10^o 이상의 술 전 경골 후방경사각을 가진 후방십자인대 대치형 슬관절 전치환술
PS-TKA with more than 10^o of Preoperative Posterior Tibial Slope
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목적: 10^o 이상의 술 전 경골 후방경사각을 가진 환자의 후방십자인대 대치형 슬관절 전치환술에서 경골 후방경사각이 신전 간격 및 슬개골의 높이 변화에 미치는 영향을 알아보고자 하였다. 대상 및 방법: 후방십자인대 대치형 슬관절 전치환술 110예를 대상으로, 술 전 경골 후방경사각이 10^o 이상인 group I; 56예와 10^o 미만인 group II; 54예로 분류하여 수술중 상대적인 신전 간격의 부족에 따른 원위 대퇴골 추가 절제의 시행빈도와 슬개골 높이 감소를 비교 분석하였다. 결과: Group I, II에서의 술 전 경골 후방경사각은 평균 12.77^o (±3.22^o)와 6.72^o (±2.58^o)(p=0.000), 경골 후방경사각 감소는 10.74^o (±3.54^o)와 4.78^o (±2.66^o)(p=0.000)이었다. 굴곡 구축이 있는 경우 수술 중 원위 대퇴골 추가 절제 빈도는 54.5%와 46.1% (p=0.448)이었으나, 굴곡 구축이 없는 경우는 11.8% (4예)와 34.1% (14예)(p=0.022)이었다. 슬개골 높이 감소는 0.35 (±4.79) mm와 1.99 (±4.78) mm (p=0.075)의 차이를 보였다. 경골 후방경사각 감소와 슬개골 높이 감소는 약한 상관관계가 있었다(r=−0.253, p=0.016). 결론: 후방십자인대 대치형 슬관절 전치환술시 10^o 이상의 경골 후방경사각을 가진 환자에서 술 후 경골 후방경사각의 감소는 굴곡 구축이 없는 경우, 10^o 미만의 경골 후방경사각을 가진 환자에 비교하여 상대적인 신전간격의 증가를 초래하여, 수술 중 굴곡 및 신전 간격을 일치시키는 과정에 고려되어야 할 요소이며, 또한 수술 전후의 슬개골의 높이 유지에 영향을 주는 요소로 생각되었다.
Abstract
Purpose: We wanted to evaluate the effects of a preoperative posterior tibial slope of more than 10^o on the extension gap and patellar height during posterior substituted total knee arthroplasty. Materials and Methods: One hundred ten posterior substituted total knee arthroplasties were divided into group I (more than 10^o of preoperative posterior tibial slope, n=56) and group II (less than 10^o of slope, n=54). Each group was evaluated to compare the frequency of additional distal femoral resections due to an insufficient extension gap and the correlation with the decrease of the patellar bone height. Results: In each group, the preoperative tibial slope was 12.77^o (±3.22^o) vs. 6.72^o (±2.58^o), respectively (p=0.000) and the decrease of the posterior slope was 10.74^o (±3.54^o) vs. 4.78^o (±2.66^o), respectively, (p=0.000). The frequencies of additional distal femoral resection were 54.5% vs. 46.1%, respectively, (p=0.448) with flexion contracture and 11.8% vs. 34.1%, respectively, (p=0.022) without flexion contracture. The decrease of the patellar bone height was 0.35 (±4.79) mm vs. 1.99 (±4.78) mm, respectively, (p=0.075). There was weak correlation between the decrease of the patellar bone height and the decrease of the posterior tibial slope (r=−0.253, p=0.016). Conclusion: In the group having more than 10^o of preoperative posterior tibial slope without flexion contracture, the decrease of the posterior tibial slope had to be considered as one of the factors that affected making the extension gap significantly greater during the gap technique and to preserve the patellar bone height.
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