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후방십자인대 절제형과 대치형 인공 슬관절의 단기 추시 결과

Short-term Results of Posterior Cruciate Sacrificing and Substitution Total Knee Arthroplasty

전승협|오광준|김진일|최혁우
대한슬관절학회 (Korean Knee Society)|2011.06|Knee Surgery and Related Research|제23권 제2호|pp. 79-87

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키워드

Total knee arthroplasty슬관절 전치환술후방십자인대 절제형후방십자인대 대치형Posterior cruciate sacrificingPosterior cruciate substitution

초록

목적: 슬관절 전치환술을 시행한 환자 중 후방십자인대 절제형과 후방십자인대 대치형의 임상적, 방사선적 결과를 비교하였다. 대상 및 방법: 퇴행성 관절염으로 가동형 슬관절 전치환술을 시행한 53명(66예)의 환자 중 후방십자인대 절제형을 시행한 27명(30예), 대치형을 시행한 31명(36예)을 대상으로 임상적 및 방사선학적 평가를 시행하였다. 결과: 슬관절 점수는 절제형 33점에서 81.9점, 대치형 35점에서 86.6점으로 향상되었으며 관절운동 범위는 절제형이 수술 전 평군 후속 굴곡 104.5^o에서 최종 추시 시 113.9o로 대치형이 104.7^o에서 114.7^o로 각각 양 군에서 유의한 향상을 보였다(p＜0.05). 최종 추시 시 방사선 평가에서는 절제형이 α각 98.9^o, β각 89.9^o, γ각 5.0^o, δ각 39.2^o였고 대치형이 α각 95.6^o, β각 89.0^o, γ각 9.0^o, δ각 88.4^o로 유의한 차이를 보이지 않았으며(p＞0.05) 두 군 모두에서 해리가 관찰되지 않았다. 합병증으로 절제형에서 폴리에틸렌 삽입물 탈구 1예(1.5%), 후방십자인대 대치형에서 인공삽입물 주위 골절 1예(1.5%)가 조사되었다. 결론: 후방십자인대 절제형 및 대치형 슬관절 전치환술을 2년에서 4.5년 추시한 결과 임상적, 방사선학적 평가에서 양호한 결과를 보였으며 두 군 간의 유의한 차이는 보이지 않았다.

Abstract

Purpose: To compare clinical and radiologic results after total knee arthroplasty (TKA) with posterior cruciate sacrificing (PCS) and posterior cruciate substitution (PS). Materials and Methods: Of 66 knees in 53 patients with degenerative arthritis, we completed both practical and radiological evaluations for 27 patients with PCS TKA (30 knees) and 31 patients with PS TKA (36 knees). Results: The knee score improved from 33 to 81.9 for PCS TKA and from 35 to 86.6 for PS TKA. Preoperative flexion was 104.5^o in the PCS TKA group and 104.7^o in the PS TKA group.These scores significantly improved to 113.9^o and 104.7^o respectively (p＜0.05 for each). However, there was no significant difference between the two groups when comparing postoperative results and improvements (p＞0.05). On radiological evaluation, the α angle was found to be 98.9^o, the β angle 89.9^o, the γ angle 5.0o, and the δ angle 39.2^o for PCS TKA. Also, the α angle was 95.6^o, β angle 89.0^o, γ angle 9.0^o, and δ angle 88.4^o for PS TKA (p＞0.05). Loosening was not encountered in either type. Postoperative complications were few; there was 1 knee (1.5%) with a polyethylene insert spin-out for the PCS TKA group and 1 knee (1.5%) with a periprosthetic fracture for the PS TKA group. Conclusion: On both clinical and radiological evaluations, PCS TKA and PS TKA demonstrated satisfactory results out to 4.5 years of follow up, which also indicated a lack of any significant difference between these two types.

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