고관절 이극성 반치환술 후 비구 연골의 퇴화에 영향을 주는 위험 요인들의 분석
Analysis of Risk Factors Affecting Degeneration of the Acetabular Cartilage after Bipolar Hemiarthroplasty
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목적: 대퇴 경부 골절이나 전자간 골절로 진단받고 고관절 이극성 반치환술을 시행 받은 환자 중에 비구 연골의 퇴화 정도를 알아보고 이에 영향을 주는 위험 요인들을 분석하고자 한다. 대상 및 방법: 대퇴 경부 골절이나 전자간 골절로 진단받고 고관절 이극성 반치환술을 시행 받은 환자 중 2년 이상 추시가 가능한 34명을 대상으로 하였다. 비구 연골의 퇴화와 여러 위험 요인들의 연관성을 알기 위하여 임상적으로 Harris Hip Score (HHS), 활동력, 골다공증 유무, 좌식 생활 여부를 조사하였고, 방사선학적으로 수술 전후와 최종 추시 방사선 사진을 분석하여비구 연골의 침식 정도를 측정하였다. 결과: 고관절 이극성 반치환술 후 측정한 관절 간격의 감소는 평균 0.20 mm/yr이었다. 비구 연골의 퇴화는 남자는 평균 0.26 mm/yr, 여자는 평균 0.19 mm/yr이었으며(p=0.039), 평균 70세 미만은 평균 0.29 mm/yr이었고, 70세 이상은 0.13 mm/yr이었다(p=0.021). 좌식 생활을 하는 환자는 0.24 mm/yr, 입식생활을 하는 환자는 0.18 mm/yr이었다(p=0.037). 시멘트를 사용한 환자는 0.22 mm/yr, 시멘트를 사용하지 않은 환자는 0.21 mm/yr이었다 (p=0.237). 골밀도 검사상 비구 연골 퇴화가 평균이상인 군에서는 T-score가 -3.7, 평균 이하인 군에서는 -3.9이었고(p=0.254), 활동력 점수는 각각 4.3과 3.2이었고(p=0.041), HHS는 각각 75점과 87점이었고(p=0.027), 대퇴 스템 정렬은 각각 내반 2도와 내반 1도였다(p=0.438). 결론: 비구 연골의 퇴화는 성별, 골다공증 유무, 대퇴스템 시멘트 유무와는 상관관계가 없었으나 나이가 젊을수록, 좌식 생활을할수록, 활동력이 높을수록, HHS가 낮을수록 비구 연골의 퇴화가 심하였다. 따라서, 고관절 치환술시 환자의 나이, 좌식 생활여부, 활동력에 따라 반치환술 혹은 전치환술을 선별하여 시행하는 것이 좋으리라 사료된다.
Abstract
Purpose: This study attempted to investigate the rate of acetabular cartilage wear, as well as the risk factors that are related to degeneration, for patients who were diagnosed with femur neck or intertrochanteric fracture and who underwent bipolar hemiarthroplasty. Materials and Methods: 34 patients who were diagnosed with femur neck or intertrochanteric fracture and who underwent bipolar hemiarthroplasty were selected as the study subjects, and they were followed up for more than 2 years. We examined potential relationships between the degeneration of acetabular cartilage and the various risk factors by comparing radiographs taken before and after operations. Results: After bipolar hemiarthroplasty, the average degenerative change in the acetabular cartilage was 0.20 mm/yr. Specifically, the average appeared significantly different according to gender (p=0.039, Male: 0.26 mm/yr, Female: 0.19 mm/yr), age (p=0.02, the under 70-year olds: 0.29 mm/yr, the upper 70-year olds: 0.13 mm/yr), the life style, (p=0.037, the stand-up life style: 0.18 mm/yr, the sit-down life style: 0.24 mm/yr), (ED note: stand up and sit down made no sense.) and using femoral stem cementing (p=0.237, cement: 0.22 mm/yr, non-cement: 0.21 mm/yr). The bone mineral density score (p=0.254), activity score (p=0.041), HHS (p=0.027) and femoral stem alignment (p=0.438) were shown to be -3.7, 3.2, 87 and varus 1 degree for people with less than average degeneration of the acetabular cartilage and -3.9, 4.3, 75 and varus 2 degrees for people with more than average degeneration of the acetabular cartilage, respectively. Conclusion: The results showed no significant relationship between degeneration of the acetabular cartilage and patient gender, the presence of osteoporosis and using femoral stem cement. The degeneration of acetabular cartilage was faster for young patients, for patients with a sit-down life style, for a higher activity score or for a lower HHS. It is strongly recommended for surgeons to consider the patients' various conditions such as age, activity and a sit-down lifestyle when deciding between hemiarthroplasty and total hip arthroplasty.
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