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2017, vol. 74, br. 8, str. 791-794
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Sekundarna osteoartroza kuka lečena ugradnjom totalne bescementne endoproteze sa Fitmore® stemom - prikaz bolesnika
Surgical treatment of secondary hip osteoarthritis using cementless total hip endoprosthesis with Fitmore® Hip Stem: A case report
aKlinički centar Niš, Klinika za ortopediju bUniverzitet u Beogradu, Medicinski fakultet, Institut za ortopedsko-hirurške bolesti 'Banjica' cUniverzitet u Nišu, Medicinski fakultet dMilitary Hospital, Niš
e-adresa: predragsss@gmail.com
Sažetak
Uvod. Razvojni poremećaj kuka sa subluksacijom predstavlja nedovoljnu pokrivenost glave butne kosti koja se nalazi u displastičnom acetabulumu. Nepokrivenost glave butne kosti acetabulumom može biti jedva primetna do nepokrivensti jedne polovine glave. Postoji povećanje kolodijafizarnog ugla i ugla anteverzije, Wiberov ugao je manji od 15 stepeni, Shenton-Menardov luk je prekinut. Vrlo rano dolazi do degenerativnih promena u zglobu kuka što je praćeno bolovima, ograničenjem pokreta u kuku i skraćenjem noge. Prikaz bolesnika. U radu je prikazana bolesnica stara 53 godine, koja je kao dete lečena neoperativno zbog razvojnog poremećaja kuka. Nakon trudnoće i porođaja javili su se bolovi u desnom zglobu kuka. Urađen je klinički i radiološki pregled pri čemu je dijagnostikovana subluksacija desnog zgloba kuka sa znacima degenerativne osteoartroze. Lečenje je započeto neoperativno, medikamentoznom terapijom i balneo-fizikalnim procedurama. Nakon konzervativnog lečenja zbog stalnih bolova i ograničenja pokreta u kuku, odlučeno je da se lečenje nastavi ugradnjom endoproteze zgloba kuka. U preoperativnoj pripremi urađen je antero-posteriorni rendgenski snimak kuka sa gornjom trećinom butne kosti, koji omogućava precizno planiranje ugradnje komponenti endoproteze. Ugrađena je bescementna endoproteza zgloba kuka sa Fitmore® stemom. Rani postoperativni tok protekao je uredno. Dobijen je dobar klinički rezultat lečenja. Nakon sprovedene rahabilitacije bolesnica se vratila svojim radnim i životnim aktivnostima. Zaključak. Primena bescementne endoproteze zgloba kuka sa Fitmore stemom u lečenju sekundarne osteoartroze kuka, predstavlja dobar izbor u lečenju mlađih bolesnika sa dobrim kvalitetom koštanog tkiva. Buduća klinička i radiološka praćenja primene ove vrste stema uz komparativne studije, su neophodna da bi se pokazale njegove prednosti u odnosu na klasični bescementni dugi stem.
Abstract
Introduction. Hip dysplasia with subluxation represents insufficient coverage of the femur’s head placed in the dysplastic acetabulum. This lack of coverage ranges from barely noticeable to condition where half of femur head is uncovered by acetabulum. The caput-collum-diaphyseal angle of the proximal femur and anteversion angle of collum are increased, Wiberg’s angle is less than 15° and Ménard-Shenton line is interrupted. Hip joint degeneration occurs very early. When radiological signs of hip joint degenerative changes are discovered in elderly they are associated with pain, limited movements and leg shortening. Case report. We present a 53-year old female treated conservatively in childhood because of hip diyplasia with subluxation. After pregnancy, right hip pain emerged. Clinical and radiological examinations revealed hip subluxation with the signs of degenerative osteoarthritis. Initial treatment was conservative and included drugs and balneophysical procedures. Since pain and movement impairment progressed and became constant, a hip replacement using cementless total endoprosthesis with Fitmore® Hip Stem was done. In the pre-operative preparation, anteroposterior x-ray of the hip(with third of the proximal femur) was made. This X-ray enabled precise planning of implantation endoprosthesis component. The early postoperative course was uneventful with very good therapeutic effect. Following successful physical rehabilitation, the patient returned to work and full life activity. Conclusion. Implantation of the cementless endoprosthesis with Fitmore® Hip Stem in the treatment of secondary hip osteoarthritis is a good choice in the treatment of young patients with good bone quality. Future clinical and radiological follow-up and comparative studies are needed to show the advantages of this type of stem compared to the classical cementless long stem.
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