20.500.12556/DKUM-39212 POMEN UPORABE DVOJNEGA SNOPA IN ANATOMSKEGA POLOŽAJA TUNELOV PRI ARTROSKOPSKI REKONSTRUKCIJI DOUBLE BUNDLE AND ANATOMIC TUNNELS POSITION IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION Uvod. Pretrganje sprednje križne vezi povzroči poslabšanje funkcije kolenskega sklepa, pretirano premikanje golenice naprej (anteriorno), rotacijsko nestabilnost in slabši nadzor mišične funkcije. Dolgoročno povzroča poškodbo meniskusov in hrustanca ter razvoj degenerativnih sprememb sklepnega hrustanca (artrozo) in potencialno posttravmatskega artritisa. Zdravljenje pretrganja sprednje križne vezi je lahko konzervativno ali operativno, prevladuje operativno zdravljenje z artroskopsko rekonstrukcijo omenjene vezi. Cilj operativnega zdravljenja je izboljšanje stabilnosti kolena ter zmanjšanje tveganja za pojav kasnejših zapletov (kronične) nestabilnosti kolena kot sta ponavljajoče poškodbe meniskusov ali obraba hrustanca. Številne, predvsem kadaverske raziskave, so pokazale, da bi rekonstrukcija sprednje križne vezi z metodo dvojnega snopa lahko prispevala k izboljšanju rezultatov, predvsem glede rotacijske stabilnosti. Ker je tovrstna operativna metoda tehnično zelo zahtevna, se je posledično razvila (tehnično lažja) metoda rekonstrukcije sprednje križne vezi z enim snopom s položajem presadka v vodoravnem (anatomskem) položaju. Namen in hipoteze. S primerjavo treh različnih metod artroskopske rekonstrukcije sprednje križne vezi smo želeli ugotoviti, s katero izmed metod lahko dosežemo boljše pooperativne izide in predvsem katera izmed njih omogoča boljšo rotacijsko stabilnost. Prva hipoteza je, da artroskopska rekonstrukcija sprednje križne vezi z enim snopom s položajem presadka v nižjem oz. vodoravnejšem (anatomskem) položaju (ASB), omogoča boljše klinične rezultate kot metoda, kjer je presadek pričvrščen v (višjem) položaju, kot smo ga uporabljali do sedaj (CSB). Druga hipoteza je, da artroskopska rekonstrukcija sprednje križne vezi s položajem presadka v nižjem oz. vodoravnejšem položaju (ASB, ADB) omogoča boljšo rotacijsko stabilnost kolena. Tretja hipoteza je, da metoda rekonstrukcije sprednje križne vezi z dvojnim snopom in horizontalnejšim položajem obeh snopov (ADB) omogoča boljše rezultate kot v prvi hipotezi navedeni metodi (ASB, CSB). S hipotezami smo želeli preveriti, ali je boljša rotacijska stabilnost posledica vodoravnejšega (bolj anatomskega) položaja tunelov in ne povečanja števila presadkov. Material in metode dela. V raziskavo je bilo vključenih 330 bolnikov s pretrgano sprednjo križno vezjo, pri katerih smo se odločili za operativno zdravljenje. Bolniki so bili naključno razporejeni (randomizirani) v tri skupine. V prvi skupini so bili bolniki operirani po standardni metodi enojnega snopa (CSB), v drugi skupini po metodi enojnega snopa, pripetega v bolj vodoravnem (anatomskem) položaju (ASB) in v tretji skupini po metodi dvojnega snopa (ASB). Ocenjevanje so izvedli neodvisni ocenjevalci, ne vedoč, katera metoda je bila uporabljena. Gibljivost smo merili z goniometrom. Ugotavljali smo zaostanek (deficit) ekstenzije in fleksije v primerjavi z zdravo nogo. Za objektivizacijo anteroposteriorne nestabilnosti smo uporabili artrometer KT-1000 (MEDmetric, CA, ZDA) z uporabo sile 136N. Za oceno rotacijske stabilnosti smo uporabili Pivot shift test, z ocenami od 0 do 3. Za subjektivno oceno stanje kolena smo uporabili mednarodno lestvico po vprašalniku Lysholm in subjektivni IKDC vprašalnik. Za objektivno oceno smo uporabili objektivni IKDC vprašalnik. Ocenjevali smo naslednje parametre: oteklina, pasivna gibljivost, stabilnost, ocena medialnega in lateralnega kompartmenta, mesto odvzema presadka, RTG glede zoženja sklepne špranje in prisotnost degenerativnih sprememb, funkcionalni test (one leg test). Rezultati. V rezultatih raziskave smo ugotovili statistično značilno boljše klinične rezultate z uporabo anatomske artroskopske rekonstrukcije sprednje križne vezi z enim snopom (ASB) v primerjavi s klasično metodo z enim snopom (CSB). Razlika je bila značilna predvsem v anteroposteriorni in rotacijski stabilnosti. Rezultati metode rekonstrukcije sprednje križne vezi z dvojnim snopom (ADB) Introduction: Complete