• MeSH
• artroplastiky kloubů metody   přístrojové vybavení   trendy   MeSH
• keramika MeSH
• kyčelní protézy škodlivé účinky   využití   MeSH
• lidé MeSH
• náhrada kyčelního kloubu MeSH
• protézy - design trendy   MeSH
• protézy kloubů * dějiny   MeSH
• totální endoprotéza kolene MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• historické články MeSH

Zlomeniny proximálního femuru patří mezi častá poranění. U dětí a u pacientů s fyziologickou kostní strukturou souvisejí s vysoko energetickým traumatem, u starších pacientů jsou typická nízko energetická traumata při osteoporóze. Tyto zlomeniny se rozdělují na zlomeniny hlavice, krčku, dále pertrochanterické, intertrochanterické a subtrochanterické. Není-li kontraindikace, vždy je indikována operační léčba. Dlouhý klidový režim na lůžku doprovází vysoké riziko rozvoje tromboembolické nemoci, pneumonie i dekubitálních lézí. Výsledkem konzervativní léčby u extrakapsulárních zlomenin je navíc zhojení ve špatném postavení nebo rozvoj pakloubu. U izolovaných zlomenin hlavice femuru je prováděna osteosyntéza šrouby. U zlomenin krčku femuru a vitální hlavici se provádí osteosyntéza 3 kanylovanými šrouby nebo dlahou typu DHS (dynamic hip screw), u avitální hlavice a u starších pacientů je implantována náhrada kyčelního kloubu. Pertrochanterické a intertrochanterické zlomeniny lze fixovat nitrodřeňovou osteosyntézou (PFN, PFN A, PFH – proximal femoral nail/hřeb), která umožňuje i miniinvazivní zavedení a má vyšší stabilitu v oblasti diafýzy, nebo dlahovou osteosyntézou (DHS) určenou pro stabilní pertrochanterické zlomeniny. Subtrochanterické zlomeniny lze stabilizovat nitrodřeňově (PFN long, PFN A long), popř. dlahou (DCS – distal condylar screw, proximální femorální LCP – locking compression plate). Otevřená repozice s dlahou je výhodná u patologických zlomenin, neboť umožňuje odběr bioptického vzorku. Nedílnou součástí léčby je rehabilitace, která zahrnuje chůzi o berlích, popř. v chodítku s odlehčením po dobu nejméně 6 týdnů.

Hip fractures are ranked among the frequent injuries. These fractures have been often coupled with high energy trauma in children and in patients with normal bone structure, low energy trauma and osteoporotic fracture (fragility fracture) is typical in elder patients. Hip fractures are divided into five groups: femoral head fracture, femoral neck fracture, pertrochanteric, intertrochateric and subtrochanteric fracture. Surgical treatment is indicated in all patients unless contraindications are present. Long bed rest has been accompanied by a high risk of development of thromboembolic disease, pneumonia and bed sore. Healing in the wrong position and nonunions are often the result of conservative treatment. Screw osteosynthesis is performed in isolated femoral head factures. Three cannulated screws or a DHS plate (dynamic hip screw) are used in fractures of the femoral neck with normal femoral head perfusion, total hip replacement is recommended in elder patients and in case of loss of blood supply of the femoral head. Pertrochanteric and intertrochanteric fractures can be stabilized by the femoral nails (PFN, PFN A, PFH – proximal femoral nail), nails are suitable for minimally invasive insertion and provide higher stability in the shaft, or plates (DHS) designed for stable pertronchanteric and intertrochanteric fractures. Subtrochanteric fractures can be fixed also intramedullary (nails – PFN long, PFN A long) and extramedullary (plates - DCS dynamic condylar screw, proximal femoral LCP – locking compression plate). Open reduction with internal plate fixation is advantageous for pathological fractures, as biopsy sampling can be performed. Hip fracture rehabilitation is integral part of the treatment, including walking on crutches or with a walker with partial weight bearing for at least six weeks.

