대퇴골두 무혈성괴사에서 시행한 핵심감압술의 유용성
The Efficacy of Core Decompression for Treating Avascular Necrosis of the Femoral Head
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목적: 초기 대퇴골두 무혈성 괴사에서 핵심 감압술의 효과 및 동반하여 시행한 자가 골 이식술, 탈회 골 기질 이식술의 효과를 알아보고자 하였다. 대상 및 방법: 핵심 감압술을 시행 받은 후 최소 2년 이상 추시가 가능했던 37명, 40예의 고관절 을 대상으로 하였다. 나이는 평균 47.8세, 추시 기간은 평균 62.4개월 이었다. 술전 방사선 및 MRI 사진을 이용하여 Ficat & Arlet (F&A) stage, ARCO stage 을 이용하였다. 결과: 수술의 실패는 26예(65%),그 중 고관절 전치환술을 시행 받은 환자는 13예(32.5%) 이었 다. F&A stage는 I. 10예, IIA. 22예, IIB. 8예였고, 성공률은 각각 60%, 36.4%, 0%로 유의한 차이가 있었다. ARCO stage는 I. 5예, II. 27예, III. 8예였고, 성공률은 각각 60%, 40.7%, 0%로 유의한 차이가 있었다. ARCO stage II 중 Subgroup은 A 2예, B 13예, C 12예였고 성공률은 각 각 50%, 46%, 33.3%로 유의한 차이가 있었다. 결론: F&A stage IIA 및 ARCO stage IIB 이상 진행된 대퇴 골두 무혈성 괴사의 경우 핵심 감압 술 시행함에 있어 신중히 고려되어야 할 것으로 사료된다.
Abstract
Purpose: We evaluated the efficacy of core decompression (CD) for treating early avascular necrosis of the femoral head (ANFH), as well as the effect of an autogeneous bone graft and an DBM graft on the results of CD. Materials and Methods: This study included 37 patients (40 cases) who were initially diagnosed as suffering with early ANFH, and they were treated with CD and followed up for a minimum of two years. The average patient age was 47.8 years and the average follow up period was 62.4 months., The Ficat & Arlet (F&A) stage and the ARCO stage were used for the radiological staging. Results: The failure rate was 65% (26 case), and 32.5% (13 cases) underwent THA due to clinical and radiological failure. According to the F&A stage, there were 10 stage I hips, 22 stage IIA hips and 8 stage IIB hips, and the success rate (SR) of core decompression was 60%, 36.4% and 0%, respectively. The differences were statistically significant. The cases of ARCO stage II were divided into subgroups: A 2 hips, B 13 hips and C 12 hips and the SR of each were 50%, 46%, and 33.3%, respectively. The differences were statistically significant. Conclusion: CD should be carefully considered for treating the advanced stages above F&A stage IIA and ARCO stage IIB.
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