시멘트형 대퇴스템 부정정렬 예방을 위한 수술 중 방사선 촬영의 유용성
The Usefulness of Intraoperative Radiography for Prevention of Malalignment of the Cemented Femoral Stem
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목적: 시멘트형 대퇴스템을 사용한 인공고관절 치환술을 시행 중 임시 대퇴삽입물(broach)을 삽입한 상태에서 c-arm 촬영을 통하여 대퇴스템 정렬 상태를 예측하여 부정정렬을 예방하였던 저자들의 방법의 유용성을 평가하고자 하였다. 대상 및 방법: 2011년 10월부터 2013년 2월까지 일차 인공 고관절 부분치환술이나 인공 고관절 전치환술을 시행 받은 103예를 대상으로 후향적으로 연구를 시행하였다. 수술 중 예측된 대퇴스템 정렬각 및 최종 대퇴스템 정렬각들을 세 군 분류하였고, 수술 중 예측된 대퇴스템 정렬각에 영향을 미칠 수 있다고 예상된 요인들(나이, 성별, 진단명, 체질량 지수, 대퇴스템 크기, 골다공증, 근위대퇴골 형태)에 대한 분석을 위해서 multinomial logistic regression analysis를 시행하였다. 결과: 수술 중 예측된 대퇴스템 정렬각은 중립위 군이 80예, 내반위 군이 18예, 외반위 군이 5예 등으로 분포하였다. 최종 대퇴스템 정렬각은 중립위 군이 100예, 내반위 군이 2예, 외반위 군이 1예 등으로 분포하였다. 수술 중 예측된 대퇴스템 정렬각에 통계적으로 유의하게 영향을 미치는 요인은 없었다. 결론: 저자들이 시행하였던 방법이 시멘트형 대퇴스템의 부정정렬을 예방하는데 있어서 유용하였다고 생각한다.
Abstract
Purpose: The purpose of this study was to evaluate the usefulness of our method, which estimated femoral stem alignment using a c-arm when the broach was inserted, for prevention of femoral stem malalignment. Materials and Methods: A total of 103 hips were enrolled in this study. All patients underwentprimary hip arthroplasty from October 2011 to February 2013. The study was conductedretrospectively. Intraoperative estimated femoral stem alignments and final femoral stem alignments were classified into three groups. Multinomial logistic regression analysis was performed for analysis of factors (age, sex, diagnosis, body mass index, femoral stem size, osteoporosis, and proximal demur geometry) thatmight affect intraoperatively estimated femoral stem alignment. Results: The distribution of intraoperative estimated femoral stem alignment was 80(78%) in the neutral group, 18(17%) in the varus group, and 5(5%) in the valgus group. The distribution of final femoral stem alignment was 100(97%) in the neutral group, 2(2%) in the varus group, and 1(1%) in the valgus group. There was no statistically significant factor affecting the intraoperatively estimated femoral stem alignment. Conclusion: Intraoperative estimated femoral stem alignment using a c-arm is an effective method for prevention of femoral stem malalignment.
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