동종해면골 압박 이식과 골시멘트를 이용한 대퇴 삽입물 재치환술 결과
Femoral Revision Hip Arthroplasty with the Use of Impacted CancellousAllograft and Cement
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목적: 동종해면골 압박 이식과 골시멘트 대퇴 주대를 이용한 인공 고관절 재치환술의 결과를 보고하고자 한다. 대상 및 방법: 동종해면골 압박 이식과 골시멘트 대퇴 주대를 이용한 인공 고관절 재치환술을 시행한 27명 환자 중 추시 가능한 26환자 28례를 후향적으로 분석하였다. 평균 연령은 59세(41~86세)였으며, 추시 기간은 최소 36개월 최고 10년 3개월로 평 균 76.6개월 이었다. 임상적 결과는 Harris 고관절 점수를 이용하여 평가하였고, 방사선학적 결과는 골시멘트내 스템의 침강 정 도, 대퇴스템-골시멘트 침강 정도, 피질골 유합과 골 소주 재형성(trabeculation), 방사선 투과음영, 골용해 등을 관찰하였다. 결과: 방사선 검사 상 우수하고 안정적인 치환물로 분석되어졌다. 27례(96%)에서 5 mm 이하의 침강이 관찰되었으며 1례에서 8 mm 정도의 침강이 관찰되었다. 그러나 기계적 실패나 대퇴 스템-골시멘트 침강은 보이지 않았다. 모든 환자에서 골 소주 (trabecular) 또는 피질골의 재형성됨을 관찰할 수 있었다. 추시 상 방사선 투과 음영과 골 용해 소견은 관찰되지 않았다. 합병 증으로 술 중 근위 대퇴부에 골균열(crack) 4례, 원위부 대퇴부 쪼개짐(splitting) 1례였다. 결론: 동종해면골 압박 이식과 골시멘트 대퇴 주대를 이용한 인공 고관절 재치환술은 초기에 대퇴 주대 안정성으로 우수한 임상 결과를 보였으며, 중장기적으로 이식골의 재형성으로 근위 대퇴부의 골결손을 성공적으로 재건할 수 있었다.
Abstract
Purpose: To evaluate the radiographic mid-to long-term result of femoral revision hip arthroplasty using impacted cancellous allograft combined with cemented, collarless, polished and tapered stem. Materials and methods: Among 27 patients with impacted cancellous allograft with a cemented stem, 28 hips from 26 consecutive patients were analyzed retrospectively. The average patient age was 59 years. The follow-up period ranged 36 months to 10 years, 3 months (mean, 76.6 months). Radiographic parameters analyzed in this study included subsidence of the stem in the cement, subsidence of the cement mantle in the femur, bone remodeling of the femur, radiolucent line, and osteolysis. Results: Radiographic analysis showed very stable stem initially. 27 stems showed minimal subsidence (less than 5 mm) and 1 stem showed moderate subsidence (about 8 mm) in the cement. But there was no mechanical failure and subsidence at the composit-femur interface. Evidence of cortical and trabecular remodeling were observed in all cases. No radiolucent line or osteolysis were found in the follow-up period. There were 4 proximal femoral cracks and 1 distal femoral splitting during operation. Conclusion: The result of cemented stem revision with the use of impacted cancellous allograft was good mid-to long-term. and femoral bone stock deficiency may be reconstructed successfully.
참고문헌 (24)
- Barrack RL, "Revision total hip arthroplasty: the femoral component", J Am Acad Orthop Surg, 3, pp.79~85 (1995)
- DeLee JG, "Radiological demarcation of cemented sockets in total hip replacement", Clin Orthop, 121, pp.20~32 (1976)
- Eldrige JD, "Massive early subsidence following femoral impaction grafting", J Arthroplasty, 12, pp.535~540 (1997)
- Elting JJ, "Preliminary report of impaction grafting for exchange femoral arthroplasty", Clin Orthop, 319, pp.159~167 (1995)
- Engelbrecht E, "Klassifikation und Behandlungsrichtlinien von Konchensubstanzverlusten bei Revisionsoperationen am Huftgelenk-mittelfristige Ergebnisse: Primare und Revisionalloarthroplastik Hrsg- Endo-Klinik" (1987), Springer-Verlag
- Fowler JL, "Experience with the Exeter total hip replacement since 1970", Orthop Clin North Am, 19, pp.477~489 (1988)
- Gie GA, "Impacted cancellous allografts and cement for revision total hip arthroplasty", J Bone and Joint Surg, 75-B, pp.14~21 (1993)
- Gruen TA, ":“Modes of failure”of cemented stem-type femoral components. A radiographic analysis of loosening", Clin Orthop, 141, pp.17~27 (1979)
- Hultmark P, "Cemented first-time revisions of the femoral component: prospective 7 to 13 years follow-up using second-generation and third-generation technique", J Arhropalaty, 15, pp.551~561 (2000)
- Karrholm J, "Subsidence of a non-polished stem in revisions of the hip using impaction allograft. Evaluation with radiosterometry and dual-energy X-ray absorptiometry", J Bone Joint Surg, 81-B, pp.135~142 (1999)
- Lawrence JM, "Revision Total Hip Arthroplasty, Long-term results without cement", Orthop Clin North Am, 24, pp.635~644 (1993)
- Linder L, "Cancellous impaction grafting in the human femur: histological and radiographic observation in 6 autopsy femurs and 8 biopsies", Acta Orthop Scand, 71, pp.543~552 (2000)
- Ling RSM, "Histology of cancellous impaction grafting in the femur. A case report", J Bone and Joint Surg, 75-B, pp.693~696 (1993)
- Malkani AL, "Femoral component revision using impacted morsellized cancellous graft. A biomechanical study of implant stability", J Bone Joint Surg, 78-B, pp.973~978 (1996)
- Masterson EL, "The cement mantle in the Exter impaction allografting technique: A cause for concern", J Arhropalaty, 12, pp.759~764 (1997)
- Meding JB, "Impaction bone-grafting before insertion of a femoral stem with cement in revision total hip arthroplasty: a minimum two-year follow-up study", J Bone Joint Surg, 79-A, pp.1834~1841 (1997)
- Mikhail WE, "Femoral bone regeneration subsequent to impacting grafting during hip revision: histologic analysis of a human biopsy specimen", J Arthroplasty, 14, pp.849~853 (1999)
- Morelend JR, "Femoral revision hip arthroplasty with uncemented, porous-coated stems", Clin Orthop, 319, pp.141~150 (1995)
- Nelissen RGHH, "Revision hip arthroplasty with the use of cement and impaction grafting. Histological analysis of four cases", J Bone and Joint Surg, 77-A, pp.412~422 (1995)
- Schreurs BW, "The initial stability of cemented and non-cemented stem fixated with a bone grafting technique", Orthop Trans, 15, pp.439~440 (1991)
- Simon JP, "Impaction cancellous grafting of the femur in cemented total hip revision arthroplasty. In Proceeding of the British Orthopaedic Association", J Bone and Joint Surg, 73-B(73) (1991)
- Slooff TJJH, "Bone grafting in total hip replacement for acetabular protrusion", Acta Orthop Scand, 5, pp.593~596 (1984)
- Ulmark G, "Impaction corticocancellous allografts and cement for revision of the femur component in total hip arthroplasty", J Arthroplasty, 17, pp.140~149 (2002)
- Van der Donk S, "Incoporation of morselized bone grafts: a study of 24 acetabular biopsy specimens", Clin Orthop, 396, pp.131~141 (2002)