Klinični in rentgenski parametri v diagnostiki in operativnem zdravljenju kostne utesnitve komolca

Meglič, Uroš (author), Zupanc, Oskar (mentor)

UVOD: Kostna utesnitev komolca je znak začetne degenerativne bolezni komolčnega sklepa, ki zaradi kostnih naplastitev omejuje njegovo gibljivost. Kljub redkosti je pomembno, da se zaradi vpliva na kvaliteto življenja taka patologija ugotovi zgodaj, saj se že na začetku odločamo za kirurško zdravljenje. Zato je pri kostni utesnitvi komolca ustrezna rentgenska diagnostika ključna. Pomaga nam ugotoviti lokacije in obseg degenerativnih sprememb, kar je nujno za odločitev o načinu zdravljenja za tovrstne bolnike. METODE: Preiskovance smo vključevali v dve skupini. V preiskovano skupino smo vključili 30 bolnikov z omejeno gibljivostjo komolca, rentgensko ugotovljeno kostno utesnitvijo in pri katerih je bila diagnoza osteofitov kasneje potrjena med artroskopskim posegom. V kontrolno skupino smo vključili 30 bolnikov, pri katerih je bila ugotovljena izvensklepna patologija komolca. Pri vseh vključenih bolnikih smo opravili meritve gibljivosti, izpolnili Mayo in Oxford vprašalnik ter izmerili utesnitvena kota AIa in PIa. Dobljene rezultate smo primerjali med skupinama. Pri prvi skupini preiskovancev smo primerjali rezultate vprašalnikov, meritve obsega gibljivosti in rentgenske meritve pred in po operaciji. Ugotavljali smo korelacijo med obsegom gibljivosti in vrednostmi kotov. Z namenom izračuna zanesljivosti in ponovljivosti rentgenskih parametrov smo s pomočjo 2-kratnih ocen s tremi ocenjevalci izračunali koeficiente korelacije za posamezne meritve. REZULTATI: Pri radiološkem testiranju je meritev AIa in PIa kotov zanesljiva meritvena metoda z zelo dobro do odlično zanesljivostjo meritve tako pri ponovnih meritvah istih ocenjevalcev kot med ocenjevalci. Prav tako zanesljivost meritve ostaja visoka ob primerjavi meritev med izkušenim in neizkušenim ocenjevalcem. V osnovnih značilnostih (spol, starost, prizadetost dominantne zgornje okončine) sta si skupini med seboj primerljivi. Razlike pri spolu in starosti bolnikov ne vplivajo na vrednosti utesnitvenih kotov. Meritev subjektivnih težav s komolcem z Oxford vprašalnikom ne kaže pomembnih razlik med skupinama. Objektivne meritve gibljivosti in Mayo vprašalnik kažejo pomembne razlike med skupinama. Med skupinama obstajajo statistično pomembne razlike tudi v vrednostih AIa in PIa kotov. Pri vseh meritvah v preiskovalni skupini pred in po operaciji so prisotne statistično pomembne razlike. Rezultati kažejo statistično pomembno linearno korelacijo med obsegom giba in pripadajočim utesnitvenim kotom. ZAKLJUČEK: Medtem ko subjektivne merilne metode ne pokažejo razlik med patologijami komolca, je z objektivnimi kliničnimi in rentgenskimi metodami možno ugotoviti kostno utesnitev komolca. Za natančno opredelitev in s tem načrtovanje zdravljenja pa so nujno potrebne rentgenske meritve. Merjenje AIa in PIa kotov predstavlja zanesljivo in ponovljivo metodo merjenja, ki pomembno korelira s kliničnimi meritvami gibljivosti.

• Language: Slovenian
• Keywords: komolec, kostna utesnitev, degenerativna bolezen, omejena gibljivost
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2022
• PID: 20.500.12556/RUL-145879
• Publication date in RUL: 17.05.2023

MEGLIČ, Uroš, 2022, Klinični in rentgenski parametri v diagnostiki in operativnem zdravljenju kostne utesnitve komolca [online]. Doctoral dissertation. [Accessed 11 April 2025]. Retrieved from: https://repozitorij.uni-lj.si/IzpisGradiva.php?lang=eng&id=145879

Secondary language

• Language: English
• Title: Clinical and radiographic parameters in diagnostics and operative treatment of bony impingement of the elbow

Abstract

INTRODUCTION: Elbow bony impingement is an early sign of the elbow degenerative disease, which limits its mobility due to osteophytes. Despite its rarity, it is important to detect it in the early stages due to the impact on the quality of life, as we decide on surgical treatment early in the progress. Therefore, proper X-ray diagnosis is crucial for elbow bone impingement. It helps us determine the location and extent of degenerative changes, which is crucial in formulating an appropriate treatment plan for such patients. METHODS: Subjects were included in two groups. The study group included 30 patients with limited elbow mobility, X-ray signs of elbow bony impingement, and in whom the diagnosis of osteophytes was later confirmed during arthroscopic surgery. The control group included 30 patients with extra-articular elbow pathology. On all patients included, mobility, Mayo and Oxford questionnaires, AIa and PIa measurements were performed. The obtained results were compared between the groups. In study group, we compared the results of questionnaires, mobility and X-ray measurements before and after surgery. We found a correlation between the range of motion and the values of the AIa and PIa angles. In order to calculate the reliability of X-ray parameters, we calculated correlation coefficients for individual measurements with 3 evaluators. RESULTS: In radiological testing, the measurement of AIa and PIa angles is a reliable measurement method with very good to excellent measurement reliability both in repeated measurements of the same evaluator and among evaluators. Also, the reliability of the measurement remains high when comparing the measurements between an experienced and an inexperienced evaluator. In the basic characteristics (sex, age, involvement of the dominant upper limb), the two groups are comparable. Differences in the sex and age of the patients do not affect the values of the impingement angles. Measuring subjective elbow problems with the Oxford questionnaire does not show significant differences between the groups. Objective measurements of mobility and the Mayo questionnaire show important differences between the groups. There are also statistically significant differences between the groups in the values of AIa and PIa arc. There were statistically significant differences in all measurements in the study group before and after surgery. The results show a statistically significant linear correlation between the range of motion and the corresponding X-ray angle. CONCLUSION: While subjective measurement methods do not show differences between elbow pathologies, it is possible to determine elbow bony impingement by objective clinical and radiological methods. However, X-ray measurements are essential for accurate identification and thus treatment planning. AIa and PIa angle measurement is a reliable and repeatable method of measurement that significantly correlates with clinical measurements of mobility.

• Keywords: elbow, bony impingement, degenerative disease, limited motion