Özlem EĞRİ, Mehmet Erdinç ÖKTEN, Hülya DEVECİ

Lomber disk herniasyonlu hastalarda, transkutanöz elektriksel sinir stimülasyonu (TENS) ve ultrason uygulamalarının, serum oksidatif stres parametreleri ve idrar kollajen yıkım ürünleri üzerine etkilerinin değerlendirilmesi

Amaç: Lomber Disk Hernisi (LDH) tedavisinde yaygın olarak kullanılan fizik tedavi modaliteleri; ultrason, diyadinamik akım, galvanik akım ve transkutanöz elektriksel sinir stimülasyonudur (TENS). Bu çalışmada LDH tedavisinde kullanılan TENS ve ultrason uygulamalarının oksidatif stres düzeyi ve kollajen yıkımı üzerine etkisini göstermeyi ve tedavideki rollerini incelemeyi amaçladık. Gereç ve Yöntemler: Araştırmaya 40 LDH tanısı almış hasta ve 30 kişilik kontrol grubu alındı. Hasta gruba 15 seans TENS ve ultrason tedavisi uygulandı. Tedavi öncesi ve sonrası hasta ve kontrol gruplarından serum ve idrar örnekleri alındı. Serum süperoksit dismutaz (SOD), malondialdehit (MDA), glutatyon peroksidaz (GSH-Px) seviyeleri ve idrar kreatin seviyeleri fotometrik yöntemle ölçüldü. İdrar ntelopeptid (NTX) ve serum kemik-alkalen fosfataz (ALP) seviyeleri ELISA yöntemiyle ölçüldü. Bulgular: Serum MDA ve GSH-Px düzeyleri hasta grubunda kontrol grubuna göre anlamlı olarak yüksek bulunmuşken, kemik-ALP ve SOD düzeyleri ile idrar NTX düzeyleri hasta grubunda kontrol grubuna göre anlamlı olarak düşük bulunmuştur. Hasta grubunda tedavi öncesi ölçümlerle tedavi sonrasında yapılan ölçümler arasında anlamlı bir değişim bulunmadı. Tedavinin etkinliği; Visual Analog Skala (VAS), Oswestry Engellilik İndeksi, Nottingham Sağlık Profili ölçekleriyle değerlendirildi ve hastaların tedaviden anlamlı düzeyde fayda sağladığı gözlendi. Sonuç: LDH’li hastalarda oksidatif hasarın hastalık gelişiminde etkili olabileceğini düşünmekteyiz. Ayrıca, bu hastalarda TENS ve ultrason tedavisinin, kısa vadede fonksiyonel rahatlama sağladığını ancak yapısal iyileşmeye yol açmadığını düşünüyoruz.

Assessment of the effects of transcutaneous electrical nerve stimulation (TENS) and ultrasound applications on serum oxidative stress parameters and urine collagen destruction products and in patients with lumbar disc herniation

Aim: Physical therapy modalities commonly used in the treatment of lumbar disc hernia (LDH) are ultrasound, diadynamic current, galvanic current, transcutaneous electrical nerve stimulation (TENS). The aim of this study was to investigate the effects of TENS and ultrasound applications on oxidative stress level and collagen destruction in LDH patients. Materials and Methods: Forty patients diagnosed with LDH and 30 control subjects were included in the study. The patient group received 15 sessions of TENS and ultrasound therapy. Serum and urine samples were taken from the patient and control groups before and after treatment. Serum superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GSH-Px) levels and urine creatine levels were measured by photometric method. Urine n-telopeptide (NTX) and serum bone alkaline phosphatase (BALP) levels were measured by ELISA method. Results: Serum MDA and GSH-Px levels were significantly higher in the patient group compared to the control group, whereas serum BALP and SOD levels and urine NTX were significantly lower in the patient group compared to the control group. There was no significant difference between the pre-treatment and post-treatment measurements in the patient group. The efficacy of the treatment was evaluated with Visual Analog Scale (VAS), Oswestry disability index and Nottingham health profile scales and patients were found to benefit significantly from the treatment. Conclusion: We think that oxidative damage may be effective in disease development in patients with LDH. In addition, we think in these patients that TENS and ultrasound therapy provides functional relief in the short term but does not lead to structural improvement.

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