Meralgia Parestetika Etyolojisinde Travmatik Nedenler
Özet
Meralgia parestetika (MP) lateral femoral kutanöz sinirin (LFKS) ağrılı bir mononöropatisidir. LFKS’nin sıkışmasına bağlı anterolateral uylukta parestezi, nöropatik ağrı ve duysal değişikliklerle karekterizedir. MP çocukluk dönemide dahil olmak üzere yaşamın herhangi bir döneminde ortaya çıkabilse de en sık yaşamın beşinci on yılında ve erkeklerde daha fazla görülür. En son MP insidansı 32,6-43/100.000 olarak bildirilmiştir. Etyolojide mekanik, metabolik ve iatrojenik nedenler suçlanır. İatrojenik yaralanma literatürde LFKS yaralanması için en sık bildirilen travmatik nedendir. İatrojenik MP, ameliyat sırasında, pozisyon verilen hastalarda ve spor aktiviteleri sonrasında görülebilir ve insidansı %10.3-23,8 arasındadır. LFKS’nin çeşitli bireysel anatomik varyasyonları potansiyel hasarın bir nedenidir.
Tanı tipik klinik öykü yanında görüntüleme ve sinir iletim çalışmaları ile konulur. Tedavisi konservatif olup yaşam tarzı değişikliği, analjezikler ve enjeksiyonlarla tedavi edilir. Dirençli vakalarda cerrahi tedavi yapılmaktadır. Her ne kadar cerrahi en sık idiyopatik MP için yapılsa da, MP hastalarının değerlendirilmesinde daha önce travma veya kitle lezyonu tarafından sıkışma olasılığını göz önünde bulundurmak ve travmatik bir nedene veya kitle lezyonu tarafından sıkışmaya işaret edebilecek olası belirtileri kontrol etmek önemlidir. Böylece kitle ekarte edildikten sonra LFKS'nin travmatik yaralanmaları erken tanınır, bu hastaların sevki gecikmez ve çok sayıda gereksiz tetkik yapılması önlenir. İatrojenik MP konusunda daha fazla farkındalık yaratılmalıdır ve gerekli önlemler alınmalıdır.
Meralgia paresthetica (MP) is a painful mononeuropathy of the lateral femoral cutaneous nerve (LFCN). It is characterised by paresthesia, neuropathic pain and sensory changes in the anterolateral thigh due to compression of the LFCN. Although MP can occur at any stage of life, including childhood, it is most common in the fifth decade of life and is more common in males. The most recent incidence of MP was reported as 32.6-43/100.000. Mechanical, metabolic and iatrogenic causes are blamed in the etiology. Iatrogenic injury is the most commonly reported traumatic cause of LFCN injury in the literature. Iatrogenic MP can occur during surgery, in patients who are positioned, and after sports activities, with an incidence of 10.3-23.8%. Various individual anatomical variations of the LFCN are a cause of potential damage.
The diagnosis is based on a typical clinical history as well as imaging and nerve conduction studies. Treatment is conservative and includes lifestyle modification, analgesics and injections. Surgical treatment is performed in resistant cases. Although surgery is most commonly performed for idiopathic MP, it is important in the evaluation of MP patients to consider the possibility of previous trauma or compression by a mass lesion and to check for possible signs that may indicate a traumatic cause or compression by a mass lesion. Thus, traumatic injuries of the LFCN can be recognised early after the mass is ruled out, referral of these patients is not delayed and many unnecessary investigations are prevented. More awareness should be raised about iatrogenic MP and necessary precautions should be taken.
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