Lomber disk herniasyonlu hastalarda, transkutanöz elektriksel sinir stimülasyonu (TENS) ve ultrason uygulamalarının, serum oksidatif stres parametreleri ve idrar kollajen yıkım ürünleri üzerine etkilerinin değerlendirilmesi
Öz
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 n-telopeptid (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.
Anahtar Kelimeler
Lomber disk herniasyonu oksidatif stres kollajen yıkım ürünleri TENS ultrason
Kaynakça
- Tulder V, Malmivaara A, Esmail R, Koes BW. Exercise therapy for low back pain. Cochrane Database Syst Rev 2000; (2): CD000335.
- Öncel A, Özcan E. Bel ağrılı hastaların rehabilitasyonu. Fiziksel Tıp ve Rehabilitasyon. Diniz F, Ketenci A ed. İstanbul: Nobel Tıp Kitabevi; 2000; 275-86.
- Koç B, Nacır B, Erdem HR, Karagöz A, Yiğit H. Lomber disk herniasyonunda frekans module nöral stimülasyon ve transkutanöz elektriksel sinir stimülasyon tedavilerinin klinik etkilerinin ve magnetik rezonans görüntüleme bulgularının karşılaştırılması. FTR Bil Der 2012; 15: 39-44.
- Stone RG, Wharton RB. Simultaneous multiple modality therapy fortension headaches and neck pain. Biomed Instrum Technol 1997; 31 (3): 259-62.
- Deyo DA, Walsh ME, Martin BC. A controlled trial of transcutaneous electrical nevre stimulation (TENS) and exercise for chronic low back pain. N Engl J Med 1990; 322 (23): 1627-34.
- Jeffry RB. Physical Agents. In: De Lisa JA ed. Physical Medicine and Rehabilitation. Fourth Edition. Philedelphia: Lippincott, Williams &Wilkins; 2005: 251-70.
- ter Haar G. Therapeutic ultrasound. Eur J Ultrasound 1999; 9 (1): 3-9.
- Craig JA, Bradley J, Walsh DM, Baxter GD, Allen JM. Delayed onset muscle soreness: Lack of effect of therapeutic ultrasound in humans. Arch Phys Med Rehabil 1999; 80 (3): 318-23.
- Sweitzer RW. Ultrasound. In: Hecox B, Mahreteab TA, Weisberg J ed. Physical Agents. Norwalk, CT: Appleton &Lange; 1994; 163-92.
- Blake DR, Allen RE, Lunec J. Free radicals in biological systems—a review orientated to inflammatory processes. Br Med Bull 1987; 43 (2): 371-85.
- Halliwell B. Free radicals, antioxidants and human disease: curiosity, cause, consequence? The Lancet 1994;344(8924):721-4.
- Cross CE, Halliwell B, Borish ET, et al. Oxygen radicals and human disease. Ann Intern Med 1987; 107 (4): 526-45.
- Borrelli E, Alexandre A, Iliakis E, Alexandre A, Bocci V. Disc herniation and knee arthritis as chronic oxidative stress diseases: the therapeutic role of oxygen ozone therapy. J Arthritis 2015; 4 (3): 1-6.
- Marshall WJ. Ilustrated Textbook of Clinical Chemistry. London: Gower Medical Puslishing; 1988: 189-206.
- Moss DW. Alkaline phosphatase isoenzymes. Clin Chem 1982; 28 (10): 2007-16.
- Chiristenson RH. Biochemical markers of bone metabolism: an overview. Clin Biochem 1997; 30 (6): 573-93.
- Atley LM, Mort JS, Lalumiere M, Eyre DR. Proteolysis of human bone collagen by cathepsin-K characterization of the clevage sites generating the cross-linked N-Telopeptides neoepitope. Bone 2000; 26 (3): 241-7.
- Eyre DR. New biomarkers of bone resorption. J Clin Endocrinol Metab 1992; 74 (3): 470A-470C.
- Adami S. Optimizing peak bone mass: what are the therapeutic possibilities? Osteoporos Int 1994; 4 (1): 27-30.
- Öngel K. Birinci basamakta bel ağrısı olan hastalara yaklaşım. Aile Hekimliği Dergisi 2007; 1: 54-8.
- Oskay D, Yakut Y. Bel ağrısı olan ve olmayan kadınların fiziksel uygunluk parametrelerinin karşılaştırılması. Göztepe Tıp Dergisi. 2011; 26 (3): 117-22.
