FEMUR BAŞI AVASKÜLER NEKROZU

Esra Sonbahar Bolat

Metin Sabancı Baltalimanı Kemik Hastalıkları EAH, Fiziksel Tıp ve Rehabilitasyon Kliniği, İstanbul, Türkiye

Sonbahar Bolat E. Femur Başı Avasküler Nekrozu. Çalış M, Talay Çalış H ed. Ağrıda Odak Noktası Kalça. 1. Baskı. Ankara: Türkiye Klinikleri; 2024. p.143-158.

ÖZET

Femur başı avasküler nekrozu (FBAVN), proksimal femurun kan akışının bozulması sonucu osteosit ölümüyle sonuçlanan bir aseptik osteonekroz (ON) türüdür, travmatik veya travmatik olmayan bir zeminde gelişen iskemi nedeniyle ortaya çıkabilir. Kortikosteroid tedavisi, kalça ekleminin çıkığı, kırıklar ve alkol kullanımı en yaygın etiyolojik faktörler arasındadır. Genellikle 20 ila 40 yaş arasındaki fiziksel olarak aktif kişileri etkiler. Tüm anatomik bölgeler arasında en sık (%75,9) kalça eklemi tutulmaktadır. Erkekleri kadınlara göre 3 kat daha fazla etkilemektedir ve %40–70 oranında her iki kalça tutulumu mevcuttur. FBAVN’ye tedavi yapılmadığı takdirde %80 oranında femur başında çökme görülmektedir.

FBAVN, genetik yatkınlıklar ve çevresel risk faktörleriyle karmaşık bir yapıya sahip bir hastalıktır. Tanı ve evreleme, herhangi bir aşamada Manyetik Rezonans Görüntüleme (MRG) ve daha ileri lezyonlarda düz radyografi dahil görüntülemeye dayanır. Femur başındaki nekrozun boyutu ve yeri, kemik çökmesi riskini belirleyen en önemli unsurlar arasında yer alır. Küçük lezyonlar genellikle ilerlemezken, orta ve büyük lezyonlar tedavi gerektirebilir. Şu ana kadar, farmakolojik tedavilerin FBAVN üzerinde etkili olduğu kanıtlanmamıştır. Özellikle iyi planlanmış cerrahi dışı müdahalelerin, genç hastalarda eklem fonksiyonunu uzun yıllar koruyabileceği ve daha invaziv prosedürlere olan ihtiyacı önleyebileceği veya geciktirebileceği yönünde güçlü kanıtlar ortaya çıkmıştır. Konservatif tedaviler; iyileşme sürecini kısaltır ve cerrahi seçeneklere göre hastaların günlük yaşamlarına daha kolay entegre edilebilir. Ek olarak, rejeneratif tıptaki gelişmeler giderek daha fazla ilgi görmektedir. Kor dekompresyon (CD) ve kemik iliği aspirat konsantresi (BMAC) gibi yöntemler büyük lezyonlarda etkili bulunmamıştır ve daha fazla araştırma yapılması gerekmektedir. FBAVN’nin erken tanısı, hekimlere total kalça artroplastisinin (TKA) ötesinde seçenekler sunar. FBAVN’si tedavi edilmezse, hastaların %70-80’inde sekonder kalça artriti gelişir. Vaka çalışmalarında, tıbbi, cerrahi yaklaşım ve rehabilitasyonu içeren multidisipliner ekibin, hastada ağrıyı azaltmada; kas gücünü, işlevsel bağımsızlığı ve yaşam kalitesini artırmada hayati bir rol oynadığı sonucuna varılmıştır. Hastalarda kor dekompresyon cerrahisi sonrası, izometri, germe ve güçlendirme egzersizleri içeren fizyoterapi uygulanması ile ağrı seviyesi, eklem hareket açıklığı ve kas gücünde iyileşmeler gözlenmiştir.

Anahtar Kelimeler: Femur başı avasküler nekrozu; Osteonekroz; Konservatif tedavi; Cerrahi tedavi; Total kalça artroplastisi; Rehabilitasyon

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