인공 고관절 전치환술 후 발생한 치환물 주위 종괴
Periprosthetic Mass after Total Hip Replacement
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목적: 인공 고관절 치환술 후 치환물 주변에 발생한 거대 종괴를 보고하고 종괴의 원인과 양상을 분석하였다. 대상 및 방법: 2000년 1월부터 2007년 10월까지 인공 고관절 치환술을 시행 받은 환자들에서 연부 조직에 거대 종괴가 발생한 10예를 대상으로 하였다. 금속 대 금속 치환술을 시행한 5예를 1군, 금속 대 폴리에틸렌 치환술을 시행한 5예를 2군으로 분류하고 각 군의 종괴 크기 및 위치, 골 용해의 양상을 관찰하고 혈액학적 검사 및 조직학적 소견을 후향적으로 검토하였다. 결과: 방사선학적 소견상 대퇴 치환물 주위 종괴의 위치는 비구 주위에서부터 대퇴 치환물 원위부까지 존재하였다. 종괴의 크기는 평균 14.6 cm(7-21 cm)×6.2 cm(3-9 cm)×7.2 cm(4-12 cm)로 측정되었다. 골용해는 1군에서 3예, 2군에서 3예가 동반되었고, 1군에서는 림프구와 호산구가 관찰되었으며, 2군은 모든 예에서 대식 세포가 관찰되었다. 결론: 인공 고관절 치환술 후 발생하는 골용해와 연부 조직의 거대 종괴는 폴리에틸렌 마모 입자에 대한 이물 반응과 금속 이온에 대한 과민 반응과 관련이 있을 것으로 생각되며, 오래 지속된 종괴의 압박 효과에 의해서 피질골이 바깥에서 안쪽으로 눌리는 양상으로 얇아지는 소견을 보일 수 있음을 고려해야 하겠다.
Abstract
Purpose: To analyze the characteristics and causes of periprosthetic huge mass which occur after treatment by total hip arthroplasty. Materials and Methods: Of the patients who had undergone total hip arthroplasty from January 2000 to October 2007, we retrospectively evaluated the 10 patients who suffered huge soft tissue mass. Five of these patients had received metal-on-metal bearing (group 1) prostheses, and the other 5 had received metal-onpolyethylene bearings (group 2). We evaluated the size and location of the mass, the extent of osteolysis, and the hematologic and pathologic examination results. Results: Roentgenographically, the location of the masses varied from the acetabular area to the distal femoral stem. The mean mass diameter of all 10 patients was 14.6 cm(7-21 cm)×6.2 cm(3-9 cm)×7.2 cm(4-12 cm). Osteolytic lesions were found in 3 group 1 patients and 3 patients in group 2. High counts of lymphocytes and eosinophils were present in group 1. High counts of macrophages were present in group 2. Conclusion: The occurrence of osteolysis and huge soft mass after total hip arthroplasty is thought to be related to foreign body reaction by polyethylene wear particles and metal hypersensitivity. Outside-in patterned cortical thinning was considered to be indicative of a long standing periprosthetic soft tissue mass effect.
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