Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Obez Olgularda Erektör Spina Kasları ve Fizik Tedavide Kullanılan Terapötik Ajanlar Açısından Hedef Doku Derinliği
Erector Spina Muscles in Obese Cases and Target Tissue Depth in Terms of Therapeutic Agents Used in Physical Therapy
Seda SERTEL MEYVACIa, Ayşe NUMANOĞLU AKBAŞb, Mustafa HIZALc
aBolu Abant İzzet Baysal Üniversitesi Tıp Fakültesi, Anatomi ABD, Bolu, TÜRKİYE
bCumhuriyet Üniversitesi Sağlık Bilimleri Fakültesi, Fizik Tedavi ve Rehabilitasyon Bölümü, Sivas, TÜRKİYE
cBolu Abant İzzet Baysal Üniversitesi Tıp Fakültesi, Radyoloji ABD, Bolu, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2021;6(4):837-44
doi: 10.5336/healthsci.2020-79902
Article Language: TR
Full Text
ÖZET
 Amaç: Lumbal bölge patolojilerinin tedavisi için sıklıkla kullanılan terapötik ajanların hedef doku derinliği 3-5 cm arasındadır. Bu çalışmanın amacı, obez olgularda lumbal bölgede deri yüzeyi ile erektör spina kasları arasındaki adipoz doku artışına bağlı yumuşak doku kalınlığını (YDK) belirlemektir. Gereç ve Yöntemler: Çalışmamıza; 18 yaş üstü, beden kitle indeksi 30 kg/m2 -40 kg/m2 arasında olan 30 kadın ve 36 erkek olmak üzere toplam 66 olgu dâhil edildi. Bilgisayarlı tomografi görüntüleri üzerinden YDK; L1-L5 lumbal vertebralar seviyesinde derinin en yüzeyel kısmı ile erektör spina kaslarının lamina superficialisi arasındaki mesafe mediyal, intermediyal ve lateral bölgelerden ölçülerek yapıldı. Erektör spina kaslarının maksimum antero-posterior mesafesi (ESAP) ölçüldü. Bulgular: Çalışmamıza dâhil edilen olgulardan beden kitle indeksi 30,00-34,99 kg/m2 olan 41 (%62,12) olgu 1. derece obez, 35,0-39,99 kg/m2 olan 25 (%38,88) olgu ise 2. derece obez olarak sınıflandırıldı. L1-L5 arasında tüm seviyeler için sağ ve sol taraf ölçümlerinde 2. derece obez olguların YDK değer aralıkları daha genişti (p=0,001-0,010 değerleri arasında). En yüksek YDK değeri 2. derece obez olguların L5 seviyesi lateral ölçümü için bulundu. Birinci derece obez olgularla 2. derece obez olguların ESAP dağılımlarında sol L4 değerleri arasında fark bulundu (p=0,037). Birinci derece obez olguların sol L4 ESAP değeri daha yüksekti. Sonuç: Çalışmamızın sonucunda, 2. derece obez olguların büyük kısmında L4- L5 seviyesinde adipoz dokunu artmasına bağlı olarak YDK'nin artmış olduğu görüldü. Fizyoterapi modalitelerinin hedef doku olan erektör spina kasının yüzeyine ulaşabileceği, ancak tüm dokuda terapötik etkiler oluşturmakta limitli etkileri olabileceği düşünüldü. Lumbal bölgeye uygulanacak terapötik ajanların seçiminde, hastaların YDK kalınlığı gibi antropometrik özelliklerin göz önünde bulundurulması gerektiği sonucuna varıldı.

Anahtar Kelimeler: Adipoz doku; bilgisayarlı tomografi; fizyoterapi modaliteleri; bel kasları; obezite
ABSTRACT
 Objective: The therapeutic agents commonly used for the treatment of lumbal region pathologies has target tissue depths between 3-5 centimeters. The aim of this study is to determine the soft tissue thickness (STT) due to adipose tissue increase between the skin surface and erector spina muscles in the lumbar region in obese patients. Material and Methods: A total of 66 cases, including 30 females and 36 males over the age of 18 years old with a body mass index between 30 kg/m2 -40 kg/m2 were included in this study. STT measurement were made by measuring the distance between the most superficial part of the skin and the lamina superficialis of the erector spinae muscles from the medial, intermedial, and lateral regions at the level of the L1-L5 lumbar vertebrae via computed tomography images. The maximum antero-posterior distance (ESAP) of the erector spinae muscles was measured. Results: Among cases included in our study; forty one (62.12%) cases with a body mass index between 30.00-34.99 kg/m2 were classified as class I obesity, and 25 (38.88%) cases with a body mass index of 35.0-39.99 kg/m2 were classified as class II obesity. STT of patients with class II obesity were wider (p=0.001-0.010 among the values) at right and left side measurements for all levels between L1- L5. The highest STT was found for lateral measurement of L5 level in class II obese patients. A difference was found between left L4 ESAP values of class I obese patients and class II obese patients (p=0.037). The left L4 ESAP value was higher in class I obese patients. Conclusion: As a result of our study, it was observed that STT increased due to the increase in adipose tissue in the majority of class II obese patients at L4-L5 level. It was thought that physiotherapy modalities can reach the surface of the target tissue, the erector spinae muscle, but may have limited effects on creating therapeutic effects in the entire tissue. It was concluded that the anthropometric properties such as STT of the patients should be taken into consideration in the selection of therapeutic agents to be applied to the lumbar region.

Keywords: Adipose tissue; computed tomography; physical therapy modalities; back muscles; obesity
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