Operativno zdravljenje bolnikov z osteohondralno lezijo talusa

doktorska disertacija

Urban Brulc (Avtor), Matej Drobnič (Mentor), Drago Dolinar (Član komisije za zagovor), Anže Kristan (Član komisije za zagovor), Gregor Rečnik (Član komisije za zagovor), Klemen Stražar (Komentor)

Povzetek

Uvod: V raziskavi smo: 1) Analizirali vpliv intrinzičnih dejavnikov na predoperativno stanje bolnikov z osteohondralno lezijo talusa (OLT); 2) Primerjali predoperativno stanje bolnikov z OLT z bolniki pred drugimi pogostimi operativnimi posegi na gležnju; 3) Primerjali uspešnost operativnega zdravljenja OLT z različnimi kirurškimi metodami, ter preučili vpliv intrinzičnih dejavnikov na stanje po operaciji. Metode: Preučili smo skupino 610 bolnikov po operaciji gležnja v obdobju med 2009-2018. Vsi bolniki so predoperativno izpolnili standardizirane vprašalnike FAOS (Foot and Ankle Outcome Score), EQ-5D (European Quality of Life in 5 Dimensions) in TAS (Tegner lestvico aktivnosti). 1) Iz primarne kohorte smo izbrali bolnike, ki so bili v opazovanem obdobju operativno zdravljeni zaradi kakršnekoli OLT. Z modelom linearne regresije smo analizirali vpliv značilnosti bolnika in karakteristike gleženjskega sklepa na predoperativno stanje. 2) Iz primarne kohorte smo izbrali samo bolnike, ki so bili operirani zaradi izolirane problematike gležnja: 19 primarna OLT (P-OLT), 18 revizijska OLT (R-OLT), 22 osteoartroza (OA), 15 lateralna nestabilnost gležnja (LN), 20 sprednji (S-US), 13 zadnji (Z-US) in 16 kombinirani utesnitveni sindrom (K-US). Med skupinami smo primerjali aktivno gibljivost, delovanja gležnja, kvaliteto življenja in telesno aktivnost pred operacijo. 3) Bolniki iz točke 1 so bili zdravljeni s 4 različnimi kirurškimi metodami. Po operaciji smo bolnikom ponovno razposlali standardizirane vprašalnike. S parnimi testi smo preverjali predoperativne in pooperativne vrednosti vprašalnikov. Z modeli logistične regresije smo analizirali uspešnost različnih kirurških metod glede na lastnosti bolnika in karakteristike gležnja. Za ovrednotenje preživetja presadkov je bil uporabljen Cox-ov regresijski model sorazmernih tveganj. Rezultati: 1) Model linearne regresije razkrije korelacijo med spolom, indeks telesne mase (ITM), Kellgren-Lawrence (KL) stopnjo artroze in predoperativno vrednostjo vprašalnikov FAOS in TAS. 2) Pri vseh analiziranih gleženjskih patologijah smo zaznali statistično pomembno slabše predoperativne vrednosti vseh vprašalnikov v primerjavi z zdravo populacijo. Najizrazitejše poslabšanje je bilo prisotno v skupinah R-OLT ter OA. 3) Vse pooperativne vrednosti FAOS in EQ-5D vprašalnikov so se statistično pomembno zvišale glede na predoperativne. Starost, spol, ITM, etiologija OLT, trajanje simptomov, lokacija lezije, spremljajoči posegi, KL stopna artroze in operativna metoda niso pomembno vplivali na pooperativne vrednosti vprašalnikov. Enoletno preživetje presadkov je bilo 100% ne glede na spol; 5-letno preživetje je bilo 77% moški (M) oz. 47% ženske (Ž). Cox-ov regresijski model sorazmernih tveganj razkrije 1,6-krat večje tveganje za odpoved presadka pri ženskah. Zaključki: 1) Ženski spol, višji ITM in višja KL stopnja artroze so napovedni dejavniki za slabše predoperativno stanje bolnikov z OLT. 2) Bolniki z OLT pred operativim posegom imajo slabše funkcionalno stanje gležnja in znižano kvaliteto življenja glede na zdravo populacijo. V primerjavi z drugim pogostimi patologijami gležnja, primarne OLT zmanjšajo delovanje gležnja primerljivo kot lateralna nestabilnost in utesnitveni sindromi, medtem ko recidivi OLT znižajo delovanje gležnja podobno kot napredovala osteoartroza tega sklepa. 3) Različne operativne metode so pomembno izboljšale stanje bolnikov z OLT. Značilnosti bolnika in uporabljena kirurška metoda niso vplivale na izid operativnega zdravljenja. Preživetje presadkov se po 2 letih slabša, izrazitejše pri ženskah.

