Non-Spesifik Bel Ağrılı Hastalarda Lumbal Lordoz Açısı ve Lumbal Kas Kalınlıklarının MRG Analizi

Year 2023, , 294 - 301, 20.10.2023

Ali Cihan Dağlı , Serkan Öner , Zülal Öner , Beyza Yazgan Dağlı

https://doi.org/10.18521/ktd.1210087

Abstract

Amaç: Karbapenem dirençli Enterobacterales (CRE) enfeksiyonlarının tedavi seçenekleri sınırlıdır ve bu enfeksiyonlar yüksek mortalite oranları ile ilişkilidir. CRE ile kolonize olan asemptomatik taşıyıcılar, CRE'nin hastanelerde yayılmasına katkıda bulunur. Bu çalışmada merkezimizde saptanan CRE izolatlarının sıklığının, bu suşlardaki karbapenemaz oranlarının, karbapenemaz genlerinin, antibiyotik direnç profillerinin, rektal CRE kolonizasyon oranlarının belirlenmesi ve CRE enfeksiyonlarının çeşitli klinik özelliklerinin değerlendirilmesi amaçlandı.
Gereç ve Yöntem: Çeşitli örneklerden izole edilen Enterobacterales türleri ve kolonizasyon taraması için gönderilen rektal sürüntü örneklerinden izole edilen Enterobacterales türleri incelenmiştir. Rektal sürüntü örneklerinde CRE kolonizasyonu olan hastalar daha sonra CRE enfeksiyonu gelişimi açısından incelendi. CRE izolatları karbapenemaz üretimi ve karbapenemaz geni varlığı açısından incelenmiştir.
Bulgular: 14521 Enterobacterales (10.161 E. coli ve 4195 K. pneumoniae, 165 Citrobacter) izolatı incelendi. Bu suşların %8.9'unda karbapenem direnci saptanmıştır. Kolonizasyon için değerlendirilen 15695 rektal sürüntü örneğinin %4,7'sinde CRE saptanmıştır. CRE kolonizasyonu olan hastaların %23,4'ünde ilerleyen dönemde rektal sürüntü dışında diğer örneklerde de CRE üremesi saptandı. CRE enfeksiyonlarının
kolonizasyondan ortalama 21 gün sonra geliştiği gözlendi.
Sonuç: CRE enfeksiyonları sadece hastanede yatan hastalarda değil toplum kökenli enfeksiyonlarda da bir etken olarak karşımıza çıkmaya başlamıştır. Çalışmamız ayrıca CRE kolonizasyonunun enfeksiyon gelişimi için önemli bir risk faktörü olabileceğini göstermiştir. Bu nedenle, kolonizasyonu saptamak için erken tarama tespiti, uygun izolasyon yöntemleriyle CRE enfeksiyonlarını önlemeye veya sınırlamaya yardımcı olabilir.

Keywords

Bel Ağrısı, Kas Kalınlığı, Omurga Eğrilikleri, Lordoz Açısı, Manyetik Rezonans Görüntüleme, Cobb Açısı

An MRI Analysis of The Lumbar Lordosis Angle and Lumbar Muscle Thicknesses in Patients with Non-Specific Low Back Pain

Abstract

Objective: This study aimed to examine the relationship of lumbar lordosis angle and lumbar muscle thickness with non-specific low back pain (LBP) through magnetic resonance imaging (MRI) images.
Methods: The study included 96 individuals (43 men/53 women) with non-specific LBP, aged between 18-65 years and had no disc pathology in MRI, who applied to affiliated Training and Research Hospital with the complaint of LBP between March-June 2019. Sociodemographic information was recorded using an LBP assessment form. The Oswestry LBP Disability Questionnaire was used for LBP disability. The thicknesses of muscle (m.) psoas major, m. multifidus, m. quadratus lumborum and m. erector spinae were measured corresponding to the L3-L4 vertebral level by using Radiant DICOM viewer program. The Cobb Angle method was used for lumbar lordosis angle determination. Measurements were made in three repetitions using the Radiant DICOM viewer program.
Results: The results showed that an inverse relationship was found between the Oswestry Disability Index (ODI) and m. psoas major thickness (p<0.05). Given the comparison of right-left side muscle thicknesses, left side muscles were thicker (p<0.05). Comparing LMT between genders, muscle thicknesses were higher in males except for the right m. quadratus lumborum and left m. erector spinae transverse measurements (p<0.05).
Conclusions: In regard to inverse relationship between m. psoas major thickness and ODI, m. psoas major should be taken into consideration to alleviate the disability caused by LBP. Additionally, the difference on both sides is likely one of the causes of muscle imbalance, and this might be one of the reasons for LBP, thereby causing disability in daily tasks due to LBP.

Keywords

Muscle thickness, Spinal Curvatures, Lordosis Angle, Magnetic Resonance Imaging, Cobb Angle, Low Back Pain,

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