고관절 고위 탈구 환자에서 전자하 횡형 단축 절골술을 이용한 무시멘트성 인공 고관절 전치환술
Cementless Total Hip Arthroplasty with Subtrochanteric Transverse Shortening Osteotomy in Patients with High Hip Dislocation
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목적: 고관절 고위 탈구 환자에서 전자하 횡형 단축 절골술을 이용하여 무시멘트성 인공 고관절 전치환술을 시행하고 그 임상적 및 방사선학적 결과를 알아보고자 하였다. 대상 및 방법: 2001년부터 2012년까지 고관절 고위 탈구로 대퇴 전자하부 횡형 단축 절골술과 함께 금속판 또는 케이블 고정 및 절골부위의 골이식을 시행하여 무시멘트성 인공 고관절 전치환술을 시행하였던 환자 18명(18예)을 대상으로 하였다. 평균 추시 기간은 5.2년(2-8.3년)이었다. 임상적으로 Harris 고관절 점수, 파행, 하지 부동의 변화를 측정하였고, 방사선학적으로 골용해, 삽입물의 해리 및 절골 부위의 유합 유무를 평가하였다. 결과: 최종 추시 시 전 예에서 Harris 고관절 점수, 파행 및 하지 부동의 호전이 관찰되었다. 방사선학적으로 감염이 발생했던 2예를 제외한 전 예에서 삽입물의 해리, 골용해 등을 보인 경우는 없었으며, 전 예에서 절골부의 유합 소견을 보였다. 합병증으로 감염 2예, 탈구 1예가 있었으며 감염으로 재수술을 시행한 2예 중 1예에서 좌골 신경 마비가 발생하였다. 결론: 고관절 고위 탈구 환자에서 전자하부 횡형 단축 절골술을 이용한 무시멘트성 인공 고관절 전치환술은 비교적 만족할 만한 결과를 보였다. 그러나 감염 등의 합병증 발생이 상대적으로 높게 나타나 이에 대한 각별한 주의가 필요할 것으로 생각된다.
Abstract
Purpose: The purpose of this study was to evaluate the clinical and radiographic results of cementless total hip arthroplasty (THA) with subtrochanteric transverse shortening osteotomy in patients with high hip dislocation. Materials and Methods: Eighteen patients with high hip dislocation who underwent cementless THA combined with a subtrochanteric transverse shortening osteotomy, plate or cable fixation and bone graft on the osteotomy site between 2001 and 2012 were evaluated in this study. The mean duration of follow-up was 5.2 (2-8.3) years. We evaluated Harris hip score, limping, limb length discrepancy as a clinical parameter andosteolysis, loosening and union of the osteotomy site as a radiographic parameter. Results: Harris hip scores at the final follow-up showed improvement of limping and limb length discrepancy in all cases. And, with the exception of two cases of infection, there were no loosening and osteolysis. All cases showed union of the osteotomy site. There were two cases of infection and one case of dislocation as acomplication. Infection occurred in two patients who underwent reoperation and one patient developed sciatic nerve palsy. Conclusion: Cementless THA with subtrochanteric transverse shortening osteotomy showed relatively satisfactory clinical and radiologic results. However, the incidence of complications, such as infection, is relatively high, therefore, careful attention is needed.
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