대퇴골 근위부에 발생한 골낭종의 수술적 치료 결과
Results of Operative Treatment for a Bone Cyst in the Proximal Femur
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목적: 대퇴골 근위부의 단순 골낭종을 가진 21명의 환자를 소파술과 골이식술로 치료하고 최소24개월 이상 추시한 후 그 결과를 후향적으로 분석하고자 하였다. 대상 및 방법: 1995년 6월부터 2008년 7월까지 대퇴골 근위부에 발생한 골낭종을 보여 소파술과골이식술로 치료한 21예를 대상으로 하였다. 연령분포는 14세에서 62세까지 평균 39.8세였고,남자 4명, 여자 17명이었으며, 추시 기간은 24개월에서 12년까지 평균 63.7개월 이였다. 추시기간 중 효과 판정 방법은 단순방사선 검사를 시행하고Oppenheim의 분류를 통하여 결과를 비교하였고, 낭종의 위치, 진단 당시 환자의 연령, 병적 골절 여부, 대퇴 비구 충돌 증후군과의 연관성그리고 골 이식의 종류에 대하여 알아보았다. 결과: 21예 중 20예에서 호전 이상의 결과를 얻었다. 자가 골만 사용한 15예 중 14예가 호전 이상 이었으며, 자가 골과 동종 골을 같이 사용한 6예는 모든 예에서 호전 이상 이었다. 활강 압박고 나사를 이용하여 안정 고정한 예는 21예 중 18예였으며 나머지 3예는 단순 골 이식만 시행되었다. 대퇴 비구 충돌 증후군과 연관된 경우는 2예 였다. 합병증으로는 활강 압박 고 나사고정이시행 되지 않았던 예에서 외상에 의한 대퇴 경부 골절이 1예에서 발생하여 인공 고관절 전 치환술로 치료 하였다. 결론: 대퇴골 근위부에 발생한 골낭종은 골 소파술과 골 이식 및 활강 압박 고 나사 고정으로 양호한 치료 결과를 보였으며, 50대 이후 골두-경부에 발생한 소 낭종은 대퇴골두-비구 충돌 증후군에 의하여 발생된 것이었다.
Abstract
Purpose: We retrospectively evaluated performing curettage and bone grafting for the treatment of simple bone cyst in 21 patients with cysts in the proximal femur. The purpose of this study was to review the results with a minimum follow up of 24 months. Material and Methods: We treated 21 cases of simple bone cysts with curettage and a bone graft from June 1995 to July 2008. 4 male and 17 female patients (age range: 14~62 years (mean age: 39.8 years) volunteered for this study. The range of the follow-up period was from 24 months to 6 years (mean follow-up: 63.7 months). We evaluated the effect of treatment by examining the simple follow-up radiographs according to Oppenheim’s classification. We retrospectively reviewed the site of the cysts, the patients’ ages at the time of the diagnosis, the incidence of pathologic fracture, the association with femoro-acetabular impingement (FAI) and the type of bone graft. Results: The investigation revealed that 20 out of 21 patients had better than improved results. 14 patients of the 15patients who were treated with an autogenous bone graft had better than improved results and all 6 patients who received an autogenous and allergenic bone graft had better than improved results. Two patients had associated FAI. These cases were managed with arthroscopic labral trimming and curettage. There were no specific complications related to the bone cyst and the operative procedure. Conclusion: We believe curettage and bone grafting and stabilization with compression hip screws is a reasonable treatment for simple bone cysts in the proximal femur. The bone cyst in the femoral head neck junction in patients older than 50 years old is related with femoroacetabular impingement.
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