발달성 고관절 이형성증 환자에 발생된 고도의 탈구에 대한 전자하부 단축 절골술을 통한 인공고관절 치환술
Arthroplasty for High-riding Development Dislocation of the Hip
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본 연구를 통해 발달성 고관절 이형성증에서의 고도의 탈구(Crowe IV)에 대한 인공 고관절 전치 환술을 시행하는데 있어 사용되는 전자하 횡-절골술에 대해 그 결과를 보고자 한다. 대상 및 방법: 1995 년부터 2000 년까지 고도의 탈구를 가진 비구 이형성증 환자에 대해 전자하 횡-절 골술과 단축술을 시행한 총 13례 (12명) 에 대해 평균 43개월 (range, 24∼83 개월)간 추시하였다. 임상적 평가는 d’Aubigne 과 Postel에 의거하였고 수술 전후로 하지 길이를 측정하였으며 방사선학적 으로는 절골 부위의 골유합 소견과 안정성을 조사하였다. 수술 전례에서 무시멘트스템과 무시멘트 컵이 이용되었으며, 절골술 부위는 초기에 5례에서 금속판을 이용한 고정이 시도되었으나, 원위부 고정이 가 능한 fluted 스템을 사용한 8례는 강선고정을 하였다. 결과: 13례의 횡-절골술 중 11례(88%)에서 방사선 사진상 골유합을 보였고, 절골술 부위의 불유합 1 례, 지연유합 1례 소견을 보여 자가 골이식을 시행하였다. d’Aubigne 과 Postel의 임상 점수는 12명 중 11명에서 개선을 보였다(11→14.5). 하지길이 부동은 수술 전 4 cm에서(range, 2.5∼7 cm) 수술 후 평균 1.5 cm(range, 1∼3.5 cm)의 차이로 개선을 보였다. 표준형 원위 원추형 스템을 이용한 5례 중 점진적인 대퇴스템의 침강을 보인1 례와 불유합을 동반한 1례는 자가골 이식과 새로운 대퇴스템(long fluted stem)으로 재치환 하였다. 탈구는 1례에서 발생하여 도수정복 후 외전 보조기로 치유하였다. 신 경손상을 보인 례는 없었다. 결론: 고도의 탈구가 동반된 고관절 이형성증 환자에서 전자하부 대퇴단축 횡-절골술을 시행하여 비구컵 의 해부학적 위치에 고정이 가능하였고, 좌골 신경의 신장이나 긴장을 주지 않았다. 무시멘트 대퇴스템으 로는 원위부 고정이 가능한 fluted 스템으로 성공적인 결과를 얻을 수 있었다
Abstract
Purpose: This study evaluated the mid-term results following subtrochanteric transverse-femoral shortening osteotomy in total hip arthroplasty for high-riding developmental dislocation of the hip (Crowe IV) and its results. Materials and Methods: Twelve patients with 13 subtrochanteric transverse femoral shortening osteotomy with total hip arthroplasties were followed from 1995 to 2000 for an average of 43 months (range, 24~83 months). Clinical assessment was scored according to the d’Aubigne and Postel scale and leg length was measured before and after surgery. Radiologically, consolidation of the osteotomy site and stability were evaluated. Noncemented femoral components and noncemented cups were used in all cases. Stabilization was obtained in 5 cases by using a plate which was managed with a conventional stem and in 7 cases by wiring which was managed with a fluted stem. Results: Eleven of the 13 osteotomies (84.6%) demonstrated radiologic evidence of union, one had a nonunion and one had a delayed union in the osteotomy site. Clinical scores of d’Aubigne and Postel were improved 11 of 12 patients (11→14.5). Leg length inequalities were restored to an average postsurgery discrepancy of 1.5 cm (range, 1-3.5), from their poeoperative discrepancy. One patient had an early dislocation and was treated with abduction orthosis after closed reduction. Another patient experienced sinking of the femoral component which was managed by total hip revision with autogenous bone graft and new femoral component (long fluted stem). Conclusion: Subtrochanteric femoral shortening transverse osteotomy in total hip arthroplasty for developmental dislocation of the hip permits acetabular fixation in the anatomical region without lengthening or tension of the sciatic nerve. The noncemented, distal fluted, femoral stem showed a superior result than conventional stem.
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