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CNAA / Theses / 2005 / May /

Hip arthroplasty in the femoral neck fractures and their results


Author: Alexandru Beţişor
Degree:doctor of medicine
Speciality: 14.00.22 - Orthopedics and Traumatology
Year:2005
Scientific adviser: Mihai Corlăteanu
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 15 May, 2005
Approved by NCAA on the 22 September, 2005

Abstract

Adobe PDF document0.40 Mb / in romanian

Thesis

CZU 616.718.42-089.23

Adobe PDF document 7.91 Mb / in romanian
128 pages


Keywords

femoral neck fractures, hip’s arthroplasty, hip’s arthroplasty algorithm

Summary

The aim of the work appears to be bettering of life’s quality and insurance of social independence or recovering of work people, using hip replacement in surgical complex in treatment of the femoral neck fractures with displacement and their results.

On the basis of work is use hemiarthroplasty with monopolar (213 – 65, 43%), modular (10-3, 07%) and bipolar (41-12, 65%) prosthesis and total endoprosthesis (60 – 18,51%) with implants of old and new conception at 320 patients in a period 1996-2003 years.

Female prevailed (77, 5%), aged and old, with age of 61-70 (42,18%); 71-80 years (36,5%). Patients are divide in 2 groups: control – 90 patients, that were operated in 1996-1999, predominant using monopolar and total endoprosthesis of old conceptions; essential – 230 patients, who performed arthroplasty in 2000-2003 with monopolar, modular, bipolar and total endoprosthesis of new conceptions.

Were analyzed dates of clinical and para clinical examinations, computer tomography and hip joint skeletal scintygrafy (by 16 patients), radiogrametry of the proximal part of the femoral bone (75 patients), morpho-pathological examinations of the femoral head and neck (28 patients), extract performing arthroplasty, results at distance by the Harris hip score at 63,45% of operated persons.

At aged and old patients with unstable and displaced fractures of the femoral neck owing to posterior wall cominution, impossibility to do ostheosinthesis, thanks to marked osteoporosis, concomitant neurologic somatic pathology, time of visit to doctor, grade of osteoporosis, femoral head and chondral surface grade of vitality before fracture functional state. There are determined advantages and disadvantages of different methods of arthroplasty. There is processed and proposed arthroplasty algoritm of hip arthroplasties in femoral neck fractures with fragment displacement and their complications; there is perfected unified endoprosthesis program, which consider the particularities of every case.

Intra and post operator lethality consists 3, 44%. Complications in control and base groups consists counts respective 20% (with repercussion at late results – 5, 5%) and 9, 13% (without repercussion at late results – 0,86%).

Analyze of results at distance concordant Harris hip score, with time of supervision 1-7 years demonstrates that there are better in primary group – excellent and good – 61,9%, in comparison with control group – 31,33% cases, insufficient respective – 8,55% and 31,37% cases.