Periferik sinirlerde olan basıncın neden olduğu yapısal ve fonksiyonel deformasyonun iyi anlaşılabilmesi için periferik sinir histolojisi George and Smith, 1996; Sağlam ve ark., 1997; Quan and Bird, 1999; Rempel et al



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Bu çalışmada, köpekte nervus radialis, nervus ulnaris ve nervus medianus’un nöropati olasılığı bulunan tuzak bölgelerinin araştırılması amaçlanmıştır. Bu amaçla 20 adet köpekten ön bacağın farklı eklem pozisyonlarında elektronörografi ve anatomik diseksiyon gibi iki farklı yöntem ile bulgular elde edilmiş ve karşılaştırmalı olarak değerlendirilmiştir.

Çalışmada materyal olarak köpeğin seçilme nedeni köpek ve insanda periferik sinirlerin seyrinin ve innervasyon alanının birbirine benzerlik göstermesidir. Bu benzerlik insanlarda sık gözlenen tuzak nöropatisi olgularının köpeklerde de görülebileceğini düşündürmektedir.

Elektronörografi, tuzak nöropatisinin teşhisinde lezyonun anatomik yerleşimi ve derecesi hakkında önemli bulgular sunduğu için, anatomik diseksiyon ise sinirlerin seyri ve yerleşiminin belirlenebildiği bir yöntem olduğu için tercih edilmiştir. Böylece, ön bacağın farklı pozisyonlarında incelenen ilgili sinirlerin bazı elektronörografik değerlerinde değişim olup olmadığı ve olası değişikliklerin anatomik nedenleri diseksiyonda elde edilen bulgularla birlikte değerlendirilmiştir. Çalışmada 20 adet köpekte toplam 920 adet sinir iletimi çalışması gerçekleştirilerek elektronörografi bulguları, altı adet köpekten de diseksiyon bulguları elde edilmiştir.

Çalışmada elde edilen bulgularla köpeklerde n. medianus, n. ulnaris ve n. radialis’in seyirleri sırasında tuzak nöropatisi riski taşıyan bölgeler ortaya konulmuştur. Bu bölgeler, her üç sinir için plexus brachialis’in m. scalenus altından axilla’ya geçiş düzeyi, n. medianus’un m. pronator teres altından ve canalis carpi içinden geçiş düzeyleri, n. ulnaris’in canalis carpi içerisinden geçişi ile epicondylus medialis humeri ve olecranon arasından geçiş düzeyleri, n. radialis’in sulcus m. brachialis’deki seyri ve m. supinator altından geçiş düzeyleri olarak tespit edilmiştir. Ayrıca tuzak nöropatisi riskinin arttığı eklem pozisyonlarıda belirlenmiştir.

Sonuç olarak incelenen bölgelerdeki anatomik yapıların yerleşimini etkileyerek, sinir üzerinde basınç etkisi oluşturabilecek tüm patolojik durumlar sonrasında, sinir iletim çalışmalarının yapılması ve sinir iletimi çalışmalarının rutin muayene prosedürü içine alınmasının gerekliliği ortaya konulmuştur. Bununla birlikte sinir iletimi uygulamalarının eklemin hangi pozisyonunda, hangi uyarım ve kayıt noktalarından yapılmasının uygun olacağı da tanımlanarak, eklemlerin nötral pozisyonunda elde edilen latans değerlerinin referans veriler olarak kullanılabileceği kanaatine de varılmıştır. Ayrıca bu çalışmayla elde edilen bulguların Veteriner nöroloji kliniğinde henüz standart muayene yöntemi olarak kullanılmayan elektrofizyolojik çalışmalara katkı sağlayabileceği umulmaktadır.

SUMMARY

In this study, the determination of possible entrapment regions of radial, ulnar and median nerves in the dog was aimed. For this aim, findings were obtained with two different methods as electroneurography (ENG) and anatomic dissection, and the results were evaluated comparatively in different positions of the forelimbs of 20 dogs.

