고관절 고위 탈구 환자에서 전자하 단축 절골술을 이용한 조립식 무시멘트형 고관절 전치환술
Modular Cementless Total Hip Arthroplasty with Subtrochanteric Shortening Osteotomy in Patients with High Hip Dislocation
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목적: 고관절 고위 탈구 환자에서 시행한 전자하 단축 절골술을 이용한 조립식 무시멘트형 고관절 전치환술의 임상적 및 방사선학적 추시 결과를 보고하고자 한다. 대상 및 방법: 1996년 5월부터 2008년 6월까지 고관절 고위 탈구 환자 중 진성 비구에 비구 컵을위치시키기 위하여 전자하 단축 절골술을 시행하고 근위 조립식 무시멘트형 대퇴 스템을 이용한고관절 전치환술을 시행 받은 23명(24예)을 대상으로 하였다. 남자 6명, 여자 17명이었으며, 평균 나이는 44세였다. 수술 후 추시 기간은 평균 5.6년이었다. 결과: Harris 고관절 점수는 수술 전 평균 53점에서 수술 후 평균 88점으로 향상되었고(P<0.001), 21예(87.5%)에서 양호 혹은 우수의 결과를 얻었다. 폴리에틸렌 마모에 의한 비구 컵 이완으로 수술 후 12년에 재치환술을 시행 받은 1예를 제외한 모든 예에서 최종 추시 시 삽입물의안정고정 소견을 관찰할 수 있었다. 총 4예(17%)에서 합병증이 발생하였는데, 탈구 1예, 일시적대퇴신경 마비 2예, 전자하 절골술 부위 불유합 1예가 있었다. 결론: 고관절 고위 탈구 환자에서 전자하 단축 절골술을 이용한 조립식 무시멘트형 고관절 전치환술을 시행하여 절골술 부위의 추가 고정을 최소화하면서 우수한 임상 결과를 얻을 수 있었다.
Abstract
Purpose: The purpose of this study was to report on the results of performing modular cementless total hip arthroplasty with a simultaneous subtrochanteric shortening osteotomy in patients with high hip dislocation. Materials and Methods: We evaluated 23 patients (24 hips) with high hip dislocation and who had undergone total hip arthroplasty using a proximally modular cementless stem in combination with a subtrochanteric shortening osteotomy in order to place the acetabular cup at the level of the anatomic hip center between May 1996 and June 2008. There were 6 males and 17 females with a mean age of 44 years. The mean duration of follow-up was 5.6 years. Results: The mean Harris hip score improved from 53 points preoperatively to 88 points at the time of final followup (P<0.001), and there were good or excellent results in 21 hips (87.5%). There was one instance of isolated loosening of the acetabular component. With the exception of one hip requiring revision surgery at 12 years postoperatively because of polyethylene wear and cup loosening, all the remaining components were well-fixed at the time of the last follow-up. A total of 4 hips (17%) had complications during follow-up; one dislocation, two transient femoral nerve palsies and one nonunion of the subtrochanteric osteotomy site. Conclusion: Modular cementless total hip arthroplasty with a subtrochanteric shortening osteotomy in patients with high hip dislocation was associated with excellent clinical outcomes while it minimized additional fixation of the osteotomy site.
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