Hirurško lečenje simptomatske patelofemoralne inkongruencije: Da li je uspostavljanje idealnih odnosa u zglobu neophodno za rešavanje simptoma?

  • Milan Apostolović Institut za ortopedsko hirurške bolesti "Banjica" BeogradMedicinski fakultet Univerziteta u Beogradu
  • Miodrag Vukčević University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Vladimir Vučković Institute for Orthopaedic Surgery „Banjica“, Belgrade, Serbia
  • Boris Vukomanović Institute for Orthopaedic Surgery „Banjica“, Belgrade, Serbia
  • Nemanja Slavković Institute for Orthopaedic Surgery „Banjica“, Belgrade, Serbia
  • Goran Djuričić University Children`s Hospital, Belgrade, Serbia
  • Nebojša Antonijević Clinic of Cardiology, Belgrade, Serbia
  • Oskar Čučilović Institute for Orthopaedic Surgery „Banjica“, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP170227056A
Ključne reči: patelofemoralni bolni sindrom;, hirurgija, operativne procedure;, funkcija, povratak.

Sažetak


Uvod/cilj. Ova prospektivna nerandomizovana studija ra­đena je sa ciljem da se u lečenju simptomatske patelofe­mo­ralne inkongruencije nepodudarnosti uporede funkcionalni rezultati postignuti različitim hirurškim strategijama. Radna hipoteza bila je da se neposredom ekstenzivnom hirurgijom ne postižu značajno bolji rezultati u odnosu na dva glavna simptoma i krajnji funkcionalni skor u poređenju sa umerenijom hirurškom strategijom. Nameravali smo da proverimo da li je postizanje idealnih geometrijskih odnosa u patelofemoralnom zglobu opsežnom hirurgijom neophodno za rešavanje glavnih simptoma patelofemoralne inokngruencije. Metode. Studija je obuhvatila ukupno 35 bolesnika sa patelofemoralnom inkongruencijom, kod kojih su i posle tri meseca neoperativnog lečenja i dalje postojali glavni simptomi: bol u prednjem delu kolena i osećaj isklizavanja patele. Svi bo­lesnici su podvrgnuti hirurškim centražnim procedurama, ali su u zavisnosti od obima i redosleda tih intervencija podeljeni u tri grupe: prva sa jednokratnom ekstenzivnom hirurgijom, druga, gde su proksimalne i distalne centražne procedure vremenski razdvojene i treća kod koje su rađene samo proksimalne procedure. Funkcionlni rezultati, kao i dva glavna simptoma, ocenjivani su na početku lečenja, posle poslednje hirurške intervencije i tokom trogodišnjeg praćenja, i na kraju međusobno upoređeni. Rezultati. U pogledu funkcionalnih rezultata, između grupa nije bilo statistički značajne razlike ni na početku (p = 0.1318), ni na kraju (p = 0.3996) lečenja, ali su u sve tri grupe postojale statistički visoko značajne razlike pri poređenju rezultata na početku, sa onim na kraju lečenja (p1 = 0.005062; p2 = 0.011719; p3 = 0.000352). Isti odnos dobijen je i za dva glavna simptoma. Zaključak. Studija je pokazala da u hirurškom lečenju simptomatske patelo­fe­mo­ralne inkongruencije, u pogledu funkcionalnih rezultata i rešavanja dva osnovna simptoma, postizanje idealnih od­no­sa u patelofemoralnom zglobu jednokratnom ekstenzivnom hirurgijom ne donosi značajnu prednost u poređenju sa manje invazivnim, sek­vencijalnim, indivi­dual­nim hirurškim pristupom.

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2021/01/13
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Vol. 75 Br. 12 (2018): Vojnosanit pregl
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Originalni članak