Omurga ve Üst Ekstremite Kas İskelet Sorunu Olan Çocuk ve Aile Merkezli Bakım
Özet
Bu çalışma; çocuklarda görülen skolyoz, kifoz, tortikolis, obstetrik brakiyal pleksus yaralanmaları ve Duşen musküler distrofi (DMD) gibi omurga ile üst ekstremite kas-iskelet sorunlarını ve tedavi yaklaşımlarını incelemektedir. Üç boyutlu bir omurga deformitesi olan skolyoz; yapısal ve fonksiyonel olarak ayrılmakta, derecesine göre takip, korse, egzersiz veya cerrahi ile tedavi edilmektedir. Torasik kıvrımın normalden fazla olması durumu olan kifoz; Scheuermann, posttravmatik, ankilozan spondilit ve konjenital gibi türlere ayrılmaktadır. Bebeklerde sternokleidomastoid kasın tek taraflı kısalığıyla karakterize tortikolis tedavisinde ise ebeveyn katılımı, pozisyonlama ve egzersizler kritik rol oynar. Doğum sırasında meydana gelen brakiyal pleksus yaralanmaları; kas zayıflığı, eklem kontraktürü ve spinal eğrilik gibi kalıcı fonksiyonel kayıplara yol açabilmekte, erken dönemde doğru hareket paternlerinin kazandırılmasını gerektirmektedir. İlerleyici genetik bir hastalık olan DMD ise baldır psödohipertrofisi ve Gower işaretiyle kendini göstererek zamanla yürüme kaybına, kalp ve solunum yetmezliğine neden olmaktadır; bu süreçte multidisipliner solunum, kardiyak ve ortopedik bakım hayat kalitesini artırmaktadır. Tüm bu pediatrik hastalıklarda, çocuk ve aile merkezli bir yaklaşımla erken müdahale ve uzun süreli takip esastır.
This study examines spine and upper extremity musculoskeletal problems in children, such as scoliosis, kyphosis, torticollis, obstetric brachial plexus injuries, and Duchenne muscular dystrophy (DMD), along with their treatment approaches. Scoliosis, a three-dimensional spinal deformity, is classified as structural or functional and treated through monitoring, bracing, exercise, or surgery based on its severity. Kyphosis, characterized by an excessive thoracic curve, is categorized into types including Scheuermann, post-traumatic, ankylosing spondylitis, and congenital. In torticollis, marked by unilateral shortening of the sternocleidomastoid muscle in infants, parental involvement, positioning, and exercises play a critical role. Brachial plexus injuries occurring during birth can lead to permanent functional losses like muscle weakness, joint contracture, and spinal curvature, necessitating the acquisition of correct movement patterns at an early age. DMD, a progressive genetic disease manifested by calf pseudohypertrophy and Gower's sign, leads to loss of ambulation, cardiac, and respiratory failure over time, where multidisciplinary respiratory, cardiac, and orthopedic care significantly improves quality of life. In all these pediatric conditions, early intervention and long-term follow-up based on a child- and family-centered approach are essential.
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