Liječenje displazija kuka u odrasloj dobi

master's thesis

• Title (english): Hip dysplasia treatment in adults
• Author: Uršula Fabijanić
• Mentor: Domagoj Delimar (mentor)
• Committee member: Mislav Jelić (predsjednik povjerenstva)
• Committee member: Tomislav Đapić (član povjerenstva)
• Committee member: Domagoj Delimar (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Orthopedics); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Orthopedics

Abstract

Razvojni poremećaj kuka u odrasloj dobi (RPKOD) je najčešći uzrok sekundarne koksartroze koji se češće javlja u žena i uglavnom je unilateralan. U ovom preglednom radu prikazani su različiti oblici liječenja RPKOD. Neoperacijsko liječenje RPKOD ima za cilj smanjenje simptoma i odgađanje operacijskog zahvata za određeno razdoblje. Kako RPKOD obuhvaća niz različitih anatomskih promjena zgloba do sada su razvijene različite operacijske tehnike i pristupi kojima se pokušava obnoviti anatomska i biomehanička funkcija zgloba. Osteotomije zdjelice uglavnom se izvode kod bolesnika mlađe životne dobi s minimalnim znakovima koksartroze dok je za teže oblike potrebna ugradnja totalne endoproteze (TEP). Ugradnja TEP tehnički je zahtjevna zbog promijenjene anatomije acetabuluma i proksimalnog femura te posljedičnog skraćenja zahvaćenog ekstremiteta. Cilj ugradnje TEP je osigurati dugoročnu stabilnost TEP, postaviti acetabularnu komponentu na mjesto pravog acetabuluma, postići normalnu biomehaniku i anatomiju zgloba te izjednačiti duljinu ekstremiteta. Kako bi se postigli zadovoljavajući dugoročni rezultati razvijeno je nekoliko različitih operacijskih pristupa i tehnika ugradnje TEP kod bolesnika s RPKOD, tako je primjerice na Klinici za ortopediju Kliničkog bolničkog centra Zagreb i Medicinskog fakulteta Sveučilišta u Zagrebu razvijen modificirani lateralni pristup zahvaljujući kojemu se postižu jednaki rezultati kod bolesnika s težim stupnjem RPKOD kao i kod bolesnika s blažim stupnjem RPKOD. Usprkos brojnim operacijskim tehnikama i pristupima opisanima u literaturi, potrebno je provesti veći broj studija dugoročnog praćenja bolesnika na temelju kojih bi se moglo zaključiti koje operacijske tehnike pružaju najbolje rezultate i koje skupine bolesnika su kandidati za određenu operacijsku tehniku i pristup.

Abstract (english)

Developmental dysplasia of the hip in adults (DDHA) is most common cause of secondary osteoarthritis. DDHA is more common in female and in most cases is unilateral. This graduate thesis is a short review of the most important treatment modalities. The primary goal of non-surgical treatment is to decrease symptoms and postpone surgery. Since DDHA includes spectrum of different anatomical changes of the hip, the aim of the operative treatment is to reestablish normal biomechanics and anatomy. Therefore, a number of different surgical techniques and approaches were developed over time. Pelvic osteotomies are predominantly performed in young patients with minimal signs of osteoarthritis, while in severe types of DDHA a total hip replacement (THR) is necessary. THR in DDHA is considered as a technically demanding procedure due to abnormal anatomy of the acetabulum and proximal femur which are frequently accompanied with leg length discrepancy. Primary goals of THR are placement of the acetabular cup at normal position, restoration of normal biomechanics and anatomy of the hip, correction of leg length discrepancy and insurance of long term stability of endoprothesis. Different surgical approaches and techniques are developed in addition to insure satisfactory long term results. Modification of lateral approach was developed at Department of Orthopedic Surgery, School of Medicine, University of Zagreb, and Clinical Hospital Centre Zagreb thanks to which is possible to achieve the same results among patients with severe types of DDHA compared to a group of patients with mild types of DDHA. Even though numerous different techniques and approaches are described in literature, there is a lack of long-term follow-up studies based on which it could be possible to conclude which surgical techniques provide the best results and which patient groups are candidates for a particular surgical technique and approach.

• Keywords: razvojni poremećaj kuka u odrasloj dobi; sekundarna koksartroza; osteotomija zdjelice; totalna endoproteza; modificirani lateralni pristup
• Keywords (english): developmental dysplasia of the hip in adults; secondary osteoarthritis; pelvic osteotomy; total endoprothesis; modification of lateral approach
• Language: croatian
• URN:NBN: urn:nbn:hr:105:349888
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-03-19 13:49:06