Case Ortho; Oa

8/15/2019 Case Ortho; Oa

1/29

LAPORAN KASUS

OSTEOARTHRITIS

Disusun oleh

ADINDA WIDYANTIDEWI

030.11.005

Pembimbing

dr. David Idrial, Sp.OT

KEPANITERAAN KLINIK ILMU BEDAH

RSUD BUDHI ASIH

PERIODE 19 OKTOBER – ! DESEMBER "1#

$AKULTAS KEDOKTERAN UNI%ERSITAS TRISAKTI

1


2/29

LEMBAR PERSETUUAN PEMB!MB!N"

OSTEOART#R!T!S

P$esen%&si K&sus

Di&'u(&n (e)&*& SM+ Be*&h RSUD Bu*hi Asih

un%u( memenuhi Pe$s,&$&%&n Mengi(u%i U'i&n Ke)&ni%e$&&n Klini( SM+ Be*&h

Pe$io*e 1- OKTOBER / DESEMBER /015

Ol&'(

A*in*& i*,&n%i*e2i

N!M 03011005

P&)*i)*i+

*$. D&4i* !*$i&l S).OT

KEPAN!TERAAN KL!N!K SM+ BEDA# RSUD BUD#! AS!#

+AKULTAS KEDOKTERAN UN!ERS!TAS TR!SAKT!

AKARTA

2


3/29

BAB I

PENDAHULUAN

Os%eo&$%$i%is 6OA7 me$u)&(&n ben%u( &$%$i%is ,&ng )&ling se$ing *i%emu(&n *i

m&s,&$&(&%8 be$si9&% ($onis8 be$*&m)&( bes&$ *&l&m m&s&l&h (eseh&%&n m&s,&$&(&%.

#&$us *i)&h&mi b&h2& )&*& OA me$u)&(&n )en,&(i% *eng&n )$og$esi9i%&s ,&ng

l&mb&%8 *eng&n e%iologi ,&ng %i*&( *i(e%&hui. OA )&ling se$ing mengen&i lu%u%8

)&nggul8 %ul&ng bel&(&ng *&n )e$gel&ng&n (&(i. K&$&(%e$is%i( OA *i%&n*&i *eng&n

(eluh&n n,e$i sen*i *&n g&nggu&n )e$ge$&(&n ,&ng %e$(&i% *eng&n *e$&'&% (e$us&(&n

)&*& %ul&ng $&2&n.1

OA s&&% ini %i*&( l&gi *i&ngg&) )en,&(i% *egene$&%i98 n&mun usi& %e%&)me$u)&(&n s&l&h s&%u 9&(%o$ $isi(on,&. Usi& *i&%&s 5 %&hun8 h&n,& 50: membe$i(&n

g&mb&$&n $&*iologis sesu&i OA8 mes(i)un h&n,& 10: )$i& *&n 1;: 2&ni%&

*i&n%&$&n,& ,&ng mem)e$lih&%(&n ge'&l& (linis OA8 *&n se(i%&$ 10: meng&l&mi

*is&bili%&s (&$en& OA n,&8 m&(& *&)&% *i)&h&mi 'i(& m&(in be$%&mb&h usi&8 m&(in

%inggi (emung(in&n un%u( %e$(en& OA. 1

Di !n*onesi& )$e4&lensi OA lu%u% ,&ng %&m)&( se


4/29

BAB II

LAPORAN KASUS

ANAMNESIS

An&mnesis *il&(u(&n se


5/29

n&9su m&(&n *is&ng(&l. P&sien su*&h be$ob&% (e RSM *&n b&$u men*&)&% ob&% &n%i

n,e$i. Ri2&,&% (e %u(&ng u$u% *is&ng(&l.

R!A?AT PEN?AK!T DA#ULU

- T&hun /000 )&sien *i*i&gnosis memili(i )eng&)u$&n )&*& (e*u& sen*i lu%u%

*&n su*&h mel&(u(&n 9isio%e$&)i.

- P&sien memili(i $i2&,&% %e(&n&n *&$&h %inggi se'&( 5 %&hun ,&ng l&lu *&n $u%in

meminum ob&% %e(&n&n *&$&h %inggi8 se$%& &*& $i2&,&% )en,&(i% '&n%ung

- P&sien meng&(u memili(i s&(i% m&&gh

- Te$&(hi$ (on%$ol )&sien memili(i gul& *&$&h %inggi8 &s&m u$&%8 *&n (oles%e$ol.

