Author/Editor		Kocjančič, Boštjan; Kersnič, Boštjan
Title		Določanje najugodnejše geometrije okolčja pri rekonstrukciji zlomov stegneničnega vratu
Translated title		Determination of the most favorable regional geometry in hip reconstruction after femoral neck fracture
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 41, št. 1
Publication year		2002
Volume		str. 13-25
Language		slo
Abstract		A mathematical model can be used to evaluate the biomechanical status of the hip after surgical intervention. By using such a model; it is possible to evaluate changes in the magnitude of the hip-joint reaction farce and its inclination, as well as the forces of the hip abductors at various positions of the greater trochanter with respect to the center of the femoral head. The purpose of this study was to establish whether the mathematical model for determination of the resultant hip force in a one-legged stance can appropriately describe the clinical status of the hip joint following surgery. The final analysis was performed for 71 patients with an average age of 73 years, who had been treated at the Clinical Department of Traumatology, Ljubljana, Slovenia, for medial femoral neck fracture over the past ten years. Out of these, 49 patients had been treated by implantation of a bipolar partial endoprosthesis, and 22 with a total endoprosthesis. The average follow-up period was four years. At the time of the last examination, the clinical status of the hip was evaluated and a radiograph of the hip and both joints was analyzed. A special computer-aided system for digitalization of radiographs was used to calculate the shift in the position of the greater trochanter of the operated hip joint with respect to the situation prior to injury. The clinical status of the hip joint was evaluated using the Harris hip score. The obtained results indicate an association between the biomechanical hip status and Harris clinical hip evaluation in patients with an implanted bipolar partial endoprosthesis. The Harris hip score increases with a lateral shift of the greater trochanter, and decreases with its medialization (r=0.25). No correlation was found between the Harris hip score and a shift of the greater trochanter in a vertical direction. (Abstract truncated at 2000 characters)
Summary		Za oceno biomehanskega statusa kolka po vstavitvi kolčne endoproteze se v klinični praksi uporablja tudi matematični model, s katerim je mogoče oceniti spremembe velikosti in smeri kolčne sklepne sile ter moč kolčnih abduktorjev pri različnih položajih velikega trohantra glede na center kolčne glavice. V naši raziskavi smo poizkušali ugotoviti, ali uporaba matematičnega modela za določanje kolčne sklepne sile v položaju stoje na eni nogi ustrezno opiše klinične razmere v kolčnem sklepu po operacijskem posegu. V raziskavo smo vključili 71 bolnikov s povprečno starostjo 73 let, ki so bili na Kliničnem oddelku za travmatologijo KC v Ljubljani operirani zaradi medialnega zloma stegneničnega vratu v zadnjih desetih letih. Devetinštiridesetim bolnikom so vstavili dvosklepno delno endoprotezo in 22 bolnikom totalno endoprotezo. Bolnike smo ponovno pregledali v poprečju štiri leta po poškodbi. Ob pregledu smo naredili klinično oceno kolka in analizo rentgenskega posnetka cele medenice in obeh kolkov. S pomočjo računalniškega sistema za digitalizacijo rentgenskih posnetkov smo ocertili vrednosti premika velikega trohantra operiranega kolka glede na stanje pred poškodbo. Klinično oceno kolka smo naredili s pomočjo Harrisove ocenjevalne lestvice. Dobljeni rezultati nakazujejo povezavo med biomehanskim statusom kolka in klinično oceno kolka po Harrisu pri bolnikih z vgrajeno dvosklepno delno endoprotezo. Ocena kolka po Harrisu se z lateralnim premikom velikega trohantra veča, z medialnim pa manjša (r=0,25). Nismo ugotovili povezave med klinično oceno kolka po Harrisu in premikom velikega trohantra v navpični smeri. Izboljšali smo metodo za določanje geometrijskih parametrov okolčja tako, da smo natančno določili povečavo za vsakega bolnika.
Descriptors		FEMORAL NECK FRACTURES HIP PROSTHESIS BIOMECHANICS HIP