고관절 전치환술 시 각도기와 지시봉을 사용한 술전 측와위 방사선 검사의 유효성
Effectiveness of a Pre-Operative Lateral Decubitus Position Radiologic Examination Using a Goniometer and Rod in THRA
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목적: 정확한 외전각으로 비구컵 삽입을 위해, 술전 각도기와 지시봉을 이용해 측와위 방사선 촬영으로 골반 경사를 확인하고, 동일한 각도기 및 지시봉을 이용하여 비구컵 삽입 후 그 정확성을확인 하고자 하였다. 대상 및 방법: 2008년 1월부터 2009년 12월까지 인공 고관절 전치환술을 시행한 50명, 56예를대상으로 하였다. 평균 나이는 63.8세로, 남자 31명(36예), 여자 19명(20예)였다. 술전 진단은대퇴 골두 괴사가 27예 , 속발성 관절염이 10예, 대퇴 경부 골절이 14예 있었다. 각도기와 지시봉을 이용하여 술전 측와위 방사선 촬영으로 골반의 경사를 측정하였다. 골반의 경사를 보정해 27예의 세라믹 대 세라믹 관절면은 40, 29예의 세라믹 대 폴리에틸렌 관절면은 45를 목표로 하여, 비구컵을 삽입하고 그 각도를 측정하였다. 결과: 최종 추시 방사선 검사에서 비구컵 외전각은 세라믹 대 세라믹 관절면은 평균 39.3, 세라믹 대 폴리에틸렌 관절면은 평균 44.4로 40와 45와 차이가 없었다(P=0.059, P=0.071). 결론: 술전 각도기와 지시봉을 이용한 측와위 방사선 촬영으로, 골반의 경사를 확인하고, 비구컵삽입시 이를 보정하는 방법은 비구컵의 외전각의 변화를 줄일 수 있는 술식이라 판단된다.
Abstract
Purpose: For inserting an acetabular cup with the correct inclination angle, we checked the pelvic tilts using the lateral decubitus position X-ray and a goniometer and pointer. The accuracy of the cup inclination at the targeted angles was evaluated after insertion of the cup at an adjusted angle with using a goniometer and pointer. Material and Methods: Between January 2008 and December 2009, 56 hips in 50 patients who underwent total hip replacement arthroplasty (THRA) were enrolled. The mean age at the time of surgery was 63.8 years. There were 31male patients (36 hips) and 19 female patients (20 hips). The preoperative diagnoses included osteonecrosis of the femoral head in 27 hips, secondary osteoarthritis in 10 hips and femoral neck fracture in 14 hips. The preoperative pelvic tilts were evaluated according to the lateral decubitus position X-ray with using a goniometer and pointer. The target inclination angle was 40 for 27 hips that underwent ceramic-on-ceramic THRA. The target inclination angle was 45 for the 29 hips that underwent ceramic-on-polyethylene THRA. The inclination of the cup was evaluated after inserting the acetabular cup at the adjusted angle using a goniometer and pointer. Results: The mean inclination angle of the acetabular cup was 39.3 for the ceramic-on-ceramic THRA and 44.4 for the ceramic-on-polyethylene THRA. There were no significant differences between the 40 and 45 (P=0.059, P=0.071). Conclusion: The pelvic tilt can be evaluated by checking the lateral decubitus X-ray with a goniometer and pointer. Insertion of an acetabular cup at the adjusted angle could be a credible method for reducing the variability of cup inclination.
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