- P&sien meng&(u )e$n&h meng&l&mi %$&um& '&%uh %e$*u*u( (e%i(& h&mil 30

%&hun l&lu.

R!A?AT KEB!ASAAN DAN L!N"KUN"AN

P&sien meng&(u se$ing be$&(%i9i%&s b&n,&( *&n meng(u%i be$b&g&i m&


6/29

- %e(&n&n *&$&h 1/0C;0

- n&*i ;0 Cmeni%

- )e$n&9&s&n /0 Cmeni%

- suhu 385

S-a-/ i0i- be$&% b&*&m =3(g

- %inggi b&*&n 10


7/29

"enu *e%$& "enu sinis%$&

Loo( De9o$mi%&s 678 oe*em 678

hi)e$emis 678 'e'&s 678

hem&%om 67

De9o$mi%&s 678 oe*em 678

hi)e$emis 678 'e'&s 678

hem&%om 67

+eel N,e$i %e(&n 67 u(u$&n 3;


8/29

LABORATORIUM

Dara' l&+2ap 31# S&p-&)*&r "1# ( Pli Or-'p&di5

Leu(osi% -.300

E$i%$osi% 3.=00

#emoglobin 10.- gC*L

#em&%o


9/29

I+-&rpr&-a/i(

- %i*&( %&m)&( 9$&(%u$

- %&m)&(


10/29

- %&m)&( s%$u(%u$ *&n (e*u*u(&n %ul&ng b&i(8 %i*&( %&m)&( &*&n,&

*is(on%inui%&s

- %e$*&)&% os%eo9i% )&*&


11/29

- 15 %&hun l&lu *i*i&gnos& )eng&)u$&n )&*& (e*u& sen*i lu%u% *&n su*&h

mel&(u(&n 9isio%e$&)i8 30 %&hun l&lu $i2&,&% '&%uh %e$*u*u( s&&% h&mil *&n

%i*&( be$ob&% (e *o(%e$

- P&sien memili(i %e(&n&n *&$&h %inggi8 %e$&(hi$ (on%$ol gul& *&$&h8 (oles%e$ol

*&n &s&m u$&%n,& %inggi. P&sien meng&(u memili(i s&(i% m&&gh

- Kebi&s&&n )&sien be(e$'& seb&g&i (e)&l& se(ol&h se'&( ; %&hun l&lu8 &(%i9

be$(egi&%&n *&n be$o$g&nis&si8 seh&$ih&$i men,e%i$ sen*i$i mobil m&nu&l8

se$ing menggun&(&n se)&%u be$h&(8 menge$'&(&n )e(e$'&&n $um&h sen*i$i8

'&$&ng be$ol&h$&g& *&n m&(&n %i*&( *i'&g&. Konsumsi ob&% ho$mon&l

*is&ng(&l )&sien.

- Ri2&,&% be$ob&% 3 bul&n l&lu (e RSM *&n h&n,& *ibe$i ob&% &n%i n,e$i8 *&$i

15 %&hun l&lu se$ing meng(onsumsi ob&% he$b&l un%u( n,e$i )&*& lu%u% n,&

- #&sil )eme$i(s&&n 9isi( compos mentis8 %&m)&( s&(i% se*&ng8 %&n*& 4i%&l

*&l&m b&%&s no$m&l8 BM! )&sien overweight, s%&%us gene$&lis *&l&m b&%&s

no$m&l8 s%&%us lo(&lis )&sien )&*& )&nggul (&n&n *&n (i$i *i*&)&%(&n ge$&(

&(%i9 ,&ng %e$b&%&s (&$en& n,e$i *eng&n su*u% 0 *&n ge$&( )&si9 158 *eng&n

(e(u&%&n mo%o$i( /. Peme$i(s&&n ge$&( )&*& sen*i lu%u% %i*&( *il&(u(&n

(&$en& n,e$i. #i)e$emis8 oe*em *&n *e9o$mi%&s %i*&( *i%emu(&n )&*& sen*i

lu%u% m&u)un sen*i )&nggul. Ke*u& %ung(&i %&m)&( sime%$is.

