Ulus Travma Acil Cerrahi Derg. 2006; 12(2): 121-128

Ekstremite replantasyon-revaskülarizasyon ve amputasyonlarýndan sonra beyinde somatotropik reorganizasyon: SPECT analizi ile araþtýrma

Kadir Ertem¹, K. Ersoy Kekilli², Cengiz Yaðmur², Ýrfan Ayan¹, Songül Turgut³, Hacý Bostan¹, Arslan Bora^1
1Ýnönü Üniversitesi Turgut Özal Týp Merkezi Ortopedi Ve Travmatoloji Anabilim Dalý, Malatya, Türkiye
²Ýnönü Üniversitesi Turgut Özal Týp Merkezi Nükleer Týp Anabilim Dalý, Malatya, Türkiye
³Mersin Üniversitesi Týp Fakültesi Ortopedi Ve Travmatoloji Anabilim Dalý, Mersin, Türkiye

AMAÇ: Ekstremitelere uygulanan replantasyon, revaskülarizasyon ve amputasyon ameliyatlarýndan sonra 99mTc-HMPAO SPECT
analizi kullanýlarak motor ve somatosensoriyel korteksteki somatotropik reorganizasyon açýsýndan araþtýrýldý.
GEREÇ-YÖNTEM: Çalýþmaya 12 hasta (11 erkek, 1 kadýn; ort. yaþ 38.9±14.7 yýl) ve 5 saðlýklý erkek (ort. yaþ 32.2±7.9 yýl) kontrol grubu olarak alýndý. Rekonstrüksiyon sonrasý presentral ve postsentral kesitlerle birlikte alt, orta ve üst orbitomeatal kesitlerde ölçümler yapýldý. Tüm görüntüler görsel ve yarý kantitatif olarak deðerlendirildi. Ýstatistiksel analizlerde Mann-Whitney U-testi kullanýldý.
BULGULAR: Revaskülarizasyon ve replantasyon hastalarýnda dominant hemisferde presentral ve postsentral hipoperfüzyon vardý. Amputasyon hastalarýnda, nondominant hemisferde presentral hipoperfüzyon ve postsentral hipoperfüzyon (dört olgunun üçünde) bulunurken; dominant hemisferde ise dört olgunun birinde postsentral hipoperfüzyon vardý. Olgularýmýzda beyin bölgesel kan akýmýnda belirgin fark posterior parietal kortekste bulundu (somatik iliþkili alan).
SONUÇ: Ekstremite replantasyon-revaskülarizasyon ameliyatlarý sonrasý beyinde presentral ve postsentral kortekste görülen deðiþiklikler somatotropik reorganizasyonun iyi bir göstergesi olabilir.

Anahtar Kelimeler: Amputasyon, motor korteks/fizyoloji, kas, iskelet/metabolizma; fantom uzuv/fizyopatoloji; replantasyon; somatosensoriyel korteks/fizyoloji; 99m-Tc-HMPAO

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Somatotrophic reorganization in the brain after extremity replantation, revascularization and amputations: investigated by SPECT analysis

Kadir Ertem¹, K. Ersoy Kekilli², Cengiz Yaðmur², Ýrfan Ayan¹, Songül Turgut³, Hacý Bostan¹, Arslan Bora^1
1Departments Of Orthopedics And Traumatology, Medicine Faculty Of Ýnönü University Turgut Özal Medical Center, Malatya, Turkey
²Departments Of Nuclear Medicine, Medicine Faculty Of Ýnönü University Turgut Özal Medical Center, Malatya
³Department Of Orthopedics And Traumatology Medicine Faculty Of Mersin University, Mersin, Turkey

BACKGROUND: We wanted to investigate the somatotropic reorganization occurring in the motor and somatosensory cortex by using 99mTc-HMPAO SPECT analyses, after the extremity revascularization, replantation or amputation. METHODS: Twelve patients (11 men, 1 female; mean age 38.9±14.7 years) and controls (5 men, mean age 32.2±7.9 years) were enrolled in this study. After reconstruction, lower, middle and upper orbitomeatal slices with precentral and postcentral slices were obtained. All images were visually and semi-quantitatively evaluated. Mann-Whitney U-test was used for statistical analysis.
RESULTS: In the revascularization and replantation patients, postcentral and precentral hypoperfusions were seen at dominant hemisphere. In the amputated patients, postcentral (in 3 of 4 cases) and precentral hypoperfusions were seen at non-dominant hemisphere and postcentral hypoperfusion (in 1 of 4 cases) was seen at dominant hemisphere. In our patients, most significant difference in regional cerebral blood flow was found in posterior parietal cortex (somatic associated area).
CONCLUSION: Changes that take place in precentral and postcentral cortical areas subsequent to the extremity replantation-revascularization of the organ is a good indicator of somatotrophic reorganization.

Keywords: Amputation, motor cortex/physiology, muscle, skeletal/metabolism, phantom limb/physiopathology; replantation; somatosensory cortex/physiology; 99m-Tc-HMPAO

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