单骨假体置换术后假体不稳定的解剖学和功能先决条件

O. Karpinska, Rami Tale Khaled Wahbeh
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引用次数: 0

摘要

单髁膝关节置换术允许恢复正常的运动学和膝关节功能的情况下,骨关节炎局限于关节的内侧或外侧部分。目标。根据患者的性别、体重、关节病的病因、原发性关节畸形的程度和骨组织状况,确定单髁关节置换术后膝关节继发解剖和功能改变的模式和特征。方法。对71例患者(年龄37 ~ 83岁,随访3 ~ 10年)的检查结果进行分析。在20例(28.2%)患者中,出现了关节置换术的问题。关节:前部畸形角度增加- 8(40%),关节活动度下降- 12(60%),植入区疼痛- 10(50%)。结果。术前可能影响单芯膝关节置换术结果的因素被确定。主要是骨密度降低,尤其是局部骨质疏松。在关节置换术区存在骨质疏松区域时,假体不稳定的风险可达100%。第二个重要因素是膝关节额部畸形超过10°。其他因素,如肥胖、半月板和交叉韧带损伤、股骨和胫骨髁骨折,也会影响并发症的发生,尤其是骨密度降低和/或膝关节明显的额部畸形。结论。单髁膝关节置换术是一种可靠、有效、低创伤的治疗膝关节病的方法,但需要明确的适应症。长期来看,骨质疏松、半月板和韧带损伤、髁突骨折和额部畸形超过10°的患者可能出现假体不稳定的迹象。
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ANATOMICAL AND FUNCTIONAL PREREQUISITES FOR THE DEVELOPMENT OF ENDOPROSTHESIS INSTABILITY AFTER MONOCANDYLAR KNEE ARTHROPLASTY
Monocondylar knee arthroplasty allows to restore normal kinematics and function of the knee joint in the case of osteoarthritis limited to the medial or lateral part of the joint. Objective. To identify the patterns and features of secondary anatomical and functional changes in the knee joint after monocandylar arthroplasty depending on the patientʼs gender, weight, etiology of gonarthrosis, the magnitude of the primary joint deformity and bone tissue condition. Methods. The results of the examination of 71 patients (age 37–83 years, follow-up period 3–10 years) were analyzed. In 20 (28.2 %) patients, problems with the arthroplasty joint occurred. joint: increased frontal deformity angle — 8 (40 %), decreased joint mobility — 12 (60 %), pain in the implantation area — 10 (50 %). Results. Preoperative factors that may affect the outcome of monocandylar knee arthroplasty were identified. The main one is reduced bone density, especially localized osteoporosis. In the presence of osteoporotic areas in the area of arthroplasty, the risk of endoprosthesisinstability can reach 100 %. The second important factor is frontal deformities of the knee joint of more than 10°. Other factors, such as obesity, meniscal and crossed ligament injuries, fractures of the femoral and tibial condyles, also affect the development of complications, especially with a simultaneousdecrease in bone mineral density and/or significant frontal deformity of the knee joint. Conclusions. Monocondylar knee arthroplasty is a reliable, costeffective, low-traumatic method of treating gonarthrosis, but subject to clear indications for its implementation. In the long term, patients with osteoporosis, meniscal and ligamentous injuries, fractures of the condyles, and frontal deformities of more than 10° may develop signs of endoprosthesis instability.
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