Úvod: Bolesti v zadní části paty bývají způsobeny tlakem obuvi proti prominenci hrbolu patní kosti. Tato bývá často spojována s anatomickou varietou patní kosti tzv. Haglundovou patou. Tlak obuvi způsobí burzitidu a tendinitidu Achillovy šlachy. Potíže se vyskytují u sportovců, hlavně bruslařů, ta k i u starší populace. Metodika: V tomto sdělení se autoři zabývají jak diagnostikou, tak zkušenostmi s konzervativní terapií a především operační léčbou. Standardně prováděnou resekci hrbolu patní kosti a bursektomii je v poslední době možné provést i artroskopickou technikou. Autoři podrobněji uvádějí přehled obou metod, jejich výhody a nevýhody. Výsledky: Autoři prezentují soubor pacientů operovaných pro bolesti v oblasti hrbolu patní kosti na I. Ortopedické klinice od roku 2002 do roku 2009. V tomto období bylo provedeno celkem 61 operací u 56 pacientů. Z toho byl v jedenácti případech výkon proveden artroskopicky. Autoři dále sledují velikost úhlu patní kosti podle Fowlera, hodnotí výsledky operace, její komplikace a celkovou spokojenost pacientů. Závěr: Bolesti v oblasti hrbolu patní kosti mohou být závažným terapeutickým problémem, hlavně u mladých aktivních sportovců.
PURPOSE OF THE STUDY The aim of the study was to evaluate the results of primary total hip arthroplasty with the use of the CLS stem at 11 to 17 years after implantation. MATERIAL AND METHODS A total of 108 patients (122 hips) in whom a CLS stem was used in the 1991-1996 period were evaluated. The group included 34 men and 74 women, with an average age of 48 years (range, 28-63). The CLS stem with a neck-shaft angle of 145° and the CLS expansion cup were used in all patients. Clinical outcomes were evaluated by Merle d?Aubigné-Postel score and Harris hip score, radiological examination was completed on AP and lateral views of the pelvis and the operated hip. RESULTS The average follow-up was 16.4 years (range, 11-17). The average Merle d?Aubigné-Postel score was 14.5 (range, 13.9-17.0) points and the average Harris hip score was 84.8 (range, 70-99) points. Very good or good outcomes were found in 81% of the patients. Three patients underwent revision surgery, in one for septic loosening, in one for aseptic loosening and in one for varus stem position leading to instability. The radiographs evaluated as described by Engh showed 116 stable stems, three fibrous stable and three unstable stems. Subsidence of more than 3 mm, without any further deterioration, was found in five hips at 12 months post-operatively. Seven hips showed one radiolucent line, four showed two radiolucent lines and three hips showed three radiolucent lines, all of them being less than 2 mm wide. DISCUSSION Radiographic evidence of a stable stem in 116 hips (116/122) suggests a high reliability of the implant. Assessment of radiolucent lines showed 108 hips without radiographic demarcation and 11 hips with slight demarcation. The signs of stress-shielding grade 1 were found in 28 hips. Good results of arthroplasty with the CLS stem can be attributed to its threedimensional wedge-shaped design that allows for an optimal press-fit in the metaphyseal region. The porous surface provides reliable osteointegration. Stress- shielding is prevented by optimal stress distribution in the metaphyseal region and by a modulus of elasticity of titanium alloy which closely approximates the modulus of elasticity of bone. CONCLUSIONS At 15 years post-operatively, the cumulative probability of clinical survivorship of the CLS stem was 98.3 %, and cumulative probability of radiographic survivorship was 87.7 %. The advantages of this stem include a technically simple implantation, reliable osteointegration and long-term stability even in high demanding patients.
