알루미나 세라믹-세라믹 관절면을 이용한 무시멘트 인공 고관절 전치환술
Cementless Total Hip Arthroplasty with Alumina Ceramic-on- Ceramic Articulation
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목적: 대퇴 골두 무혈성 괴사의 환자에서 세라믹- 세라믹 관절면을 이용한 인공 고관절 전 치환술 후 임상적, 방사선학적 결과를 평가하고자 하였다. 대상 및 방법: 2004년 3월부터 2006년 2월까지 고관절 전 치환술을 시행 받은 21명 31예를 대상으로 하였고 평균 추시 기간은 56개월(48~72개월)이었다. 무혈성 괴사증의 원인은 알코올 12예,특발성 10예, 스테로이드 6예, 후 외상성 3예였다. 임상적 결과는 Harris 고관절 점수와 서혜부및 대퇴부 동통 유무를, 방사선학적 결과는 비구컵과 대퇴 스템 주변의 골 용해, 불안정성, 대퇴스템의 고정위치, 관절 면 마모등을 평가 하였다. 결과: 최종 추시 결과 Harris 고관절 점수는 평균 93점 이었고, 서혜부 및 대퇴부 통증은 없었다. 합병증으로는 비골 신경마비 1예, 세라믹 골두 골절 1예, 관절내 소리가 2예, 후방탈구 2예가 관찰되었고, 최종 추시 결과 2명이 간경화 후유증으로 사망하였다. 방사선 최종 추시시 전례에서 골내 성장을 얻었고, 비구 컵과 대퇴 스템의 이동, 위치 변형, 골 용해 소견은 관찰되지 않았다. 결론: 평균 56개월 추시 결과 전례에서 골내 성장 고정을 얻었고, 세라믹 골두 골절 1예를 제외하고 양호한 결과를 얻을 수 있었으나 좀 더 장기 추시가 필요할 것으로 사료된다.
Abstract
Purpose: We wanted to evaluate the clinical and radiological results of total hip arthroplasty using a ceramic-onceramic articulation Materials and methods: From March 2004 to February 2006, total hip arthroplasty was performed in 21 patients and 31 hips. The mean follow up period was 56 months (range: 48~72 months). The causes for the AVN were alcohol in 12 cases, idiopathic in 10 cases, steroid in 6 cases and post-traumatic in 3 cases. The clinical results were evaluated using the Harris hip score and according to the pain on the inguinal area or thigh. The radiographic evaluation was performed to determine the level of osteolysis and instability around the acetabular cup and femoral stem, the position of the femoral stem and the wear of the articular surface. Results: At the most recent follow-up, the mean Harris hip score was 93 points with no inguinal or thigh pain. The complications included one case of peroneal nerve palsy, one case of ceramic head fracture, two cases of noise in the joint, two cases of posterior dislocation and two patients died because of complication related to liver cirrhosis. Radiologically, bone ingrowth was noted in all the cases with no migration of the acetabular component and femoral stem, changing of the position or osteolysis. Conculsion: Total hip arthroplasty with ceramic on ceramic articulation shows satisfactory results at an average of 56 months follow up. There was bone ingrowth in all cases except for one ceramic head fracture. Further follow-up study should be performed to evaluate the long-term results.
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