Liječenje ruptura rotatorne manžete ramena

master's thesis

• Title (english): Treatment of shoulder rotator cuff tears
• Author: Laura Karla Božić
• Mentor: Ivan Bohaček (mentor)
• Committee member: Tomislav Smoljanović (predsjednik povjerenstva)
• Committee member: Tomislav Đapić (član povjerenstva)
• Committee member: Ivan Bohaček (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anatomy and Clinical Anatomy); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Basic Medical Sciences; Anatomy

Abstract

Ruptura rotatorne manžete ramena predstavlja ozljedu tetivno-mišićne ovojnice koju čine četiri mišića (supraspinatus, infrapsinatus, subskapularis, teres minor). Oštećenje već samo jednog od navedenih mišića bitno smanjuje funkciju ramena, odnosno ruke. Klinička slika uključuje prvenstveno bol u ramenu, pretežito s vanjske strane nadlaktice, posebice kod poslova koji uključuju dizanje ruke iznad razine ramena. Također, uključuje slabost ruke te poteškoće u obavljanju, inače, jednostavnih svakodnevnih poslova. Većinom se radi o degenerativnim rupturama kod starijih osoba, ali ruptura se može javiti i u mlađih osoba koje se bave poslovima koji uključuju učestala dizanja ruku. Glavna dijagnostička sredstva, uz anamnezu i klinički pregled, su ultrazvuk i magnetna rezonancija kojima se može procijeniti rupturirana tetiva i veličina same rupture, a u većini slučajeva oštećena je tetiva supraspinatusa. Osobama starije životne dobi koje nemaju većih poteškoća savjetuje se izbjegavanje većih opterećenja te uzimanje nesteroidnih protuupalnih lijekova uz provođenje fizikalne terapije, a mlađima i aktivnijim bolesnicima se preporučuje operativno liječenje. Operacijski pristup može biti otvoreni ili artroskopski. Otvoreni je tehnički manje zahtjevan, ali također daje slabiji pregled tkiva i uvjetuje duže razdoblje oporavka za razliku od artroskopskog. Standardno, kod totalnih ruptura, izvodi se šivanje rupturiranih tetiva te pričvršćivanje istih za kost transosealnim šavima, ili se koriste koštana sidra koja rekonstruiraju hvatišta tetiva te osiguravaju optimalnu čvrstoću. Jedna od novijih metoda koristi ksenografte (submukozu svinjskoga tankog crijeva te acelularni matriks iz svinjske kože) kojima se nadomješta deficit tkiva. Kod parcijalnih ruptura izvodi se čišćenje, tj. debridement puknutoga dijela, a fiksacija za kost potrebna je ako je defekt veći od 25% debljine same tetive. Nakon operacije potrebno je imobilizirati operiranu ruku u abdukcijskoj ortozi 3-4 tjedna, započeti s fizikalnom terapijom dan nakon operacije uz postizanje pasivne pokretljivosti prvih 6 tjedana, a 8 tjedana nakon operacije počinje jačanje mišića. Otprilike 16 tjedana nakon operacije dopušteno je puno opterećenje ruke.

Abstract (english)

Shoulder cuff tear is a pathological condition in which tendinous-muscular sheet, consisted of supraspinatus, infraspinatus, teres minor and subscapularis, ruptures. If only one of those muscles is damaged the function of shoulder is reduced. Patients suffering from the rupture may present with mainly shoulder pain, located on the outer side of the upper arm, especially during chores which require elevation of the hand above shoulder level. Also, they may present with shoulder weakness and difficulties in performing, otherwise, simple everyday tasks. Ruptures are mostly of degenerative origin in elderly, but younger people may also be affected if doing frequent elevation required jobs. The main diagnostic means, besides anamnesis and clinical examination, are ultrasound and magnetic resonance to which ruptures and their size can be found and measured. Most affected tendon is supraspinatus one. Nonsteroid anti-inflammatory drugs and avoidance of the load are advised to the elderly, and surgery is recommended for the rest of the patients. Surgical approach may be open or an arthroscopic. The open one is technically less demanding, but also gives a weaker examination of the tissue and requires longer recovery. As for total ruptures, suturing of ruptured tendons and fixating with transosseous sutures is standard procedure, as well as fixating this tendons to the bone using bone anchors which reconstruct tendon binding point and provide optimal solidity. One of the newest methods uses xenografts (porcine small intestinal submucosa and porcine acellular dermal matrix) that compensate for tissue deficiency. As for partial ruptures, cleansing and debridement of the cracked part is performed, and bone fixation is required if the defect is greater than 25% of the tendon thickness. After the surgery, it is necessary to wear an orthosis 3-4 weeks, start with physical therapy the day after to achieve passive mobility in first 6 weeks, and 8 weeks after surgery begin with muscle strengthening. Approximately 16 weeks after surgery full load oft he shoulder is allowed.

• Keywords: rotatorna manžeta ramena; ruptura tetive; artroskopija; koštana sidra
• Keywords (english): shoulder cuff; tendon rupture; arthroscopy; bone anchors
• Language: croatian
• URN:NBN: urn:nbn:hr:105:583720
• 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: 2019-11-20 16:10:28