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시멘트 광택 대퇴 금속주(Cemented Polished Femoral Stem)의 5년 이상 추시 연구

Follow-up Study of the Cemented Polished Femoral Stem for More than Five Years

허영재|이주원|손원용|윤호현|허창룡
대한고관절학회 (The Korean Hip Society)|2011.03|Hip and Pelvis|제23권 제1호|pp. 25-31

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참고문헌

키워드

인공 고관절 전치환술Total hip arthroplasty시멘트형 광택 대퇴 금속주Cemented polished femoral stem

초록

목적: 시멘트 대퇴 금속주(stem)의 표면 처리는 현재 골 시멘트 기법이 크게 발전하였음에도 불구하고 아직 논란 거리로 남아있는 문제이다. 최근의 골 시멘트 기법을 적용한 Versys Heritage 대퇴 주대 의 임상적 추시를 조사하여 시멘트 광택 대퇴 금속주의 결과를 평가하였다. 대상 및 방법: 2000년 10월부터 2003년 8월까지 시멘트 광택 대퇴 금속주를 이용하여 인공 고관절 전치환술을 시행한 82 환자의 95 고관절을 대상으로 하였다. 환자 중 남자는 58명(64 고관절), 여자는 24명(31 고관절)이었으며 수술시 평균 연령은 52.3세(26~74세), 환자의 평균 신체질량지수는 평균 24.2±2.75(19.1~29.8), 평균 추시 기간은 82.1개월(64~109개월)이었고, 임상적 결과는 해리스 고관절 지수(Harris hip score)및 대퇴부 동통 유무를 이용하여 평가하였으며 방사선학적 평가에 있어서는 시멘트 등급과 대퇴 스템 주위의 해리 및 대퇴 근위부의 응력방패 현상을 평가하였다. 결과: 술 후 마지막 추시 임상적인 평가에서 해리스 고관절 지수는 수술 전 평균 58.9점(17~83점)에서 최종 추시에서 평균 91.7점(72~100점)으로 향상되었다. 시멘트 A 등급이 45예(47.3%), B 등급이 48예(50.5%), 그리고 C1 등급이 2예(2.1%), 였다. 추시기간동안 1예의 대퇴 스템에서 definite 이완의 소견이 관찰되었으며, None 등급 65예(68.4%), 1등급 19예(20.0%)의 응력 방패 현상이 발견되었다. 결론: 개선된 골 시멘트 기법을 이용한 광택 Versys Heritage 대퇴 금속주의 인공 고관절 치환술의 최소 5년 이상 추시 결과는 만족스러우나 향후 장기 추시가 필요할 것으로 사료된다.

Abstract

Purpose: Surface finishing of a cemented femoral stem is a subject of controversy even though the contemporary cementing techniques have improved results. Using the Versys Heritage femoral stem, we evaluated the outcome of using a polished surface. Materials and Methods: The subjects of this study were 95 hip arthroplasties in 82 patients and we used a cemented polished femoral stem with the 3rd generation cement technique and all the surgeries were done between October 2000 and August 2003. There were 58 male patients (64 hips) and 24 female patients (31 hips). The mean age at the time of the index arthroplasty was 52.3 years (26~74 years), and the average body mass index was 24.2±2.75(19.1~29.8). The average follow up period was 80.7 months (64~109 months). All the hips were evaluated clinically by the Harris hip score and the thigh pain, and they were radiologically assessed by the cement grade and the presence of osteolysis around the femoral stem, as well as the presence of stress shielding of the proximal femur. Results: At the final follow up, the Harris hip score for all the patients had improved from preoperative 58.9 (17-83)to post operative 91.7 (72~100). The cement grade was measured using Barrack’s method. Of the 95 hips, 45 (47.3%)cases were grade A, 48 (50.5%) cases were grade B and 2 (2.1%) cases were grade C1 at the final follow up. There was 1 case of definite loosening. Stress shielding was noted in 65 (68.4%) cases of the zero grade and 19 (20.0%)cases of the 1st grade. Conclusion: In this study, the cemented polished femoral stem showed excellent results at the mid term with a minimum follow up of 5 years. But a longer-term follow-up study will be needed for further understanding the implications of cemented polished femoral stem.

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