The mid-term longevity of femoral components varies considerably, with some showing failure due to early aseptic loosening. Since the hip joint is subject to heavy mechanical loads, it can be assumed that the mechanical interaction of the implant, bone cement and femur will play a key role in the resultant reliability of an arthroplasty. This study was designed to examine this mechanical interaction in four femoral components different in construction (Poldi-Cech, CF-30, MS-30 and PFC) using mathematical simulation. MATERIAL AND METHODS Four stem/cement/femur 3-D mathematical models, comparable in quality, infolving the Poldi-Cech, CF-30, MS-30 and PFC stems, respectively, were constructed. A 3-D model for each stem was created according to its real, middle-size femoral component. Each 3-D model of the cement mantle corresponded in shape to the mantle of the appropriate real stem, with its thickness based on the recommended values of 4-7 mm in the proximal and 1-3 mm in the distal part, and with the cement mantle reaching as far as 10 mm distal to the femoral stem tip. For simplicitys sake the outer surface of the cement mantle was simulated as smooth. A 3-D model involving the proximal epiphysis and the metaphysis of a femur was reconstructed, based on a series of CT cross-sections obtained periodically at 10.5-mm and 2.5-mm distances. The sten/cement/femur model with the MS-30 stem also included a centraliser. The mechanical interaction of the stem, bone cement and bone tissue was examined by means of mathematical stimulation using ANSYS 5.7 software based on finite element analysis. RESULTS For the sake of simplicity, only two key parameters are presented, namely, contact stress at the stem-cement interface and equivalent deformation in the stem/cement/femur system. The least satisfactory stress loading was in the CF-30 stem whose sharp edges showed the values of contact stress about six-times higher than on the mid-medial portion of the stem, with the sharp edges behaving as stress concentrators. A satisfactory stress loading was found in Poldi-Cech, MS-30 and PFC stems, in which contact stress was evenly distributed along the whole lenght of the stem and the values at the edges and on the midmedial portion did not differ much. DISCUSSION The distribution of contact stress is one of the most important factors for the long-term longevity of implants. It was found least satisfactory in the CF-30 stem whose sharp edges act as stress condenser adversely affecting not only the stemcement interface, but also the resultant stress distribution within the femur. The most satisfactory results of stress distribution were recorded in the Poldi-Cech and MS-30 stems. The PFC stem also responded satisfactorily to the simulated stress loading. However, on loading whose substantial part would be torsion, the stems circular or oval cross-section could interfere with rotation stability of the implant; but this was impossible to detect by the mathematical simulation used in this study. CONCLUSIONS The results presented here show that, in the Poldi-Cech, CF-30, MS-30 and PFC femoral stems, a good agreement was achieved between the results of their clinical application and those of mathematical modelling of their mechanical properties. It can be concluded that mechanical interaction among the femoral stem, cement mantle and bone tissue plays the key role in the long-term longevity of such an implant. Key words: Poldi-Cech, CF-30, MS-30, PFC, mechanical interaction, contact stress.
- MeSH
- femur MeSH
- kostní cementy MeSH
- kyčelní protézy MeSH
- lidé MeSH
- mechanický stres MeSH
- počítačová simulace MeSH
- Check Tag
- lidé MeSH
Cílem studie bylo měření periprotetické hustoty kosti BMD (bone mineral density – hustota kostního minerálu), kterou jsme měřili metodou DEXA (duálně energetické rentgenové měření absorpce). BMD je objektivní parametr, kterým lze posoudit změny mechanických vlastností femuru. Hustotu kosti jsme měřili pomocí přístroje Hologic 2000 v sedmi Gruenových zónách. Jedná se o zóny velkého trochanteru, kalkaru, laterální a mediální oblasti střední části dříku, laterální a mediální oblasti dolní části dříku a oblast pod hrotem dříku. Denzitometrické vyšetření bylo provedeno desátý den po operaci, rok po ní a za dva roky po operaci. Srovnávali jsme BMD v jednotlivých časových údobích u dříků PFC, Exeter a CLS. Z denzitometrických vyšetření jako nejlepší vychází cementový dřík Exeter, u něhož došlo ke statisticky významnému zvýšení středních hodnot BMD celkem ve čtyřech zónách (R1, R3, R4, R5). U necementovaného dříku CLS došlo ke statisticky významnému zvýšení BMD ve třech zónách (R1, R4, R5). Z pohledu denzitometrie se jako nejhorší jeví cementovaný dřík PFC, u něhož se nepodařilo zjistit statisticky významné změny středních hodnot v žádné zóně. Denzitometrie může být přínosem pro zhodnocení a sledování kvality kosti kolem dříku totálních endoprotéz kyčelního kloubu.
