Prevalenca izolirane skrajšave m. gastrocnemius pri pacientih s patologijo kolena in kolka : magistrsko delo

Kralj, Špela (author), Drobnič, Matej (mentor), Grapar Žargi, Tina (co-mentor)

Uvod: Izolirana skrajšava m. gastrocnemius (ISG) omejuje dorzalno fleksijo gležnja, kar povzroči kompenzatorne mehanizme med hojo, ki zaradi prekomernega pritiska in preobremenitve stopala lahko vodijo v bolečino in deformacijo. Klinično se ISG določi kot razliko med dorzalno fleksijo gležnja pri iztegnjenem in pokrčenem kolenu. V literaturi še ni jasnega konsenza o definiciji vrednosti, največ avtorjev predlaga razliko 10°–13°. Prevalenca ISG naj bi bila v splošni zdravi populaciji visoka, pri patologiji sprednjega stopala višja, pri pacientih s patologijo kolenskega ali/in kolčnega sklepa pa še ni znana. Namen: Ugotoviti prevalenco in stopnjo ISG pri pacientih s patologijo kolena in kolka, pri katerih je bil predviden operativni poseg (artroskopija kolena ali kolka oz. artroplastika kolena ali kolka), ter morebitne povezave ISG z demografskimi podatki preiskovancev, z obsegom gibljivosti in bolečino. Metode dela: 80 pacientov, sprejetih na Ortopedsko kliniko UKC Ljubljana zaradi elektivnega operativnega posega na kolenu ali kolku, smo razvrstili v 4 skupine glede na patologijo in starost. Meritve smo opravili pred posegom s testom merjenja dorzalne fleksije v stoječem položaju pri iztegnjenem in pokrčenem kolenu s tekočinskim goniometrom, izpolnjen je bil tudi vprašalnik. Rezultati: V skupini pacientov z artrozo kolka je bilo pri ISG ? 10° statistično pomembno večje število pacientov z ISG v primerjavi s skupino pacientov z okvaro labruma kolka. Statistično pomembnih razlik pri primerjavi prisotnosti ISG med pacienti z okvaro meniskusov kolena in labruma kolka ter pacienti z artrozo kolena in okvaro meniskusov kolena ni bilo. Prevalenca ISG ? 10° je pri preiskovancih s patologijo kolka znašala 47,5 %, pri ISG ? 13° pa 21,2 %. Pri preiskovancih s patologijo kolena je prevalenca pri ISG ? 10° znašala 26,2 %, pri ISG ? 13° pa 7,5 %. Povprečna razlika med dorzalno fleksijo pri iztegnjenem in pokrčenem kolenu vseh preiskovancev je znašala 7,79° ± 3,96° in je bila statistično pozitivno povezana s starostjo in bolečino ter negativno s telesno aktivnostjo. Razprava in zaključek: ISG je v določeni meri prisotna pri različnih populacijah pacientov, potrebno pa bo opraviti več raziskav po standardiziranem protokolu za diagnosticiranje ISG, kar bi omogočilo tudi ugotavljanje incidence in vpliva različnih patologij.

• Language: Slovenian
• Keywords: izolirana skrajšava m. gastrocnemius, kolk, koleno, test funkcijskega merjenja dorzalne fleksije
• Work type: Master's thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2020
• PID: 20.500.12556/RUL-113502
• COBISS.SI-ID: 5763435
• Publication date in RUL: 12.01.2020

Secondary language

• Language: English
• Title: The prevalence of isolated shortening of m. gastrocnemius in patients with knee and hip pathology : master's thesis

Abstract

Introduction: Isolated shortening of m. gastrocnemius (ISG) restricts dorsal flexion of the ankle resulting in compensatory mechanisms during gait which can lead to pain and deformity due to excessive pressure and foot overload. Clinically, ISG is defined as the difference between dorsal flexion of the ankle with the knee in extension and flexion. There is no clear consensus on the definition of an ISG value in the literature, but most authors suggest a difference of 10° – 13°. The prevalence of ISG is thought to be high in a healthy population, even higher in patients with forefoot pathology and still unknown in patients with knee and/or hip pathology. Purpose: To determine the prevalence and value of ISG in patients with knee and hip pathology before elective surgery (arthroscopy of knee/hip and arthroplasty of knee/hip), and to find possible correlations between ISG and the following variables: patients demographic data, range of motion and pain. Methods: 80 patients who were admitted to the Orthopedic clinic of the University Medical Center of Ljubljana for elective surgery on the knee or hip joint were classified into 4 groups according to pathology and age. We measured ISG with a weight-bearing lunge test with knee in extension and flexion using a fluid goniometer. Patients also filled out a questionnaire. Results: Patients in hip arthrosis group had a statistically significant increase in the ISG at ISG ⡥ 10 ° than patients in the hip labrum injury group. There were no statistically significant differences when comparing the presence of ISG between patients with menisci injury of the knee and hip labrum injury, and patients with knee arthrosis and menisci injury of the knee. The prevalence of ISG ⡥ 10° in subjects with hip pathology was 47,5 % and the prevalence of ISG ⡥ 13° was 21,2 %. In subjects with knee pathology, the prevalence of ISG ⡥ 10° was 26,2 % and the prevalence of ISG ⡥ 13° was 7,5 %. The mean difference between dorsal flexion of the ankle with the knee in extension and flexion of all subjects was 7,79° ± 3,96° and was statistically positively correlated with age and pain and negatively correlated with physical activity. Discussion and conclusion: ISG is to some extent present in different patient populations. Further research using a standardized protocol needs to be done for the diagnosis of ISG, which would allow for incidences and impact of different pathologies to be determined.

• Keywords: isolated shortening of m. gastrocnemius, hip, knee, weight-bearing lunge test