고관절 이형성증에서 시행한 무시멘트형 인공 고관절 전치환술
Cementless Total Hip Arthroplasty in Dysplastic Hips
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초록
비구 이형성증 환자에서 무시멘트형 삽입물을 이용한 인공 고관절 전치환술을 시행하고 장기 추시하여 임상적 및 방사선학적 결과를 알아보고자 하였다. 대상 및 방법: 1990년 7월부터 2008년 5월까지 본원에서 비구 이형성증으로 인공 고관절 전치환술을 받은 환자 35명 39예 중 사망한 4명을 제외한 35예를 대상으로 하였다. 추시 기간은 평균 103.7개월 이었다. 여자가 24명 27예, 남자가 7명 8예 이었으며 평균 연령은 55.7세(29-80세) 이었다. Crowe 1형이 26예, 2형이 8예, 4형이 1예이었다. 술 후 방사선 사진에서 눈물 방울 선을 기준하여 비구컵의 삽입 위치와 각도를 측정하였으며, 비구골과 비구컵의 접촉률을 구하였다. 임상적 결과는 해리스 고관절 점수를 이용하였다. 삽입물의 생존율은 재치환을 기준으로 구하였다. 결과: 술 전 해리스 고관절 점수는 평균 55.1점이었으며, 최종 추시에서 평균 86.1점 이었다. 재치환술은 12예(33.3%)에서 시행하였으며, 10예에서 비구컵을 재치환 하였으며 2예에서는 폴리에틸렌 라이너 만 교체하였다. 결론: 고관절 이형성증에서 시행한 인공관절 치환술은 수산화인회석 피복 비구컵을 제외한 무시멘트형 비구컵은 비구골과 70%이상의 접촉률을 얻으면 좋은 임상적 및 방사선학적 결과를 얻었다.
Abstract
To evaluate the clinical and radiological results after cementless total hip arthroplasty in dysplastic hips. Materials and Methods: This study included 36 cases that underwent total hip arthroplasty using a cementless prosthesis in our hospital from July 1990 to May 2008. The average time of of follow-up was 103.7 months. In total, 27 cases about 24 patients were women, and 8 cases about 7 patients were men. The average age at the time of operation was 55.7 years(29-80 years). In total, 26 cases were Crowe type I and 8 cases were Crowe type II. One case was Crowe type IV. Acetabular cup angles and the contact ratio between the acetabular cup and the host bone were measured, and the grafting bone was observed for absorption in the follow-up radiographs. Revision of components was defined as a failure. Results: Harris hip score was improved from 55.1 points pre-operatively to 86.1 points in the last follow-up. Revision was done in 12 cases(33.3%). Altogether, 10 cases revised the acetabular cup for osteolysis and polyethylene wear and 2 cases exchanged a polyethylene liner for only liner wear. Conclusion: Total hip arthroplasty in the dysplastic hip using a cementless acetabular cup, not a hydroxyapatitecoated acetabular cup, showed good clinical and radiological results when the contact ratio between acetabular cup and bone was above 70%.
참고문헌 (24)
- Anderson MJ, "Total hip arthroplasty with insertion of the acetabular component without cement in hips with total congenital dislocation or marked congenital dysplasia", J Bone Joint Surg Am, 81, pp.347~354 (1999)
- Charnley J, "Low-friction arthroplasty in congenital subluxation of the hip", Clin Orthop Relat Res, 91, pp.98~113 (1973)
- Crowe JF, "Total hip replacement in congenital dislocation and dysplasia of the hip", J Bone Joint Surg Am, 61, pp.15~23 (1979)
- Garvin KL, "Longterm results of total hip arthroplasty in congenital dislocation and dysplasia of the hip. A follow-up note", J Bone Joint Surg Am, 73, pp.1348~1354 (1991)
- Wolfgang GL, "Femoral head autografting with total hip arthroplasty for lateral acetabular dysplasia. A 12-year experience", Clin Orthop Relat Res, 255, pp.173~185 (1990)
- Shinar AA, "Bulk structural autogenous grafts and allografts for reconstruction of the acetabulum in total hip arthroplasty. Sixteen-year-average follow-up", J Bone Joint Surg Am, 79, pp.159~168 (1997)
- Kobayashi S, "Total hip arthroplasty with bulk femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip", J Bone Joint Surg Am, 85-A, pp.615~621 (2003)
- Iida H, "Cemented total hip arthroplasty with acetabular bone graft for developmental dysplasia. Longterm results and survivorship analysis", J Bone Joint Surg Br, 82, pp.176~184 (2000)
- Ito H, "Intermediate-term results after hybrid total hip arthroplasty for the treatment of dysplastic hips", J Bone Joint Surg Am, 85-A, pp.1725~1732 (2003)
- Kim M, "High long-term survival of bulk femoral head autograft for acetabular reconstruction in cementless THA for developmental hip dysplasia", Clin Orthop Relat Res, 468, pp.1611~1620 (2010)
- Spangehl MJ, "Uncemented acetabular components with bulk femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip: results at five to twelve years", J Bone Joint Surg Am, 83-A, pp.1484~1489 (2001)
- Rozkydal Z, "Total hip replacement with the CLS expansion shell and a structural femoral head autograft for patients with congenital hip disease", J Bone Joint Surg Am, 87, pp.801~807 (2005)
- Shetty AA, "Bulk femoral-head autografting in uncemented total hip arthroplasty for acetabular dysplasia: results at 8 to 11 years follow-up", J Arthroplasty, 19, pp.706~713 (2004)
- Goto K, "Long-term results of cemented total hip arthroplasty for dysplasia, with structural autograft fixed with poly-L-lactic acid screws", J Arthroplasty, 24, pp.1146~1151 (2009)
- Livermore J, "Effect of femoral head size on wear of the polyethylene acetabular component", J Bone Joint Surg Am, 72, pp.518~528 (1990)
- Krych AJ, "Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia: surgical technique", J Bone Joint Surg Am, 92 Suppl, pp.176~187 (2010)
- Cho CH, "Total hip replacement in unreduced hip dislocation", J Korean Orthop Assoc, 34, pp.17~22 (1999)
- Marti RK, "Superolateral bone grafting for acetabular deficiency in primary total hip replacement and revision", J Bone Joint Surg Br, 76, pp.728~734 (1994)
- Nousiainen MT, "Long-term outcome of shelf grafts in total hip arthroplasty for developmental hip dysplasia", Orthopedics, 32 (2009)[DOI]
- Numair J, "Total hip arthroplasty for congenital dysplasia or dislocation of the hip. Survivorship analysis and long-term results", J Bone Joint Surg Am, 79, pp.1352~1360 (1997)
- Howie CR, "Cemented total hip arthroplasty with subtrochanteric osteotomy in dysplastic hips", Clin Orthop Relat Res, 468, pp.3240~3247 (2010)
- Mackenzie JR, "Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation of the hip. Long-term results", J Bone Joint Surg Am, 78, pp.55~61 (1996)
- Bruzzone M, "Long-term results of cementless anatomic total hip replacement in dysplastic hips", Chir Organi Mov, 93, pp.131~136 (2009)
- Ohnsorge JA, "Early polyethylene wear and excessive acetabular granuloma in an uncemented HA-coated total hip arthroplasty-midterm results of a prospective study", HSS J, 2, pp.114~120 (2006)