<p>Uvod: Termin - temporomandibularne disfunkcije (TMD) obuhvata veći broj oboljenja TMZ, mastikatorne muskulature i okolnih struktura. Epidemiolo&scaron;ke studije pokazuju da 50-75% osoba u toku života ima neki znak poremećaja funkcije mastikatornog sistema. TMD se najče&scaron;će javljaju između 20-40 godine života. Najznačajniji znaci i simptomi TMD su bol u predelu maseteričnog mi&scaron;ića, TMZ, regiona temporalnog mi&scaron;ića, ograničeno otvaranje usta i zvučne pojave (kliktaji i krepitacije). Bol u predelu TMZ je najče&scaron;ći razlog javljanja pacijenta lekaru. Cilj Utvrđivanje validnosti kliničkog nalaza TMD dobijenog kori&scaron;ćenjem RDC/TMD (engl. Research Diagnostic Criteria/ Temporomandibular Disorders) i nalaza na MR pregledu radi utvrđivanja prisustva disfunkcije u cilju blagovremenog i adekvatnog kliničkog zbrinjavanja. Istraživanje je sprovedeno kao prospektivna studija u Centru za Imidžing dijagnostiku, Institutu za Onkologiju Vojvodine u Sremskoj Kamenici, u periodu od januara 2011. do maja 2013. godine. Istraživanjem je obuhvaćeno 200 ispitanica (400TMZ) koje su do&scaron;le na zakazani MR pregled endokranijuma nevezano za eventualnu patologiju TMZ tj. zbog neurolo&scaron;ke simptomatologije. Ispitanicama je prvo snimljen MR endokranijuma zbog osnovnog oboljenja a zatim je pregled nastavljen snimanjem oba TMZ. Snimanje je izvedeno na aparatu Siemens (Erlangen, SR Nemačka) jačine magnetnog polja 3Tesla &ndash; Siemens AVANTO 3T, istog dana, nakon obavljenog kliničkog pregleda. Svakoj ispitanici urađen je parasagitalni (Slika 8) i koronalni presek TMZ kroz oba kondila sa sledećim parametrima snimanja: proton density sekvenca, vreme repeticije (TR) 1850 ms, vreme ehoa (TE) 15 ms, vidno polje (FOV) 13 cm, kao i matrica 128 x 256. Debljina preseka prilikom snimanja MR bila je manja od 2 mm. Prilikom snimanja svakoj ispitanici je bio stavljen osmokanalni zapreminski kalem (engl. head matrix coil) da bi signal u antero-posteriornom pravcu na dobijenim snimcima bio ujednačen. Ukupno vreme snimanja oba TMZ iznosilo je 4 minuta. Na osnovu MR pregleda, najveći broj TMZ je bio bez patolo&scaron;kih promena, njih 198 (49,5%). Prednja dislokacija diska sa redukcijom je ustanovljena kod 46 TMZ (11,5%), sledili su prednja dislokacija diska bez redukcije (18 TMZ (4,5%)), zadnja dislokacija 4 TMZ (1%) I osteoartritis kod 100 TMZ (25%)). Kombinacija poremećaja dislokacije diska sa redukcijom i osteoartritisa ustanovljena je kod 20 TMZ (5%), dislokacije diska bez redukcije i osteoartritisa kod 6 TMZ (1,5%), dok je kombinacija zadnje dislokacije i osteoartritisa detektovana kod 8 TMZ (2%). Rezultati Najče&scaron;ći oblik diska bio je bikonkavan i identifikovan je kod 278 (69,5%) TMZ, slede biplanaran kod 76 (19%), hemikonveksan kod 20 (5%) i bikonveksan kod 14 TMZ (3,5%). Zaključak Na osnovu MR pregleda 51 % TMZ je imalo patolo&scaron;ki nalaz. Korelacija dijagnoza postavljenih na osnovu RDC/TMD i MR pregleda pokazala je umereno dobro slaganje dijagnoza. MR pregled je detektovao dislokaciju diska kod 18% ispitanica koje nisu imale tegobe. Korelacija dijagnoza dislokacije diska postavljenih na osnovu RDC/TMD i MR pregleda je pokazala umereno dobro slaganje. Dijagnoza dislokacije diska sa i bez redukcije, na RDC/TMD ima visoku specifičnost i nisku senzitivnost u poređenju sa dijagnozom postavljenom na MR pregledu. Primenom RDC/TMD, postoji mala verovatnoća za postavljanje lažno pozitivne dijagnoza dislokacije diska sa i bez redukcije. Korelacija dijagnoza degenerativnih promena postavljenih na osnovu RDC/TMD i MR pregleda pokazala je slabo slaganje dijagnoza. RDC/TMD nije optimalna metoda za dijagnostiku degenerativnih promena temporomandibularnih zglobova.</p> / <p>Introduction&nbsp; The term temporomandibular disorders (TMD) encompasses a large number of diseases of TMJ, masticatory musculature and surrounding structures. Epidemiological studies show that 50-75% of people have some type of impaired function of the masticatory system in the course of their lives. TMJ most commonly occurs between the ages of 20 to 40. The most important signs and symptoms of TMD are the pains in the area of masseter muscle; TMJ; temporal muscle; with limited mouth opening and sound phenomena (clicking and crepitus). Pain in the TMJ is the most common reason for a patient&rsquo;s visit to a doctor.