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대퇴골두 무혈성 괴사의 비수술적 관절보존 치료

Joint Preserving Non-surgical Treatment of Osteonecrosis of Femoral Head

김용식|권순용|임영욱
대한고관절학회 (The Korean Hip Society)|2012.12|Hip and Pelvis|제24권 제4호|pp. 273-278|DOI http://dx.doi.org/10.5371/hp.2012.24.4.273

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Non-surgical treatmentOsteonecrosis대퇴골두 무혈성 괴사비수술적 치료

초록

대퇴골두 무혈성 괴사를 처음 진단 시에는 환자나 의사 모두 가능한 관절을 보존하는 방법을 가장 먼저 고려하고 궁극적인 성취 목표로 설정하게 되나, 다양한 인자로 인한 질병으로 지엽적인 병리학적 분석에 따른 원인에 대한 단순한 치료적 접근으로는 소기의 목적을 달성하는 것이 어렵다. 이러한 대퇴골두 무혈성 괴사의 자연 경과는 컴퓨터 단층촬영, 골 주사 혹은 자기공명영상과 같은 영상기술의발달로 다수의 예후인자들이 연구됨으로써, 이에 근거한 보다 정확하고 과학적 측면에서 객관적인 예 후 판단이 가능하게 되었다. 대다수의 대퇴골두 무혈성 괴사의 호발 연령은 20-50대의 청장년층이기 때문에 일차적으로 통증만을 해소하려는 것을 목표로 하여 무조건 수술적 치료 특히 인공관절 치환을 시행하는 것은 바람직하지 않다. 따라서 초기의 경우에는 이차적인 퇴행성 관절을 방지하고 관절을 보존하는 측면에서 접근하여야 하는 다양한 시도가 현재 실험적 혹은 임상적 측면에서 이루어지고 있다. 본문에서는 초기의 대퇴골두 무혈성 괴사에서 실험적 혹은 임상적 측면에서 시행되고 있는 비수술적 관절 보존 치료법을 고찰하고자 한다.

Abstract

A patient and physician initially consider how to preserve a joint, and make a goal to achieve this aim when osteonecrosis is initially diagnosed. On the other hand, it is almost imposs able to make a decision with only a herapeutic approach based on the pathology, because osteonecrosis of the femoral head is caused by a range of factors. An objective prognosis has now become possible due to the development of radiologic diagnostic assessment tools, such as CT, bone scans and MRI. Most osteonecrosis patients are in their 20-50’s. Therefore, physicians make a primary goal to control pain. The surgical approach, such as total joint replacement, is not the first option for early stage osteonecrosis. In the first stage, osteonecrosis should be treated to prevent secondary degenerative diseases and preserve the hip joint. This paper introduces a non-surgical joint preserving treatment in scientific and clinical aspects for early stage osteonecrosis.

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