UZHHOROD NATIONAL UNIVERSITY, UZHHOROD, UKRAINE.
ST. JOHN PAUL II MAZOVIAN PROVINCIAL HOSPITAL, SIEDLCE, POLAND.
Wiad Lek. 2023;76(11):2474-2480. doi: 10.36740/WLek202311121.
The aim: To justify the concept and features of acetabular reconstruction during primary endoprosthesis for transcatheter fractures from the standpoint of radiological data, biomechanical calculations and intraoperative observations.
Materials and methods: A retrospective analysis of the use of primary cement arthroplasty for osteoporotic fractures of the trochanteric zone in 52 elderly and senile patients was conducted. Before implantation of the femoral component, fragments of the proximal metaphysis were fixed with cerclage tightening loops which depended on the type of fracture. For fractures 31-A2.1, 31-A2.2, 31-A2.3, reconstruction of the destroyed trochanteric zone and the walls of the bone marrow canal opening was performed using our own methodology. Finite-element modeling with the SolidWorks program was used to investigate the influence of the reconstruction of the trochanteric zone on the distribution of strain on the bone tissue around the implant under osteopenic conditions and load during single-support standing.
Results: Clinical and X-ray results were studied in 39 (74.36%) operated patients within 3 to 33 months. There were no complications associated with recon-struction of the proximal part of the femur and implantation of endoprostheses. Restoration of movements in the hip joint and full loading of the operated limb was allowed the day after surgery, depending on the patients` physical condition. The results of finite-element modeling indicate a significant reduction of the strain on the proximal metaphysis in the zone of predominant destruction of the medial and posterior walls of the bone marrow canal of the trochanteric zone reconstruction and ensuring the stability of the femoral component.
Conclusions: Clinical results and biomechanical calculations confirm the possibility and feasibility of using primary arthroplasty in unstable osteoporotic fractures of the trochanteric zone with the aim of early restoration of the support function of the damaged limb in individuals with limited physical capabili¬ties. Reconstruction of the intertrochanteric area with a ring-shaped autograft contributes to the achievement of primary stability of the femoral component, restoration of the total femoral offset and stabilizing function of muscles around the joints.
从影像学数据、生物力学计算和术中观察的角度，论证初次全髋关节置换术中髋臼重建的概念和特点。
回顾性分析了 52 例老年和老年骨质疏松性转子间骨折患者初次行骨水泥型人工关节置换术的情况。在植入股骨部件之前，使用环扎收紧环固定近段干骺端骨折碎片，这取决于骨折的类型。对于 31-A2.1、31-A2.2 和 31-A2.3 型骨折，采用我们自己的方法重建破坏的转子间区和骨髓腔开口的壁。使用 SolidWorks 程序进行有限元建模，研究在骨质疏松条件下和单足支撑站立时负荷作用下，重建转子间区对植入物周围骨组织应变分布的影响。
在 39 例（74.36%）手术患者中，对术后 3 至 33 个月的临床和 X 线结果进行了研究。在重建股骨近端和植入假体方面没有并发症。根据患者的身体状况，手术后第二天即可恢复髋关节活动并完全负重患肢。有限元建模的结果表明，在转子间区的内侧和后侧骨骨髓腔壁主要破坏区进行重建可显著降低近段干骺端的应变，从而确保股骨部件的稳定性。
临床结果和生物力学计算证实，在身体能力有限的个体中，不稳定骨质疏松性转子间骨折患者行初次全髋关节置换术具有可能性和可行性，可早期恢复受损肢体的支撑功能。环形自体移植物重建转子间区有助于实现股骨部件的初始稳定性，恢复股骨总偏心距和关节周围肌肉的稳定功能。
