EGEUMUT \u00a0Hastanesi Ortopedi ve Travmatoloji Uzman\u0131 Op.Dr. A.Celil Amiri, Diz A\u011fr\u0131lar\u0131n\u0131n Nedeni Menisk\u00fcs Y\u0131rt\u0131klar\u0131 Olabilir, konusu hakk\u0131nda gazetemizi bilgilendirici a\u00e7\u0131klamalarda bulundu.<\/p>\n

Op.Dr. A.Celil Amiri yapt\u0131\u011f\u0131 a\u00e7\u0131klamada: \u201c Menisk\u00fcsler diz ekleminde yer alan C \u015feklinde k\u0131k\u0131rdak benzeri yap\u0131lard\u0131r. Diz eklemini olu\u015fturan iki ana kemik olan uyluk kemi\u011fi alt k\u0131sm\u0131 ve kaval kemi\u011fi \u00fcst k\u0131sm\u0131 aras\u0131nda yer al\u0131rlar. Biri i\u00e7 di\u011feri d\u0131\u015f olmak \u00fczere her dizde iki\u015fer tane menisk\u00fcs bulunur. \u00a0K\u0131k\u0131rdak yap\u0131s\u0131nda olup kaval kemiklerimizin \u00fcst eklem y\u00fcz\u00fcnde yerle\u015fik durumdad\u0131rlar. \u0130ki kemik aras\u0131nda yerle\u015fen menisk\u00fcslerin g\u00f6revleri, eklemin sa\u011flaml\u0131\u011f\u0131na ve hareketine katk\u0131da bulunmak, \u00a0bir conta yada amartis\u00f6r gibi g\u00f6rev yaparak eklem k\u0131k\u0131rda\u011f\u0131n\u0131 anormal y\u00fcklenmelerden korumakt\u0131r.<\/p>\n

Menisk\u00fcsler, diz ekleminin en \u00e7ok yaralanan yap\u0131lar\u0131d\u0131r. \u0130\u00e7 menisk\u00fcs, d\u0131\u015f menisk\u00fcse g\u00f6re daha s\u0131k y\u0131rt\u0131l\u0131r. Gen\u00e7lerde ve ileri ya\u015ftaki bireylerde menisk\u00fcs y\u0131rt\u0131klar\u0131n\u0131n olu\u015f \u015fekli farkl\u0131d\u0131r. Gen\u00e7lerde, menisk\u00fcs\u00fcn y\u0131rt\u0131lmas\u0131 i\u00e7in \u00a0ciddi bir travma gerekir. Bu genellikle sabit ayak \u00fczerinde d\u00f6nme hareketi s\u0131ras\u0131nda olu\u015fur. Ya\u015f ilerledik\u00e7e menisk\u00fcsler sa\u011flaml\u0131k ve esnekliklerini kaybederek y\u0131pran\u0131rlar. Y\u0131pranm\u0131\u015f mesk\u00fcsler \u00e7ok daha kolay y\u0131rt\u0131labilirler. \u0130leri ya\u015ftaki ki\u015filerde basit bir \u00e7\u00f6melme veya hal\u0131ya tak\u0131lma ile menisk\u00fcs y\u0131rt\u0131klar\u0131 olu\u015fabilir. Menisk\u00fcs y\u0131rt\u0131klar\u0131 olu\u015furken hastalar genellikle ani bir a\u011fr\u0131 batma ya da y\u0131rt\u0131lma hissederler. Y\u0131rt\u0131lan menisk\u00fcs\u00fcn hangisi oldu\u011funa ba\u011fl\u0131 olarak a\u011fr\u0131 dizin i\u00e7 ya da d\u0131\u015f k\u0131sm\u0131nda daha belirgindir. Birka\u00e7 saat i\u00e7erisinde dizin i\u00e7inde s\u0131v\u0131 veya kan toplanmas\u0131na ba\u011fl\u0131 olarak diz ekleminde \u015fi\u015flik ortaya \u00e7\u0131kar. Genellikle yaralanan dizin \u00fczerine basmak m\u00fcmk\u00fcnd\u00fcr ancak topallama vard\u0131r. Yaralanma \u015fiddetli ise menisk\u00fcs y\u0131rt\u0131klar\u0131na diz ekleminin \u00e7apraz ya da yan ba\u011flar\u0131n\u0131n kopmalar\u0131 da