무시멘트형 비구컵을 이용한 비구 재치환술
Acetabular Revision Using Uncemented Acetabular Cup
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초록
목적: 골 결손이 동반된 비구컵 재치환술시 골 이식 및 무시멘트형 비구컵으로 치환한 후 임상적, 방사선학적 결과를 알아보고 자 한다. 대상 및 방법: 1990년 6월부터 2006월 3월까지 무시멘트형 비구컵과 골이식을 이용한 재치환술을 시행하였던 124명 환자, 131개 고관절을 대상으로 하였으며, 평균 추시 기간은 5년 6개월이었다. 임상적 결과로 Harris 고관절 점수를, 방사선학적 결 과로 이식골 유합시기, 이식골 흡수율, 비구컵 이동과 경사각 변화를 조사하였으며, 실패율과 생존율 분석을 하였다. 결과: Harris 고관절 점수는 술 전 51.8에서 술 후 82.5로 향상되었다. 이식골의 골유합시기는 평균 6.4 개월이었으며, 방사선 학적 이식골의 흡수는 10% 이하 흡수율이 가장 많았다. 최종 추시시 비구컵의 이동은 상방이동 평균 1.37mm, 내측이동 평균 1.20 mm, 비구컵의 경사각 변화는 평균 1.24도이었다. 5 례에서 재수술이 시행되었다. 실패율은 3.8 %, 비구컵 해리기준 13 년 생존율은 94.9%이었다. 결론: 비구골 결손이 동반된 경우 골이식을 함께한 무시멘트 비구컵을 이용한 재치환술은 빠른 이식골의 골결합과 안정적 비구 컵을 얻을 수 있어 권장할 만한 술식으로 사료된다.
Abstract
Purpose: The purpose of this study is to evaluate the clinical and radiological results of revision total hip arthroplasty with using impacted bone grafts and uncemented acetabular cups on the acetabulum with bone defects. Materials and Methods: From June 1990 to March 2006, 131 revision total hip arthroplasties using an uncemented acetabular cup and impacted bone graft, were performed in 124 patients. The average follow-up period was 66 months. The clinical results were evaluated with the Harris hip score. The radiological results included the period of graft incorporation, the rate of resorption, the migration and the change of inclination of the cup. The failure rate and 13 year survival rate were analyzed. Results: The Harris hip scores were 51.8 preoperatively and 82.5 postoperatively. The period of incorporation was a mean of 6.38 month. Most cases showed a resorption rate below 10%. The mean migrations of the acetabular cup were 1.37 mm superiorly and 1.20 mm medially. The mean change of inclination was 1.24. There were 5 re-revision surgeries. The failure rate was 3.8%. The survival rate of the revision that was done due to loosening was 94.9% at 13 years. Conclusion: Acetabular revision arthroplasty with bone grafts, and an uncemented cup is recommendable as it achieves favorable outcomes in terms of rapid incorporation of the grafted bone and stable fixation of the cup.
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