&nbsp;</p><p>The aim&nbsp;&nbsp; To determine the validity of the clinical findings of TMD obtained by using RDC / TMD (Research Diagnostic Criteria / Temporomandibular Disorders) and MRI examination findings which could determine the presence of a disorder and therefore provide prompt and adequate clinical care.&nbsp;</p><p>Materials and Methods&nbsp; The research was conducted as a prospective study at the Diagnostic Imaging Center, Oncology Institute of Vojvodina in Sremska Kamenica in the period from January 2011 to May 2013. The study included 200 subjects (400 TMJs) who came for a scheduled MRI of endocranium not related to potential TMJ pathology i.e. having neurological symptoms. Firstly, the subjects underwent the MRI of the endocranium due to their underlying diseases and then the examination continued with MRI of both TMJs. The imaging was performed using Siemens device (Erlangen, Germany) with the magnetic field strength 3Tesla - Siemens Avanto 3T the same day after their<br />clinical examination. Each subject underwent a parasagital and coronal cross section of TMJ through both condyles with the following imaging parameters: proton density sequence, repetition time (TR) 1850 ms, echo time (TE) 15 ms, field of view (FOV) 13 cm and a matrix of 128 x 256. The section thickness during MRI was less than 2 mm. During imaging, 8-channel head matrix coil was placed on each subject so that the signal in antero-posterior direction at the obtained images was uniform. Total imaging time for both TMJs was 4 minutes.</p><p>Results&nbsp;&nbsp; Based on the MRI examination, the largest number of TMJs had no pathological changes - 198 of them (49.5%). Anterior disc displacement with reduction was found in 46 TMJs (11.5%), followed by the anterior disc displacement without reduction (18 TMJs (4.5%)), posterior displacement of TMJ 4 (1%) and osteoarthritis in 100 TMJs (25 %)). The combination of disorders of disc displacement with reduction and osteoarthritis was found in 20 TMJs (5%), disc displacement without reduction and osteoarthritis in 6 TMJs (1.5%), while the combination of the posterior displacement and osteoarthritis was found in 8 TMJs (2%). The most common shape of a disc was biconcave and was identified in 278 (69.5%) TMJs, followed by biplanar in 76 (19%), hemiconvex 20 (5%) and biconvex in 14 TMJs (3.5%).</p><p>Conclusion&nbsp;&nbsp; Based on the MRI examination, 51% of TMJs had pathological findings. Correlation of diagnoses which was determined based on RDC / TMD and MRI examination was moderately present. MRI examination detected disc displacement in 18% of subjects who did not have any problems. Correlation of diagnoses of disc displacement which was determined based on RDC / TMD and MRI examination showed moderately good results. The diagnosis of disc displacement with and<br />without reduction on the RDC / TMD has a high specificity and low sensitivity compared with the diagnosis from the MRI examination. When applying the RDC / TMD there is little chance of setting a false positive diagnosis of disc displacement with and without reduction. The correlation of the degenerative changes diagnoses which were set based on the RDC / TMD and MRI examination showed poor results. RDC / TMD is not an optimal method for the diagnosing the degenerative changes of temporomandibular joints.</p>

<p>I&scaron;ča&scaron;enje, luksacija ili dislokacija ča&scaron;ice (patele), predstavlja povredu kolena prilikom koje dolazi do pomeranja patele iz patelofemoralnog dela zgloba kolena. Pri ovoj povredi dolazi do o&scaron;tećenja medijalnih mekotkivnih struktura kolena koje su zadužene za pravilno pomeranje ča&scaron;ice unutar patelofemoralnog zgloba. Nakon prve povrede kod velikog borja pacijenata razvije se hronična nestabilnost patelofemoralnog zgloba sa posledičnim recidivantnim luksacijama patele. Mehanizam nastanka hronične nestabilnosti nije u potpunosti razja&scaron;njen i smatra se multifaktorijalnim, a za jedan od faktora smatra se naru&scaron;avanje neurolo&scaron;ke regulacije pokreta kolena. Propriocepcija je složen neurolo&scaron;ki mehanizam koji nam omogućava mentalno mapiranje delova tela, sprečavajući prekomerne i nepravilne pokrete koji mogu dovesti do povređivanja. Za njegovu procenu u zglobu kolena najče&scaron;će se procenjuje osećaj pozicije zgloba (JPS &ndash; eng. &bdquo;Joint Position Sense&ldquo;) kao jedne od komponenti propriocepcije. Nerazja&scaron;njeno je koji