e\u015flik edebilir. Bu durumda dizde emniyetsizlik ve bo\u015fluk hissi gibi belirtiler de ortaya \u00e7\u0131kabilir. Bazen y\u0131rt\u0131lan menisk\u00fcs par\u00e7as\u0131, diz eklemini olu\u015fturan kemiklerin aras\u0131nda s\u0131k\u0131\u015farak diz hareketini k\u0131s\u0131tlar. Zaman ge\u00e7tik\u00e7e dizdeki yayg\u0131n a\u011fr\u0131 azalarak ilgili menisk\u00fcs\u00fcn \u00fczerinde noktasal hale gelir. A\u011fr\u0131 \u00f6zellikle ani d\u00f6n\u00fc\u015flerde ve \u00e7\u00f6melme s\u0131ras\u0131nda ortaya \u00e7\u0131kar. Y\u0131rt\u0131k menisk\u00fcs par\u00e7alar\u0131, eklem y\u00fczleri aras\u0131na girerek dizde tak\u0131lma ve kilitlenme gibi belirtiler otaya \u00e7\u0131kabilir beraberinde daha \u00f6nceden dizde olmayan k\u0131t\u0131rt\u0131 benzeri seslere de yol a\u00e7abilir.<\/p>\n

Tan\u0131da, hastan\u0131n ya\u015f\u0131, \u00f6yk\u00fcs\u00fc, yak\u0131nmalar\u0131, muayene ve radyolojik bulgular\u0131 hep birlikte etkilidir. Menisk\u00fcs \u00a0y\u0131rt\u0131\u011f\u0131 tan\u0131s\u0131na ula\u015fmak i\u00e7in \u00f6nce olay\u0131n olu\u015f \u015feklini anlatman\u0131z istenecektir. Daha sonra diz eklemi muayene edilerek menisk\u00fcs y\u0131rt\u0131\u011f\u0131 bulgular\u0131 ara\u015ft\u0131r\u0131l\u0131r. Bu s\u0131rada yan ve \u00e7apraz ba\u011flar\u0131n\u0131z muayene edilir. \u0130yi bir hikaye ve fizik muayene sonras\u0131nda menisk\u00fcs y\u0131rt\u0131\u011f\u0131 tan\u0131s\u0131 b\u00fcy\u00fck \u00f6l\u00e7\u00fcde ortaya \u00e7\u0131kar. Dizinizdeki a\u015f\u0131nma-eskimenin miktar\u0131n\u0131 de\u011ferlendirmek ve kemik yap\u0131larda ba\u015fka bir sorun olup olmad\u0131\u011f\u0131n\u0131 anlamak i\u00e7in \u00a0r\u00f6ntgen grafileri istenebilir. Genellikle gen\u00e7lerde r\u00f6ntgen filmi ile herhangi bir sorun izlenmez. MR \u00e7ekilirse, y\u0131rt\u0131k olup olmad\u0131\u011f\u0131 ortaya konabilir. Gen\u00e7 hastalarda, ilk travman\u0131n etkisi azald\u0131ktan sonra yap\u0131lan muayenede, menisk\u00fcs y\u0131rt\u0131\u011f\u0131 tan\u0131s\u0131 % 80 oran\u0131nda konulabilir; e\u011fer MR\u2019da da y\u0131rt\u0131k varsa do\u011fruluk oran\u0131 % 95-98\u2019e \u00e7\u0131kar. MR\u2019\u0131n menisk\u00fcs y\u0131rt\u0131klar\u0131nda % 2-5 kadar bir yan\u0131lma pay\u0131 vard\u0131r. E\u011fer hasta kilitlenme ile gelmi\u015fse veya s\u0131k kilitlenme yak\u0131nmas\u0131 varsa, aksi ispat edilene kadar menisk\u00fcs y\u0131rt\u0131\u011f\u0131 kabul edilebilir. \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u0130leri ya\u015flardaki y\u0131rt\u0131klar\u0131n \u00f6nemli bir k\u0131sm\u0131nda travma ya yoktur ya da genellikle hafiftir. Bazen \u00e7ok basit bir hareket, \u00f6rne\u011fin \u00e7\u00f6melme veya y\u00fcr\u00fcy\u00fc\u015f, bile y\u0131rt\u0131lmaya neden olabilir. Bu ya\u015flarda \u00f6nemli olan husus, menisk\u00fcs y\u0131rt\u0131klar\u0131n\u0131n s\u0131kl\u0131kla diz eklemi k\u0131k\u0131rdak y\u0131k\u0131m\u0131 ile beraber g\u00f6r\u00fclmesidir.<\/p>\n

