СОВРЕМЕННЫЕ ФИЛОСОФИИ ВЫРАВНИВАНИЯ ОСИ НИЖНЕЙ КОНЕЧНОСТИ ПРИ ТОТАЛЬНОМ ЭНДОПРОТЕЗИРОВАНИИ КОЛЕННОГО СУСТАВА



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Аннотация

Введение. Эндопротезирование коленного сустава является основным методом лечения поздних стадий гонартроза. При этом согласно данным литературы от 10 до 20% пациентов остаются неудовлетворенными проведенным оперативным лечением. С целью улучшения результатов артропластики коленного сустава в течении многих десятков лет разрабатываются и предлагаются к использованию разные методики выравнивания оси нижней конечности.

Цель: провести анализ современных методик выравнивания оси нижней конечности при эндопротезировании коленного сустава.

Материалы и методы. Для поиcка научных работ использовались базы данных Sсopus, PubMed, платформа ResearchGate, а также электронная научная библиотека eLIBRARY. Поиск и анализ публикаций проводился на двух языках: руccком и английcком.

Результаты и обсуждение. Каждый принцип выравнивания имеет свои преимущества и недостатки. К наиболее популярным философиям выравнивания оси относят: 1. Механическое выравнивание, 2. Анатомическое выравнивание – системные методики, формирующие нейтральную ось; 3. Отрегулированное механическое выравнивание, 4. Ограниченное кинематическое выравнивание – гибридные методики, 5. Кинематическое выравнивание, 6. Функциональное выравнивание – персонифицированные методики.

Заключение. В связи с более детальным изучением анатомии коленного сустава, его кинематики и описании различных фенотипов колена, ряд хирургов предлагает выполнять гибридные и персонифицированные выравнивания оси нижней конечности, учитывая конституциональное строение коленного сустава. При этом данные литературы свидетельствуют о том, что долгосрочные результаты после эндопротезирования коленного сустава лучше или сопоставимы при применении классической механической философии выравнивания оси. Безусловно описанные в данной работе современные альтернативные методики выравнивания оси конечности направлены на улучшение результатов эндопротезирования коленного сустава. Однако в виду недостаточной информации об отдаленных результатах выживаемости имплантов требуется время для полного понимания целесообразности их применения в практике хирурга-ортопеда.

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