Totālās gūžas locītavas endoprotezēšanas efektivitāte jauniem pacientiem ar ciskas kaula galviņas avaskulāru nekrozi
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Date
2021
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads:
Avaskulāra nekroze ir patoloģisks process, kura laikā rodas traucējumi kaula asins apgādē. Ārstēšana ievērojami mainās atkarībā no avaskulāras nekrozes skartās zonas un smaguma, bet iniciālās terapijas mērķis ir locītavvirsmas kolapsa novēršana. Viena no ārstēšanas metodēm ir totālā gūžas endoprotezēšana.
Mērķi:
Novērtēt totālās gūžas endoprotezēšanas efektivitāti un nepieciešamību jauniem pacientiem vecumā no 20 līdz 55 gadiem ar ciskas kaula galviņas avaskulāru nekrozi; salīdzināt preoperatīvus un postoperatīvus rentgenattēlus, pamatojoties uz Harisa skalu; izzināt, vai pastāv statistiski nozīmīga korelācija starp Kerbula leņķi un preoperatīviem Harisa skalas rezultātiem un avaskulāras nekrozes stadiju.
Materiāli un metodes:
49 pacienti piedalījās pētījumā. Katrs pacients tika izvērtēts, balstoties uz Harisa skalu preoperatīvi un postoperatīvi. Preoperatīvie rentgenattēli (AP un LL projekcijās) tika izmantoti, lai diagnosticētu avaskulāras nekrozes stadiju un lai izmērītu Kerbula leņķi, kas tiek izmantots kā ciskas kaula galviņas kolapsa prognostiskais rādītājs.
Rezultāti:
Balstoties uz Harisa skalu, tika konstatēts vidēji 101,36% uzlabojums visiem pacientiem pēc totālās gūžas endoprotezēšanas. 48 no 49 pacientiem Kerbula leņķis bija lielāks par 200 grādiem. Netika atrasta statistiski nozīmīga atšķirība starp Kerbula leņķi un preoperatīvajiem Harisa skalas rezultātiem (p=0,229). Netika atrasta statistiski nozīmīga atšķirība starp Kerbula leņķi un avaskulāras nekrozes stadiju (p=0,719).
Secinājumi:
Visiem pacientiem vidēji bija 101,36% uzlabojums, balstoties uz postoperatīvajiem Harisa skalas rezultātiem, salīdzinot ar preoperatīvajiem. Visi pacienti guva labumu no totālās gūžas endoprotezēšanas. 48 pacientiem Kerbula leņķis bija lielāks par 200 grādiem, kas norāda uz lielu ciskas kaula galviņas kolapsa varbūtību. Visiem pacientiem nebija alternatīvās ārstēšanas metodes. Tika atrasta tendence, kas parādīja, ka augstāki Harisa skalas rezultāti korelēja ar zemākām Kerbula lēņķa vērtībām, tomēr tā nebija statistiski nozīmīga (p=0.229).
Introduction Avascular necrosis of the femoral head is a pathologic process that results from interruption of blood supply to the bone. Treatment varies considerably, depending on the location and severity of AVN, but the goal of initial treatment is to prevent collapse of the joint surface. One of the treatment methods is total hip replacement. Objectives To evaluate effectiveness and feasibility of total hip replacement (THR) in young patients aged 20 to 55 with avascular necrosis of the femoral head, to compare preoperative and postoperative findings, based on the Harris hip score (HHS), to find if there is a statistically significant correlation between the Kerboul angle and preoperative HHS results, and the stage of AVN. Methods Forty nine patients participated in the study. Each patient was evaluated by the Harris hip score (HHS) preoperatively and postoperatively. Preoperative radiographic findings (AP and LL projections) were used to diagnose the stage of AVN and to measure the Kerboul angle, which is used as a prognostic indicator of the femoral head collapse. Results According to the Harris hip score, there was a 101,36% improvement in all patients on average after total hip replacement. In forty eight out of forty nine patients the Kerboul angle was > 200 degrees. There was no statistically significant difference between the Kerboul angle and preoperative HHS results (p=0,229). There was no statistically significant difference between the Kerboul angle and the stage of AVN (p=0,719). Conclusions All patients had a 101,36% improvement according to the postoperative HHS results comparing to preoperative ones. All patients benefited from THR. In forty eight patients the Kerboul angle was bigger than 200 degrees, which is indicative of high probability of the femoral head collapse. There was a tendency found showing higher HHS results correlated with lower values of the Kerboul angle, although it was statistically insignificant (p=0,229).
Introduction Avascular necrosis of the femoral head is a pathologic process that results from interruption of blood supply to the bone. Treatment varies considerably, depending on the location and severity of AVN, but the goal of initial treatment is to prevent collapse of the joint surface. One of the treatment methods is total hip replacement. Objectives To evaluate effectiveness and feasibility of total hip replacement (THR) in young patients aged 20 to 55 with avascular necrosis of the femoral head, to compare preoperative and postoperative findings, based on the Harris hip score (HHS), to find if there is a statistically significant correlation between the Kerboul angle and preoperative HHS results, and the stage of AVN. Methods Forty nine patients participated in the study. Each patient was evaluated by the Harris hip score (HHS) preoperatively and postoperatively. Preoperative radiographic findings (AP and LL projections) were used to diagnose the stage of AVN and to measure the Kerboul angle, which is used as a prognostic indicator of the femoral head collapse. Results According to the Harris hip score, there was a 101,36% improvement in all patients on average after total hip replacement. In forty eight out of forty nine patients the Kerboul angle was > 200 degrees. There was no statistically significant difference between the Kerboul angle and preoperative HHS results (p=0,229). There was no statistically significant difference between the Kerboul angle and the stage of AVN (p=0,719). Conclusions All patients had a 101,36% improvement according to the postoperative HHS results comparing to preoperative ones. All patients benefited from THR. In forty eight patients the Kerboul angle was bigger than 200 degrees, which is indicative of high probability of the femoral head collapse. There was a tendency found showing higher HHS results correlated with lower values of the Kerboul angle, although it was statistically insignificant (p=0,229).
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
avaskulāra nekroze, gūžas endoprotezēšana, ortopēdija, avascular necrosis, hip replacement, orthopaedics