수산화 인회석 전 표면 처리 대퇴 스템을 이용한 무시멘트 인공 고관절 전 치환술의 단기 추시 결과
Short-term Results after Cementless Total Hip Arthroplasty Using a Fully Hydroxyapatite-coated Femoral Stem
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목적: 수산화 인회석 전 표면 처리된 대퇴 스템을 이용한 무시멘트 인공 고관절 전 치환술의 최소 2년 추시 상 임상적, 방사선 결과를 평가하였다. 대상 및 방법: 2007년 9월부터 2009년 5월까지 수산화 인회석 전 표면 처리 대퇴 스템으로 무시멘트 인공 고관절 전 치환술을 시행하여 최소 2년 추시가 가능하였던 28명, 31예를 대상으로 하였다. 평균 연령은 67세, 평균 추시 기간은 35개월이었다. 술 전 진단은 골 괴사 17예, 대퇴 경부 골절 10예 등이었다. 임상적 평가는 Harris hip score (HHS)를 이용하였고, 방사선학적으로 삽입물의 안정성과 스템의 침강, 골용해 등을 관찰하였다. 결과: HHS는 술 전 평균 34.3점에서 최종 추시 시 평균 82.6점으로 호전되었고, 방사선 상 대퇴 스템은 골성 안정이 23예(74%), 섬유성 안정이 8예(26%)였으며, 스템 침강은 5예로 술 후 6주 내에서 2-4 mm 이내로 있었다. 술 중 스템 주변 대퇴 골절 4예, 술 후 감염 1예 등의 합병증이 발생하였다. 결론: 수산화 인회석으로 전 표면 처리된 대퇴 스템을 이용한 무시멘트 인공 고관절 전 치환술의 단기 추시 결과, 방사선학적으로 골성 안정을 보인 예가 74%이므로 좀 더 면밀한 장기 추시가 필요할 것으로 사료된다.
Abstract
Purpose: This study was accomplished to evaluate the clinical & radiological results of cementless total hip arthroplasty using a fully hydroxyapatite-coated femoral stem after follow up of at least, 2 years. Materials and Methods: Thirty one hips in 28 patients, who underwent primary total hip arthroplasty using a fully hydroxyapatite-coated femoral stem between september 2007 and May 2009, were followed up for more than 2 years after surgery. The average age of patients was 67 years old, and the average duration of follow up was 35 months. Preoperative diagnosis was 17 cases of osteonecrosis and 10 cases of femoral neck fracture. Clinical evaluation was done by Harris hip score (HHS). Radiological evaluation was done in terms of stability of components, subsidence of femoral stem and occurrence of osteolysis. Results: The average of HHS improved from 34.3 preoperatively to 82.6 at final follow-up. Radiologically, fixation by bony ingrowth was 23 cases(74%) and fibrous ingrowth was 8 cases(26%). Subsidence was within 2-4 mm and occurred within 6 weeks in all 5 cases. There were 4 cases of intra-operative femoral fracture, 1 case of superficial infection. Conclusion: Short-term clinical and radiological results of cementless total hip arthroplasty using a fully hydroxyapatite-coated femoral stem were not good enough. Radiologically, bony ingrowth were no more than 74%. Therefore, longer-term follow up would be necessary.
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