대퇴골두 무혈성 괴사에서 시행한 무시멘트형 인공고관절 전치환술- 10년이상 장기추시 결과 -
Long Tern Follow up Study of Comentless Totla Hip Arthloplasty For Osteonecrosis of the Femoral Head -Minimum 10-year Follow up study-
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대퇴골두 무혈성 괴사 환자에서 무시멘트 반구형 비구컵과 대퇴스템을 이용한 인공고관절 전치환술 시행 후 장기 추시 결과를 분석 하였다. 대상 및 방법: 진행된 대퇴골두 무혈성 괴사증으로 무시멘트형 인공고관절 전치환술을 시행받은 후 최소 10년 이상 추시된 84명 119례를 대상으로 하였으며 남자가 69명(99례), 여자가 15명(20례)였다. 수술 당시 평균 연령은 42세, 평균 추시기간은 12년 1개월이었다. 무혈성 괴사의 원인은 특발성이 74례, 알 콜성이 28례, 스테로이드 유발성이 10례, 후외상성이 7례였다. 비구삽입물은 Harris-Galante(HG) I 이 33례, HG II가 86례였다. 대퇴삽입물은 HG stem 이 56례, Anatomic stem 이 63례였다. 방사선 적 분석은 수술후 3, 6, 12개월, 그 이후에는 매년 정기적으로 하였으며 임상적으로는 Harris 고관절 점수(HHS)를 분석하였다. 결과: HHS는 술 전 평균 57점에서 최종 추시시 92점이었고, 골용해는 비구부에서 24례, 대퇴부는 28 례 발생하였다. 폴리에틸렌 삽입물의 마모는 평균 1.50 mm, 연평균 선형 마모율은 0.15 mm/year로 계측되었다. 재치환술은 비구부 7례, 대퇴부 4례에서 시행되었다. Kaplan-Meier방식에 의한 비구컵 및 대퇴스템의 10년 생존률은 96%와 97.5%였다. 결론: 진행된 대퇴골두 무혈성 괴사에서 무시멘트형 인공고관절 전치환술시 좋은 결과를 얻기 위하여 개 선된 관절면의 사용 및 대퇴스템의 디자인 개발이 필요할 것으로 생각된다.
Abstract
P u r p o s e: To analyze the results of primary cementless total hip arthroplasties (THA) for osteonecrosis of the femoral head (ONFH). Materials and Methods: One hundred-nineteen cementless primary THA in 84 patients with ONFH were analysed. Minimum follow-up period was 10 years and average follow-up period was 12 years and one month. The mean age was 42 years. The causes of ONFH were idiopathic in 74 cases, alcoholic in 28, steroid induced in 10 and post traumatic in 7. We used Harris-Galante (HG) I cup in 33 cases and HG II cup in 86 as the acetabular component, and HG stem in 56 cases and Anatomic stem in 63 as the femoral component. Patients were evaluated using the modified Harris hip score and serial radiographs. Results: Final clinical evaluation showed an average of 92 points, from an average preoperative rating of 57 points. Radiographic evaluation demonstrated acetabular osteolysis in 24 hips, and femoral osteolysis in 28. The average linear wear rate of the polyethylene liner was 0.15 mm/year. Seven acetabular revisions and four femoral revisions were performed. The Kaplan-Meier survivorship of the acetabular cup was 96% and of the femoral stem was 97.5%, at 10 years. Conclusion: To obtain favorable long-term results in THA with ONFH, the use of improved tribology and design of cementless stem should be considered.
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