• Klíčová slova
• proximální femur, dlahová osteosyntéza, femorální hřeby,
• MeSH
• dlahy MeSH
• femur anatomie a histologie   chirurgie   zranění   MeSH
• fraktury femuru * diagnóza   klasifikace   terapie   MeSH
• fraktury krčku femuru diagnóza   klasifikace   terapie   MeSH
• hlavice femuru chirurgie   zranění   MeSH
• interní fixátory MeSH
• intramedulární fixace fraktury metody   MeSH
• kostní hřeby MeSH
• kyčelní kloub * anatomie a histologie   chirurgie   MeSH
• kyčelní protézy využití   MeSH
• lidé MeSH
• náhrada kyčelního kloubu MeSH
• ortopedické výkony * MeSH
• osteoporóza MeSH
• pooperační komplikace MeSH
• radiografie MeSH
• vnitřní fixace fraktury metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

At the present time proximal femoral fractures account for 30% of all fractures referred to hospitals for treatment. Our population is ageing, the proportion of patients with post-menopausal or senile osteoporosis is increasing and therefore the number of proximal femoral fractures requiring urgent treatment is growing too. In the age category of 50 years and older, the incidence of these fractures has increased exponentially. Our department serves as a trauma centre for half of Prague and part of the Central Bohemia Region with a population of 1 150 000. Prague in particular has a high number of elderly citizens. Our experience is based on extensive clinical data obtained from the Register of Proximal Femoral Fractures established in 1997. During 14 years, 4280 patients, 3112 women and 1168 men, were admitted to our department for treatment of proximal femoral fractures. All patients were followed up until healing or development of complications. In the group understudy, 82% were patients older than 70 years; 72% of those requiring surgery were in their seventies and eighties. Men were significantly younger than women (p<0.001) and represented 30% of the group. The fractures were 2.3-times more frequent in women than in men. In the category under 60 years, men significantly outnumbered women (p<0.001). The patients with pertrochanteric fractures were, on the average, eight years older than the patients with intertrochanteric fractures, which is a significant difference (p<0.001). The mortality rate within a year of injury was about 30%. Trochanteric fractures accounted for 54.7% and femoral neck fractures for 45.3% of all fractures. The inter-annual increase was 5.9%, with more trochanteric than femoral neck fractures. There was a non-significant decrease in intertrochanteric (AO 31-A3) fractures. On the other hand, the number of pertrochanteric (AO 31-A1+2) fractures increased significantly (p<0.001). A total of 1 394 fractures were treated with a proximal femoral nail; a short nail was used in 1260 and a long nail in 134 of them. A dynamic hip screw (DHS) was employed to treat 947 fractures. Distinguishing between pertrochanteric (21-A1, 31-A2) and intertrochanteric (31 -A3) fractures is considered an important approach because of their different behaviour at reduction. Pertrochanteric fractures occurred more frequently (81.5%); the patients' age was higher (80 years on the average) and women outnumbered men at a ratio of 3:1. Intertrochanteric fractures were found in significantly younger patients (average, 72 years), with a women-to-men ratio of 1.3:1. Stable pertrochanteric fractures (31-A1) were preferably indicated for DHS surgery. Unstable pertrochanteric (31-A2) and intertrochanteric (31-A3) fractures were treated with a nail. The patients underwent surgery on the day of injury or the next day. In the case of contraindications to an urgent intervention, surgery was performed after the patient's medical condition had stabilised. The number of complications was largely related to technical errors, such as insufficient reduction or an incorrectly inserted implant. Intertrochanteric fractures were associated with a higher occurrence of complications. No implant can compensate for errors due to surgery. Serious complications can be reduced by the correct assessment of fracture type, the use of an appropriate operative technique and early treatment of potential complications. The necessity of restoring continuity in the medial cortex of the femoral neck (Adams' arch) is the requirement that should be observed. Pseudoarthrosis or varus malalignment in a healed hip should be managed by valgus osteotomy. When the femoral head or the acetabulum is damaged, total hip arthroplasty is indicated. A prerequisite for successful surgical outcome is urgently and correctly performed osteosynthesis allowing for early rehabilitation and mobilisation of the patient

