안정된 Harris-Galante 비구컵 주위의 골용해의 치료 - 비구컵 보존군과 재치환군 간의 비교 -
Management of Osteolysis around a Stable Harris-Galante Acetabular Cup - Retention vs Revision of the Acetabular Component -
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 본 연구는 견고하게 고정된 무시멘트형 비구컵 주위에 발생한 골용해에 대해서 수술적으로 치료한 결과를 분석하고, 비구컵을 재치환하는 것과 비구컵을 유지한 채 골이식과 함께 폴리에틸렌 라이너만 교체하는 것에 대해 비교하였다. 대상 및 방법: 견고하게 고정된 무시멘트형 비구컵 주위에 발생한 골용해로 수술적 치료를 시행하고 2년 이상 추시가 가능하였던 30예를 대상으로 하였다. 비구컵을 보존하며 라이너만 교체한 경우가 7예, 비구컵을 재치환한 경우가 23예였다. 각군에서 비구컵의 크기, 폴리에틸렌 라이너의 두께, 비구부 골용해의 진행 정도, 치료 결과 등을 분석하였다. 결과: Harris 고관절 점수는 두 군 모두에서 향상되었다. 보존군에서는 평균 59.9개월 추시 시 7예 모두 안정적 고정을 보였고, 3예에서 국소적 골용해의 소견을 보였다. 재치환군에서는 평균57.2개월 추시 시 무시멘트형 비구컵을 사용한 20예 모두 안정적 고정을 보였다. 결론: 견고하게 고정되어 있는 무시멘트형 비구컵 주위에 발생한 골용해의 치료로써 비구컵 재치환술과 비구컵을 보존하며 골이식을 시행하는 방법 모두 만족스런 임상적 결과를 보였으나, 골용해가 광범위한 경우에는 잠금 기전의 손상이 없더라도 무시멘트형 비구컵으로 재치환하는 것이 보다 믿을 수 있는 방법으로 판단되었다.
Abstract
Purpose: We analyzed and compared 30 clinical cases of acetabular osteolysis around a stably fixed acetabular cup,and this was managed by changing the liner along with retaining or revising the cup. Materials and Methods: We analyzed 30 patients who underwent acetabular component revision or retention with a bone graft for osteolysis around a stably fixed Harris-Galante acetabular cup and these patients were followed up for more than 2 years. There were 7 cases with a conserved the acetabular cup and only the liner was changed, and 23cases with a totally revised acetabular component. We compared the size of the acetabular cup, the thickness of the polyethylene liner, the progression of osteolysis and the clinical outcomes. Results: The Harris hip score was improved in both groups. In the retention group, during an average of 59.9 months of follow up, 7 cases showed stable fixation and 3 cases showed locally advanced osteolysis. In the revision group,during an average of 57.2 months of follow up, all 20 cementless acetabular cups showed stable fixation. Conclusion: We suggest that in patients with osteolysis around the stable cementless acetabular cup, both methods show satisfactory clinical outcomes. But considering recurrence of osteolysis, cup revision is more reliable than changing the liner with a bone graft.
참고문헌 (24)
- Harris WH, "Wear and periprosthetic osteolysis: the problem", Clin Orthop Relat Res, 393, pp.66~70 (2001)
- Hozack WJ, "Relationship between polyethylene wear, pelvic osteolysis, and clinical symptomatology in patients with cementless acetabular components in A framework for decision making", J Arthroplasty, 11, pp.769~772 (1996)
- Jacobs JJ, "Osteolysis: basic science", Clin Orthop Relat Res, 393, pp.71~77 (2001)
- Kavanagh BF, "Pelvic osteolysis associated with an uncemented acetabular component in total hip arthroplasty", Orthopedics, 19, pp.159~163 (1996)
- Mallory TH, "Noncemented acetabular component removal in the presence of osteolysis: the affirmative", Clin Orthop Relat Res, 381, pp.120~128 (2000)
- Schmalzried TP, "The relationship between the design, position, and articular wear of acetabular components inserted without cement and the development of pelvic osteolysis", J Bone Joint Surg Am, 76, pp.677~688 (1994)
- Sinha RK, "Osteolysis: cause and effect", Instr Course Lect, 47, pp.307~320 (1998)
- Zicat B, "Patterns of osteolysis around total hip components inserted with and without cement", J Bone Joint Surg Am, 77, pp.432~439 (1995)
- Chang JD, "Revision total hip arthroplasty for pelvic osteolysis with well-fixed cementless cup", J Arthroplasty, 22, pp.987~992 (2007)
- Peters CL, "Revision of well-fixed cementless acetabulr components for polyethylene failure", Clin Orthop Relat Res, 414, pp.129~135 (2003)
- Claus AM, "Management of patients with acetabular socket wear and pelvic osteolysis", J Arthroplasty, 18, pp.112~117 (2003)
- Maloney WJ, "Severe Osteolysis of the pelvic in association with acetabular replacement without cement", J Bone Joint Surg Am, 75, pp.1627~1635 (1993)
- Deheshi BM, "Treatment of retroacetabular osteolysis with calcium sulfate and retention of original components", J Arthroplasty, 23, pp.1240~ (2008)
- LaPorte DM, "Technique for acetabular liner revision in a nonmodular metal-backed component", J Arthroplasty, 13, pp.348~350 (1998)
- Naudie DD, "Surgical management of polyethylene wear and pelvic osteolysis with modular uncemented acetabular components", J Arthroplasty, 19, pp.124~129 (2004)
- 손원용, "안정된 무시멘트 비구컵에서 폴리에틸렌 삽입물 교환과동종골 이식술을 시행한 비구컵 골용해의 치료", 대한고관절학회지, 18(3), pp.103~109 (2006), 대한고관절학회
- DeLee JG, "Radiological demarcation of cemented sockets in total hip replacement", Clin Orthop Relat Res, 121, pp.20~32 (1976)
- Maloney WJ, "Sugical treatment of pelvic osteolysis", Clin Orthop Relat Res, 393, pp.78~84 (2001)
- Maloney WJ, "Socket retention: staying in place", Orthopedics, 23, pp.965~966 (2000)
- Maloney WJ, "Engh CA. Treatment of pelvic osteolysis associated with a stable acetabular component inserted without cement as part of a total hip replacement", J Bone Joint Surg Am, 79, pp.1628~1634 (1997)
- William LG, "Early morbidity of modular exchange for polyethylene wear and osteolysis", J arthroplasty, 19, pp.61~66 (2004)
- Boucher HR, "Dislocation after polyethylene liner exchange in total hip arthroplasty", J Arthroplasty, 18, pp.654~657 (2003)
- Chatoo M, "Periprosthetic acetabular fracture associated with extensive osteolysis", J arthroplasty, 13, pp.843~845 (1998)
- Yoon TR, "Cementation of a metal-inlay polyethylene liner into a stable metal shell in revision total hip arthroplasty", J Arthroplasty, 20, pp.652~657 (2005)