-#&sil l&bo$&%o$ium *&$&h *&l&m b&%&s no$m&l- +o%o $on%gen )el4is menun'u(&n


12/29

o E*u(&si ,&ng *ibe$i(&n be$u)& )en'el&s&n %en%&ng )en,&(i% OA &g&$

)&sien mem&h&mi )en,&(i%n,&8 meen'el&s(&n mengen&i h&lh&l ,&ng

h&$us *il&(u(&n *&n &)& ,&ng h&$us *ihin*&$(&n8 )e$b&i(&n g&,&

hi*u)8 se$%& menge*u(&si un%u( *il&(u(&nn,& %in*&(&n o)e$&si- Penu$un&n be$&% b&*&n

o Be$&% b&*&n ,&ng be$lebih me$u)&(&n 9&(%o$ ,&ng mem)e$be$&% OA8

oleh (&$en& i%u8 be$&% b&*&n h&$us *&)&% *i'&g& &g&$ %i*&( be$lebih *&n

*iu)&,&(&n un%u( mel&(u(&n )enu$un&n be$&% b&*&n &)&bil& be$&%

b&*&n be$lebih

- Ol&h$&g& $ing&n %e$&%u$ 30 meni% seh&$i

o Be$se)e*&8 be$'&l&n8 be$en&ng

- Menggun&(&n &l&% b&n%u

o Un%u( menghin*&$i )em&(&i&n be$lebih )&*& sen*i ,&ng be$m&s&l&h

sehingg& %i*&( %e$'&*in,& (e$us&(&n lebih l&n'u%

o on%oh &l&% 2&l(e$8 (u$si $o*&

- +isio%e$&)i

o Me$u'u( (e $eh&bili%&si me*i(

o +isio%e$&)i *&)&% *il&(u(&n se%el&h *il&(u(&nn,& %in*&(&n o)e$&si

un%u( mel&%ih ge$&( sen*i )&nggul *&n lu%u% *&n (e(u&%&n o%o%

MED!KAMENTOSA

- NSA!D Meloi


13/29

BAB III

PEMBAHASAN

I. ANATOMI

SEND! S?NO!AL8 KART!LA"O

SEND!8 DAN A!RAN S?NO!AL

Sen*i s,no4i&l &%&u sen*i *i&$%h$osis

me$u)&(&n )e$%emu&n *u& %ul&ng ,&ng

be$sen*i *&n %e$*&)&% $u&ng *i&n%&$&n,&

se$%& memili(i lig&men un%u(

mem)e$%&h&n(&n )e$sen*i&n. on%oh *&$i

sen*i s,no4i&l ini &*&l&h sen*isen*i ,&ng memili(i ge$&(&n lu&s8 se)e$%i sen*i lu%u%

6tibiofemoral joint 7 *&n sen*i )&nggul (femoroacetabular joint 7./

13


14/29

U'ung %ul&ng )&*& sen*i ini *il&)isi oleh %ul&ng $&2&n hi&lin. Tul&ng $&2&n

hi&lin &*&l&h '&$ing&n i(&% &4&s sul9&% *&n (on*$oi%in sul9&%. Sel&in i%u m&%$i(s

meng&n*ung gli(o)$o%ein ,&ng memb&n%u selsel *&l&m mem)e$%&h&n(&n hubung&n

*eng&n m&%$i(s &n%&$ sel. Sel (&$%il&go ini %e$*i$i *&$i sel (on*$osi% ,&ng be$)e$&n

*&l&m mensin%esis selu$uh elemen ,&ng %e$*&)&% )&*& m&%$i(s (&$%il&go8 ,&i%u 9&(%o$

9&(%o$ )e$%umbuh&n %ul&ng $&2&n se$%& enFimenFim *eg$&*&si )eme


15/29


16/29

(&$%il&go sen*i se$%& m&%$i(s e(s%$&selule$8 (on*$osi%8 *&n %ul&ng sub(on*$&l )&*& usi&

%u&. Pe$ub&h&n mo$9ologi bio(imi&8 mole(ule$8 *&n biome(&ni( )&*& %ul&ng $&2&n ini

be$)e$&n %e$h&*&) %e$'&*in,& os%eo&$%h$i%is. 18/

. E-ili

6A7

a)*ar 6. a)*ara+ /&+di d&+a+ /-&ar-'ri-i/< OA l-- 3A5< OA pa+l 3B5

6B7

16


17/29

Be$*&s&$(&n )en,eb&bn,&8 OA *ibe*&(&n men'&*i *u& ,&i%u OA )$ime$ *&n OA

se(un*e$. OA )$ime$8 &%&u *&)&% *isebu% OA i*io)&%i(8 %i*&( memili(i )en,eb&b ,&ng

