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Instrumentalno merjenje ohlapnosti kolena v antero-posteriorni smeri v normalni populaciji in pri poškodovancih s strganimi križnimi vezmi
Avtor: Miran Jeromel, Sergeja Kozar
Mentor: doc. dr. Matjaž Veselko, dr. med., spec. Travmatologije
IZHODIŠCE: V diagnostiki antero-posteriorne nestabilnosti kolena uporabljamo veliko testov (kot npr. Lachmanov test). Vecina teh testov je enostavnih, vendar so zelo subjektivni in zahtevajo izkušenega preiskovalca.
Metoda izbire je instrumentalno merjenje z artrometrom.
Omenjena metoda, ki je že dalj casa uveljavljena, nam pomaga pri ocenjevanju poškodbe (pretrganju) križnih vezi.
NAMEN: Namen naše raziskave je bil dolociti antero-posteriorno ohlapnost obeh kolen v normalni populaciji (populacija, ki ni utrpela poškodbe kolena). Poleg tega smo hoteli ugotoviti vpliv anestezije na ohlapnost kolen. Ravno tako smo želeli primerjati levo in desno koleno posameznika ter vpliv spola in starosti na antero-posteriorno ohlapnost kolena. Proucevali smo tudi vpliv diabetesa in dolgotrajne kortikosteroidne terapije na omenjeno ohlapnost.
HIPOTEZE: Naše hipoteze so bile, da ima uporaba anestezije pomemben vpliv na merjeno ohlapnost. Preiskovanec, ki ni imel poškodbe kolen, nima vecje razlike med ohlapnostjo levega in desnega kolena. Ohlapnost kolenskih vezi narašca s starostjo, ravno tako imajo ženske vecjo ohlapnost kot moški. Diabetes in dolgotrajna kortikosteroidna terapija povecujeta ohlapnost kolenskih vezi.
METODE: V študiji smo uporabili artrometer KT 1000/STM. V raziskavo smo vkljucili 90 preiskovancev (starih od 18 do 81 let), ki v anamnezi niso imeli poškodbe kolena. Med njimi je bilo 45 (50%) žensk, 45 (50%) pa moških. 8 (8,9%) je bilo diabetikov, medtem ko so 4 (4,4%) prejemali dolgotrajno sistemsko terapijo s kortikosteroidi.
Meritve so potekale v dveh delih. En del meritev je potekal v splošni anesteziji, drugi del pa brez anestezije. Merili smo anteriorno ter posteriorno ohlapnost kolen.
Vsako meritev smo ponovili trikrat.
REZULTATI: Vrednosti meritev v anesteziji so statisticno pomembno vecje od vrednosti pri budnih preiskovancih (p<0, 001). Razlike med kolenoma zdravega preiskovanca so statisticno nepomembne (p>0, 05). Povprecna ohlapnost moških in žensk se ne razlikuje, starost nanjo ne vpliva. Vpliva diabetesa in kortikosteroidov nismo uspeli dokazati.
ZAKLJUCKI: Naša študija je pokazala pomemben vpliv mišicne relaksacije na ohlapnost kolena. Posameznik brez predhodne poškodbe kolena nima vecje razlike v ohlapnosti levega in desnega kolena. Spol in starost ne vplivata na ohlapnost kolena. Bolniki z diabetesom in tisti na dolgotrajni sistemski kortikosteroidni terapiji se glede na izmerjeno ohlapnost ne razlikujejo od ostalih preiskovancev.
Zakljucili smo, da je uporaba artrometra dobra metoda za ocenjevanje ohlapnosti kolenskih vezi, še posebej v pogojih splošne anestezije.
Primerjava ohlapnosti med moškimi in ženskami zahteva dodatne preiskave, ki bi dolocile hormonski status in mišicno moc. Vpliv starosti, diabetesa in dolgotrajne kortikosteroidne terapije bi bilo dobro prouciti na bolj reprezentativnem vzorcu.
[Abstract / English version]
Instrumental measurement of antero-posterior knee laxity in normal population and in patients with knee ligament injury
Author: Miran Jeromel, Sergeja Kozar
Mentor: doc. dr. Matjaž Veselko, dr. med., spec. Travmatologije
BACKGROUND: A magnitude of clinical tests (like Lachman test) are used to diagnose antero-posterior knee instability. They are easy to preform but they are very subjective. An experienced practitioner is often required.
An alternative to standard clinical tests is the usage of arthrometer.
Measurement of knee laxity with an arthrometer is particulary useful in assessment of the injuries of the cruciate ligaments.
AIM: The aims of this study were to assess the antero-posterior laxity of both knees in the normal population as well as the effect of miorelaxant on antero-posterior laxity.
We compared the difference between the left and right knee of the same individual and the influence of ageing and gender on knee laxity.
We also studied the influences of diabetes and long-term corticosteroid therapy.
HYPOTHESIS: We wanted to prove the following theories: anaesthesia has an effect on measurement of knee laxity; the individual without prior knee injury has no statistically side to side difference; the laxity increases with age; women have grater ligamentous laxity than men ; laxity increases as the result of diabetes and also as a result of long-term corticosteroid therapy.
METHODS: Arthrometer KT 1000/STM (Medmetric) was used in our survey.
We analysed 90 individuals (aged 18-81) who haven't had knee injuries in the past. Among them were 45 (50%) men and 45 (50%) women. 8 (8,9%) of them were diabetics and 4 (4,4%) of them received long-term coricosteroid therapy. We assessed the antero-posterior laxity of both knees of an individual under the effect of general anaesthetic. Each measurement was repeated thrice. The same procedure was used to determinate antero-posterior laxity without the usage of anaesthetic.
RESULTS: We concluded that muscle relaxation affects the antero-posterior laxity of the knee (all the differences were statistically significant, p<0, 001). Side to side difference was minimal (statistically unsignificant, p>0, 05). The average laxity between men and women showed no difference. We obtained the same results considering age.
We coudn't prove the effects of long _term corticosteroid therapy and diabetes on knee laxity.
CONCLUSIONS: Our study has showed the importance of muscle relaxation on knee laxity. An individual who hasn't experienced any knee trauma has practically no side to side difference. Women and men have the similar knee laxity, so do the younger and older individuals. Individuals on long-term corticosteroid therapy and those with diabetes showed no difference as compared to normal population. Therefore we assume that arthrometer is very useful, particulary in measurements under the effect of anaesthetic. Comparision between men/women requires detailed investigation including hormone status and muscle strenght. The effect of age, diabetes and long-term corticosteroid therapy should be studied on a more representative sample.