anuler ligament radial ba\u015f\u0131n etraf\u0131nda ve eklem aral\u0131\u011f\u0131n\u0131n d\u0131\u015f\u0131nda.\u00a0<strong>B.<\/strong>\u00a0Radial ba\u015f\u0131n sublukse g\u00f6r\u00fcnt\u00fcs\u00fc; anuler ligament eklem aral\u0131\u011f\u0131n\u0131n i\u00e7ine yer de\u011fi\u015ftirmi\u015f, birlikte supinator kas\u0131 da \u00e7ekti\u011fi i\u00e7in patolojik \u201ckanca\u201d g\u00f6r\u00fcnt\u00fcs\u00fc olu\u015fmu\u015f.\u00a0<strong>C.<\/strong>\u00a0Ba\u015far\u0131l\u0131 red\u00fcksiyon sonras\u0131 \u201ckanca\u201d g\u00f6r\u00fcnt\u00fcs\u00fcn\u00fcn kayboldu\u011funa dikkat ediniz. Cp: kapitellum, An: anuler ligament, R: radius, Sm: supinator kas.\u00a0<em>(PMID:28284770)<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" class=\"wp-image-830\" src=\"https:\/\/tatd.org.tr\/tatdus\/wp-content\/uploads\/sites\/5\/2021\/10\/deniz-makale-sekil-3-1024x628.png\" alt=\"\" \/>\r\n<figcaption><strong>\u015eekil 3.\u00a0<\/strong>Normal ve patolojik kanca bulgusunu demonstre eden ultrasonografik g\u00f6r\u00fcnt\u00fcler.\u00a0<strong>A.<\/strong>\u00a0Normal anatomik yap\u0131lar.\u00a0<strong>B.<\/strong>\u00a0Patolojik \u201ckanca\u201d bulgusu g\u00f6r\u00fcn\u00fcm\u00fc. Anuler ligament: mavi i\u015faretli, supinator kas: k\u0131rm\u0131z\u0131 i\u015faretli.\u00a0<em>(PMID:28284770)<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<p>RBS\u2019nin tipik olgular\u0131nda d\u00fcz grafilerin k\u0131r\u0131klar\u0131 d\u0131\u015flama a\u00e7\u0131s\u0131ndan kan\u0131tlanm\u0131\u015f bir yarar\u0131 bulunmamaktad\u0131r. Hatta bu t\u00fcr vakalarda d\u00fcz grafiler s\u0131kl\u0131kla normal olarak de\u011ferlendirilir. Bu a\u00e7\u0131dan tan\u0131 testi olarak kullan\u0131mlar\u0131 k\u0131s\u0131tl\u0131d\u0131r. Eismann ve arkada\u015flar\u0131n\u0131n yapt\u0131\u011f\u0131 bir \u00e7al\u0131\u015fmada proksimal radial uzunluk, anterior veya posterior ya\u011f yast\u0131k\u00e7\u0131\u011f\u0131 g\u00f6r\u00fcn\u00fcm\u00fcn\u00fcn varl\u0131\u011f\u0131n\u0131n subluksasyonu normal eklemden ay\u0131ramad\u0131\u011f\u0131 saptanm\u0131\u015f. Ayr\u0131ca hasta bu g\u00f6r\u00fcnt\u00fcleme i\u00e7in radrasyon da almaktad\u0131r.<\/p>\r\n\r\n\r\n\r\n<p>Manyetik rezonans her ne kadar anatomiyi \u00e7ok iyi g\u00f6r\u00fcnt\u00fclese de acil serviste kullan\u0131m\u0131 pratik de\u011fildir. Ayr\u0131ca hasta pop\u00fclasyonunun \u00e7ocuk oldu\u011fu d\u00fc\u015f\u00fcn\u00fcld\u00fc\u011f\u00fcnde sedasyon ihtiyac\u0131n\u0131 da do\u011furacakt\u0131r.<\/p>\r\n\r\n\r\n\r\n<p>Ultrason yatakba\u015f\u0131 kullan\u0131labilen, radrasyon vermeyen, tekrarlanabilen bir g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemidir. Son y\u0131llarda literat\u00fcrde acil hekimleri aras\u0131nda \u201chekimin steteskopu\u201d olarak da tan\u0131mlanmaya ba\u015flam\u0131\u015ft\u0131r. Daha \u00f6nce RBS i\u00e7in Diab ve arkada\u015flar\u0131 radiokapiteller mesafeyi ultrasonla kar\u015f\u0131la\u015ft\u0131rmal\u0131 olarak her iki tarafl\u0131 \u00f6l\u00e7\u00fclm\u00fc\u015flerdir. Ancak anlaml\u0131 bir sonu\u00e7 bulunamam\u0131\u015ft\u0131r. 70 \u00e7ocuk hastada RBS tan\u0131s\u0131 i\u00e7in \u201ckanca\u201d-\u201cJ\u201d bulgusuna bakan Dohi ve arkada\u015flar\u0131 bu patolojik g\u00f6r\u00fcnt\u00fcy\u00fc %100 spesifik bulmu\u015flard\u0131r. Sensitivitesi ve negatif prediktif de\u011feri ise %64.9\u2019dur.<\/p>\r\n\r\n\r\n\r\n<p>Ultrason RBS tan\u0131s\u0131 i\u00e7in optimal g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemi gibi g\u00f6r\u00fcnmektedir. Ancak her zamanki gibi bakan ki\u015fi ba\u011f\u0131ml\u0131d\u0131r. Klinik \u015f\u00fcphe devam ediyorsa hekim tan\u0131y\u0131 d\u0131\u015flarken dikkatli olmal\u0131d\u0131r.<\/p>\r\n\r\n\r\n\r\n<p><strong>AC\u0130L HEK\u0130M\u0130 NEDEN BU UYGULAMA HAKKINDA B\u0130LG\u0130 SAH\u0130B\u0130 OLMALIDIR?<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Tan\u0131 a\u00e7\u0131s\u0131ndan \u015f\u00fcphe i\u00e7inde olunan, yaralanma mekanizmas\u0131n\u0131n net bilinmedi\u011fi atipik olgularda ultrason, tan\u0131 ve hasta y\u00f6netimi hakk\u0131nda yard\u0131mc\u0131 bilgiler vermektedir. Ayr\u0131ca ba\u015far\u0131l\u0131 red\u00fcksiyonun tan\u0131nmas\u0131 i\u00e7in de olduk\u00e7a de\u011ferli olan bir g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemidir.\u00a0<\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>\u201cDad\u0131 dirse\u011fi\u201d olarak da bilinen radius ba\u015f\u0131 subluksasyonu (RBS) 6 ya\u015f ve \u00f6ncesi pediyatrik pop\u00fclasyonda g\u00f6r\u00fclen ortopedik bir yaralanmad\u0131r. S\u0131kl\u0131kla kolun pronasyon&hellip;<\/p>\n","protected":false},"author":1529,"featured_media":2164,"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-2160","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\/2160","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\/1529"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/comments?post=2160"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2160\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media\/2164"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media?parent=2160"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/categories?post=2160"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/tags?post=2160"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}