인공 고관절 전치환술 후 탈구
Dislocation as a Complication after Total Hip Arthroplasty
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초록
고관절 전치환술 후 탈구는 무균성해리, 인공관절 삽입물 주위 골절, 감염과 함께 재수술의 유병률이 높은 합병증이다. 일차성고관절 전치환술 후 일년 이내에 0.5% 에서 4%정도로 탈구가 발생한다. 탈구를 일으키는 위험인자는 삽입물의 위치, 수술적 도달법, 수술 수기, 인공관절 삽입물의디자인, 원인 질병, 그리고 환자의 순응도 등이다. 탈구의 원인을 이해하고 수술 수기를 개선하므로써 추후 탈구의 빈도를 줄일 수 있다. 고관절 전치환술 후 탈구는 대부분 한번의 비수술적 방법으로 치료가 되지만 재발될 경우 수술적 방법이 필요하다. 재발성 탈구의 수술방법의 선택은 탈구의 원인에 따라 달라지며, 삽입물의 재치환, 조립식 삽입물의 교체, 큰 대퇴골두의 사용, 연부조직 강화, 대결절의 이동, 양극성치환술, 구속형 비구내피의 사용 등을 시행할 수 있다.
Abstract
The prevalence of reoperation due to dislocation after total hip arthroplasty ranks high because of aseptic loosening,periprosthetic fracture and infection. Dislocation occurs in 0.5% to 4% of the cases in a year after primary total hip arthroplasty. The risk of dislocation is influenced by the position of the components, the surgical approach, the surgical techniques, the design of the prosthesis, the underlying diagnosis and the patient’s compliance with restrictions. A better understanding of the etiology of dislocation and refinements of surgical techniques have led to a decrease in the rate of dislocation over time. Although most dislocations after total hip arthroplasty are a single episode that can be managed nonoperatively, some patients require surgical intervention to treat recurrent dislocation. The choice of surgical technique to manage recurrent dislocation depends on the etiology of the problem. The surgical options available for the treatment of recurrent dislocation consist of component revision, modular component exchange, use of a larger femoral head, soft tissue reinforcement, advancement of the greater trochanter,bipolar arthroplasty and use of a constrained liner.
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