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골용해의 진단 및 치료

Diagnosis and Treatment of Osteolysis

원성훈|서유성
대한고관절학회 (The Korean Hip Society)|2011.12|Hip and Pelvis|제23권 제4호|pp. 248-257

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키워드

PathophysiologyOsteolysis골용해진단 및 치료Diagnosis and treatment병태 생리

초록

고관절 치환술 후 발생하는 골용해는 관절면의 마모편에 의한 만성적인 염증 단계를 거쳐 골용해에 의한 골 소실과 삽입물의 이완으로 이어져 인공 관절의 수명을 마치게 하는 질환이다. 초기 인공관절술은 주로 시멘트 고정방식이었으므로 연구자들은 시멘트의 PMMA 마모입자들이 골용해와 무균성 해리의 원인이라고 판단하여 이를‘cement disease’라고 명하기도 하였다. 그러나 시멘트 기법의 발전과 무시멘트 인공 삽입물의 사용에도 불구하고 골용해의 문제는 지속되어 폴리에틸렌 마모 입자가 골용해의 주요 원인으로 여겨지면서‘particle disease’라 명하게 되었다. 이에 따라 새로운 마모입자들에 관심을 기울이게 되었고, 이제는ultra-highmolecular-weight-polyethylene (UHMWPE)나 금속입자가 주 원인이라고 밝히고 있다. 그러나, 심각한 골결손 및 이완이 발생하기 전까지 증세가 나타나지 않아 조기진단과 치료에 어려움이 있다. 이에 최근까지 정립된 가설과 이론적 배경을 바탕으로 인공 고관절 전치환술 시행 후 발생하는 골용해의 병태 생리 및 진단과 치료에 대하여 정리해 보고자 한다.

Abstract

Total hip replacement arthroplasty (THRA) is widely performed, and is a successful orthopedic treatment method. Osteolysis, which often happens after THRA, causes a chronic inflammation stage due to wear debris in the artificial articular surface, leading to bone loss or loosening of implants. Osteolysis eventually results in shortening the lifespan of the joint. Afterwards, many researchers reported on the basis of experiments with tissue cultivation that due to the influence of wear particles, the surrounding tissues of the implants as obtained during replacement and the surrounding cells of the implants are secreting enzymes, prostaglandin, cytokine, and the like that stimulate the formation of fibrous tissues or bone resorption by osteoclasts. At this time, THRA was a main cement fixation method, so researchers thought that the loose particles of cement were the cause of osteolysis and aseptic loosening, and so they named these symptoms “cement disease”. However, despite the advancement of cement techniques and the use of cement-free implants, the osteolysis problem continued to rise, leading to polyethylene wear particles being regarded as the main cause of osteolysis, and naming these symptoms “particle disease”. In this way attention was drawn to new wear particles, now that it is revealed that ultra-high-molecular-weightpolyethylene (UHMWPE) or metal particles constitute the main cause. However, because no symptoms arise until serious bone defects or loosening occurs, it is difficult to diagnose or treat the disease early on. Thus, based on updated hypotheses and theories, this study examines the pathophysiology of osteolysis following THRA, as well as the diagnosis and treatment of osteolysis in the acetabular and femoral regions.

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