• MeSH
• dlahy využití   MeSH
• fraktury kyčle * epidemiologie   chirurgie   klasifikace   MeSH
• intramedulární fixace fraktury * metody   MeSH
• kostní šrouby využití   MeSH
• kyčelní protézy využití   MeSH
• lidé MeSH
• pooperační komplikace * etiologie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• přehledy MeSH

x

• Klíčová slova
• operace, totální endoprotéza, edukace,
• MeSH
• kyčelní kloub * chirurgie   MeSH
• kyčelní protézy využití   MeSH
• lidé MeSH
• ortopedie MeSH
• ošetřovatelská péče MeSH
• péče o pacienta * metody   MeSH
• perioperační péče metody   ošetřování   MeSH
• pooperační péče metody   ošetřování   MeSH
• předoperační péče metody   psychologie   MeSH
• zdravotní sestry MeSH
• Check Tag
• lidé MeSH

PURPOSE OF THE STUDY The aim of the study was to analyse the long-term clinical and radiographic results of total hip arthroplasty (THA) with the Bicontact-Plasmacup prosthesis. MATERIAL AND METHODS In this retrospective observational study, 34 consecutive patients undergoing Bicontact-Plasmacup THA between August 1998 and July 2000 were evaluated. The group included 15 women and 19 men with an average age of 56 years (30 to 67 years). The mean ? SD of follow-up was 132 ? 9 months (122 to 149 months). Patients' satisfaction with the treatment outcome and selected clinical and radiographic features were evaluated. The data were analysed using the concordance test, Spearman's correlation coefficient and chi-square test. RESULTS At the final follow-up, 94% of the interviewed patients reported satisfaction with the surgery outcome. The mean Harris score was 93 (67 to 98) points, with excellent or very good results in 91% of the patients. Compared with the post-operative radiographs, the mean ? SD value for vertical migration of the acetabular cup was 2.43 ? 3.21 mm (0 to 12 mm) and that for horizontal migration was 0.35 ? 1.0 mm (0 to 4.3 mm). The mean stem subsidence was by 3.87 mm (range, 0.36 to 21.11 mm; SD 4.03). At the final follow-up, all implants showed radiographic stability and absence of radiolucent lines. Early acetabular osteolysis was detected in two patients (5.9 %). In 19 patients (56%) a change in bone architecture, similar to alterations due to weight-bearing adaptation, was seen around the cup following surgery. The stress shielding effect of the femoral component was recorded in 79%, bypass phenomenon in 41 % and pedestal formation under the apex of the stem in 18% of the patients. The mean rate of polyethylene wear measured by the Dorr and Wan method was 0.106 mm per year (range, 0.00 to 0.267 mm) or it was 0.078 mm per year (0.00 to 0.19 mm) when assessed by a modification of the method described by Kang et al. DISCUSSION The clinical and radiographic findings presented here are in accordance with the relevant literature data. This implant design is associated with a relatively infrequent osteolysis around the cup probably due to a low wear rate of polyethylene and a stable polyethylene liner-metal cup interface. Based on this work and some other studies it can be concluded that a post-operative migration of several millimetres is compatible with a long-term, stable cementless THA. CONCLUSIONS The Bicontact-Plasmacup THA meets the National Institute for Health and Clinical Excellence (NICE) criteria for a very good implant (ten-year survival rate of over 90%). At 10 years after surgery, however, the first signs of complaints about surgery outcome // dissatisfaction with surgery outcomes were recorded. This may, at least partly, be related to aseptic loosening which is one of the symptoms of particle disease.

