www.ksmf.org/arhimed   arhimed@ksmf.org   [5/10/2025 4:28:22 PM] http://www.ksmf.org/arhimed/poglej.asp?id=41 Dolocanje najugodnejše geometrije okolcja pri rekonstrukciji zlomov stegnenicnega vratu Avtor: Boštjan Kersnic Boštjan Kocjancic Mentor: prof. dr. Srecko Hermana, dr.med Somentor: doc. dr. Veronika Kralj-Iglic, dipl. ing.; asist. mag. Dragica Smrke, dr. med Izhodišca: Za oceno biomehanskega statusa kolka po operativnem posegu vstavitve kolcne endoproteze se v klinicni praksi lahko uporablja tudi matematicni model s pomocjo katerega je mogoce oceniti spremembe velikosti in smeri kolcne sklepne sile ter moc kolcnih abduktorjev pri razlicnih položajih velikega trohantra glede na center kolcne glavice. V naši raziskavi smo poizkušali ugotoviti, ali uporaba matematicnega modela za dolocanje kolcne sklepne sile v položaju stoje na eni nogi ustrezno opiše klinicne razmere v kolcnem sklepu po operativnem posegu. Klinicno oceno kolka po Harrisu sestavljajo: prisotnost ali odsotnost bolecine, ocena funkcije kolka, ocena pasivne in aktivne gibljivost v kolku ter prisotnost deformacij. Ugotoviti smo hoteli, kakšen je vpliv premika velikega trohantra na klinicno oceno kolka po vstavitvi EP. Izboljšali smo metodo za dolocanje geometrijskih parametrov okolcja tako, da smo dolocili povecavo rentgenskega posnetka okolcja. Ugotoviti smo želeli, ali obstaja korelacija med telesno težo in povecavo. Bolniki in metode: V raziskavo smo vkljucili 71 bolnikov s povprecno starostjo 73 let, ki so bili na Klinicnem oddelku za travmatologijo operirani zaradi medialnega zloma stegnenicnega vratu v zadnjih desetih letih. 49 bolnikom so vstavili biartikularno parcialno endoprotezo in 22 bolnikom totalno endoprotezo. Bolnike smo ponovno pregledali v poprecju 4 leta po poškodbi. Ob pregledu smo naredili klinicno oceno kolka in analizo rentgenskega posnetka cele medenice in obeh kolkov. S pomocjo racunalniškega sistema za digitalizacijo rentgenskih posnetkov smo ocenili vrednosti premika velikega trohantra operiranega kolka glede na stanje pred poškodbo. Klinicno oceno kolka smo naredili s pomocjo Harrisove ocenjevalne lestvice. Rezultati: Dobljeni rezultati nakazujejo povezavo med biomehanskim statusom kolka in klinicno oceno kolka po Harrisu pri bolnikih z vgrajeno biartikularno parcialno endoprotezo. Ocena kolka po Harrisu se z lateralnim premikom velikega trohantra veca, z medialnim pa manjša (r = 0,25). Nismo ugotovili korelacije med klinicno oceno kolka po Harrisu in premikom velikega trohantra v navpicni smeri. Ti rezultati se ujemajo z napovedmi matematicnega modela v okviru natancnosti metode. Izboljšali smo metodo za dolocanje geometrijskih parametrov okolcja tako, da smo natancno dolocili povecavo za vsakega bolnika. Ugotovili smo, da ni korelacije med povecavo rentgenske slike in telesno težo bolnika (r = 0,09). Zakljucki: Analiza premikov velikega trohantra je primerna za biomehansko oceno kolka z vgrajeno biartikularno parcialno endoprotezo. Matematicni model kolka napove spremembe klinicnega statusa kolka ob spremembah položaja velikega trohantra glede na center kolcne glavice. Prihodnost vidimo v nadaljnem razvoju matematicnega modela in njegovi širši uporabi pri klinicnem delu. «» [Abstract / English version] Dolocanje najugodnejše geometrije okolcja pri rekonstrukciji zlomov stegnenicnega vratu Author: Boštjan Kersnic Boštjan Kocjancic Mentor: prof. dr. Srecko Hermana, dr.med Co-mentor: doc. dr. Veronika Kralj-Iglic, dipl. ing.; asist. mag. Dragica Smrke, dr. med Background: A mathematical model can be used to evaluate the biomechanical status of the hip after a surgical intervention in where hip endoprosthesis has been implanted. By using the mathematical model it is possible to evaluate changes in the magnitude of the hip-joint reaction force and its inclination, as well as the forces of the hip abductors for different positions of the greater trochanter with respect to the femoral head center. The purpose of this work was to evaluate whether the mathematical model for determination of the resultant hip force in the one-legged stance can describe the clinical status of the hip-joint following a surgical intervention. The clinical status of the hip was measured by the Harris hip score (presence or absence of pain, hip function, mobility and absence of deformity). It was our aim to determine the influence of the shift of the grater trochanter position on the clinical status of the hip after the implantation of the endoprosthesis. We tried to improve the method for determination of the geometrical parametres of the hip by accurately determining the magnification of the rentgeonogram. We also checked whether there is a correlation between the body weight of the patient and the magnification of the rentgenogram. Patients and methods: The final analysis was performed for 71 patients with average age of 73 years that have been treated at the Clinical Deparment of Traumatology for medial femoral neck fracture in the last ten years. Out of these, 49 patients have been treated with implantation of bipolar partial endoprosthesis and 22 patients have been treated with total endoprosthesis. The average follow-up time was 4 years. At the time of the last examination the clinical status of the hip was evaluated and radiograph of the hip and both joints was analysed. A special computer aided system for digitalization of the radiographs was used to calculate the shift of the position of the greater trochanter of the operated hip-joint with respect to the situation befor the injury. The clinical status of the hip-joint was evaluated by using the Harris hip score. Results: The results indicate a dependance between the biomechanical status of the hip and the Harris's clinical evaluation of the hip in patients with implanted bipolar partial endoprosthesis. Harris hip score increases with lateral shift of the great trochanter, while it decreases with its medialization (r = 0,25). There was no correlation between the Harris hip score and the shift of the grater trochanter in the vertical direction. These results agree with the predictions of the mathematical model with accurancy of the method used. We improved the method for determination of geometrical parameters of the hip by accurately determining the magnification of the rentgenogram for each patient. We established that there is no correlation between the magnification of the rentgenogram and the body weight (r = 0,09). Conclusions: The analysis of the shift of the greater trochanter position is applicable for evaluation of the clinical status of the hip with an implanted bipolar partial endoprosthesis. The mathematical model of the hip predicts the change in the clinical status of the hip following a shift in the position of the greater trochanter with respect to the femoral head centre. The mathematical model should be further developed with the purpose of more elaborate (extensive) use in clinical practice.