je najbolji način za njegovu procenu u pogledu izbora različitih uglova fleksije kolena i pozicija ispitanika, ali i kakav je uticaj povreda struktura kolena na njega. U istraživanju su učestvovale isključivo osobe ženskog pola (15-17 godina), svrstane u tri kategorije od po 30 ispitanika. Prvu, kontrolnu grupu, činile su zdrave ne sportistkinje; drugu, grupu sportistkinja, činile su ispitanice koje su se takmičarski bavile ko&scaron;arkom; treću, grupu pacijentkinja, činile su osobe sa luksacijom ča&scaron;ice kolena. Za merenje JPS kori&scaron;ten je VICON optički sistem (&copy;Vicon Motion Systems Ltd. UK registered no. 1801446) za analizu pokreta. Za svaku grupu meren je JPS metodom pasivnog pozicioniranja-aktivne reprodukcije sa kolenom u različitim nivoima fleksije (30&deg;, 45&deg; i 60&deg;), u uspravnom, ležećem i sedećem položaju, nakon čega su rezultati bili poređeni između grupa. Na&scaron;i rezultati su pokazali da odabir pozicije ispitanika i ugla merenja ne utiče na JPS u zdravim populacijama, kontrolnoj grupi i grupi sportiskinja, niti postoji statistički značajna razlika odgovarajućih pozicija i uglova između ovih grupa. Za grupu pacijentkinja dobili smo da postoji deficit propriocepcije, i da je sedeći stav najosetljivijim za procenu deficita osećaja pozicija zgloba kolena. U odnosu na odgovarajuće uglove kontrolne grupe i grupe sportistkinja, kod pacijentkinja postoji statistički značajno veća gre&scaron;ka traženih uglova u sedećem stavu, zbog čega je ovaj stav karakterističan za ovu grupu. Takođe smo uočili da je najveća razlika pri uglu od 45&deg;, čineći ga kritičnim uglom za grupu pacijentkinja. Ono &scaron;to je ključni zaključak je da nakon povrede kolena po tipu luksacije ča&scaron;ice postoji neurolo&scaron;ki deficit kontrole pokreta kolena, koji potencijalno može dovesti do daljeg povređivanja. Obzirom da je JPS metod kumulativne procene proprioceptivnog sistema, dalja istraživanja bi trebala da budu usmerena na određivanje mesta o&scaron;tećenja istog, čime bi se postiglo bolje razumevanje funkcionisanja sistema regulacije pokreta kao i mogućnost sprovođenja efikasnijeg lečenja nakon povrede kolena.</p> / <p><!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Author>Vukadin Milankov</o:Author> <o:Version>16.00</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings></xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> 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<p>U prvom poglavlju je ukazano na potrebu ugradnje implantata u cilju ponovnog<br />uspostavljanja normalnog funkcionisanja lokomotornog sistema čoveka. Na osnovu<br />analize broja i strukture ugrađenih endoproteza zgloba kuka za 2014. i 2015. godinu na<br />IOHB &bdquo;Banjica&ldquo;, Beograd, i Kliničkom centru Vojvodine Novi Sad, Klinika za ortopediju<br />i traumatologiju, zaključuje se da ovi pokazatelji ukazuju na sličnost i uporedivost, sa<br />podacima iz SAD, u odnosu na broj stanovnika.<br />Drugo poglavlje, u uvodnom delu, sadrži sistematizaciju endoproteza zgloba kuka u skladu sa standardom ISO 7216. Nakon toga, dat je prikaz dosadašnjih rezultata primene tumorskih modularnih endoproteza. Pažnja je poklonjena opisu i varijantnosti konstrukcionih elemenata modularnih endoproteza zgloba kuka, kao i analizi izvedenih konstrukcionih rešenja. Prikaz dosadašnjih istraživanja je upotpunjen analizom patentnih rešenja modularnih endoproteza zgloba kuka. Na kraju, polazeći od prethodno sumiranih saznanja, i iskustva u razvoju protetičkih pomagala je definisan cilj istraživanja, osnovne hipoteze, materijal i metode.<br />Treće poglavnje sadrži kratak prikaz koštanih tumora i istorijat tumorske<br />endoproteze. Ukazuje se na komplikacije nakon ugradnje kao i na kriterijume za ugradnju<br />tumorske endoproteze. Primarni i sekundarni tumori, neuspela aloartroplastika,<br />prelomi preko ili ispod trohantera, patološki prelom, često prouzrukuju totalno<br />razaranje gornjeg dela butne kosti, i ovi uslovi predstavljaju indikaciju za zamenu<br />gornjeg dela butne kosti tumorskom endoprotezom. Cilj ugradnje tumorske endoproteze<br />zgloba kuka je da se spase ekstremitet, očuva estetika i obezbedi zadovoljavajuća<br />funkcionalnost i neutrališe prisustvo bola. Ne može se očekivati da endoprotetski<br />sistem ima neograničen vek. Za pojedine delove koji su izloženi intenzivnom habanju u<br />toku eksplatacije potrebno je obezbediti mogućnost jednostavne zamene uz minimalan<br />hirurški zahvat.</p><p>Sa biomehaničkog aspekta projektovanja, sistem fiksacije i konfiguracija tela<br />endoproteze mora biti takav da minimizira naponsko stanje ili obezbedi povoljniju<br />raspodelu napona.<br />Četvrto poglavlje je posvećeno definisanju strukture i dimenzija komponenti sistema<br />tumorske modularne endoproteze zgloba kuka. Ukazuje se na postupak i uticajne faktore<br />na proces projektovanja, kao i na pouzdanost projektovanog rešenja. Posebna pažnja je<br />posvećena dimenzionisanju donje komponente endoproteze sa stanovišta pojave<br />koncentracije napona, kao i elementima za vezu i stezanje komponenti u jedinstven<br />mehanički sistem. Dimenzije pojedinih komponenti su definisane na bazi statističkih<br />razultata do sada ugrađenih tumorskih monolitnih endoproteza na IOHB &bdquo;Banjica&ldquo;<br />Beograd.<br />U okviru petog poglavlja, prikazani su rezultati računarske analize statičkog<br />ponašanja tela monolitne, odnosno donje komponente tumorske modularne endoproteze<br />zgloba kuka. Prvo su prikazana preliminarna ipsitivanja pri statičkom opterećenju, i to<br />računarsko simuliranje eksperimentalnih ispitivanja i sama eksperimentalna<br />ispitivanja za obe vrste tumorskih endoproteza. Na bazi ovih rezultata izvršeno je<br />remodelovanje donje komponente i umesto radijusa prelaza između kragne i tela - mesto<br />maksimalnih napona u implantatu, definisan je optimalni bionički profil prelaza.<br />Nakon izrade donjih komponenti od različitih materijala i različitih profila prelaza<br />realizovana su završna ispitivanja komponenti tumorske modularne endoproteze pri<br />statičkom opterećenju. I kod završnog ispitivanja prvo je izvršeno računarsko<br />modelovanje a nakon toga i eksperimentalno ispitivanje. Pri eksperimentalnom<br />ispitivanju meren je napon u jedanaest mernih tačaka po profilu prelaza između kragne<br />i tela. Dobijeni rezultati su poređeni sa računarskim modeliranjem i konstatovano je<br />zadovoljavajuće poklapanje raspodele i maksimalnih napona po profilu prelaza između<br />kragne i tela endoproteze. Za slučaj delovanja dinamičkog opterećenja izvršena su<br />eksperimentalna laboratorijska ispitivanja. Pri ovom ispitivanju definisane su<br />sledeće promenljive: 1. vrsta endoproteze: monolitna i modularna, 2. materijal:<br />superlegure čelika 316LVM i titanijuma Ti6Al4V, 3. oblik prelaza: sa radijusom i<br />optimizirani prelaz. Cilj ovog ispitivanja ja da se utvrdi broj ciklusa koji će dovesti<br />do početka razlabavljenja tela endoproteze pri maksimalnim uslovima opterećenja, tj.<br />da li navedene promenljive daju statistički značajnu razliku u broju ciklusa do pojave<br />razlabavljenja, kasne mehaničke komplikacije koja prethodi lomu usled zamora<br />materijala, ili zahteva reviziju. Pri ovom ispitivanju fizički prototipovi<br />endoproteza su, izloženi jednosmerno promenljivoj sili, Fmax=2500N, amplitude 2000N i<br />frekvencije 15-20 Hz. Vršena je vizuelena kontrola pojave radiolucentne linije između<br />tela endoproteze i koštanog cementa, odnosno kosti, kao pouzdani znak početka<br />razlabavljenja, kao i Rtg snimaka od strane ortopedskih hirurga nakon svakih 500.000<br />ciklusa, za sve uzorke. Analiza rezultata nakon ispitivanja pri dinamičkom opterećenju<br />uzoraka izrađenih od superlegure čelika 316LVM i uzoraka izrađenih od superlegure<br />titanijuma Ti6Al4V ukazuje na visoku pouzdanost odnosno nizak nivo rizika da može doći<br />do razlabavljenja i do pojave loma usled zamora materijala. Profil prelaza sa velikog<br />na mali prečnik za slučaj radijusa i optimizirani bionički profil nisu pokazali<br />značajnu statističku razliku kod ispitivanja pri dinamičkom opterećenju. Na kraju je<br />pojava razlabavlja utvrđivana i inženjerskom metodom. Nakon ispitivanja dinamičkim<br />opterećenjem fizički prototipovi endoproteza su ponovo izloženi statičkom<br />opterećenju i konstatovano je da nema značajnijih promena u raspodeli i vrednostima<br />maksimalnih napona, što ukazuje da nije došlo da pojave razlabavljenja.<br />Kroz šesto poglavlje dat je kratak opis biokompatabilnih materijala, legura čelika<br />316LVM, kobalta CoCrMo, titanijuma Ti6A14V &bdquo;eli&ldquo;, poroznih i keramičkih materijala,<br />materijala od plastične mase, kompozita i bioreseptivih materijala. Nakon toga su<br />prikazani rezultati ispitivanja biokompatabilnosti materijala koji su primenjeni za<br />izradu elemenata modularnog sistema endoproteza. Rezultati ispitivanja su pokazali<br />da materijali i tehnološki proces proizvodnje zadovoljavaju sa stanovišta<br />biokompatabilnosti.<br />Sedmo poglavlje sadrži zaključke, na osnovu rezultata pojedinih poglavlja i<br />izvedenih istraživanja. Nakon toga dati su pravci budućih istraživanja.<br />Osmo poglavlje sadrži pregled korišćene literature, koju čini 68 literaturnih<br />naslova od kojih je najveći broj citiran u radu.</p> / <p>In the first chapter, the need of implant insertion was apostrophed, with the purpose to achieve<br />normal functioning of human locomotory system. On the base of analysis of the number and the<br />structure of implanted hip endoprosthesis during the years 2014. and 2015. at IOHB &ldquo;Banjica&rdquo;,<br />Belgrade, and at Clinical center of Vojvodina, Novi Sad, Clinic of orthopedy and traumatology, it<br />was concluded that the data, related to the number of citizens, show to be similar and<br />comparable with those from the USA.<br />In the second chapter, in the preface section, the systematization of hip endoprosthesis<br />according to the norm ISO 7216 was presented. After that, the results of historical application of<br />modular tumor endoprosthesis was presented. The attention was paid to the description and<br />structure element variants of modular hip endoprosthesis, and also to the analyses of existing<br />prosthesis constructions. The results of up to now conducted research were additionally enriched<br />with patented variants of modular hip endoprosthesis. At the end, based on previously summed<br />knowledge and experiences in the field of development of prosthetic aids, the goal of the<br />research was determined, so as basic hypothesis, materials and methods.<br />Third chapter comprises short description of bone tumors and historic development of tumor<br />endoprosthesis. The complications after implantation were discussed and also the criteria for the<br />implantation of tumor prosthesis. Primary and secondary tumors, failed arthroplasty, fractures<br />across or beneath trochanter and pathologic fractures are frequent causes of total destruction of<br />the upper portion of the femur and require the replacement of it with tumor prosthesis. The aim of<br />hip tumor prosthesis implantation is to save the limb, to preserve esthetic, to provide satisfactory<br />functionality and to neutralize the pain. It is not possible to expect that endoprosthetic system<br />achieves en infinitely long service life. For some of the components, which are during the service<br />exposed to intensive wear and tear, it is necessary to provide the possibility of simple<br />replacement, with the need for a minimal surgical intervention. From the aspect of biomechanical</p><p>design, the fixation system and body configuration of an endoprosthesis must be such, as to<br />minimize stress level and to provide for a convenient stress distribution.<br />The fourth chapter is dedicated to the definition of the structure and components&rsquo; dimensions<br />for a system of modular hip endoprosthesis. It was dealt with the procedure and with the<br />influencefull factors on a design process and also with the reliability of a designed solution.<br />Special care was devoted to the dimensioning of the upper portion of endoprosthesis from the<br />standpoint of stress concentration and to the elements for the connection and joining the<br />elements in a compact mechanical system. The measures of certain components were defined<br />on the base of statistic analysis of up to now implanted monolithic tumor endoprosthesis at IOHB<br />&ldquo;Banjica&rdquo;, Belgrade.<br />Within fifth chapter, the results of computer analysis of static behavior of the body of monolithic<br />component (lower section) of modular tumor hip endoprosthesis was presented. As the first, the<br />results of preliminary examinations with static load were presented, both the computer simulation<br />of experimental testing and the results of real experimental testing, for both types of tumor<br />endoprosthesis. On the base of these results, the remodeling of the lower component was<br />undertaken so that instead of the connection of a collar and the prosthesis body with the shape<br />of a constant radius (the spot with the maximum stress in the prosthesis), an optimal bionically<br />shaped connection was defined. After the production of lower prosthesis components from<br />different materials and with the different shapes, the final examinations of the components of<br />modular tumor hip endoprosthesis under static load were performed. For the final examinations,<br />in the first step also the computer modeling was performed, and consequently experimental<br />testing. When performing experimental testing, the stress level was determined at eleven<br />measuring spots, on the prosthesis section between the collar and the body. Acquired results<br />were compared to the results acquired through computer modeling and an adequate overlapping<br />of stress distribution and maximum stress in the region between the collar and the prosthesis<br />body was detected. For the case of dynamic load, the laboratory experimental examinations<br />were performed. For these examinations the following variables were determined: 1.<br />endoprosthesis type: monolithic and modular, 2. material: steel superalloy 316LVM and of<br />titanium Ti6Al4V, 3. shape of a connection between the collar and prosthesis body: with constant<br />radius and with the optimized shape. The aim of this examination was to determine the number<br />of cycles which would lead to the beginning of the loosening of the prosthesis body under the<br />conditions of maximum load or, with other words, it was to be determined if mentioned variables<br />provide for significant statistic difference in cycle numbers to the point of prosthesis loosening, to<br />the consequent mechanic complication predicting material fatigue failure or demanding surgical<br />revision. When conducting the examination, physical models of endoprosthesis were exposed to<br />the influence of unidirectionally changing force with the parameters of Fmax = 2500N, Fampl =<br />2000N, frequency 15-20 Hz. After every 500.000 load cycles, for all the samples, the appearance<br />of a radiolucent line between the prosthesis body and bone cement and the bone itself, as the<br />reliable sign of the loosening onset, was visually checked on Rtg shots by orthopedic surgeons.<br />The analysis of the results for behavior under dynamic load, for the samples from steel<br />superalloy 316LVM and from titanium Ti6Al4V shows that they posses high reliability and that<br />there is a low probability that the loosening and the fatigue failure will occur. When examined<br />under dynamic load, prosthesis section with the change from small diameter to large diameter,<br />for the case with constant radius and for the case with optimized bionic profile, have not shown<br />statistically significant difference. At the end, the loosening appearance was examined under the<br />application of engineering methods. After exposing the prosthesis to the dynamic load, physical<br />prototypes of prosthesis were anew exposed to static load and it was confirmed that there is no<br />significant change in the distribution and the level of maximum stress, what was the proof that no<br />loosening has occurred.<br />Within the sixth chapter, the short description of biocompatible materials was given, of steel<br />alloy 316LVM, cobalt CoCrMo, titanium Ti6Al4V &ldquo;eli&rdquo;, of porous and ceramic materials, plastic<br />materials, composites and bioreceptive materials. Subsequently, the results of biocompatibility<br />examination of materials which were applied for the production of the elements of modular<br />endoprosthesis system were presented. The acquired results have proved that the materials and<br />the production process are satisfactory from the standpoint of biocompatibility.<br />Seventh chapter comprises the conclusions, based on specific previous chapters and the<br />research results. After that, the suggestions for the future research were outlined.<br />Eight chapter comprises an overview of used literature, with 68 titles, most of which were cited<br />in this work.</p>

<p>Osnovni cilj rekonstrukcije prednjeg ukr&scaron;tenog ligamenta kolena je dobijanje pune stabilnosti kolena u celom obimu pokreta. Bez obzira na razvoj operativne tehnike i rehabilitacije i dalje postoji jedan broj pacijenata koji nije u potpunosti zadovoljan rezultatom rekonstrukcije prednjeg ukr&scaron;tenog ligamenta kolena, te je potrebno izvr&scaron;iti ponovnu operaciju. Smatra se da je najče&scaron;ći uzrok rane ponovne nestabilnosti lo&scaron;a pozicija kalema, tj. pozicija tunela koja nije na anatomskom mestu. Većina hirurga koji se bave ovom problematikom procenjuju poziciju kalema u golenjači na osnovu standardnih radiograma: prednje-zadnje i bočne projekcije, &scaron;to svakako nije dovoljno precizno. U ekonomski&nbsp; razvijenim zemljama poziciju kalema određuju analizirajući snimke kompjuterizovane tomografije (CT) ili magnetne rezonance (MRI). Prvenstveno zbog smanjenja doze zračenja kojoj se izlažu pacijenti prilikom kompjuterizovane tomografije, ali i iz ekonomskih razloga bilo bi korisno razvijanje jednog lako dostupnog, jeftinog ali preciznog i jednostavnog metoda određivanja položaja kalema u golenjači. Osnovni cilj ovog istraživanja bio je da se dokaže značaj pozicije kalema u golenjači i mogućnost svakodnevne kliničke primene novorazvijenog kompjuterskog programa u cilju određivanja prostorne pozicije kalema u golenjači iz samo dva standardna radiograma. Studija je bila eksperimentalno-prospektivnog karaktera. Eksperimentalni deo istraživanja sproveden je na Fakultetu tehničkih nauka (FTN) u Novom Sadu na Departmanu za proizvodno ma&scaron;instvo gde je na osnovu standardnih RTG snimaka (prednje-zadnje i bočne projekcije) razvijen kompjuterski program za određivanje prostornog položaja kalema u golenjači. U cilju verifikacije novorazvijenog programa realizovano je prostorno određivanje položaja kalema u golenjači obradom standardnih RTG snimaka (prednje-zadnje i bočne projekcije) kod 10 pacijenata kod kojih je izvr&scaron;ena primarna rekonstrukcija prednjeg ukr&scaron;tenog ligamenta kolena. Dobijeni rezultati su upoređeni sa položajem kalema na CT snimcima koji su obezbeđeni za sve pacijente. Na taj način je eksperimentalnim putem utvrđena preciznost novorazvijenog softvera u određivanju prostornog položaja kalema u golenjači. Drugi deo istraživanja bilo je prospektivno kliničko ispitivanje koje je sprovedeno na Klinici za ortopedsku hirurgiju i traumatologiju Kliničkog centra Vojvodine u Novom Sadu. Ispitivanu grupu je činilo 120 pacijenata, oba pola, sa prekidom prednjeg ukr&scaron;tenog ligamenta levog ili desnog kolena. Metodom slučajnog izbora pacijenti su podeljeni u četiri grupe od po 30 pacijenata prema veličini sagitalnog ugla (S) bu&scaron;enja kanala u golenjači (S 60&ordm;-69,9&ordm; i S 70&ordm;-80&ordm;) i prema veličini transverzalnog ugla (T) bu&scaron;enja kanala u golenjači (T 60&ordm;-69,9&ordm; i T 70&ordm;-80&ordm;). Grupa I 30 pacijenata (S 60&ordm;-69,9&ordm; i T 60&ordm;-69,9&ordm;), grupa II 30 pacijenata (S 60&ordm;-69,9&ordm; i T 70&ordm;-80&ordm;), grupa III 30 pacijenata (S 70&ordm;-80&ordm; i T 60&ordm;-69,9&ordm;), grupa IV 30 pacijenata (S 70&ordm;-80&ordm; i T 70&ordm;-80&ordm;). Svi pacijenti su godinu dana nakon operacije pro&scaron;li klinička ispitivanja po bodovnim skalama (Tegner bodovna skala, Lysholm bodovna skala i IKDC standard) i artrometrijska merenja. Rezultati dobijeni merenjem položaja kalema u golenjači, kliničkim ispitivanjima i artrometrijskim merenjima poređani su unutar svake grupe posebno, a izvr&scaron;eno je i poređenje dobijenih rezultata između svih grupa. U ispitivanje su uključeni samo oni pacijenti koji su dali potpisani informisani pristanak da učestvuju u ispitivanju nakon detaljnog upoznavanja sa planiranom procedurom. Svaki pacijent je bio informisan o svrsi i načinu sprovođenja istraživanja, kao i o pregledima i merenjima koja će biti vr&scaron;ena. Statističkom analizom rezultata utvrđeno je da veličina gre&scaron;ke prostornog određivanja položaja kalema u golenjači posle rekonstrukcije prednjeg ukr&scaron;tenog ligamenta kolena novorazvijenim kompjuterskim programom nije statistički značajna, a kompjutersko određivanje položaja kalema u golenjači omogućava iste rezultate kao i CT snimci. Sumiranjem zaključaka nakon sveobuhvatne analize dobijenih rezultata istraživanja, može se zaključiti da pozicija kalema u golenjači posle rekonstrukcije prednjeg ukr&scaron;tenog ligamenta kolena utiče na postoperativni funkcionalni rezultat.</p> / <p>The main goal of reconstruction of the anterior cruciate ligament of the knee is to obtain complete knee stability in the full range of movement. Regardless of the development of operational techniques and rehabilitation, there is still a number of patients who are not completely satisfied with the result of reconstruction of the anterior cruciate ligament, and a re-operation is required. It is believed that the most common cause of the instability is the bad position of the graft, i.e. position of the tunnel that is not at the anatomical place insertion. Most surgeons who deal with this problem evaluate the position of the graft in the tibia based on standard radiograms: anterior-posterior and lateral projections, which is not precise enough. In economically developed countries, the position of the graft is determined by analyzing images of computerized tomography (CT) or magnetic resonance (MRI). Primarily due to a decrease in the radiation dose exposed to patients during computerized tomography, but also for economic reasons, it would be useful to develop an easily accessible, inexpensive but precise and simple method for determining the position of the graft in the tibia. The main goal of this examination was to prove the significance of the position of the graft and the possibility of daily clinical use of the newly developed computer program in order to determine in-space position of the graft in only two standard radiograms. The study was experimental-prospective. The experimental part of the research was conducted at the Faculty of Technical Sciences (FTN) in Novi Sad at the Department of Production Engineering, where a computer program for determining in-space position of the graft in the tibia was developed on the basis of standard RTG images (anterior-posterior and lateral projections). In order to verify the newly developed program, in-space determination of the position of the graft in the tibia by processing standard RTG images (anterior-posterior and lateral projections) was performed in 10 patients in which the primary reconstruction of the anterior cruciate ligament was performed. The obtained results were compared with the position of the grafts on CT images provided to all patients. In this way, the accuracy of newly developed software in determining in-space position of the graft in the tibia was determined experimentally. The second part of the study was a prospective clinical trial conducted at the Clinic for Orthopedic Surgery and Traumatology at the Clinical Center of Vojvodina in Novi Sad. The investigated group consisted of 120 patients, both sexes, with a break of the anterior cruciate ligament of the left or right knee. By random selection, patients were divided into four groups of 30 patients according to the size of the sagital angle (S) of the tunnel drilling in the tibia (S 60&ordm;-69,9&ordm; and S 70&ordm;-80&ordm;) and according to the transversal angle (T) of the drill tunnel in the tibia ( T 60&ordm;-69.9&ordm; and T 70&ordm;-80&ordm;). Group I 30 patients (S 60&ordm;-69.9&ordm; and T 60&ordm;-69.9&ordm;), group II 30 patients (S 60&ordm;-69.9&ordm; and T 70&ordm;-80&ordm;), group III 30 patients (S 70&ordm;-80&ordm; and T&ordm;60&ordm; -69.9&ordm;), group IV 30 patients (S 70&ordm;-80&ordm; and T 70&ordm;-80&ordm;). All of the patients underwent clinical trials by scales (Tegner score scale, Lysholm score scale and IKDC standard) and arthrometric measurements one year after surgery. The results obtained by measuring the position of the graft in the tibia, clinical trials and arthrometric measurements were classified separately in each group, and obtained results were compared between all groups. The study included only those patients who gave signed informed consent to participate in the study after being thoroughly informed about planned procedure. Each patient was informed about the purpose and method of conducting the research, as well as the examinations and measurements to be performed. Statistical analysis of the results showed that the size of the error in measuring in-space determination of the position of the graft in tibia after reconstruction of the anterior cruciate ligament of the knee by a newly developed computer program was not statistically significant, and the computer determination of the position of the graft in the tibia provides the same results as the CT images. Summarizing the conclusions after a comprehensive analysis of the obtained results of the study, it can be concluded that the position of the graft in tibia after reconstruction of the anterior cruciate ligament affects the postoperative functional result.</p>