The aim of this study was to measure periprosthetic bone mineral density (= BMD). We measured BMD by DEXA (= dual energetic X-ray absorption). BMD is an objective parameter by which changes of mechanical properties of the femur can be assessed. BMD was measured by Hologic 2000 in seven Gruen´s areas. It means: greater trochanter area, calcar area, area of lateral and medial zone of middle part of the femoral stem, area of lateral and medial zone of lower part of the femoral stem and area under the tip of the femoral stem. Densitometric measurement was made 10 days after the implantation of total hip arthroplasty (= THA), one year and two years after the operation. In such time intervals after implantation the PFC stem, Exeter stem and CLS stem BMD were compared. Exeter stem shows the best densitometric data. There is a statistic significant increase of medial values of BMD in four areas (R1, R3, R4, R5). Non-cement stem CLS has a statistic significant increase in three areas (R1,R4, R5). Cemented PFC stem has the worst densitometric measurement. There is no statistic significant increase of BMD in any areas. The densitometric measurement can contribute to evaluating and monitoring the quality of periprosthetic bone around the femoral stem of the THA.
- MeSH
- artroskopie metody MeSH
- kotvící implantáty MeSH
- lidé MeSH
- luxace ramenního kloubu chirurgie MeSH
- Check Tag
- lidé MeSH
Cílem sdělení je podat stručný přehled možností ošetření ramenního kloubu pomocí artroskopie. Ramenní kloub je druhým nejčastěji artroskopovaným kloubem. S rozvojem videotechniky, instrumentárií a zkušeností dochází k rozšiřování spektra operačních výkonů. V úvodu autoři popisují základní artroskopické instrumentarium, polohu pacienta, základní operační přístupy do glenohumerálního kloubu a subakromiálního prostoru a komplikace metody. Indikace k artroskopii ramenního kloubu je impingement syndrom a léze rotátorové manžety, instabilita ramenního kloubu, SLAP léze, léze šlachy dlouhé hlavy bicepsu, synovitida a léze chrupavek. Podrobněji se autoři zabývají impingement syndromem, jeho rozdělením, klasifikací dle Neera, diagnostikou a možnostmi řešení.
The aim of this notification is to give a brief survey of shoulder joint treatment possibilities by means of arthroscopy. The shoulder joint is the second most frequently arthroscopied joint. The wide spectrum of operations responds to the development of video technique, surgical instruments and experience. In the introduction of that issue, the authors describe basic arthroscopic instruments, position of the patient, basic operational approaches to glenohumeral joint and subacromial space, as well as complications of the method. Indication for shoulder joint arthroscopy is impingement syndrome and lesion of rotator cuff, instability of shoulder joint, SLAP lesion, synovialitis and lesion of cartilage. The authors are specifically engaged in impingement syndrome, its division, classification according to Neer, diagnostics and possible solutions.
- MeSH
- anestezie metody využití MeSH
- artroskopie metody využití MeSH
- artroskopy klasifikace využití MeSH
- chirurgické nástroje klasifikace využití MeSH
- lidé MeSH
- nestabilita kloubu chirurgie terapie MeSH
- poranění ramene MeSH
- ramenní kloub chirurgie patologie MeSH
- rotátorová manžeta chirurgie MeSH
- syndrom zhmožděného ramene chirurgie terapie MeSH
- video-asistovaná chirurgie metody přístrojové vybavení využití MeSH
- Check Tag
- lidé MeSH
- MeSH
- artroskopie metody MeSH
- lidé MeSH
- luxace pately chirurgie rehabilitace MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
