3D CT 를 이용한 비구 컵 주위 골용해 측정 및 임상 결과와의 관련성
Measurements of Socket Osteolysis with using 3D CT and their Correlation with the Clinical Outcome
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목적: 골반골 주위에서 발생한 골 용해 크기 및 위치를 측정하고 임상 성적과의 관련성을 알아 보고자 하였다. 대상 및 방법: 무 시멘트형 비구컵을 사용한 인공 고관절 전치환술을 받은 환자 97명 (116례) 에게 3D CT 가 시행되었고, 이 중 명확한 골 용해를 가진 40례(31 환자)에 대해 연구를 시행하였다. 대상 환자들은 수술 후 6-12주에 방사선 사진을 촬영하 였고, 추시 기간이 18개월 이상이며 감염의 과거력이 없었다. 골 용해의 크기 1 cm3미만(A), 1 cm3에서 2 cm3 미만(B), 2 cm3 에서 3 cm3 미만(C), 3 cm3(D) 이상의 4개의 군으로 분류 하였으며, 골 용해의 위치를 전방, 후방, 상방, 하방, 중앙의 5 군으로 분류하였다. 골 용해 크기, 골 용해 위치, 폴리에틸렌 마모와 임상결과(Harris hip score)간의 관련성을 통계학적으로 분석하였 다. 결과: 골 용해군의 평균 체적은 3.2 cm3 이었으며 (A 군 14 례, B 군 11 례, C 군 4례, D 군은 11례) 골 용해 크기와 임상성적간 에 통계적으로 유의한 상관관계를 보였다(Rs=-0569). 그러나 골 용해의 위치에 따른 분류 상 전방 18례, 상방 5례, 후방 10 례, 하방 33례, 중앙 32례 이었으며 골 용해 위치와 임상성적간에 통계적으로 유의한 차이는 없었다(P=0.35). 결론: 골 용해 크기와 임상 성적 사이에는 의미있는 상관 관계가 보였고(Rs=-0569), 특히 3 cm3 이상의 골 용해 군에서는 통 계학적으로 유의한 임상성적의 감소가 관찰 되었다 (P=0.022). 이는 추 후 골 용해에 대한 치료를 결정하는데 있어 하나의 지 침이 될 수 있으리라 사료된다.
Abstract
Purpose: We wanted to measure the size of the osteolysis of the pelvis and to quantify its location and we wanted to assess the correlation of these measurements with the clinical result. Materials and methods: We evaluated 40 hips (31 patients) that showed definitive osteolysis among 116 hips (97 patients) that underwent 3 dimensional CT scanning post-operatively after total hip arthroplasties with using cementless acetabular cups. The inclusion criteria were a follow up duration of more than 18 months and no history of infection. The radiographs were obtained at the 6th to 12th week postoperatively. The size of pelvic osteolysis was divided into 4 groups (less than 1 cm3 (A), between 1 cm3 to 2 cm3 (B), between 2 cm3 to 3 cm3 (C), more than 3 cm3 (D)), and the location of osteolysis was divided into 5 groups (anterior, posterior, superior, inferior and central) The size and location of osteolysis and the wear of the polyethylene were analysed in relation to the clinical outcome, which was assessed using the Harris Hip Score). Results: The average size of the osteolysis was 3.2 cm3 (A 14 cases in group A, B 11 cases in group B, C 4 cases in group C, and D 11 cases in group D). There was significant correlation between the size of the osteolysis and the clinical outcome (Rs=-0569). However, there was no significant correlation between the osteolysis location (Anterior: 18 cases, Superior: 5 cases, Posterior: 10 cases, Inferior: 33 cases and Central: 32 cases) and the clinical outcome (P=0.35). Conclusion: There is a significant correlation between the size of the osteolysis and the Harris Hip Score (Rs=- 0569). Especially, a pelvic osteolysis of more than 3 cm3 was found to be correlated with a decreased postoperative HHS (P=0.022). We hope that these results may be useful to help guide the treatment of osteolysis.
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