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The surgical treatment in the rehabilitation complex of the patients with coxarthrosis


Author: Croitor Gheorghe
Degree:doctor habilitat of medicine
Speciality: 14.00.22 - Orthopedics and Traumatology
Year:2009
Scientific consultants: Vitalie (decedat) Beţişor
doctor habilitat, professor
Gavriuşenco Nicolai, membru
doctor habilitat în ştiinţe tehnice, profesor universitar, Institutul „N.Priorov”, Moscova , Rusia
Institution:
Scientific council:

Status

The thesis was presented on the 29 October, 2008
Approved by NCAA on the 22 January, 2009

Abstract

Adobe PDF document0.72 Mb / in romanian

Keywords

Hip joint, coxarthrosis, hip functional score, proximal femoral osteotomies, hip arthrodesis, hip prosthesis, total hip arthroplasty, component loosening and failure of the cemented component, bone grafting, allotransplant, hip revision, postoperative recovery.

Summary

The surgical treatment in the rehabilitation complex of the patients with coxarthrosis” The goal of this study – optimization of the therapeutical strategies of the coxarthrosis by examination of the epidemiological peculiarities, assessment of the early methods of diagnosis and evaluation of the methods of treatment by elaborating of the postoperative functional rehabilitation programs, assessment of the perioperative complications and elaboration of methods of prophylaxis and treatment of these complications.

The incidence of coxarthrosis according addressability and hospitalisation was estimated to be 21,29 per 10000 adult population of the Chisinau town or 0,62‰. It was proven, that in ambulatory conditions, most frequently is being registered the posttraumatic coxarthrosis (1,11‰0). On the second place, according to the incidence level, is the idiopathic coxarthrosis (0,702‰0), and on the third place are the consequences of the avascular necrosis of the femoral head (0,370‰0) (p<0,05).

During the study was registered a continuously growing, statistically conclusive (p<0,01) of the patients number annually hospitalized for coxarthrosis. Coxarthrosis occurred 3 times more frequently in the rural population (1,49‰) of the Chisinau town comparatively to the urban population – 0,52‰ (p<0,05). During the period 1991-2005, 456 patients undergone the surgical treatment that constitutes in average 42,6% from the total number of those hospitalized with coxarthrosis. In 103 patients were performed 112 intertrochanterian osteotomies, in 64 patients was performed hip arthrodesis, THR was performed in 289 patients, 309 were primary THR and 64 were revisions.

The postero-lateral approach with ligation of the medial circumflex vessels of the femur diminishes the perioperative bleeding with about 1/3, manages the periarticular muscles and has extended indications in young patients.

To repair acetabular defects type I and II Paprosky were used morselized cancelous autografts and bone matrix. In periacetabular defects type III were proposed original methods of combined bone grafting, in which with the help of cortical allografts harvested from tibial crest is ensured the primary stability of the implants. In case of femoral instabilities with type IV Paprosky defects, was designed a femoral stem with distal locking and the necessary instruments for it. Was implemented in clinic an original method of osteosynthesis of the femoral periprosthetic fractures. Accordind to the performed studies were elaborated and applied in practice 8 breveted inventions. The implementation of the results of the study leaded to improvement of the results and decreasing of the hospital stay period for the surgical treatment from 36,9 ± 1,1 days in year 2001 to 18,64 ± 0,7 days in 2006 (p<0,01).