시멘트를 이용한 대퇴stem 고정술
Cement Fixation Technique for a Femoral Stem
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초록
시멘트를 이용한 인공관절고정술은 1961년 John Charnly경이 처음 도입한 이후 지금까지 사용되어지고 있는 대표적인 인공관절고정술이다. 시멘트를 이용한 인공고관절의 수술의 임상적인결과는 과거 1세대 시멘트기법의 10년 추적에 30~40%에 이르는 대퇴스템의 실패부터 2세대 시멘트기법을 사용한 Barrack 등의 보고에 의하면 14년 추적결과 2%의 기계적 실패 등 좋은 결과를 보여주고 있다. 과거보다 우수한 임상결과의 원인은 시멘트삽입기법의 진화와 스템 디자인의발전이 크게 역할을 하였다. 고령 환자들의 심한 골다공증 및 stove-pipe형의 대퇴골수강에 대한 대퇴스템의 고정에 있어 큰 직경의 무시멘트형 스템을 삽입하려도 사실상 초기 안정성을 얻기어렵고, 대퇴부 동통이나 조기 보행에 따른 대퇴스템 침강등 좋지 않은 결과가 보고되고 있다. 이경우 좋은 결과를 얻기 위해서는 시멘트를 이용한 삽입이외에 다른 대안이 없어 정확한 시멘트 삽입기술을 익히는 것이 중요하다. 시멘트 사용의 장점은 수술후 조기 보행이 가능하여 침상안정에따른 합병증을 감소시킬 수 있고,수술후 대퇴부 통증이 없다는 점이다. 저자는 현재 사용되는 대퇴스템의 시멘트 고정기법에 대하여 기술하고자 한다.
Abstract
Cemented total hip arthroplasty was first introduced by Sir John Charnley in 1961 and it has become one of the principal fixation techniques for fixation of an implant. The surgical technique has since been modified and this has resulted in improved longevity and reliability. The clinical success of the cemented technique has varied in literature, and this has been reported as 30~40% failure to 2% failure for 14 years of follow up using the 2nd generation cement technique. Currently, the successful clinical results can be contributed to the better developed design of the femoral stem and the advancement of the 3rd and 4th generation cement fixation techniques. As society gains more elderly people, for the older patients who have osteoporosis, a wide and thin femur would be the best indication for cement fixation in order to achieve early stability and better clinical results. It is imperative to learn and practice performing the exact cement fixation technique to achieve the best clinical results.
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