Preoperative preparation of patients for hip joint replacement
Background. The influence of muscles — pelvic stabilizers on preservation of the postural balance in patients with coxarthrosis was analyzed, and the working hypothesis was developed, according to which the positional adaptation of the hip endoprosthesis components during surgery is determined by the state of these muscles. The purpose of the work is to develop a method for preoperative physical therapy, which has a positive effect on the state of muscles — horizontal pelvic stabilizers, to optimize the positional adaptation of the hip endoprosthesis components during surgery. Materials and methods. The method of exercises performing from the facilitated initial position is developed. To increase the strength of pelvic muscles, exercises are being performed with counteraction to maximum resistance, with a gravitationally unloaded joint. To increase the volume of movements in the hip joint, exercises are performed on gravitationally unloaded joint with elongation or using special elastic traction, using swaying and passive exercises. Increased tone of muscle groups (adductors, flexors) is eliminated by means of relaxing techniques and passive exercises. The tone of hypotrophic muscles (abductors, extensors) is increased by stimulating massage. The pain syndrome is reduced by the extension of the lower limb due to the dose cuff extraction, as well as part of the exercises. The results of the work were tested in a group of 10 patients with unilateral coxarthrosis, in whom we used a method of preoperative treatment developed by us. The results of treatment and the effectiveness of the proposed method were evaluated according to our method for evaluating the function of the muscles responsible for the postural balance. Results. Clinical testing of the developed method of preoperative treatment showed that after the course of exercise the-rapy before surgery, some patients noted a decrease in the pain level, increase in the movements of the affected hip joint, subjective improvement in support ability of the compromised limb and improved quality of life. Comparison of the size of the abductor moment arm before surgery and after arthroplasty showed that in any case, there was no discrepancy in the indicators of more than 5 mm, suggesting that the positional adaptation of the hip endoprosthesis components depends on the state of soft tissues surrounding the hip joint. And it can be argued that eliminating the muscular contracture of adductors and hip flexors, as well as restoring the elasticity and strength of the abductors and extensor hips, provides optimal positional adaptation of the hip endoprosthesis components. Conclusions. Previous studies have shown that patients receiving a special course of exercise therapy, due to the elimination of muscular contracture and restoration of elasticity and strength of abductors and hip extensors, provide optimal positio-nal adaptation of the hip endoprosthesis components, but confirmation of the reliability of the research requires further observations.
Full Text:PDF (Русский)
Ankin L.N. Operative treatment of over- and supra-lateral fractures of the femoral and tibia bones / LN Ankin // Orthopedics, traumatology and prosthetics. –1982. - No. 11. – P. 65-66.
Kalashnikov AV Experience in treating patients with fractures of the distal femur / AV Kalashnikov, Yu. V. Lazarenko // Medicine today and tomorrow. - 2012. - No. 1 (54). - P. 87-90.
Intraarticular fractures of the distal femur: a long-term follow-up study of surgically treated patients / M. V. Rademakers, G. M. Kerkhoffs, I. N. Sierevelt [et al.] // J. Orthop.Trauma. – 2004. – Vol. 18, № 4. – P. 213-219.
Neubauer T. Distal femoral fractures / T. Neubauer. – 2012. – Vol. 115 (5). – P. 433-449.
Trends in subtrochanteric, diaphyseal, and distal femur fractures, 1984-2007 / A. C. Ng, M. T. Drake, B. L. Clarke [et al.] // Osteoporosis International. 2012. – Vol. 23, Issue 6. – P. 1721-1726.
Pankov IO Fractures of the knee joint region. Mechanism of damage. Clinic. Diagnostics. Treatment / IO Pankov, IV Ryabchikov. - Moscow: Academy of Natural Sciences, 2012. - 203 p.
Campell’s Operative Orthopaedics / Ed. by S. T. Canale, J. H. Beaty. – 12th ed. – MOSBY ELSEVIER, 2013. – 4664 p.
Nonunion of distal femoral fractures: a systematic review / N. A. Ebraheim, A. Martin, K. R. Sochacki [et al.] // J. Liu Orthop Surg. – 2013. – Vol. 5 (1). – P. 46-50.
Distal femoral fractures: current concepts / F. W. Gwathmey Jr., Jones- S. M. Quaidoo, D. Kahler [et al.] // J. Am. Acad. Orthop. Surg. – 2010. – Vol. 18 (10). – P. 597-607.
Ruedi T. P. AO Principles of Fracture Management / T. P. Ruedi, R. E. Buckley, C. G. Moran // AO Publishing. – 2007. – Vol. 1. – 635 p.
Bets I. G., Logvin A.V., Malyasov O.G.. Purulent-septic complications of treatment of meta-pituitary fractures of long bones / Orthopedics, traumatology and prosthetics. - 2017. - No. 4. - P. 62-66.
Tumyan S.D. To the results of the discussion on the evaluation of outcomes of treatment of fractures of long tubular bones / S.D. Tumyan // Orthopedics, traumatology and prosthetics. - 1983. - No. 6. - P. 63-65.
Copyright (c) 2018 TRAUMA
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2018