금속 대 금속 인공 고관절 치환술에서 제거된 거칠기 처리 시멘트형 스템의 표면 분석
The Retrieval Study of the Rough Blasted Surface Finish Cement Stem in Metal on Metal Total Hip Arthroplasty
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목적: 금속 대 금속 인공고관절 치환술 시행 후 실패한 대퇴스템의 표면을 분석하여 스템의 이완과 골용해의 원인, 임상적 요인 등을 문헌고찰과 함께 조사하고자 한다. 대상 및 방법: 관찰대상은 1996년 1월부터 1998년 12월까지 41명(남자 30명, 여자 11명) 43 고관절을 대상으로 하였으며, 거칠기 처리(Ra=1.6 μm) 된 시멘트형이 18례, 무시멘트형이 25례였다. 평균 10.15년 추적 조사 후 임상결과는 Harris hip score (HHS), 운동량은 Devane 지수를, 방사선적 결과는 Engh 방법으로 조사하였으며, 제거된 대퇴스템은 SEM (scanning electron microscopy) 방법으로 조사 되었다. 결과: 임상결과로 HHS는 수술 전 56.2에서 92.6로 향상 되었으며, 방사선상 전 례에서 무시멘트 비구컵과 무시멘트 대퇴스템 은 골형성이 관찰되었다. 재치환술은 8례 시멘트 스템에서 시행되었으며 이중 1례는 반복된 탈구로 인한 재치환술로 나머지 7 례에서는 조기 골용해와 이완소견이 발견되어 재치환술이 시행되었다. 통계학적으로 거칠기 처리된 시멘트스템과 최종추시 생 존률(p=0.001)은 통계학적 관련이 있었으며, 직업등과 관련된 운동량과 생존률 (p=0.031)도 통계학적 의미를 보였다. 결론: 본 논문의 후향적 연구 결과, 금속-금속 인공 고관절 전치환술에서, 시멘트 스템을 사용하는 경우에 발생된 조기 골용해 와 이완의 높은 발생률을 볼 때, 활동량이 높은 환자에서 표면 처리가 거칠기 처리 된 시멘트 스템 (≥Ra=1.6 μm)의 사용은 고 려되어야 할 것으로 보인다.
Abstract
Purpose: This study investigated the possible etiologic role of stem loosening and osteolysis by examining the surface of a rough blast retrieval cement stem and physical activity in second generation metal-on-metal (MOM) total hip arthroplasty (THA) Materials and Methods: Forty one patients (43 hips) were analyzed retrospectively from Jan. 1996 to Dec.1998. Of the femoral stem, a rough blasted (Ra=1.6 um) cement stem and a cementless Ti-alloy stem was used in 18 and 25 hips, respectively. The mean follow-up duration was 10.15 years. Each patient was evaluated clinically by the HSS and radiographically by Engh’s method. Scanning electron microscopy was used to observe the retrieved femoral stem and histology studies were performed. Results: The mean Harris hip score improved from 56.2 points before surgery to 92.6 points after surgery. All the cementless stems and cups showed excellent results at the last follow-up. Eight of the rough blast cement stems were revised. Seven showed loosening and one was a recurrent dislocation. Cross-validation evaluation revealed osteolysis to be associated with a rough surface cement stem of metal on metal THAs (p=0.001). In addition, patients who underwent strenuous activity had a higher incidence of osteolysis (p=0.031). Conclusion: These findings suggest that a rough blast surface cement stem is associated with early osteolysis and loosening in patients with a metal-on-metal hip replacement. A prospective study with a large group of patients and multiple diagnostic methods will be needed to determine if there is a causal relationship between metal hypersensitivity and osteolysis. These results suggest that a cement stem with a rough blasted surface should be considered in metal-on-metal total hip arthroplasty.
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