• Klíčová slova
• Plasmacup-Bicontact,
• MeSH
• dospělí MeSH
• financování organizované MeSH
• interpretace statistických dat MeSH
• kyčelní protézy statistika a číselné údaje   využití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu MeSH
• následné studie MeSH
• protézy a implantáty klasifikace   statistika a číselné údaje   využití   MeSH
• průzkumy a dotazníky MeSH
• radiografie MeSH
• retrospektivní studie MeSH
• senioři MeSH
• spokojenost pacientů MeSH
• výsledek terapie MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) klasifikace   statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH

PURPOSE OF THE STUDY Revision total hip arthroplasty is a demanding surgical procedure. It involves a massive loss of acetabular bone stock associated with primary implant removal, and a complicated revision cup fixation in the highly damaged surrounding bone. The authors describe the use of a novel oblong acetabular cup, type TC (Trč-Cingr), for replacement of a loose a cetabular component. The aim of the study is to present this novel implant with evaluation of the first clinical results and to report on the authors' experience with revision arthroplasty assessed at 24 to 62 months of follow-up. MATERIAL The TC cup was used in revision total hip arthroplasty in 40 patients treated between February 2004 and June 2007. Aseptic loosening of a cemented cup was an indication for surgery in the majority of patients. The first 10 treated patients were supervised, according to the strict rules of good clinical practice, by the State Institute for Drug Control. A total of 31 patients were evaluated. There were 20 women and 11 men with an average age of 68 years (range, 41 to 81 years) at the time of primary implantation. METHODS At the end of 2009, 31 patients were evaluated at a follow-up of 24 to 62 months (average, 44.8 months) after revision surgery. The patients' age, gender, body mass index, physical activity, diagnosis for indication, implant size and intra- and post-operative complications were recorded. The development of secondary implant stability was assessed on X-ray films taken at 3, 6, and 12 months and then at 1 year after surgery. Attention was paid to implant and screw positions and potential implant migration and signs of osteolysis around the cup and screws. An objective assessment of the results was obtained by comparing the pre- and post-operative values of the Harris hip score (HHS). RESULTS A femoral component was replaced together with a revision cup in 20 patients. The average HHS value increased from 41.86 points pre-operatively to 82.70 points post-operatively. The results were recorded as excellent in six, very good in 17, satisfactory in six and poor in two patients. The radiographic findings showed good bone-implant integration in 26 patients and radiolucent lines < 1mm in width in DeLee zone 3 in three patients. In one overweight patient, discontinuity of two proximally inserted screws, but no detectable implant migration, was recorded. There was only one case of proximal migration of the TC cup, with osteolysis detected around all screws (Paprosky type 3B defect). DISCUSSION The acetabular cup is the most frequently re-implanted component in our country. This is due to a high proportion of total hip arthroplasties with the previous frequent use of a cemented POLDI prosthesis whose neck in a valgus position probably played its role in increased wear of the cup. Acetabular bone defects are usually extensive and the operative tactics are based on the Paprosky classification. Type 3A and 3B defects, exceptionally also type 2C defects, are most serious and acetabular cup replacement is most difficult. The oval-shaped uncemented TC cup was developed with the objective to reconstruct defects on the bottom of the acetabulum, with stable and firm primary fixation of the implant secured in bone with implant augmentation screws and additional fixation screws. Good primary fixation with bone grafting to fill defects and spaces between implant ribs should facilitate bone remodelling in the close vicinity of the cup. A minimum of 24 months after revision cup implantation is regarded as sufficient for an objective evaluation of hip function and radiographic evidence of good bone-implant integration. CONCLUSIONS The results show good applicability of the oval-shaped implant which is easy to implant, maintains good primary fixation and allows for good bone remodelling in its vicinity.

• MeSH
• acetabulum * MeSH
• kyčelní protézy * využití   MeSH
• lidé MeSH
• náhrada kyčelního kloubu * metody   MeSH
• osteointegrace MeSH
• protézy a implantáty využití   MeSH
• reoperace * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH

The authors discuss arguments concerning indications and selection of implants and operative techniques for arthroplasty in the treatment of femoral neck fractures. Their analysis is based on long-term experience with surgical treatment of patients with hip fractures and on the evaluation of a large number of publications by well-known specialists. The assessed group included 4795 patients treated at their institution between 1997 and 2010, of whom 1532 underwent hip replacement, with 1032 receiving hemiarthroplasty (HA) and 500 having total hip replacement (THR) indicated for femoral neck fractures. A painful hemiarthroplasty due to acetabular cartilage erosion and subsequent head protrusion is still a challenging clinical problem. The most important factor in prevention of this complication remains strict adherence to indication criteria. A metal monoblock hemiarthroplasty should be indicated only in very old patients with serious co-morbidities or in patients whose pre-operative mobility has been greatly restricted. For the other cases, a modular prosthesis is preferred because it allows for more exact alignment and, if necessary, its conversion to a total hip prosthesis is relatively easy. The stem to be implanted should be the one used in standard THR procedures. A ceramic modular head then enables hemiarthroplasty to function for long with a low risk of cartilage erosion and head protrusion. Even if the choice of an optimal prosthesis, in terms of its biomechanical and biological properties, has been correct, the prosthesis' long life span and good functioning still depends on the surgeon's adherence to the principles of the correct operative technique (the head centre situated 1 to 2 mm below the level of the apex of the greater trochanter, 12- to 15-degree anteversion, articular capsule suture, and re-insertion of external rotator tendons if the Koch-Langenbeck approach is used. This is the only way of minimising acetabular erosion and other complications. Indications for total replacement include, in addition to fractures at joints affected by arthritis, most often a displaced fracture of the femoral neck found in younger patients still in good general health with a good prospect for a long life. Even if dislocation and loosening occur in these patients more often than in those with a THR procedure indicated for other reasons (primary or post-dysplastic arthritis), this therapy offers fewer complications and longer functioning in comparison with other methods of treating femoral neck fractures. A cemented prosthesis can be regarded as the standard implant; however, if the proximal femur shows good quality cortical bone, an uncemented implant can be used without a greater risk of future loosening. In the absence of hip arthritis which leads to the development of subchondral sclerosis required for the correct acetabular cup fixation, a hybrid THR with an expansion cup or a screw-in cup is recommended.

• MeSH
• časové faktory MeSH
• cementování metody   využití   MeSH
• fraktury krčku femuru * chirurgie   klasifikace   MeSH
• kyčelní protézy * normy   využití   MeSH
• lidé MeSH
• náhrada kyčelního kloubu * metody   MeSH
• pooperační komplikace epidemiologie   etiologie   MeSH
• protézy - design MeSH
• senioři MeSH
• věkové faktory MeSH
• vnitřní fixace fraktury * metody   využití   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• implantace protézy metody   MeSH
• kyčelní kloub chirurgie   MeSH
• kyčelní protézy využití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• longitudinální studie MeSH
• náhrada kyčelního kloubu metody   MeSH
• statistika jako téma MeSH
• výsledek terapie MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• výzkum statistika a číselné údaje   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH

• MeSH
• kyčelní protézy klasifikace   využití   MeSH
• lidé MeSH
• náhrada kyčelního kloubu metody   ošetřování   využití   MeSH
• perioperační péče metody   MeSH
• pooperační péče metody   MeSH
• Check Tag
• lidé MeSH

Zlomeniny proximálního femuru (dále jen PF), tj. zlomeniny krčku a zlomeniny trochanterické, jsou jedny z nejčastějších zlomenin, se kterými se v traumatologické praxi setkáváme. Přesná celostátní statistika sice neexistuje, nicméně podle střízlivých odhadů dochází v České republice k 8 až 11 tisícům těchto zlomenin ročně. Průměrný věk pacientů se pohybuje kolem 78 let. To znamená, že zlomeniny proximálního femuru jsou problémem nejen terapeutickým, ale i sociálním a ekonomickým.

• Klíčová slova
• Mydocalm,
• MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• fraktury femuru diagnóza   chirurgie   terapie   MeSH
• fraktury krčku femuru diagnóza   chirurgie   terapie   MeSH
• fraktury kyčle diagnóza   chirurgie   terapie   MeSH
• kyčelní protézy využití   MeSH
• lidé MeSH
• magnetická rezonanční tomografie využití   MeSH
• ortopedické výkony metody   využití   MeSH
• pooperační komplikace klasifikace   ošetřování   terapie   MeSH
• pooperační péče metody   MeSH
• primární prevence metody   MeSH
• prospektivní studie MeSH
• radiografie metody   využití   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• úrazy pádem MeSH
• vnitřní fixace fraktury metody   využití   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH