{"id":6563,"date":"2021-03-22T18:48:34","date_gmt":"2021-03-22T18:48:34","guid":{"rendered":"http:\/\/www.orthes.cz\/?page_id=6563"},"modified":"2021-05-21T18:47:13","modified_gmt":"2021-05-21T18:47:13","slug":"artroskopie","status":"publish","type":"page","link":"https:\/\/www.orthes.cz\/index.php\/artroskopie\/","title":{"rendered":"Artroskopie"},"content":{"rendered":"[vc_row type=“full_width_background“ full_screen_row_position=“middle“ column_margin=“default“ column_direction=“default“ column_direction_tablet=“default“ column_direction_phone=“default“ bg_image=“6565″ bg_position=“center center“ bg_repeat=“no-repeat“ scene_position=“center“ text_color=“dark“ text_align=“left“ row_border_radius=“none“ row_border_radius_applies=“bg“ color_overlay=“#ffffff“ overlay_strength=“0.5″ gradient_direction=“left_to_right“ shape_divider_position=“bottom“ bg_image_animation=“none“ shape_type=““][vc_column column_padding=“no-extra-padding“ column_padding_tablet=“inherit“ column_padding_phone=“inherit“ column_padding_position=“all“ background_color_opacity=“1″ background_hover_color_opacity=“1″ column_shadow=“none“ column_border_radius=“none“ column_link_target=“_self“ gradient_direction=“left_to_right“ overlay_strength=“0.3″ width=“1\/1″ tablet_width_inherit=“default“ tablet_text_alignment=“default“ phone_text_alignment=“default“ column_border_width=“none“ column_border_style=“solid“ bg_image_animation=“none“][divider line_type=“No Line“ custom_height=“650″][\/vc_column][\/vc_row][vc_row type=“in_container“ full_screen_row_position=“middle“ column_margin=“default“ column_direction=“default“ column_direction_tablet=“default“ column_direction_phone=“default“ scene_position=“center“ top_padding=“5%“ text_color=“dark“ text_align=“left“ row_border_radius=“none“ row_border_radius_applies=“bg“ overlay_strength=“0.3″ gradient_direction=“left_to_right“ shape_divider_position=“bottom“ bg_image_animation=“none“ shape_type=““][vc_column column_padding=“no-extra-padding“ column_padding_tablet=“inherit“ column_padding_phone=“inherit“ column_padding_position=“all“ background_color_opacity=“1″ background_hover_color_opacity=“1″ column_shadow=“none“ column_border_radius=“none“ column_link_target=“_self“ gradient_direction=“left_to_right“ overlay_strength=“0.3″ width=“1\/1″ tablet_width_inherit=“default“ tablet_text_alignment=“default“ phone_text_alignment=“default“ column_border_width=“none“ column_border_style=“solid“ bg_image_animation=“none“][vc_column_text]\n
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Artroskopie<\/h2>\n

O artroskopii<\/h3>\n

Slovo artroskopie poch\u00e1z\u00ed z \u0159eck\u00fdch slov, „arthro“ (kloub) a „skopein“ (pod\u00edvat se). Slovo ve slovn\u00edku znamen\u00e1 „pod\u00edvat se do kloubu“. Na pacientov\u011b k\u016f\u017ei se ud\u011bl\u00e1 mal\u00e1 \u0159ezn\u00e1 r\u00e1na a artroskop, instrument podobn\u00fd teleskopu, je vsunut do kloubu. Sv\u011btlo je p\u0159en\u00e1\u0161eno p\u0159es optick\u00fd kabel na konec artroskopu. Cel\u00fd instrument je p\u0159ipojen na video monitor.
\nArtroskopie umo\u017e\u0148uje p\u0159\u00edm\u00fd pohled na cel\u00fd kloubn\u00ed povrch, zejm\u00e9na chrupavku, vazy, menisky a kloubn\u00ed pouzdro. Opera\u010dn\u00ed z\u00e1krok se prov\u00e1d\u00ed n\u00e1stroji vsunut\u00fdmi do kloubu p\u0159es dal\u0161\u00ed mal\u00fd otvor. Artroskopie je v p\u0159ev\u00e1\u017en\u00e9 m\u00ed\u0159e prov\u00e1d\u011bna na kolenn\u00edm kloubu, prov\u00e1d\u00ed se v\u0161ak tak\u00e9 na rameni, ky\u010dli, lokti a dal\u0161\u00edch kloubech.<\/p>\n

Mezi nej\u010dast\u011bj\u0161\u00ed stavy nalezen\u00e9 v kloubech b\u011bhem artroskopick\u00e9 operace pat\u0159\u00ed:<\/h3>\n

v kolen\u011b:<\/strong><\/p>\n

    \n
  • trhliny v menisku (chrupavce)<\/li>\n
  • chondromalacie (po\u0161kozen\u00ed kloubn\u00ed chrupavky r\u016fzn\u00e9 intenzity a charakteru)<\/li>\n
  • utr\u017een\u00fd p\u0159edn\u00ed zk\u0159\u00ed\u017een\u00fd vaz<\/li>\n<\/ul>\n

    v ramen\u011b:<\/strong><\/p>\n

      \n
    • odlou\u010den\u00ed a po\u0161kozen\u00ed \u010d\u00e1sti \u00faponu kloubn\u00edho pouzdra na okraji kloubn\u00ed plochy lopatky<\/li>\n
    • po\u0161kozen\u00ed \u0161lachy dvojhlav\u00e9ho svalu<\/li>\n
    • po\u0161kozen\u00ed kloubn\u00edho povrchu<\/li>\n
    • utr\u017een\u00e1 rot\u00e1torov\u00e1 man\u017eeta<\/li>\n
    • degenerativn\u00ed po\u0161kozen\u00ed rot\u00e1torov\u00e9 man\u017eety<\/li>\n<\/ul>\n

      v jak\u00e9mkoliv kloubu:<\/strong><\/p>\n

        \n
      • zran\u011bn\u00ed<\/li>\n
      • z\u00e1n\u011bt nitrokloubn\u00ed v\u00fdstelky (revmatismus apod.)<\/li>\n
      • uvoln\u011bn\u00e9 t\u011bl\u00edsko – kost nebo chrupavka<\/li>\n<\/ul>\n

        Artroskopick\u00e1 operace<\/h3>\n

        Artroskopick\u00e1 operace se prov\u00e1d\u00ed p\u0159i celkov\u00e9, spin\u00e1ln\u00ed nebo lok\u00e1ln\u00ed anestezii, v z\u00e1vislosti na kloubu a celkov\u00e9ho stavu pacienta.
        \nK vsunut\u00ed artroskopu se ud\u011bl\u00e1 mal\u00e1 ranka (cca 1 cm dlouh\u00e1). Podle pot\u0159eby m\u016f\u017ee b\u00fdt pou\u017eito i n\u011bkolik dal\u0161\u00edch ranek, ke zlep\u0161en\u00ed p\u0159ehledu i v jin\u00fdch \u010d\u00e1stech kloubu, pop\u0159\u00edpad\u011b k vsunut\u00ed speci\u00e1ln\u011b upraven\u00fdch instrument\u016f.<\/p>\n

        N\u011bkter\u00e9 operace, kter\u00e9 mohou b\u00fdt prov\u00e1d\u011bny artroskopicky:<\/strong><\/p>\n

          \n
        • O\u0161et\u0159en\u00ed utr\u017een\u00e9 rot\u00e1torov\u00e9 man\u017eety v rameni<\/li>\n
        • O\u0161et\u0159en\u00ed nebo vyjmut\u00ed po\u0161kozen\u00e9ho menisku (chrupavky) z kolena<\/li>\n
        • Rekonstrukce p\u0159edn\u00edho zk\u0159\u00ed\u017een\u00e9ho vazu v kolen\u011b<\/li>\n
        • Odstran\u011bn\u00ed z\u00e1n\u011btliv\u011b zm\u011bn\u011bn\u00e9 nitrokloubn\u00ed v\u00fdstelky (synovie)<\/li>\n
        • Uvoln\u011bn\u00ed karp\u00e1ln\u00edho tunelu<\/li>\n
        • O\u0161et\u0159en\u00ed utr\u017een\u00fdch vaz\u016f<\/li>\n
        • Odstran\u011bn\u00ed uvoln\u011bn\u00fdch t\u011bl\u00edsek v kloubech<\/li>\n<\/ul>\n

          Po operaci jsou mal\u00e9 jizvy kryty obvazem. Poopera\u010dn\u00ed bolesti a d\u00e9lka \u00fapln\u00e9ho dol\u00e9\u010den\u00ed z\u00e1vis\u00ed na rozsahu a charakteru po\u0161kozen\u00ed kloubu, kv\u016fli kter\u00fdm byla artroskopie provedena. Uveden\u00e9 okolnosti ur\u010duj\u00ed tak\u00e9 d\u00e9lku a typ operace. Pacienti b\u00fdvaj\u00ed zpravidla propu\u0161t\u011bni dom\u016f prvn\u00ed a\u017e t\u0159et\u00ed den po operaci. Po z\u00e1kroc\u00edch je prov\u00e1d\u011bna rehabilitace.<\/p>\n

          Mo\u017en\u00e9 komplikace<\/h3>\n

          A\u010dkoliv velmi z\u0159\u00eddka (m\u00e9n\u011b ne\u017e v 1% v\u0161ech artroskopick\u00fdch operac\u00ed), mohou se b\u011bhem nebo po skon\u010den\u00ed operace p\u0159ihodit komplikace.<\/p>\n

          Zahrnuj\u00ed:<\/strong><\/p>\n

            \n
          • infekci<\/li>\n
          • krevn\u00ed sra\u017eeniny<\/li>\n
          • nadm\u011brn\u00fd otok nebo krv\u00e1cen\u00ed<\/li>\n
          • nervov\u011b-c\u00e9vn\u00ed po\u0161kozen\u00ed<\/li>\n<\/ul>\n<\/div>\n
            <\/div>\n<\/div>\n<\/div>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=“in_container“ full_screen_row_position=“middle“ column_margin=“default“ column_direction=“default“ column_direction_tablet=“default“ column_direction_phone=“default“ scene_position=“center“ text_color=“dark“ text_align=“left“ row_border_radius=“none“ row_border_radius_applies=“bg“ overlay_strength=“0.3″ gradient_direction=“left_to_right“ shape_divider_position=“bottom“ bg_image_animation=“none“][vc_column column_padding=“no-extra-padding“ column_padding_tablet=“inherit“ column_padding_phone=“inherit“ column_padding_position=“all“ background_color_opacity=“1″ background_hover_color_opacity=“1″ column_shadow=“none“ column_border_radius=“none“ column_link_target=“_self“ gradient_direction=“left_to_right“ overlay_strength=“0.3″ width=“1\/1″ tablet_width_inherit=“default“ tablet_text_alignment=“default“ phone_text_alignment=“default“ column_border_width=“none“ column_border_style=“solid“ bg_image_animation=“none“][toggles style=“minimal“][toggle color=“Default“ title=“Koleno – Meniskus“][vc_column_text]\n
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            Meniskus je ve tvaru kruhovit\u00e9ho disku, jeho funkc\u00ed je absorbovat n\u00e1razy mezi kostmi v kolen\u011b a zlep\u0161uje stabilitu kloubu v jednotliv\u00fdch f\u00e1z\u00edch pohybu. Meniskus je \u010dasto po\u0161kozen p\u0159i prudk\u00e9m pohybu nebo p\u0159i opakovan\u00fdch siln\u00fdch n\u00e1razech. Kdy\u017e se meniskus roztrhne, m\u016f\u017ee se jeho kousek dostat do nep\u0159irozen\u00e9 polohy uvnit\u0159 kloubu a m\u016f\u017ee zp\u016fsobit bolest a otok. Tk\u00e1\u0148 menisku se zp\u011bt sama nep\u0159ihoj\u00ed.<\/p>\n

            Mo\u017enosti l\u00e9\u010dby<\/h3>\n

            Sou\u010dasn\u00e9 nov\u00e9 techniky umo\u017e\u0148uj\u00ed o\u0161et\u0159en\u00ed menisku artroskopicky, pou\u017eit\u00edm \u0161it\u00ed nebo mal\u00fdch samovst\u0159ebateln\u00fdch skobi\u010dek.<\/p>\n

            V p\u0159\u00edpad\u011b, \u017ee utr\u017een\u00fd meniskus nem\u016f\u017ee b\u00fdt rekonstruov\u00e1n, je odstran\u011bn jeho nejmen\u0161\u00ed mo\u017en\u00fd kousek.<\/p>\n

            V sou\u010dasn\u00e9 dob\u011b se ve sv\u011bt\u011b zkou\u0161\u00ed mo\u017enosti n\u00e1hrady po\u0161kozen\u00e9ho menisku transplant\u00e1tem.<\/p>\n

            Poopera\u010dn\u00ed p\u00e9\u010de<\/h3>\n

            Je mo\u017en\u00e9 okam\u017eit\u00e9 zat\u00ed\u017een\u00ed p\u0159i ch\u016fzi, v prvn\u00edch 48 hodin\u00e1ch je mo\u017eno pou\u017e\u00edt berle. Obnoven\u00ed rozsahu pohybu a rehabilitace je zah\u00e1jena okam\u017eit\u011b. B\u011bhem n\u011bkolika dn\u016f je mo\u017en\u00e1 j\u00edzda na kole.<\/p>\n

            Progn\u00f3za:<\/strong> V 90-95% jsou v\u00fdsledky \u00fasp\u011b\u0161n\u00e9, s n\u00e1vratem ke sportovn\u00ed \u010dinnosti b\u011bhem 4-6 t\u00fddn\u016f ve v\u011bt\u0161in\u011b p\u0159\u00edpad\u016f. P\u0159i rozs\u00e1hlej\u0161\u00edch v\u00fdkonech a transplantaci je t\u0159eba k \u00fapln\u00e9mu dol\u00e9\u010den\u00ed 6 m\u011bs\u00edc\u016f.<\/em><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n[\/vc_column_text][\/toggle][toggle color=“Default“ title=“Rameno“][vc_column_text]\n

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            \n
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            Ramenn\u00ed kloub je kloub s nejv\u011bt\u0161\u00edm rozsahem pohybu v lidsk\u00e9m t\u011ble a proto je nejv\u00edce n\u00e1chyln\u00fd k nestabilit\u011b.<\/p>\n

            Typy nestability ramene<\/h3>\n

            Subluxace:<\/strong> \u010c\u00e1ste\u010dn\u00e9 vyklouben\u00ed kloubu. Kloubn\u00ed hlavice \u010d\u00e1ste\u010dn\u011b vyklouz\u00e1v\u00e1 z jamky, ale nikdy ne \u00fapln\u011b.<\/p>\n

            Dislokace:<\/strong> \u00dapln\u00e9 vyklouben\u00ed kloubn\u00ed hlavice z jamky<\/p>\n

            Sm\u011bry vyklouben\u00ed ramene<\/h3>\n

            P\u0159edn\u00ed (Anterior):<\/strong> Toto je nej\u010dast\u011bj\u0161\u00ed p\u0159\u00edpad vyklouben\u00ed (95%) a znamen\u00e1, \u017ee rameno vypad\u00e1v\u00e1 dop\u0159edu (viz. obr\u00e1zek).<\/p>\n

            V\u00edcesm\u011brn\u00e9 (Multidirectional):<\/strong> Znamen\u00e1 to, \u017ee rameno je nestabiln\u00ed ve v\u00edce ne\u017e jednom sm\u011bru. Oby\u010dejn\u011b je rameno nestabiln\u00ed dop\u0159edu a dol\u016f, ale m\u016f\u017ee b\u00fdt nestabiln\u00ed i dozadu. Tento typ nestability je n\u011bkdy spat\u0159ov\u00e1n u plavc\u016f.<\/p>\n

            Zadn\u00ed (Posterior):<\/strong> Vyklouben\u00ed sm\u011brem dozadu. Tento typ vyklouben\u00ed je velmi vz\u00e1cn\u00fd.<\/p>\n

            P\u0159\u00edznaky<\/h3>\n

            Pacienti s mal\u00fdmi p\u0159\u00edznaky nestability maj\u00ed pouze ob\u010das pocit nestabiln\u00edho ramene. \u010cast\u011bji je vyklouben\u00ed doprov\u00e1zeno bolest\u00ed a v\u00fdrazn\u00fdm omezen\u00edm hybnosti kon\u010detiny.<\/p>\n

            P\u0159\u00edpady \u00fapln\u00e9ho vyklouben\u00ed jsou jednodu\u0161eji rozpoznateln\u00e9. Pacient by m\u011bl vyhledat l\u00e9ka\u0159e, kter\u00fd ud\u011bl\u00e1 rentgenov\u00fd sn\u00edmek a rameno vr\u00e1t\u00ed do spr\u00e1vn\u00e9 polohy.<\/p>\n

            Mo\u017enosti l\u00e9\u010dby<\/h3>\n

            L\u00e9\u010dba z\u00e1vis\u00ed na druhu nestability a v\u011bku pacienta. \u010c\u00edm mlad\u0161\u00ed pacient, t\u00edm je v\u011bt\u0161\u00ed \u0161ance, \u017ee rameno bude opakovan\u011b a st\u00e1le \u010dast\u011bji vyskakovat. Opakovan\u00e1 vyklouben\u00ed omezuj\u00ed aktivity a vedou k mo\u017en\u00fdm po\u0161kozen\u00edm kloubu. Operace je mo\u017enost jak p\u0159edej\u00edt opakovan\u00fdm vyklouben\u00edm. Sou\u010dasn\u00e9 l\u00e9ka\u0159sk\u00e9 postupy doporu\u010duj\u00ed p\u0159i opakovan\u00fdch vyklouben\u00edch operativn\u011b opravit po\u0161kozen\u00e9 vazy a u velmi mlad\u00fdch pacient\u016f prov\u00e9st operaci ihned po prvn\u00edm vyklouben\u00ed.<\/p>\n

            Operace<\/h3>\n

             <\/p>\n

            Artroskopick\u00e9 metody<\/h3>\n

            T\u00e9m\u011b\u0159 v\u0161echny typy nestability mohou b\u00fdt v sou\u010dasnosti o\u0161et\u0159eny artroskopicky. Pokud jsou vazy odtr\u017eeny \u00fapln\u011b, mohou b\u00fdt znovu p\u0159ipevn\u011bny pou\u017eit\u00edm mal\u00fdch skobi\u010dek, nebo po zaveden\u00ed speci\u00e1ln\u00edch steh\u016f artroskopicky, bez nutnosti velk\u00e9 jizvy, jak tomu je p\u0159i pou\u017eit\u00ed otev\u0159en\u00e9 operace (Bankartovy operace). Sou\u010dasn\u00e9 metody maj\u00ed 75-90% \u00fasp\u011b\u0161nost p\u0159i prevenci opakovan\u00fdch vyklouben\u00ed.<\/p>\n

            Kapsulografie<\/h3>\n

            Pokud je pouzdro p\u0159\u00edli\u0161 voln\u00e9 a vazy vytahan\u00e9, ale ne utr\u017een\u00e9, existuje n\u011bkolik nov\u00fdch artroskopick\u00fdch metod k jejich zpevn\u011bn\u00ed. Vazy m\u016f\u017eou b\u00fdt bu\u010f p\u0159i\u0161ity, nebo jsou m\u011bkk\u00e9 tk\u00e1n\u011b vystaveny \u00fa\u010dink\u016fm tepla (laser, wapor), co\u017e zp\u016fsob\u00ed zmen\u0161en\u00ed objemu kloubn\u00edho pouzdra. Ob\u011b metody jsou prov\u00e1d\u011bny artroskopicky, hojn\u011b diskutov\u00e1ny a dlouhodob\u00e9 v\u00fdsledky zat\u00edm nejsou zn\u00e1my.<\/p>\n

            Poopera\u010dn\u00ed p\u00e9\u010de:<\/strong> Pacienti dostanou na 3 t\u00fddny ort\u00e9zu, pouze s minim\u00e1ln\u00edm rozsahem pohybu. \u00dapln\u00fd rozsah pohyb\u016f je omezen do 6 t\u00fddn\u016f po operaci. Neomezen\u00e1 aktivita je mo\u017en\u00e1 po 6 m\u011bs\u00edc\u00edch.<\/p>\n

            Progn\u00f3za:<\/strong> Bez opera\u010dn\u00edho z\u00e1kroku bude u v\u011bt\u0161iny pacient\u016f probl\u00e9m s nestabilitou pokra\u010dovat. Po operaci se m\u016f\u017ee 90% pacient\u016f vr\u00e1tit k p\u016fvodn\u00edm sportovn\u00edm aktivit\u00e1m.<\/em><\/p>\n<\/div>\n<\/div>\n<\/div>\n[\/vc_column_text][\/toggle][\/toggles][\/vc_column][\/vc_row]\n","protected":false},"excerpt":{"rendered":"

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