- Halliwell B, Gutteridge JMC. Free radicals in biyology and medicine.Fifth edition. Oxford Universty Press; 2015: 18-19.
- Quiñonez-Flores CM, González-Chávez SA, Del Río Nájera D, Pacheco-Tena C. Oxidative stress relevance in the pathogenesis of the rheumatoid arthritis: a systematic review. Biomed Res Int 2016: 6097417. 390 Ege Tıp Dergisi
- Roughley PJ, Alini M, Antoniou J. The role of proteoglycans in aging, degeneration and repair of the intervertebral disc. Biochem Soc Trans. 2002; 30 (6): 869-74.
- Antoniou J, Steffen T, Nelson F, et al. The human lumbar intervertebral disc: evidence for changes in the biosynthesis and denaturation of the extracellular matrix with growth, maturation, ageing, and degeneration. J Clin Invest. 1996; 98 (4): 996-1003.
- Rutges J, Creemers LB, Dhert W et al. Variations in gene and protein expression in human nucleus pulposus in comparison with annulus fibrosus and cartilage cells: potential associations with aging and degeneration. Osteoarthritis Cartilage. 2010; 18 (3): 416-23.
- Glendenning P, Chubb SAP, Vasikaran S. Clinical utility of bone turnover markers in the management of common metabolic bone diseases in adults. Clin Chim Acta 2018; 481: 161-70.
- Delmas PD, Eastell R, Garnero P, Seibel MJ, Stepan J. The use of biochemical markers of bone turnover in osteoporosis. Committee of Scientific Advisors of the International Osteoporosis Foundation. Osteoporos Int 2000; 6: 2-17.
- Chailurkit L, Ongphiphadhanakul B, Piaseu N, Saetung S, Rajatanavin R. Biochemical markers of bone turnover and response of bone mineral density to intervention in early postmenopausal women: An experience in clinical laboratory. Clin Chem 2001; 47 (6): 1083-8.
- Linton SJ, van Tulder M W. Preventive interventions for back and neck pain problems: what is the evidence? Spine 2001; 26 (7): 778-87.
- Darlow B, Fullen BM, Dean S, Hurley DA, Baxter GD, Dowell A. The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review. Eur J Pain 2012; 16 (1): 3-17.
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
Öz
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.
Anahtar Kelimeler
Lumbar disc herniation oxidative stress collagen destruction products TENS ultrasound
Kaynakça
- Tulder V, Malmivaara A, Esmail R, Koes BW. Exercise therapy for low back pain. Cochrane Database Syst Rev 2000; (2): CD000335.
- Öncel A, Özcan E. Bel ağrılı hastaların rehabilitasyonu. Fiziksel Tıp ve Rehabilitasyon. Diniz F, Ketenci A ed. İstanbul: Nobel Tıp Kitabevi; 2000; 275-86.
- Koç B, Nacır B, Erdem HR, Karagöz A, Yiğit H. Lomber disk herniasyonunda frekans module nöral stimülasyon ve transkutanöz elektriksel sinir stimülasyon tedavilerinin klinik etkilerinin ve magnetik rezonans görüntüleme bulgularının karşılaştırılması. FTR Bil Der 2012; 15: 39-44.
- Stone RG, Wharton RB. Simultaneous multiple modality therapy fortension headaches and neck pain. Biomed Instrum Technol 1997; 31 (3): 259-62.
- Deyo DA, Walsh ME, Martin BC. A controlled trial of transcutaneous electrical nevre stimulation (TENS) and exercise for chronic low back pain. N Engl J Med 1990; 322 (23): 1627-34.
- Jeffry RB. Physical Agents. In: De Lisa JA ed. Physical Medicine and Rehabilitation. Fourth Edition. Philedelphia: Lippincott, Williams &Wilkins; 2005: 251-70.
- ter Haar G. Therapeutic ultrasound. Eur J Ultrasound 1999; 9 (1): 3-9.
- Craig JA, Bradley J, Walsh DM, Baxter GD, Allen JM. Delayed onset muscle soreness: Lack of effect of therapeutic ultrasound in humans. Arch Phys Med Rehabil 1999; 80 (3): 318-23.
- Sweitzer RW. Ultrasound. In: Hecox B, Mahreteab TA, Weisberg J ed. Physical Agents. Norwalk, CT: Appleton &Lange; 1994; 163-92.
