Morfološke promene glave i vrata femura kao faktor rane artroze kuka i hiruško lečenje
Anđelković, Zoran R.
Faculty:University of Niš, Faculty of Medicine
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Introduction: Femoroacetabularni impingement is the pathophysiological mechanism of early contact of the femoral head and neck junction with the anterior or antero-superior edge of the acetabulum, in patients with the small morphological bone changes in the hip. Objective: To prove that there are at least two main morphotypes changes in the proximal femur: one, with femoral head tilt posterior and/or inferior, relative to the femoral neck in patients with cam form of the femoroacetabular impingement and the other morphotype, without femoral head tilt in relation at the femoral neck or, if the tilt exists, then it was significantly lower in patients with mixed form of femoroacetabular impingement. To show, that surgical correction of soft tissue and bone changes in the form of a bone bank at the femoral head and neck junction in patients with cam and mixed form femoroacetabular impingement, leads to a significant improvement of subjective complaints of patients, objekiv clinical findings
and to the stabilization of radiographic parameters in relation to preoperative findings. Method: The study included three groups of respondents, 78 pilot group persons, 28 mixed form femoroacetabular impingement operated persons and 31 cam form femoroacetabular impingement operated persons. All subjects were aged 18-55 years, approximately equal gender representation. In pilot group pearsons, only anteroposterior and profile radiographs of the hips were done, and in operated person, clinical and operative method was used in addition to radiographic images, and all tested parameters were statistically analyzed. On the hips radiograms, parameters available in the literature and the parameters identified for the first time were measured and tested for the purpose of this dissertation. Results: Results of the dissertation were grouped on demographic, clinical and radiographic results with special emphasising of the normal radiographic values in patients of the pilot group and pathological values of clinical and radiographic preoperative and postoperative results of the operated patients of mixed and cam form of femoroacetabular impingement. For the pilot group pearsons parameter values, that exist in the literature were, standardized and compared with the same values of the newly introduced parameters that are not present yet in the literature, and in other operated person, the values of all parameters were tested before and after surgery, and than compared with the values of those of the pilot group pearsons and with the values that exist in the literature. Newly introduced parameters by using contingency tables were tested for sensitivity, specificity, positive and negative predictive values of parameters. There were significant differences between preoperative and postoperative values of the tested parameters in both operated groups and using the newly introduced parameters four morphotypes of the femoral head tilt relative to the neck were identified. Conclusion: We have identified two morphotypes of the secondary bone changes at the femoral head and neck junction that are significantly different between the pearsos operated from mixed and cam form of the femoroacetabular impingement. Four types of primary pathological changes in the form of the femoral head tilt were found with a significant difference in the degree of inclination of the slope and in the distribution of the femoral head tilt in both operated group of persons. There were a significant differences in the preoperative and postoperative values of parameters within each group of the operated persons, and a significant difference in the values of the tested parameters between the groups, but overall, there was a significant improvement of subjective, clinical and radiographic parameters after surgical treatment of the both operated groups of pearsons.View More
Keywords:artroza kuka; hip osteoarthritis; femoroacetabularni impingement; morfološke promene; operativno lečenje; femoroacetabular impingement; morphological changes; surgical treatment