\u00d6zellikle han\u0131mlarda, bu ya\u015f grubunda diz eklemi a\u011fr\u0131s\u0131n\u0131n uzun s\u00fcreli olmas\u0131, her iki dizin de a\u011fr\u0131l\u0131 olmas\u0131, hastan\u0131n herhangi bir travma \u00f6yk\u00fcs\u00fcn\u00fcn bulunmamas\u0131 ve diz a\u011fr\u0131s\u0131n\u0131n yayg\u0131n olup dizin belli bir b\u00f6lgesine lokalize olmamas\u0131, hekimi bir menisk\u00fcs y\u0131rt\u0131\u011f\u0131ndan uzakla\u015ft\u0131ran nedenlerdir. Bu olgularda, \u00f6ncelikle diz eklemi k\u0131k\u0131rdak y\u0131k\u0131m\u0131 d\u00fc\u015f\u00fcn\u00fclmelidir ve tan\u0131y\u0131 g\u00fc\u00e7lendirmek amac\u0131yla \u00f6ncelikle ayakta \u00e7ekilen r\u00f6ntgen filmlerinin incelenmesi gereklidir. Bu filmlerde, eklem aral\u0131\u011f\u0131n\u0131n daralmas\u0131 ve v\u00fccut y\u00fcklenme aks\u0131n\u0131n derece cinsinden belirlenmesi ile k\u0131k\u0131rdak y\u0131k\u0131m\u0131n\u0131n miktar\u0131 ve yap\u0131lmas\u0131 gereken tedavi ortaya konabilir. K\u0131k\u0131rdak y\u0131k\u0131m\u0131 belirginse, a\u011fr\u0131 veren esas fakt\u00f6rd\u00fcr; fakat ek olarak bir menisk\u00fcs y\u0131rt\u0131\u011f\u0131 da bulunabilir. \u00a0K\u0131k\u0131rdak y\u0131k\u0131m\u0131 ileri derecedeyse ve v\u00fccut y\u00fcklenme aks\u0131 5 dereceyi ge\u00e7iyorsa, sadece menisk\u00fcs y\u0131rt\u0131\u011f\u0131n\u0131n al\u0131nm\u0131\u015f olmas\u0131, iyile\u015fmeyi sa\u011flamayabilir. Bu durumda yap\u0131lmas\u0131 gereken, ba\u015fka bir ameliyat tekni\u011fi ile bu aks\u0131n d\u00fczeltilmesidir. \u00c7ekilen r\u00f6ntgen filmlerinde v\u00fccut y\u00fcklenme aks\u0131nda ciddi bir sapma yoksa, menisk\u00fcs y\u0131rt\u0131\u011f\u0131 tan\u0131s\u0131 i\u00e7in MR istenebilir. Her iki hasta grubunda da unutulmamas\u0131 gereken, menisk\u00fcs y\u0131rt\u0131\u011f\u0131n\u0131n kesin tan\u0131s\u0131n\u0131n ameliyat s\u0131ras\u0131nda g\u00f6r\u00fclerek kondu\u011fu ve olabildi\u011fince sa\u011flam menisk\u00fcs dokusunun b\u0131rak\u0131lmas\u0131 gereklili\u011fidir. Menisk\u00fcsler, diz eklemi i\u00e7in \u00e7ok \u00f6nemli yap\u0131lard\u0131r ve eksiklikleri, zaman i\u00e7inde k\u0131k\u0131rdak y\u0131k\u0131m\u0131na yol a\u00e7ar. \u00a0Gen\u00e7lerde menisk\u00fcs y\u0131rt\u0131klar\u0131n\u0131n tedavisi \u00e7o\u011funlukla cerrahidir. \u00c7ok nadir g\u00f6r\u00fclen ve tam kat olmayan baz\u0131 k\u00fc\u00e7\u00fck y\u0131rt\u0131klar d\u0131\u015f\u0131nda menisk\u00fcslerin kendili\u011finden iyile\u015fme yetene\u011fi yoktur. Belirgin yak\u0131nmalar\u0131 olan hastalarda cerrahi m\u00fcdahale ile menisk\u00fcs y\u0131rt\u0131\u011f\u0131 onar\u0131lmaya \u00e7al\u0131\u015f\u0131l\u0131r. E\u011fer y\u0131rt\u0131k onar\u0131ma uygun de\u011filse y\u0131rt\u0131k olan k\u0131s\u0131m \u00e7\u0131kart\u0131l\u0131r.\u0130leri ya\u015ftaki hastalarda menisk\u00fcs y\u0131rt\u0131klar\u0131na genellikle dizde artroz (a\u015f\u0131nma, y\u0131pranma, kire\u00e7lenme) e\u015flik eder. Bu durumda sadece menisk\u00fcs y\u0131rt\u0131\u011f\u0131na m\u00fcdahale etmek sorunu tam olarak \u00e7\u00f6zmeyebilir. Bu durumda ila\u00e7 tedavisi ile belirtilerin bask\u0131lanmas\u0131n\u0131, eklem i\u00e7i enjeksiyonlar\u0131, artroskopik cerrahiyi ya da artroskopi ile birlikte kemik d\u00fczeltici ameliyatlardan birine karar verilir. Menisk\u00fcs y\u0131rt\u0131klar\u0131n\u0131n tan\u0131 ve tedavisinde, g\u00fcn\u00fcm\u00fczde art\u0131k tamamen artroskopi dedi\u011fimiz kapal\u0131 y\u00f6ntemler kullan\u0131lmaktad\u0131r. Lokal veya spinal anestezi alt\u0131nda, kamera ile ekleme girilerek menisk\u00fcs ve diz i\u00e7indeki di\u011fer yap\u0131lar tan\u0131nmakta ve gereken i\u015flem o s\u0131rada yap\u0131lmaktad\u0131r. Hekim ve hasta e\u011fer isterse, t\u00fcm ameliyat i\u015flemleri, monit\u00f6rden hasta taraf\u0131ndan da izlenebilir. \u0130\u015flemin s\u00fcresi, y\u0131rt\u0131\u011f\u0131n tipine g\u00f6re de\u011fi\u015fmekle beraber 15-60 dakika aras\u0131nda s\u00fcrebilir.<\/p>\n

Artroskopi k\u00fc\u00e7\u00fck kesiler kullan\u0131larak, eklemlerin i\u00e7inin kalem boyunda bir kamera ile g\u00f6r\u00fcnt\u00fclenmesidir. \u00a0G\u00fcn\u00fcm\u00fczde geli\u015fen teknoloji ve \u00f6zel aletler sayesinde hem te\u015fhis hem tedavi i\u00e7in kullan\u0131lmaktad\u0131r. Artroskopi, anestezi alt\u0131nda ve ameliyathane \u015fartlar\u0131nda yap\u0131l\u0131r. Tan\u0131 ama\u00e7l\u0131 basit giri\u015fimler lokal anestezi alt\u0131nda yap\u0131labilir ancak tedavi ama\u00e7l\u0131 artroskopiler i\u00e7in b\u00f6lgesel veya genel anestezi kullan\u0131l\u0131r. G\u00f6r\u00fcnt\u00fcy\u00fc sa\u011flamak i\u00e7in eklemin i\u00e7i bir s\u0131v\u0131 kullan\u0131larak \u015fi\u015firilir, i\u015flem sonunda bu s\u0131v\u0131 bo\u015falt\u0131l\u0131r. Ameliyat s\u0131ras\u0131nda, eklem i\u00e7indeki yap\u0131lar 4-6 kez b\u00fcy\u00fct\u00fclerek g\u00f6r\u00fcnt\u00fc sa\u011flan\u0131r, b\u00f6ylece ayr\u0131nt\u0131l\u0131 bir tan\u0131 imkan\u0131 vard\u0131r. Kamera, a\u00e7\u0131k cerrahi s\u0131ras\u0131nda kolay ula\u015f\u0131lamayan b\u00f6lgeleri de g\u00f6r\u00fcnt\u00fcleyebildi\u011fi i\u00e7in eksiksiz bir tan\u0131 i\u015flemi yap\u0131labilir. Tan\u0131sal inceleme tamamland\u0131ktan sonra, eklem i\u00e7inde saptanan sorunlar\u0131n tedavisi, yine ayn\u0131 