)&s%i 6 %i*&( *i(e%&hui 7 *&n %i*&( *iseb&b(&n oleh )en,&(i% sis%emi( m&u)un )$oses

)e$ub&h&n lo(&l )&*& sen*i. OA se(un*e$8 be$be*& *eng&n OA )$ime$8 me$u)&(&n OA

,&ng *iseb&b(&n oleh in9l&m&si8 (el&in&n sis%em en*o($in8 me%&boli(8 )e$%umbuh&n8

9&(%o$ (e%u$un&n 6he$e*i%e$78 *&n immobilis&si ,&ng %e$l&lu l&m& 6%&bel 17. K&sus OA

)$ime$ lebih se$ing *i'um)&i )&*& )$&(%i( seh&$ih&$i *ib&n*ing(&n *eng&n OA

se(un*e$.1

T&bel 1. E%iologi se(un*e$ OA

Me%&boli( Kel&in&n &n&%omiC s%$u(%u$

sen*i

T$&um& !n9l&m&si

&$%$i%is K$is%&l

&($omeg&li

o($onosis

6&l(&)%onu$i&7

hem&%o(eom&%osis

)en,&(i% ilson

sli))e* 9emo$&l e)i)h,sis

e)i)h,se&l *,s)l&si&s

bloun%s *ise&se

)en,&(i% leggPe$%he

*islo(&si (o(s& (ongeni%&l

)&n'&ng %ung(&i %i*&( s&m&

*e9o$mi%&s 4&lgusC4&$us

sin*$om& hi)e$mobili%i

%$&um& sen*i

m&,o$

9$&(%u$ )&*&

sen*i &%&u

os%eone85

/.3.1 +&(%o$ ,&ng %i*&( *&)&% *imo*i9i(&si

Umu$

Sei$ing *eng&n be$%&mb&hn,& usi&8 9ungsi *&$i (on*$osi% *&)&% be$ub&h *&n

%e$'&*i $es)on ,&ng %i*&( sesu&i %e$h&*&) si%o(in *&n 9&(%o$9&(%o$ )e$%umbuh&n )&*&

(&$%il&go. +&(%o$ me(&ni( *&n )$o%e(%i9 )&*& (&$%il&go &(&n %e$g&nggu *eng&n

be$%&mb&hn,& usi&8 se)e$%i )$o)$iose)si sen*i8 valgus-valrus laxity *&n (e(u&%&n o%o%.

17


18/29

OA *i&l&mi se(i%&$ 50: o$&ng be$usi& 5 %&hun (e &%&s *&n )$e4&lensin,& mening(&%

men'&*i ;5: )&*& (elom)o( =5 %&hun (e&%&s.>

enis (el&min

enis (el&min *&)&% mem)eng&$uhi %e$'&*in,& OA mel&lui be$b&g&i 9&(%o$8

se)e$%i )eng&$uh ho$mon&l )&*& me%&bolisme (&$%il&go. &ni%& lebih se$ing

meng&l&mi OA *ib&n*ing(&n )$i&. P$e4&lensi OA mening(&% sesu*&h usi& >0 %&hun

)&*& 2&ni%& *&n 50 %&hun )&*& )$i&. Es%$ogen mung(in memili(i e9e( l&ngsung

%e$h&*&) (&$%il&go sen*i *&n mung(in mem)un,&i )e$&n&n %e$h&*&) %e$'&*in,& OA

mel&lui e9e(n,& )&*& %ul&ng *&n '&$ing&n sen*i l&inn,&. P&*& sebu&h s%u*i *eng&n

MR! *i*&)&%(&n 4olume (&$%il&go ,&ng lebih bes&$ )&*& 2&ni%& ,&ng meng(onsumsi

%e$&)i ho$mon es%$ogen *ib&n*ing(&n ,&ng %i*&(./

R&s

P$e4&lensi OA lu%u% )&*& )en*e$i%& *i neg&$& E$o)& *&n Ame$i(& %i*&(

be$be*&8 se*&ng(&n su&%u )eneli%i&n membu(%i(&n b&h2& $&s A9$i(& H Ame$i(&

memili(i $isi(o men*e$i%& OA lu%u% / (&li lebih bes&$ *ib&n*ing(&n $&s K&u(&si&.

