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샌드위치 타입의 세라믹-세라믹 관절면을 이용한 일차성 무시멘트 고관절 전치환술 (최소 10년 추시 결과)

Primary Cementless Total Hip Arthroplasty with a Sandwich Type in Ceramic-Ceramic Articulation (Minimum 10-Year Follow up Results)

김진수|오현석|김준엽|백승엽|임병호|서재성|민학진|윤의성|석주필
대한고관절학회 (The Korean Hip Society)|2011.09|Hip and Pelvis|제23권 제3호|pp. 206-212

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참고문헌

키워드

고관절 전치환술Total hip arthroplasty샌드위치 라이너세라믹-세라믹Sandwich-typedCeramic-ceramic

초록

목적: 세라믹 라이너에 폴리에틸렌을 부착한 샌드위치형 라이너를 이용한 일차성 고관절 전치환술의 최소 10년 이상 추시 결과를 평가하였다. 대상 및 방법: 1998년 11월부터 2000년 12월까지 샌드위치형 라이너를 이용한 고관절 전치환술을 시행하고 최소 10년 이상 추시 가능하였던 34명(40예)을 대상으로 하였다. 평균 추시 기간은134개월(120~145개월), 수술 시 평균 연령은 47.1세(24~65세)이었다. 임상적 평가는 Harris hip score, 대퇴부통증 등을 조사하였으며, 방사선학적 평가는 골내막 신생골, 방사선 투과성선,삽입물의 이동 등을 관찰하였다. 결과: Harris hip score는 최종 추시에서 평균 90.9점으로 향상되었다. 전례에서 골성 고정을 얻었으며 삽입물의 이동이나 해리는 관찰되지 않았다. 합병증으로 수술 시 대퇴골의 비전위 골절이2예(5%), 후방 탈구가 1예(2.5%), 세라믹 라이너 파손이 1예(2.5%)가 있었다. 결론: 샌드위치형 라이너를 이용한 고관절 전치환술의 최소 10년 이상 추시 생존율은 양호한 결과를 보였으나, 세라믹의 골절은 여전히 중요한 문제점으로 판단되며 비구컵의 정확한 고정과 지속적인 세라믹 부품의 재질 개선이 필요할 것으로 사료된다.

Abstract

Purpose: To evaluate the minimum 10-year follow up results of primary total hip arthroplasty (THA) performed using a sandwich-type (alumina-polyethylene-titanium) ceramic bearing. Materials and Methods: Thirty four patients (40 hips) who underwent a THA with sandwich typed liners from November 1998 to December 2000 were analyzed. Among the 34 patients, 25 were men and nine were women. Mean follow-up was 134 months (range, 120~145 months) and mean patient age at the time of THA was 47.1 years (range,24~65 years). The clinical results were evaluated using the Harris hip score and level of thigh pain with a limping gait. The radiographic evaluation was done in terms of the endosteal new bone formation, radiolucent line,subsidence of the stem, migration of the acetabular cup, and proof of loosening. Results: The mean preoperative Harris hip score of 50.2 points (range, 31~87 points) was improved to 90.9 points (range, 75~99 points) at the final follow-up and thigh pain with limping gait in one case. All cases had fixation by bony ingrowth. No radiographically detectable loosening was observed in any hip. Fracture of ceramic liner in one case required change of the polyethylene liner. Conclusion: At the minimum 10-year follow up, survival rate as the end-point was favorable. However, fracture of the ceramic is still a major problem. Satisfactory results can be obtained by more precise surgical technique for acerabular inclincation and anteversion, and by improving the quality of the ceramic.

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