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06280cam a2200397 i 4500 |
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NSK01000142677 |
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HR-ZaNSK |
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20070917110017.0 |
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960308s1996 ci a m 000 0 hrv |
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|9 (HR-ZaNSK)142832
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|9 (HR-ZaNSK)960308058
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|a (HR-ZaNSK)000142677
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|a ci
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|a 616.728.4-001.5
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1 |
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|a Šarić, Vedran
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|a Klinička i eksperimentalna istraživanja biomehanike gornjeg nožnog zgloba nakon loma vanjskog gležnja :
|b doktorska disertacija /
|c Vedran Šarić.
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|a Zagreb :
|b V. Šarić,
|c 1996
|e ([s. l. :
|f s. n.])
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| 300 |
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|a 158 listova :
|b ilustr. djelomično u bojama, table, graf. prikazi ;
|c 30 cm.
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|a Sveučilište u Zagrebu, Medicinski fakultet, Zagreb, 1996
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|a Bibliografija: str. 142-157
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|a Summary
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|a Sažetak: Brojnim kliničkim i eksperimentalnim istraživanjima dokazano je da svaka inkongruencija zglobnih tijela uzrokuje promjenu fizioloških intraartikularnih opterećenja i naprezanja, što ubrzava proces degeneracije zglobne hrskavice. Zbog toga traumatolozi nastoje da sve zglobne frakture, posebice na donjim ekstremitetima, gdje su zglobovi izloženi i dinamičkim i statičkim opterećenjima, liječe operacijski. Samo na taj način, anatomskom repozicijom i stabilnom fiksacijom ulomaka, moguće je svesti na najmanju mjeru posljedice koje intraartikularne frakture nose sa sobom.
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| 520 |
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|a Unatoč ovim spoznajama javlja se u zadnje vrijeme dosta traumatologa koji pacijente s izoliranim frakturama fibule u području tibiofibularne sindesmoze i distalno od nje, dakle u slučajevima intraartikularne frakture statički najopterećenijeg zgloba ljudskog tijela, liječe konzervativno dozvoljavajući da lom zacijeli s pomakom ulomka. U nedoumici zbog izbora načina liječenja svojih ozlijeđenika pristupili smo kliničkim i eksperimentalnim istraživanjima, pa smo testiranjem operacijski i neoperacijski liječenih pacijenata i pokusima utvrdili sljedeće: a) Primarna dislokacija fragmenata značajno utječe na rezultate liječenja izoliranih fraktura fibule u području tibiofibularne sindesmoze i distalno od nje. U operiranih ispitanika postotak posttraumatske artroze i lošeg ishoda liječenja upola je manji nego u neoperiranih.
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| 520 |
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|a b) Tlak u gornjem nožnom zglobu u svim fazama statičkog i dinamičkog opterećenja različit je na svakoj jedinici zglobne površine. c) Najopterećeniji su ventralni i lateralni dio zgloba. d) Proporcionalno veličini djelujuće sile i anatomskim promjenama u distalnom dijelu fibule mijenjaju se opterećenje i deformacija tog dijela kosti, a te promjene uzrokuju poremećaj biomehaničke ravnoteže u gornjem nožnom zglobu. e) Kost i na nju montiran vanjski fiksator sudjeluju u prijenosu opterećenja obrnuto proporcionalno, što otvara mogućnost proširenja primjene vanjskog fiksatora u koštanoj kirurgiji.Na temelju kliničkih i eksperimentalnih ispitivanja držimo da otvarena repozicija i osteosinteza izoliranih fraktura fibule u području tibiofibularne sindesmoze i distalno od nje daje ozlijeđenicima bolje izglede za povoljan ishod nego konzervativno liječenje.
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|a Summary: It has been proven by numerous clinical and experimental studies that even the smallest incongruency of articular bodies may lead to changes in the physiology of intraarticular loading and stress, which promotes degeneration of the articular cartilage. Therefore, in the treatment of all articular fractures, especially in the lower extremity, operative methods have been accepted as the preferred method of treatment by many surgeons since these joints are exerted to excessive dynamic and static loading. Only by open reduction and stable fixation of these fractures it is possible to minimize the rate of complications associated with intraarticular fractures.
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|a Despite the above discussed postulates, a number of trauma and orthopaedic surgeons have recently begun applying the non- operative methods for the treatment of isolated fibular fractures in the zone of tibiofibular syndesmosis as well as distal to it, i.e. intraarticular fractures of the statically most highly loaded joint of the human body have been treated non-operatively, thus allowing fractures to heal with fracture fragments remaining displaced. Having doubts about the choice of the most appropriate method of treatment we conducted a clinical and experimental research. Our operatively and non-operatively treated patients were tested and experiments were performed.
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| 520 |
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|a It was found that: a) the results of treatment of isolated fibular fractures in the zone of tibiofibular syndesmosis and distal to it depended largely upon the degree of primary dislocation of fracture fragments. The rate of posttraumatic arthrosis and poor outcomes in the operatively treated patients was half as high as in the non-operatively treated ones. b) The pressure in the ankle joint during all phases of static and dynamic loading was found to be different in each segment of the articular surface. c) Ventral and lateral articular portions were exerted to the greatest loading.
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|a d) The magnitude of loading and bone deformation in the distal portion of the fibula was found to be directly proportional to the magnitude of the acting forces and anatomic changes. These changes disturbed the biomechanical balance in the ankle joint. e) The magnitude of loading in the fractured bone was found to be reversely proportional to the magnitude of loading in the mounted external fixator, which makes it possible to broaden the scope of application of external fixation in bone surgery. Based on the results of the clinical and experimental study it may be concluded that open reduction and fixation of isolated fibular fractures in the zone of tibiofibular syndesmosis and distal to it offer better chances for good results than the non-operative treatment.
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| 650 |
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7 |
|a Nožni zglob
|x Klinička istraživanja prijeloma
|2 nskps
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| 981 |
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|p CRO
|r HRB1996
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| 998 |
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|n DCD
|c sbno9802
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|j DCD-ZG-46/96
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| 876 |
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|e DCD
|a 46/1996
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| 886 |
0 |
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|b 05982nam0 2200325 450
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