Pen*u*u( Asi& 'ug& memili(i $isi(o men*e$i%& OA lu%u% lebih %inggi *ib&n*ing(&n

K&u(&si&. Su&%u s%u*i l&in men,im)ul(&n b&h2& )o)ul&si (uli% be$2&$n& lebih

b&n,&( %e$se$&ng OA *ib&n*ing(&n (uli% )u%ih.5

"ene%i(

Ke'&*i&n OA lebih b&n,&( )&*& (emb&$ monoFigo% *&$i)&*& (emb&$ *iFigo%.

B&n,&( gen ,&ng %e$(&i% *eng&n OA8 mis&ln,& ($omosom /I8 >8 *&n 1. Pol&

)enu$un&nn,& *i)e$(i$&(&n mel&lui gen &u%osom *omin&n. "en ,&ng meng&l&mi

g&nggu&n *&l&h gen ,&ng meng(o*e )$o%ein s%$u


19/29

%e$u%&m& *&l&m )e$(emb&ng&n )en,&(i% (e *e$&'&% ,&ng lebih %inggi. Kelebih&n be$&%

b&*&n &(&n mening(&%(&n s%$ess biome(&nis )&*& sen*i ,&ng men,&ngg& be$&% b&*&n

*&n *&)&% meng&(ib&%(&n (e$us&(&n (&$%il&go. Deng&n be$&% b&*&n ,&ng lebih &%&u

overweight *&)&% membe$i(&n beb&n ,&ng be$lebih )&*& sen*isen*i )en,&ngg&

%ubuh8 *&n *&)&% men,eb&b(&n in9l&m&si *&n n,e$i )&*& sen*i ,&ng be$s&ng(u%&n.58

T$&um&

T$&um& &%&u $i2&,&% o)e$&si ,&ng mem)eng&$uhi (&$%il&go sen*i8 lig&men%8

%ul&n *&)&% men,eb&b(&n &bno$m&li%&s bio(imi& *i sen*i *&n men,eb&b(&n OA.

&l&u)un )e$b&i(&n %$&um& lig&men% bi&s&n,& mengemb&li(&n 9ungsi sen*i8 n&mun

OA *&)&% %e$'&*i 515 %&hun (emu*i&n )&*& 500: )&sien.5

A(%i9i%&s be$lebih

P&*& )e(e$'&&n ,&ng membe$i(&n s%$ess be$ul&ng )&*& sen*i %e$%en%u sen*i

%e$sebu% mu*&h men*e$i%& OA. Mi($o%$&um& 'ug& bis& men,eb&b(&n (e$us&(&n8

(hususn,& )&*& in*i4i*u ,&ng memili(i )e(e$'&&n &%&u g&,& hi*u) ,&ng be$hubung&n

*eng&n ge$&(&nge$&(&n $e)e%i%i4e )&*& sen*i.5

.= Pa-:i/ili

OA &*&l&h g&nggu&n sen*i ($onis ,&ng *iseb&b(&n oleh (e%i*&(seimb&ng&n

&n%&$& *eg$&*&si *&n sin%esis $&2&n sen*i se$%& m&%$i(s e(s%$&selule$8 (on*$osi% *&n

%ul&ng sub(on*$&l )&*& usi& %u&. P&*& OA %e$'&*i )e$ub&h&n mo$9ologi8 bio(imi&8

mole(ule$ *&n biome(&ni( b&i( )&*& sel (on*$osi% m&u)un m&%$i(s %ul&ng $&2&n

sen*i ,&ng meng&(ib&%(&n )e$lun&(&n8 ulse$&si8 hil&ngn,& $&2&n sen*i8 s(le$osis *&n

ebu$n&si %ul&ng sub(on*$&l8 os%eo9i% *&n (is%& sub(on*$&l./83

Te$*&)&% lim& g&mb&$&n (h&s )&*& OA 17 (e$us&(&n (&$%il&go ,&ng )$og$esi98

/7 %e$ben%u(n,& (is%& sub&$%i(ul&$8 37 s7 )emben%u(&n

os%eo9i%8 57 (&)sul&$ 9ib$osis./

+$e(uensi OA 'el&s mening(&% *eng&n be$%&mb&hn,& usi&. Te%&)i h&l ini bu(&n

be$&$%i )en&mb&h&n usi& me$u)&(&n h&l ,&ng men'&*i )en,eb&b u%&m& *&$i %e$'&*in,&