- Blake DR, Allen RE, Lunec J. Free radicals in biological systems—a review orientated to inflammatory processes. Br Med Bull 1987; 43 (2): 371-85.
- Halliwell B. Free radicals, antioxidants and human disease: curiosity, cause, consequence? The Lancet 1994;344(8924):721-4.
- Cross CE, Halliwell B, Borish ET, et al. Oxygen radicals and human disease. Ann Intern Med 1987; 107 (4): 526-45.
- Borrelli E, Alexandre A, Iliakis E, Alexandre A, Bocci V. Disc herniation and knee arthritis as chronic oxidative stress diseases: the therapeutic role of oxygen ozone therapy. J Arthritis 2015; 4 (3): 1-6.
- Marshall WJ. Ilustrated Textbook of Clinical Chemistry. London: Gower Medical Puslishing; 1988: 189-206.
- Moss DW. Alkaline phosphatase isoenzymes. Clin Chem 1982; 28 (10): 2007-16.
- Chiristenson RH. Biochemical markers of bone metabolism: an overview. Clin Biochem 1997; 30 (6): 573-93.
- Atley LM, Mort JS, Lalumiere M, Eyre DR. Proteolysis of human bone collagen by cathepsin-K characterization of the clevage sites generating the cross-linked N-Telopeptides neoepitope. Bone 2000; 26 (3): 241-7.
- Eyre DR. New biomarkers of bone resorption. J Clin Endocrinol Metab 1992; 74 (3): 470A-470C.
- Adami S. Optimizing peak bone mass: what are the therapeutic possibilities? Osteoporos Int 1994; 4 (1): 27-30.
- Öngel K. Birinci basamakta bel ağrısı olan hastalara yaklaşım. Aile Hekimliği Dergisi 2007; 1: 54-8.
- Oskay D, Yakut Y. Bel ağrısı olan ve olmayan kadınların fiziksel uygunluk parametrelerinin karşılaştırılması. Göztepe Tıp Dergisi. 2011; 26 (3): 117-22.
- Halliwell B, Gutteridge JMC. Free radicals in biyology and medicine.Fifth edition. Oxford Universty Press; 2015: 18-19.
- Quiñonez-Flores CM, González-Chávez SA, Del Río Nájera D, Pacheco-Tena C. Oxidative stress relevance in the pathogenesis of the rheumatoid arthritis: a systematic review. Biomed Res Int 2016: 6097417. 390 Ege Tıp Dergisi
- Roughley PJ, Alini M, Antoniou J. The role of proteoglycans in aging, degeneration and repair of the intervertebral disc. Biochem Soc Trans. 2002; 30 (6): 869-74.
- Antoniou J, Steffen T, Nelson F, et al. The human lumbar intervertebral disc: evidence for changes in the biosynthesis and denaturation of the extracellular matrix with growth, maturation, ageing, and degeneration. J Clin Invest. 1996; 98 (4): 996-1003.
- Rutges J, Creemers LB, Dhert W et al. Variations in gene and protein expression in human nucleus pulposus in comparison with annulus fibrosus and cartilage cells: potential associations with aging and degeneration. Osteoarthritis Cartilage. 2010; 18 (3): 416-23.
- Glendenning P, Chubb SAP, Vasikaran S. Clinical utility of bone turnover markers in the management of common metabolic bone diseases in adults. Clin Chim Acta 2018; 481: 161-70.
- Delmas PD, Eastell R, Garnero P, Seibel MJ, Stepan J. The use of biochemical markers of bone turnover in osteoporosis. Committee of Scientific Advisors of the International Osteoporosis Foundation. Osteoporos Int 2000; 6: 2-17.
- Chailurkit L, Ongphiphadhanakul B, Piaseu N, Saetung S, Rajatanavin R. Biochemical markers of bone turnover and response of bone mineral density to intervention in early postmenopausal women: An experience in clinical laboratory. Clin Chem 2001; 47 (6): 1083-8.
- Linton SJ, van Tulder M W. Preventive interventions for back and neck pain problems: what is the evidence? Spine 2001; 26 (7): 778-87.
- Darlow B, Fullen BM, Dean S, Hurley DA, Baxter GD, Dowell A. The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review. Eur J Pain 2012; 16 (1): 3-17.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Aralık 2019 |
| Gönderilme Tarihi | 27 Ağustos 2018 |
| Yayımlandığı Sayı | Yıl 2019 |