k\u00fc\u00e7\u00fck kesilerden yerle\u015ftirilen mekanik, motorlu veya termal enerji (radyofrekans veya lazer) aletleri kullan\u0131larak yap\u0131labilir. A\u00e7\u0131k cerrahi s\u0131ras\u0131nda ekleme ula\u015fmak i\u00e7in sa\u011flam dokular\u0131n kesilmesi gerekir. Buna kar\u015f\u0131n artroskopi i\u015flemi sa\u011flam dokulara zarar vermeyecek \u015fekilde \u00e7ok k\u00fc\u00e7\u00fck kesilerden yap\u0131ld\u0131\u011f\u0131 i\u00e7in, ameliyat sonras\u0131 a\u011fr\u0131, a\u00e7\u0131k cerrahiye g\u00f6re \u00e7ok daha azd\u0131r. Eklemde enfeksiyon ve hareket k\u0131s\u0131tl\u0131l\u0131\u011f\u0131 olu\u015fma riski \u00e7ok daha d\u00fc\u015f\u00fckt\u00fcr. Hastanede kal\u0131\u015f, g\u00fcnl\u00fck ya\u015fam aktiviteleri ve spora d\u00f6n\u00fc\u015f s\u00fcresi \u00e7ok daha k\u0131sad\u0131r. Cerrahiden hemen sonra rehabilitasyon program\u0131na ba\u015flanabilir.\u201d \u0130fadelerini kulland\u0131.<\/p>\n","protected":false},"excerpt":{"rendered":"

EGEUMUT \u00a0Hastanesi Ortopedi ve Travmatoloji Uzman\u0131 Op.Dr. A.Celil Amiri, Diz A\u011fr\u0131lar\u0131n\u0131n Nedeni Menisk\u00fcs Y\u0131rt\u0131klar\u0131 Olabilir, konusu hakk\u0131nda gazetemizi bilgilendirici a\u00e7\u0131klamalarda bulundu. Op.Dr. A.Celil Amiri yapt\u0131\u011f\u0131 a\u00e7\u0131klamada: \u201c Menisk\u00fcsler diz ekleminde yer alan C \u015feklinde k\u0131k\u0131rdak benzeri yap\u0131lard\u0131r. Diz eklemini olu\u015fturan iki ana kemik olan uyluk kemi\u011fi alt k\u0131sm\u0131 ve kaval kemi\u011fi \u00fcst k\u0131sm\u0131 aras\u0131nda yer […]<\/p>\n","protected":false},"author":1,"featured_media":11371,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6,7,10,13],"tags":[],"views":837,"_links":{"self":[{"href":"https:\/\/kasabamedya.com\/wp-json\/wp\/v2\/posts\/11370"}],"collection":[{"href":"https:\/\/kasabamedya.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kasabamedya.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kasabamedya.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kasabamedya.com\/wp-json\/wp\/v2\/comments?post=11370"}],"version-history":[{"count":1,"href":"https:\/\/kasabamedya.com\/wp-json\/wp\/v2\/posts\/11370\/revisions"}],"predecessor-version":[{"id":11372,"href":"https:\/\/kasabamedya.com\/wp-json\/wp\/v2\/posts\/11370\/revisions\/11372"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/kasabamedya.com\/wp-json\/wp\/v2\/media\/11371"}],"wp:attachment":[{"href":"https:\/\/kasabamedya.com\/wp-json\/wp\/v2\/media?parent=11370"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kasabamedya.com\/wp-json\/wp\/v2\/categories?post=11370"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kasabamedya.com\/wp-json\/wp\/v2\/tags?post=11370"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}