OA. K&$%il&go mem&ng &(&n @menu&8 %e$lih&% *&$i selul&$i%&sn,& ,&ng be$(u$&ng8

be$(u$&ngn,& (onsen%$&si )$o%eogli(&n8 hil&ngn,& el&s%isi%&s *eng&n be$%&mb&hn,&

usi&. +&(%o$9&(%o$ )e$ub&h&n )&*& (&$%il&go ini *&)&% *i(&%&(&n me$u)&(&n sebu&h

)$e*is)osisi %e$h&*&) %e$'&*in,& OA8 n&mun h&l ini *&)&% *ilih&% 'el&s mel&lui ge'&l&

19


20/29

(linis *&n $&*iologi b&h2& h&n,& %e$b&%&s )&*& sen*isen*i %e$%en%u8 semen%&$& sen*i

l&inn,& h&n,& mem)e$lih&%(&n se*i(i% )e$ub&h&n &%&u %i*&( &*& s&m& se(&li (el&in&n

sei$ing *eng&n be$%&mb&hn,& usi&./

Pe$u&h&n u%&m& )&*& m&%$i %ul&ng $&2&n *&)&% melem&h(&n s%$u(%u$ %ul&ng

$&2&n %e$sebu% *&n h&l ini me$u)&(&n )$e*is)osisi %e$h&*&) %e$'&*in,& (e$us&(&n )&*&

(&$%il&go. Pe$ub&h&n ,&ng )&ling


21/29

P&*& umumn,& )en*e$i%& OA meng&%&(&n b&h2& (eluh&nn,& su*&h

be$l&ng&ung l&m& %e%&)i be$(emb&ng se

OA PAN""UL

B&rda/ar2a+ 2ri-&ria 2li+i/ da+ la*ra-ri/(

N,e$i )&*& )&nggulC(o(s& *&n )&ling se*i(i% s&l&h s&%u *&$i *u& (elom)o( ($i%e$i& *i

b&2&h ini

1. $o%&si in%e$n&l sen*i )&nggul J15 *e$&'&% *ise$%&i LED J >5mmC'&m &%&u 9le(si

sen*i )&nggul J115 *e$&'&% 6'i(& LED suli% *il&(u(&n7

/. $o%&si in%e$n&l sen*i )&nggul 15 *e$&'&% *ise$%&i n,e$i ,&ng %e$(&i% )e$ge$&(&n

$o%&si in%e$n&l sen*i )&nggul8 (e(&(u&n sen*i )&nggul )&gi h&$i J0 meni%8 *&n

usi& 50 %&hun

B&rda/ar2a+ 2ri-&ria 2li+i/, la*ra-ri/ da+ radili/

N,e$i )&*& sen*i )&nggulC(o(s& *&n )&ling se*i(i% *u& *&$i %ig& ($i%e$i& *ib&2&h ini

1. LED J/0mm )&*& '&m )e$%&m&

/. Os%eo9i% )&*& 9emo$&l *&n &%&u &se%&bul&$ )&*& g&mb&$ $&*iologis

3. Pen,em)i%&n


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B&rda/ar2a+ 2ri-&ria 2li+i/ da+ radili/(

N,e$i sen*i lu%u% *&n &*&n,& os%eo9i% *&n )&ling se*i(i% s&%u *&$i %ig& ($i%e$i& *ib&2&h

ini

1. (&(u sen*i J30 meni%

/. umu$ 50 %&hun

3. ($e)i%us )&*& ge$&(&n sen*i &(%i9

B&rda/ar2a+ 2ri-&ria 2li+i/ da+ la*ra-ri/(

N,e$i sen*i lu%u% *&n )&ling se*i(i% lim& *&$i Sembil&n ($i%e$i& *i b&2&h ini

1. usi& 50 %&hun

/. (&(u sen*i J 30 meni%

3. ($e)i%us )&*& ge$&(&n &(%i9

>. n,e$i %e(&n )&*& %e)i %ul&ng

5. )embes&$&n %ul&ng. %i*&( %e$&b& h&ng&% )&*& sino4ium sen*i lu%u%

=. LED J>0 mmC'&m

;. R+ J1>0

-. An&lisis a- OA *&rda/ar2a+ K&llr&+4La@r&+&

22


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S%$&%egi )en&%&l&(s&n&&n )&sien *&n )ilih&n 'enis )engob&%&n *i%en%u(&n oleh

le%&( sen*i ,&ng meng&l&mi OA8 sesu&i *eng&n (&$&(%e$is%i( m&singm&sing se$%&

(ebu%uh&nn,&. Oleh (&$en& i%u *i)e$lu(&n )enil&i&n ,&ng


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*u& (&li l&%ih&n (e(u&%&n *&l&m seminggu un%u( mengu$&ngi n,e$i *&n ge'&l& l&inn,&