Ključne besede

osteohondralna lezija talusa;gleženj;operativno zdravljenje;Bolezni gibal;Disertacije;Gleženj;Skočni sklep;Stopalo;Kirurško zdravljenje;

Podatki

Jezik:	Slovenski jezik
Leto izida:	2022
Tipologija:	2.08 - Doktorska disertacija
Organizacija:	UL MF - Medicinska fakulteta
Založnik:	[U. Brulc]
UDK:	617.585(043.3)
COBISS:	111083523
Št. ogledov:	642
Št. prenosov:	67
Ocena:	0 (0 glasov)
Metapodatki:

Ostali podatki

Sekundarni jezik:	Angleški jezik
Sekundarni naslov:	Operative treatment of patients with osteochondral lesion of talus
Sekundarni povzetek:	Introduction: The aim of current study was to: 1) analyse the impact of intrinsic factors on preoperative status of patients with osteochondral lesion of talus (OLT); 2) compare preoperative status of patients scheduled for surgical treatment of seven common ankle disorders; 3) evaluate the outcome after various operative interventions for OLT and identify predicting factors for the patients’ subjective outcome. Methods: Hospital records of 610 patients that were admitted for surgical intervention on the ankle joint between 2009 and 2018 were reviewed. Patients’ general and ankle-related subjective status, quality of life, and activity levels were recorded at the admission by standard questionnaires (PROMs): FAOS (Foot and Ankle Outcome Score), EQ-5D (European Quality of Life in 5 Dimensions) and TAS (Tegner activity scale). 1) First, all the patients who were admitted for OLT surgery of any kind were selected. Their demographics, medical history, and the index ankle joint status were tested as possible predictors for patients’ subjective status by a linear regression model. 2) Secondly, all the patients who were treated operatively for an isolated ankle pathology were identified: 19 primary OLT (P-OLT), 18 recurrent OLT (R-OLT), 22 osteoarthritis (OA), 15 lateral instability, 20 anterior, 13 posterior, and 16 combined ankle impingement. Across these seven groups, preoperative active range of motion, subjective ankle status, quality of life, and patients’ activity levels were compared. 3) The patients from the first cohort (OLT of any kind) were cross-sectionally re-evaluated after the operation by using the same PROMs. Preoperative to postoperative values of PROMs were compared with a paired Student t-test. Possible predicting factors (patients’ demographics, ankle characteristics, surgical technique) for the treatment improvement (postoperative to preoperative PROMs differences) were tested via a linear regression model. A Cox proportional hazard model was used fort the graft survival analysis. Results: 1) Linear regression model revealed that gender, body mass index (BMI), and Kellgren-Lawrence (KL) osteoarthritis score were correlated with the preoperative FAOS and TAS. 2) All evaluated ankle disorders induced significant preoperative subjective joint dysfunction, decreased quality of life, and activity level. The most profound impairments were reported by patients treated for OA and recurrent OLT. 3) All FAOS and EQ-5Q values increased from preoperative to the final follow-up values. There was no correlation between age, gender, BMI, aetiology, symptoms duration, lesion characteristics, additional procedures, OA toward the postoperative improvement of PROMs values. Graft survival rates were 100% at 1 year and 77% (males)/47% (females) at 5 years. A Cox proportional hazard model revealed 1,6-times higher risk of graft failure for females. Conclusions: Female gender, higher BMI, and higher grade of ankle OA were negative predictors for the preoperative status of patients with OLT. 2) Patients amenable for surgical treatment of the common ankle pathology reported considerable functional decline in comparison to the general population. The worst subjective ankle status was reported equally by OA and R-OLT patients, while patients with other five disorders reported comparable values. 3) Various operative interventions for OLT significantly improved patients’ ankle status, and quality of life. Patients’ characteristics and surgical technique had no influence on the treatment outcome. High graft survival rates were demonstrated over first two years, but notable decline was confirmed thereafter, especially in females.
Sekundarne ključne besede:	osteochondral lesion of talus;ankle;surgical treatment;Mišično-skeletne bolezni;Skočni sklep;Gleženj;Kirurško zdravljenje;Ortopedija;Univerzitetna in visokošolska dela;
Vrsta dela (COBISS):	Doktorska disertacija
Študijski program:	0
Konec prepovedi (OpenAIRE):	1970-01-01
Komentar na gradivo:	Univ. v Ljubljani, Medicinska fak.
Strani:	XII, 51 f.
ID:	14976265