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ID naloge: 122 Letnik: 2002 Predmet: ortopedija
Vpliv sklepnega kolcnega tlaka na razvoj artroze kolka
Avtor: Matevž Tomaževic
Mentor: doc. dr. Veronike Kralj-Iglic
Somentor: asist. mag. Roka Vengusta
Izhodišce. Degenerativni procesi v kolku, kot je na primer artroza kolka, predstavljajo pomemben problem v cloveški populaciji z visokim življenskim pricakovanjem. Klinicna opazovanja so pripeljala do hipoteze, da je razvoj degenerativnih procesov v kolku povezan s previsokim kolcnim sklepnim tlakom. Ta hipoteza do sedaj še ni potrjena ali ovržena, predvsem zaradi tega, ker ni bilo na voljo uveljavljene metode, s katero bi lahko dolocili kolcni sklepni tlak na vecji populaciji. Pred kratkim je bila na osnovi matematicnega modeliranja razvita metoda HIPSTRESS, ki temelji na matematicnem modelu in s katero je mogoce dolociti porazdelitev kolcnega sklepnega tlaka za doloceno osebo iz standardnega anteroposteriornega rentgenograma medenice in zgornjih delov obeh stegnenic. Uporaba te metode in rentgenogramov iz arhivov omogoca retrospektiven študij razvoja kolkov skozi daljše obdobje, primeren vzorec za raziskavo vpliva kolcnega sklepnega tlaka na klinicni status kolka pa predstavljajo neoperirani kolki, ki jim je mogoce slediti skozi daljše obdobje.
Namen in hipoteza. Namen tega dela je bil prispevati k razumevanju vzrokov o nastanku artroze v kolcnem sklepu - s preverjanjem veljavnosti hipoteze, da je kolcni sklepni tlak v zgodnji odrasli dobi povezan s klinicnim statusom kolka v starejši dobi.
Metode. Kolcni sklepni tlak smo opisali z že uveljavljenim parametrom - najvišjim tlakom na obremenjeni površini kolka, vpeljali pa smo tudi nov parameter - indeks tlacnega gradienta, ki opisuje, kako se tlak spreminja na lateralnem robu acetabula. Klinicni status kolka smo dolocali s Harrisovo ocenjevalno lestvico. Analizirali smo 45 kolkov 27 bolnikov, ki so se v zgodnji otroški dobi zdravili konzervativno na Ortopedski kliniki v Ljubljani zaradi prirojenega izpaha kolka in pri katerih je bil opravljen kontrolni pregled z rentgenskim slikanjem v zgodnji odrasli dobi med l.1965 in 1970. Kolcni sklepni tlak smo dolocili iz rentgenograma, posnetega v zgodnji odrasli dobi. Klinicni status kolkov s Harrisovo lestvico smo ocenili ob pregledu, opravljenem najmanj 30 let kasneje.
Rezultati. Ugotovili smo, da obstoja statisticno pomembna povezava med najvišjim tlakom v zgodnji odrasli dobi in klinicno oceno 30 let kasneje (p < 0.001) kot tudi med indeksom tlacnega gradienta v zgodnji odrasli dobi in klinicno oceno 30 let kasneje (p < 0.001).
Zakljucki. Nižji najvišji kolcni sklepni tlak v zgodnji odrasli dobi kot tudi manjši indeks tlacnega gradienta napovedujeta boljši klinicni izid v starejši dobi. Naši rezultati so v prid hipotezi, da so degenerativni procesi v kolku povezani z višjim kolcnim sklepnim tlakom. Ker lahko z uporabljeno metodo HIPSTRESS nacrtujemo geometrijo kolka, ki bi dala optimalno postoperativno porazdelitev tlaka po obremenjeni površini, prispevajo naši rezultati tudi k utemeljitvi uporabnosti te metode pri nacrtovanju zdravljenja.
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[Abstract / English version]
Vpliv sklepnega kolcnega tlaka na razvoj artroze kolka
Author: Matevž Tomaževic
Mentor: doc. dr. Veronike Kralj-Iglic
Co-mentor: asist. mag. Roka Vengusta
Background. Degenerative processes in the hip such as coxarthrosis are an important problem in human population with high life expectancy. The results of clinical observations have indicated a hypothesis that the development of the degenerative processes in the hip is connected to a too high stress in the hip. This hypothesis has not yet been proved or disproved, mostly due to the fact that no acknowledged method for determination of the hip stress has been available to assess the contact hip joint stress on a larger population. Recently, the method HIPSTRESS, based on the mathematical modelling, was developed by which the contact hip stress distribution for a particular person can be determined from a standard anteroposterior rentgenograph of the pelvis and both proximal femurs. Applying this method and using rentgenographs from the archives enable retrospective study of the hip development over long-term follow up. The population with nonoperated hips is suitable for the study of the influence of the hip stress on the long term clinical outcome.
Aim and hypothesis. The aim of this work was to contribute to the understanding of the reasons for coxarthrosis development - by verifying the validity of the hypothesis that the contact hip joint stress in early adulthood is connected to the clinical status of the hip in the older age.
Methods. The hip stress was determined by an already acknowledged parameter - the peak stress on the hip weight bearing area. In addition, we introduced a new parameter - the index of stress gradient which describes how stress changes on the lateral edge of the acetabulum. Clinical status of the hip was determined by the Harris hip score. We have analysed 45 hips of 27 patients who were treated conservatively in their early childhood at the Department of Orthopaedic Surgery in Ljubljana due to the congenital hip dysplasia and who had had a control examination including a rentgenograph in the early adulthood (taken between 1965 and 1970). The hip stress was determined from the rentgenograph taken in the early adulthood. The clinical status was determined at a clinical examination, at least 30 years later.
Results. We have found out that there exists a statistically significant correlation between the peak stress in the early adulthood and the clinical status of the hip 30 years later (p < 0.001) as well as between the index of stress gradient in the early adulthood and the clinical status of the hip 30 years later (p < 0.001).
Conclusions. Lower value of the peak hip stress in the early adulthood as well as lower index of the stress gradient foretell better clinical outcome in the older age. Our results are in favour of the hypothesis that too high hip stress accelerates the development of degenerative processes in the hip. As the applied method HIPSTRESS can be used to plan the postoperative geometry, our results also contribute to the establishment of this method as useful tool in the planning of the optimal treatment.
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