)&*& OA.;

$ar)a2li/

American Colleges of Rheumatology men'&*i(&n NSA!D seb&g&i )ilih&n %e$&)i

9&$m&(ologi lini )e$%&m& )&*& OA )&nggul *&n lu%u% *eng&n men&mb&h )embe$i&n

proton pump inhibitor 6PP!7 un%u( mengu$&ngi )o%ensi %e$'&*in,& g&nggu&n )&*&

sis%em g&s%$oin%es%in&l &(ib&% )enggun&&n NSA!D '&ng(& )&n'&ng. S&&% ini T$&m&*ol

*&n in'e(si in%$&&$%i(ul&$ (o$%i(os%e$oi* men'&*i inisi&l %e$&)i )&*& OA8 *im&n&

sebelumn,& &


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OA mem)un,&i )eng&$uh bes&$ %e$h&*&) (eseh&%&n 9isi( *&n men%&l )&sien.

OA )&nggul *&n lu%u% memili(i hubung&n ,&ng e$&% *eng&n %e$'&*in,& *is&bili%&s *&n

(esuli%&n mel&(u(&n &(%i9i%&s seh&$ih&$i. OA 'ug& *&)&% mem)eng&$uhi (e&*&&n

men%&l )&sien se)e$%i (e&*&&n )esimis8 )e$&s&&n %e$%e(&n &(ib&% (onse(uensi men&h&n

$&s& n,e$i ,&ng be$(e)&n'&ng&n. P&*& )&sien OA b&n,&( *il&)o$(&nn,& )enu$un&n

(u&li%&s hi*u) *ib&n*ing(&n *eng&n )&sien ,&ng %i*&( men*e$i%& OA. Lebih *&$i 0:

)en*e$i%& OA memili(i (e&*&&n (o$mobi*i%&s l&inn,& ,&n men&mb&h beb&n )&*&

)&sien ,&ng *&)&% men,eb&b(&n )enu$un&n )$o*u(%i9i%&s hi*u) )&sien. P&*& bebe$&)&

)eneli%i&n be$)en*&)&% b&h2& )&sien *eng&n OA lu%u% *&n )&nggul memili(i $esi(o

mo$%&li%&s ,&ng lebih %inggi *ib&n*ing(&n )o)ul&si bi&s&.11

BAB I%

25


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ANALISA KASUS

P&*& (&sus8 )&sien 2&ni%& *eng&n usi& / %&hun *i*i&gnos& *eng&n OA

)&nggul *&n genu bil&%e$&l. P&sien *i*i&gnos& be$*&s&$(&n ge'&l& (linis *&n $&*iologis

)&sien ,&ng memenuhi ($i%e$i& OA )&nggul *&n OA genu menu$u% AR 6 American

College of Rheumatology". D&n be$*&s&$(&n *e$&'&%n,& menu$u% (l&si9i(&si Kellgren-

awrence *eng&n melih&% h&sil $&*iologis8 )&sien *i(l&si9i(&si(&n *&l&m OA )&nggul

*e$&'&% ! *&n OA genu *e$&'&% !! bil&%e$&l.18/

D&)&% *ilih&% 9&(%o$ $esi(o ,&ng %e$*&)&% )&*& )&sien8 *im&n& OA %e$'&*i lebih

se$ing %e$'&*i )&*& 2&ni%& *ib&n*ing(&n )$i&8 %e$u%&m& )&*& usi& *i &%&s 50 %&hun.

