동일 환자에서 시행한 고정형과 회전형 슬관절 전치환술
Bilateral Total Knee Arthroplasty using the Fixed Bearing Platform and the Rotating Platform in the Same Patient
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목적: 고령의 양측성 슬관절염 환자에서 고정형과 회전형 삽입물을 이용한 단계적 슬관절 전치환술 시행후 임상적, 방사선적 결과를 분석하여 문헌고찰과 함께 보고하고자 한다. 대상 및 방법: 2001년 11월부터 2004년 12월까지 양측 퇴행성 슬관절염이 있는 동일 환자에서 단계적으로 Press Fit Condylar (PFC) Sigma 고정형과 회전형 인공 슬관절을 사용하여 양측성 슬관절 전치환술을 시행한 44명을 대상으로 하였다. 평균 연령은 71.5 (65∼85)세였고 평균 추시 기간은 74.3 (62∼86)개월이었다. 슬관절 점수, 굴곡구축, 운동범위, 합병증, 주관적 만족도 등의 임상적 평가 결과와 수술 전후의 대퇴-경골간 각도 및 American knee society의 방사선적 평가 방법에 따른 결과를 분석하였다. 결과: 최종 추시에서 슬관절 점수는 고정형에서 36.5점에서 87.3점, 회전형에서 38.8점에서 87.9점으로, 기능적 점수는 고정형에서 28.4점에서 83.5점, 회전형에서 32.6점에서 85.8점으로 향상되었다. 관절 운동 범위는 고정형에서 85.5o에서 115.5o, 회전형에서 86.6o에서 116.8o로 향상되었다. 대퇴-경골간 각도는 고정형에서 내반 8.2o에서 외반 5.5o로 회전형에서 내반 7.1o에서 외반 5.3o로 전례에서 허용 범위 내로 교정되었다. 임상적으로 의미있는 골용해 및 해리는 관찰되지 않았으나 회전형을 사용한 경우, 수술 전 15o 이상의 내반 변형을 가진 13예 중 3예에서 불안정성이 관찰되었고, 회전형을 사용한 6예에서 수술 후 보행 중 삽입물 마찰음이 나타났다. 결론: 동일 환자에서 회전형과 고정형 슬관절 전치환술의 추시 결과, 임상적, 방사선학적 결과는 모두 우수하게 나타났으나, 내반 변형이 심한 경우 gap balance를 맞추기 위한 연부 조직 유리가 많아질 경우 인대 균형, spin-out, 적절한 관절 간격의 형성 및 변형 교정을 고려할 때 고정형의 선택도 유용한 방법으로 생각된다.
Abstract
Purpose: We wanted to evaluate the clinical and radiological results after total knee arthoplasty using the Press Fit Condylar (PFC) Sigma fixed bearing platform knee and the rotating platform knee in the same patient. Materials and Methods: We enrolled 44 patients who had undergone bilateral total knee arthroplasties due to osteoarthritis of both knees from November 2001 to December 2004, using the fixed bearing platform and the rotating platform, respectively. The mean age of the study group was 71.5 years (range: 65∼85 years). The mean follow up period was 74.3 months (range: 62∼86 months). The clinical results were evaluated according to the knee score, the functional score, the presence of flexion contracture, the range of motion and the complications, and the visual analog scale system was used for the patients’ satisfaction. The radiological results using the American Knee Society criteria and the tibiofemoral angle were also evaluated. Results: The average knee score improved from 36.5 to 87.3 in the fixed bearing group and from 38.8 to 87.9 in the rotating platform group, respectively. The average functional score improved from 28.4 to 83.5 in the fixed bearing group and from 32.6 to 85.8 in the rotating platform group, respectively. The average range of knee motion improved from 85.5o to 115.5o in the fixed bearing group and from 86.6o to 116.8o in the rotating platform group. The average tibiofemoral angle improved from varus 8.2o to valgus 5.5o in the fixed bearing group and from varus 7.1o to valgus 5.3o in the rotating platform group. We did not observe any clinically significant osteolysis or wear. However, there were 3 cases of instability out of the 13 cases in rotating platform group, and this was accompanied by varus deformities of over 15 degree and 6 cases of friction sound during walking. Conclusion: We could find no clinical and radiological differences between the fixed bearing platform and the rotating platform in this study. However, we should regard the fixed bearing prosthesis as a good option for the patients with severe varus deformities, with considering performing bulky soft tissue release for obtaining a balanced gap, for preventing spin-out and to correct deformity.
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