대퇴 골두 골괴사에서 괴사 범위 측정 방법의 비교 분석
Measurement of Necrotic Lesion in Osteonecrosis of Femoral Head
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목적: 대퇴 골두 괴사의 예후는 괴사의 크기가 가장 중요한 예후 인자이지만, 괴사의 크기나 범위를 측정하는 방법이 저자마다 차이가 있다. 본 연구는 대퇴 골두 괴사 범위를 측정하는 3가지 방법 에 대해 정확도와 상호 연관성을 비교 분석하였다. 대상 및 방법: 대퇴 골두 괴사로 진단된 60 고관절을 대상으로 하였다. 자기 공명 영상 사진에서 괴사 크기를 Steinberg, Kim, 수정된 Kerboul 방법으로 두 명의 측정자가 3회 반복 측정하였다. Steinberg 방법은 자기 공명 영상에서 전산 프로그램을 이용하여 괴사의 실제 면적을 측정하여 15% 미만을 1군(소형 크기 괴사), 15~30%는 2군(중형 크기 괴사), 30% 이상을 3군(대형 크기 괴사)로 분류한 한 후 각 군에 해당하는 다른 두 측정 방법을 대입하여 통계적으로 유의한 값을 산출하였다. 결과: Steinberg 방법에 의한 1군(16예)의 평균 괴사크기는 10.92%, 2군(33예)은 평균 괴사 크기는 21.68%, 3군(11예)의 평균 괴사크기는 36.80% 이었다. Steinberg 방법에 의한 분류를 통계적으로 가장 유의한 수준으로 분석한 결과 Kim 방법은 18% 미만은 1군, 33% 2군, 33% 이상은 3군에 분류되었다. 또한 수정된 Kerboul 방법의 경우는 200.6。미만은 1군, 262.3。2군, 262.4。이상은 3군으로 분류되었다. 결론: Kim 방법과 수정된 Kerboul 방법의 새로운 분류 기준은 대퇴 골두 괴사 치료 방법의 결정 및 예후 판단에 있어 임상적인 연구가 추가로 시행된다면 유용한 지표로 사용될 수 있을 것으로 사료된다.
Abstract
Purpose: The size of the necrotic lesion is known to be the most important prognostic factor in osteonecrosis of the femoral head (ONFH). We evaluated the accuracy and relationship of three different measuring methods of necrotic lesions for ONFH. Materials and Methods: Sixty hips that had ONFH were measured on an MRI by two orthopaedic surgeons using Steinberg, Kim, and modified Kerboul methods. Based on the lesion size of the necrosis as measured with the computerized Steinberg method, the hips were divided into Group I (small lesion: less than 15%), Group II (medium lesion: 15~30%), and Group III (large lesion: more than 30%). Data of the Kim and modified Kerboul methods were reclassified by statistical analysis according to the groups classified by the Steinberg method. Results: Average lesion size of Group I (16 hips) was 10.92%, the average size of Group II (33 hips) was 21.68%, and the average size of Group III (11 hips) was 36.80%. We established a new criteria of the Kim and modified Kerboul methods based on Steinberg. The Kim method was reclassified into Groups I (less than 18%), II (18~33%), and III (33% or more). And the modified Kerboul method was divided into Groups I (less than 200.6。), II(200.6~262.4。), and III (more than 262.4。) as well. Conclusion: New criteria for the Kim and modified Kerboul method would be a useful indicator for the prognosis and treatment plan in ONFH.
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