RESUMO
Objective - to justify the use of hip endoprosthesis techniques in dysplastic coxarthrosis depending on the type of dysplasia according to Crowe JF. The study is based on the analysis of hip replacement in 390 patients with dysplastic coxarthrosis, who underwent 436 endoprosthetics. There were 192 patients with type 1 dysplasia according to Crowe, type II - 142, type III - 38 and type IV - 18 patients. The age of patients ranged from 15 to 61 years and averaged 43 years. Pathology was prevalent in women, which accounted for 90 %. Preference was given to prostheses with a cementless type of fixation, which accounted for 89 %. An important task of the surgeon during hip replacement in patients with dysplastic coxarthrosis is to install the acetabulum component of the prosthesis in an anatomical position in compliance with the recommendations of spatial location, especially in types III and IV of dysplasia. Endoprosthetics in types 1 and II of hip dysplasia did not present any difficulties. The amount of bone tissue of the acetabulum of the pelvis is sufficient for the use of cups with primary press-fit fixation. Usually, acetabular components of small size were used. In type III dysplasia, there was a significant deficit of bone tissue of the anterior, posterior columns and acetabular roof. In such cases, bone grafting is used. Shortening of the limb in type III dysplasia, as a rule, does not exceed 4 cm, so the surgery may be performed in one stage and without a shortening osteotomy. In type IV dysplasia with shortening of the lower limb to 4 cm, a single stage endoprosthetics is performed it is possible to perform a shortening osteotomy of the proximal femur. Ðn patients with a unilateral process and shortening of the limb more than 4 centimeters, we used the two-stage surgery method. At the first stage, we applied a rod device for external fixation with the introduction of rods into the pelvis and hip, then gradually performed hip traction in order to lower the femoral head to the level of the acetabulum, after which the device was dismantled and at the second stage hip replacement was performed. The acetabular component in hip replacement in Crowe type III or IV dysplasia should be placed in the anatomical position of the acetabulum. If the cranial displacement of the femoral head is less than 4 cm, hip replacement should be performed in one stage. In a unilateral cranial displacement of the femoral head of more than 4 cm, in order to avoid neurovascular bundle traction damage and facilitate the reduction of the prosthesis, preparation should be performed with the reduction of the femoral head to the level of the anatomical acetabulum using an external fixation rod device. It is possible to use a shortening osteotomy of the proximal femur, but then the length of the limb is not restored.
Assuntos
Artroplastia de Quadril , Luxação Congênita de Quadril , Osteoartrite do Quadril , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Osteoartrite do Quadril/cirurgia , Luxação Congênita de Quadril/patologia , Luxação Congênita de Quadril/cirurgia , Acetábulo/patologia , Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Cabeça do Fêmur/patologia , Cabeça do Fêmur/cirurgia , Fêmur/cirurgia , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Anticoagulantes/uso terapêutico , Neoplasias/tratamento farmacológico , Embolia Pulmonar/prevenção & controle , Rivaroxabana/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Tromboembolia Venosa/prevenção & controle , Trombose Venosa/tratamento farmacológico , Consenso , Gerenciamento Clínico , Esquema de Medicação , Cálculos da Dosagem de Medicamento , Humanos , Neoplasias/sangue , Neoplasias/complicações , Neoplasias/patologia , Guias de Prática Clínica como Assunto , Embolia Pulmonar/sangue , Embolia Pulmonar/complicações , Embolia Pulmonar/patologia , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/patologia , Tromboembolia Venosa/sangue , Tromboembolia Venosa/complicações , Tromboembolia Venosa/patologia , Trombose Venosa/sangue , Trombose Venosa/complicações , Trombose Venosa/patologiaRESUMO
Forty patients with neurosensory hearing disorders of vascular genesis were examined and divided into two groups. Patients with tone hearing disorders in conventional (0.125-8 kHz) and extended (9-16 kHz) frequency ranges entered group 1, those with such disorders in the extended range--group 2. Patients of group 1 had more pronounced cardiovascular dysfunction. Control group consisted of 15 persons with normal hearing. Electroencephalography (EEG) has shown that initial neurosensory hearing disorders were accompanied with redistribution of the main EEG rhythms especially in group 1. Compared to controls, these patients demonstrated significantly (p<0.05) reduced representation of alpha-rhythm while that of beta-activity rose showing involvement of cerebral cortical structures. Adequate preventive measures in patients with initial neurosensory hearing disorders of vascular genesis are able to protect such patients against development of neurosensory hypoacusis of vascular genesis.