The similarity in the course and innervation area of the peripheric nerves between human and dogs was the reason in preference to dog for this study. This similarity made us thought that entrapment neuropathies often seen in human could also be seen in dog.

ENG technique was choosen because it supplies to us the important findings about anatomic localization and severity of lesion in diagnosis of entrapment neuropathies. Meantime, anatomic disection method was choosen because of determination of course and placement of nerves. Therefore it was evaluated the differences of the electroneurographic values relation to the forelimb position on the studied nerves. When it was found a difference, it was tired to explain the reasons of these differences by using the anatomic findings. In this study, ENG findings were obtained by 920 nerve conduction studies in 20 dogs and disection findings were obtained from 6 dogs of these 20 dogs.

According to the results of this study, the entrapment neuropathy risk areas for median, ulnar and radial nerves were considered in dogs. These areas were determined for three nerves at the level of scalenus muscle that the plexus brachialis pass under this muscle to axilla, for the median nerve at the level of the pass under the pronator teres muscle and through the carpal canal, for the ulnar nerve at the level of the pass through carpal canal and between olecranon and medial humeral condyle, for the radial nerve at the level of the brachial groove and pass under the supinator muscle. Furthermore, joint positions may cause to accelerate the entrapment neuropathy risk was determined.

In conclusion, the electrophysiologic studies should be accepted one of routine diagnostic test, and special attention should be paid in case of the pathologic condution of some areas which were pointed out in this study. In addition suitable stimulating and recording points depending on the joint positions were describe in detail, also it is here proposed that the electrophysiologic values which obtained in neutral position should be accepted a reference value. It is hoped that all these findings can supply valuable knowledge in electrophysiologic studies of veterinary fields which have not been a standart examination protocol.



TEŞEKKÜR


Bu tezin tüm aşamalarında, sonsuz desteğini ve engin hoş görüsünü esirgemeyen Tez Danışmanın Sayın Prof. Dr. Hasan ERDEN’e ve Anabilim Dalı Başkanımız Sayın Prof. Dr. M. Kamil ÖCAL’a teşekkürlerimi sunarım. Hocalarımdan sadece akademik çalışmalar konusunda değil, bir akademisyende bulunması gereken bilgi, görgü, anlayış ve vizyon konusunda da çok şey öğrendim. Bana kazandırdıkları hayata dair bilgiler için de minnettarım. Gerek tez çalışmam sırasında gerekse akademik yaşamımda karşılaştığım tüm sorunlarımda engin desteğini aldığım, başvuru kitabım gibi sürekli yanımda bulunan Nöroloji uzmanı Doç. Dr. Okan BÖLÜKBAŞI’na teşekkür ederim. Birlikte çalışmaktan mutluluk duyduğum tüm çalışma arkadaşlarıma, çalışmanın deneysel aşaması sırasında yardımlarını gördüğüm öğrenci arkadaşlarım O. Çağlar ORTANCA, Uğur PARIN, Alper AKIN, Kaya GİRAY ve Ece ATABEYOĞLU’na da teşekkürlerimi sunarım.

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ÖZGEÇMİŞ

1973 yılında Aydın’ın Nazilli ilçesinde doğdum. İlk orta ve lise öğrenimimi Nazilli’de tamamladım. 1991 yılında Fırat Üniversitesi Veteriner Fakültesi’nde Üniversite eğitimime başladım ve 1997 yılında mezun oldum. 1998 yılında Adnan Menderes Üniversitesi, Sağlık Bilimleri Enstitüsü, Anatomi Anabilim Dalı’nda Yüksek Lisans Öğrenimime başladım ve 2001 yılında yüksek lisans tezimi tamamladım. Aynı yıl Adnan Menderes Üniversitesi Veteriner Fakültesi Anatomi Anabilim Dalı Araştırma Görevliliği sınavını kazandım. Halen Adnan Menderes Üniversitesi Veteriner Fakültesi’nde çalışmaktayım. Bekarım.


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