Mening(&%n,& &ng(& (e'&*i&n OA )&*& 2&ni%& *eng&n usi& %e$sebu% *ihubung(&n

*eng&n (e&*&&n 2&ni%& meno)&use ,&ng memili(i (&*&$ es%$ogen ,&ng lebih $en*&h

*i*ug& be$)e$&n *&l&m $egul&si %e$'&*in,& OA )&*& usi& %e$sebu%. N&mun *&$i

)eneli%i&n8 %i*&( *i%emu(&n bu(%i 'el&s hubung&n *&$i 9&(%o$ ho$mon&l %e$sebu%

%e$h&*&) (e'&*i&n OA.5

OA %e$'&*i sel&in (&$en& 9&(%o$ in%$insi( se)e$%i be$(u$&ngn,& 9ungsi )&*& sel

%ul&ng $&2&n8 menu$unn,& (e(u&%&n *&n 9ungsi )$o%e(si ,&ng *iseb&b(&n oleh

be$%&mb&hn,& usi&8 9&(%o$ biome(&ni(&l 'ug& memeg&ng )eng&$uh bes&$ %e$h&*&)

%e$'&*in,& OA./ P&*& (&sus ini )&sien memili(i 9&(%o$ $esi(o %e$h&*&) OA l&inn,&

se)e$%i8 &(%i9i%&s ,&ng be$lebih8 $i2&,&% (ebi&s&&&n menggun&(&n se)&%u be$h&(8

$i2&,&% %$&um&8 *&n be$&% b&*&n ,&ng be$lebih. #&lh&l ini *&)&% men,eb&b(&n s%$ess

me(&nis be$ul&ng *eng&n membe$i beb&n be$lebih )&*& sen*isen*i ,&ng

be$hubung&n8 (hususn,& &*&l&h sen*isen*i weight bearing se)e$%i sen*i )&nggul *&n

lu%u%. Ke&*&&n ini me$u)&(&n h&l ,&ng *&)&% men'&*i 9&(%o$ )en,eb&b %e$'&*in,& OA.

Keluh&n n,e$i )&*& )&sien OA memili(i me(&nisme ,&ng be$m&


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P&*& (&sus OA h&$us (i%& *&)&% be*&(&n *eng&n *eng&n )en,&(i% &$%h$i%is

l&inn,&8 %e$u%&m& $heum&%oi* &$%h$i%is 6RA7. Rheum&%oi* A$%h$i%is me$u)&(&n

)en,&(i% &u%oimun ,&ng me$us&( sino4ium 6b&gi&n *&$i sen*i7 ,&ng be$9ungsi un%u(

membe$i(&n nu%$isi )elum&s sen*i su)&,& sen*i mu*&h be$ge$&(. Umumn,&

men,e$&ng sen*isen*i (e


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)engg&n%i&n sen*i )&nggul me$u)&(& %in*&(&n o)e$&%i9 ,&ng *i&ngg&) )&ling e9e(%i9

*eng&n mengg&n%i sen*i *&n %ul&ng ,&ng meng&l&mi (e$us&(&n *eng&n b&h&n sin%e%is.

#&sil *&$i )$ose*u$ ini *i&ngg&) memu&s(&n *&)&% menghil&ng(&n n,e$i8

mem)e$b&i(i 9ungsi *&$i sen*i *&n mening(&%(&n (u&li%&s hi*u) )&sien. Te$bu(%i )&*&

)&sien %el&h *il&(u(&n %in*&(&n T#R )&*& )&nggul (&n&n *&n *i*&)&%(&n h&sil ,&ng

*ih&$&)(&n8 $&s& n,e$i )&*& )&sien be$(u$&ng *&n ge$&(&n sen*i )&nggul )&sien '&uh

lebih memb&i( *&$i sebelumn,&. &l&u)un su*&h %e$'&*i )e$b&i(&n8 )&sien m&sih

meme$lu(&n l&%ih&n (e(u&%&n o%o% *&n l&%ih&n ge$&(&nge$&(&n un%u( sen*i )&nggul

m&u)un sen*i lu%u% )&sien. M&(& *&$i i%u )&sien m&sih membu%uh(&n %e$&)i *eng&n

$eh&bili%&si me*i< se$%& *ibe$i(&n e*u(&si %en%&ng )en,&(i% os%eo&$%h$i%is bese$%& h&l

h&l ,&ng )e$lu *il&(u(&n (e*e)&nn,&./

DA$TAR PUSTAKA

28


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1. Re(omen*&si !RA un%u( *i&gnos& *&n )en&%&l&(s&n&&n Os%eo&$%h$i%is. /01>.

).1/3.

/. Solomon Louis. Os%eo&$%h$i%is. A)le,s s,s%em o9 o$%ho)e*i. No.;./00>.).>1=

10. Thom&s . Len K$&4i%F. Ee$

Case Ortho; Oa

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