세라믹-세라믹형 무시멘트 인공 고관절 전치환술의 임상결과 단기추시
clinical result of total arthroplasty with cementless ceramic to ceramic bearing short-term follow up
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목적: 50세 이하 환자에서 시행한 세라믹-세라믹형 무시멘트 인공 고관절 전치환술의 결과를 보고하고자 한다. 대상 및 방법: 1998년 1월부터 2001년 12월까지 본원에서 세라믹-세라믹형 인공 고관절 전치환술을 시행 받은 환자 중 최소 2년 이상 추시가 가능했던 50세 이하 31명(남자 25명, 여자 6명) 36례를 대상으로 하였다. 수술시 평균 연령은42.7세(범위, 23~49세), 추시기간은 평균 35.3개월(범위, 24~49)이었다. 수술의 원인으로 대퇴 골두 무혈성 괴사 29례 및 퇴행성 골관절염 7례였고 양측 모두 시행한 경우는 5명이었다. 임상적으로는 Harris hip score 등을 평가하였고, 방사선학적으로 관절면의 마모, 골용해, 치환물의 안정도 등을 평가하였다. 결과: Harris 고관절 점수는 수술 전 57.7점에서 최종 추시시 93.3점으로 향상되었다. 최종 추시 방사선 소견 상 전례에서 안정된 고정을 얻었다. 또한, Muller hip template 상에서 세라믹 삽입물의 전이나 치환물 주위 골용해가 발생한 경우는 한 예도 없었다. 또한 탈구, 술 후 감염, 세라믹 삽입물의 파손 또한 없었다. 결론: 50세 이하 대퇴 골두 무혈성 괴사 및 퇴행성 골관절염에서 시행한 세라믹-세라믹형 무시멘트 인공 고관절 전치환술의 단기 추시 결과는 만족할 만한 것이며 향후 장기적인 추시 결과의 분석이 필요할 것으로 사료된다.
Abstract
Purpose: To evaluate the results associated with the use of ceramic on ceramic articulation cementless total hip arthroplasty (THA) in patients less than 50 years old. Materials and Methods: Between Jan. 1998 and Dec. 2001, thirty-six THA's, using ceramic on ceramic articulation, were performed in thirty-one patients younger than fifty years old. The patient's average age was 42.7 years (range: 23~49 years) and the mean duration of follow up was 35.3 months (range: 24~49 months). The initial diagnoses were osteonecrosis of the femoral head in 29 hips, with osteoarthritis in 7. The clinical results were analyzed using the Harris hip scores. Radiographic evaluation, in terms of stability of components and osteolysis, were performed. Results: The mean Harris hip score improved from 57.7 to 93.3 points at the time of the last follow-up. On the last radiographs, all cases showed fixation due to bone ingrowth. There was no migration of the ceramic on ceramic articulation, as measured by the Muller hip template. No acetabular and femoral components were found to have loosened on the radiographs. There was no evidence of osteolysis, dislocation, postoperative infection or ceramic fracture. Conclusion: The short-term clinical and radiographic results for the use of cementless ceramic on ceramic articulation total hip replacement in patients under fifty years old, with osteonecrosis of femoral head and an osteoarthritic hip were very satisfactory. However, a long term follow up will be required
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