인공 고관절 재치환술: 비구컵
Revision Total Hip Arthroplasty: Acetabular Cup
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초록
일차성 인공 고관절 치환술의 시행이 증가됨에 따라 최근 인공 고관절 재치환술의 빈도도 증가하고 있다. 하지만, 인공 고관절 재치환술은 일차 치환술보다 훨씬 더 어렵고 보통 일차 치환술의 결과만큼 만족스럽지 못하다. 따라서 수술 전에 충분하고도 신중한 계획을 세워야만 좋은 결과를 얻을 수 있다. 특히, 인공 고관절 치환술에서 비구골 결손의 위치와 크기는 비구컵 재치환술의 종류를 결정한다. 대부분의 비구 결손에서는 다발성 나사못으로 튼튼히 고정된 미세 피복 반구형 비구컵이 사용된다. 이러한 재건술시 비구컵이 숙주골에 적어도 50% 이상의 접촉을 얻어야 가능하다. 적합한 내측 및 변연부 골이 있고 50% 이상의 접촉이 불가능할 시 대체 가능한 무시멘트 비구컵을 사용하는 술식을 사용 할 수 있다. 골 결손이 심하거나 골주의 결손시 반구형 비구컵과 금속 보강물의 사용, 비구 보강환,구조적 골이식 또는 감입 동종골 이식법이 요구된다. 이에 지금까지 가장 많이 사용되고 있는 비구 결손의 분류법을 소개하고, 비구 결손 재건술 시 필요한 수술 전 평가, 수술 중 세부 사항 및 비구 재치환술의 결과에 대하여 기술하고자 한다.
Abstract
Recently, the incidence of revision total hip arthroplasty following primary total hip arthroplasty has increased. However, revision after primary total hip arthroplasty is usually much more difficult than the first time, and the results are typically not as satisfactory as that after most primary total hip arthroplasty procedures. Therefore, thoughtful and thorough preoperative planning will certainly provides the patient with the best opportunity for long-term success. In particular, location and size of acetabular bone defects dictate the type of acetabular component in revision in total hip arthroplasty. For most defects, a porous-coated hemispherical shell secured to host bone with multiple screws is the implant of choice. This reconstruction is feasible provided that at least 50% of the implant is in contact with host bone. When such contact is not possible, and there is adequate medial and peripheral bone, techniques using alternative uncemented implants can be used for acetabular reconstruction. Defects with greater bone loss or compromised columns require the use of either modular augments combined with a hemispherical shell, reconstruction cages, structural allografts, or impaction allograft. Therefore, we attempt to introduce the most commonly-adopted system for classification of acetabular defects and the necessary preoperative evaluation, intraoperative detail, and reported results of these acetabular revisions.
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