anterior cruciate ligament (ACL) rupture can lead to recurrent knee instability, meniscal tears, and articular cartilage degeneration. The ACL does not heal when torn. Treatment can be conservative, but surgical reconstruction is the standard treatment. Reconstruction aims at restoring the kinematics and stability of the injured knee to prevent cronic instability, meniscus injury and future degenerative changes. Many cadaveric investigations have indicated that anatomic ACL double-bundle reconstruction (ADB) restores knee stability closer to normal than conventional single-bundle ACL reconstruction (CSB). As this procedure is technically demandable with higher costs, another operative technique had been developed, anatomic single bundle ACL reconstruction (ASB). Purpose and Hypothesis. The aim of this study was to determine which of three methods gives better results especially according to rotational stability. Our first hypothesis was that anatomic single-bundle ACL reconstruction (ASB) is superior to conventional single-bundle ACL reconstruction (CSB). The second hypothesis was that anatomic ACL reconstruction with tunnels in more horizontal position (ASB, ADB) will improve rotation stability. The third hypothesis was that anatomic double bundle ACL reconstruction (ADB) is superior to the first two described methods (CSB and ASB). Confirming these hypotheses we wanted to show that better results are due to anatomic horizontal position of tunnels and not the numbers of them. Materials and methods. 320 patients were randomized into 3 groups: conventional single-bundle group (CSB), anatomic single-bundle group (ASB) and anatomic double-bundle group (ADB). The outcomes were evaluated by an independent blinded observer using goniometer for range of motion, the Lysholm score and subjective International Knee Documentation Committee (IKDC) form. The KT-1000 arthrometer was used to evaluate anteroposterior stability, and the pivot-shift test was used to determine rotational stability. Results. Comparing the outcomes in single-bundle groups showed that at the final evaluation, the outcome of anatomic single group (ASB) was statistically significantly better than in conventional single-bundle group (CSB) for anteroposterior and rotational stability. Comparing the outcomes between conventional single-bundle (CSB) and anatomic double-bundle reconstruction (ADB) showed that the outcome of the anatomic double-bundle group (ADB) was statistically significantly better than in conventional single-bundle group (CSB) for all the measured parameters except objective IKDC. Comparing the outcomes between anatomic single- bundle (ASB) and anatomic double-bundle reconstruction (ADB) showed that the results of the anatomic double-bundle group (ADB) were statistically significantly better than in anatomic single-bundle group (ASB) for antero- posterior and rotational stability and knee range of motion. Conclusion. The results of the study statistically significantly support the use of anatomic methods (ASB, ADB) in comparison to classic arthroscopic single-bundle method (CSB). Respecting that the difference between the second and the third method (anatomic single-bundle (ASB) and anatomic double-bundle (ADB)) is not significant for most parameters we might conclude that double-bundle reconstruction, which is technically more demandable with higher costs, is not needed to be performed in all patients. ACL anatomska rekonstrukcija individualizacija enosnopna dvosnopna rotacijska stabilnost. ACL anatomic reconstruction individualization single bundle double bundle rotation stability. true false false M. Hussein] Slovenski jezik Angleški jezik Doktorska disertacija 2012-12-11 09:50:52 2013-01-14 12:57:24 2022-05-04 14:12:43 2021-04-21 03:38:12 2012 0 [Maribor 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 616.728.3 512244024 URN:SI:UM:DK:MAH9DUCO DR_Hussein_Mohsen_2012.pdf DR_Hussein_Mohsen_2012.pdf 1 6A732BA14B2355A2C7031E054B31FA12 39d32922e39a0ab0c87359f6369b507002518653c329c10cd9b5d6512f91c9d3 a5abbdb8-7c08-11eb-bb7a-00155d0001ca 20.500.12556/dkum/39b8a5e4-9ca4-41e6-a84e-d160f60ca1da https://dk.um.si/Dokument.php?lang=slv&id=52856 Medicinska fakulteta 0 0 0