Proteza e Gjurit. (Pjesa e tretë)

Ligamenti kruciat posterior

Funksioni kryesor i ligamentit kruciat posterior (LCP) eshte te lejoje “rrollback-un” femoral ne flexion dhe ti rezistoje zhvendosjes posteriore te tibias mbi femur. LCP kontrollon gjithashtu rocionin ekstern te tibias we shtimin e fleksionit te gjurit.

Ruajtja e LCP ne Protezat e Gjurit eshte para qe nga ana biomekanike siguron nje kinematike normale te “rrollback-ut” te femurit mbi tibian. Kjo eshte gjithashtu e rendesishme per te permiresuar krahun ngrites te mekanizmit te mm kuadriceps me gjurin ne fleksion.

Patellofemoral joint

Levizjet e artikulacionit patello-femoral mund te karakterizohen si levizje rreshqitese. Gjate fleksionit te gjurit, patella leviz distalisht mbi femur. Kjo levizje realizohet prej inserimeve ne patele te tendinit te kuadricepsit dhe ligamentum patellae, si dhe prej pjeses anterior te kondyleve femorale. Muskujt dhe ligamentet e artikulacionit patello-femoral jane pergjegjes per ekstensionin e gjurit. Patella luan rolin e makarase ne transmetimin e forcave nga muskuli kuadriceps ne femur dhe ligamentin patellar.

Akset mekanike

Aksi mekanik i anesise inferior eshte nje linje imagjinare neper te cilen kalon pesha e trupit. Ajo kalon nga qendra e kokso-femoralit ne qender te artikulacionit talo-krural duke kaluar ne mes te gjurit. Ne prezence te deformimeve te ndryshme kjo linje alterohet dhe duhet rivendosur me rruge kirurgjikale, e cila lejon normalizimin e ecjes dhe ruan protezen nga ngarkesat eksentrike dhe nga komplikacionet e hershme.

Kunderindikimet

Kunderindikimet absolute per Protezimin e gjurit perfshine: sepsis, infeksion prezent aktiv ne organizem, mosfunksionim i mekanizmit ekstensor, semundje te renda vaskulare, deformim rekurvatum si pasoje e humbjes se mases muskulare si dhe prezenca e nje artrodeze funksionante.

Kunderindikimet relative perfshijne gjendjet shendetesore qe nuk lejojne kryerjen e anestezise si dhe nevojat e kirurgjise dhe rehabilitimit. Kunderindikime te tjera relative perfshijne gjendjen e lekures mbi gjurin qe do i nenshtrohet interventit (p.sh. psoriazis), histori osteomieliti pereth gjurit, artikulacion neuropatik dhe obeziteti.

Rezultatet dhe Prognoza

Pjesa me e madhe e pacienteve jane te kenaqur me Protezen e gjurit, sidomos kur indikacioni kryesor per nderhyrje ka qene qetesimi i dhimbjes. 15,16 Funksioni i gjurit rikthehet shpejt zakonisht pas protezimit te gjurit. Studimet afatgjata konfirmojne rezultate te kenaqshme funksionale dhe tregojne nje mbijetese 91-96% ne 14-15 vjet pas protezimit.

Nuk eshte evidentuar ndonje diference midis protezave me rujtjete LCP dhe protezave me sakrifikim te LCP. Per protezat pa cement nuk ka akoma ndonje studim afatgjate, por studimet 10-12 vjet pas protezimit tregojne nje mbijetese 95%.3,7,8,17,18.

E ardhmja dhe Diskutimet

Protezat totale te Gjurit me cement do te ngelen kriteri standart per protezimin e gjurit, por gjithashtu perdorimi i protezave pa cement me siperfaqe bioactive (p.sh. hidroksiapatite) kane treguar rezultate afatmesme premtuese.

Referencat

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19. Meneghini RM, Hanssen AD. Cementless fixation in total knee arthroplasty: past, present, and future. J Knee Surg. Oct 2008;21(4):307-14.