경골 내측 골 결손 시 자가 지주 골 이식술을 이용한슬관절 전치환술 후 조기 완전 체중 부하-최소 5년 추시 결과-
Early Full Weight Bearing after an Autogenous Structural Bone Graft for Treating a Medial Tibial Bone Defect in Total Knee Arthroplasty -Minimum 5 Years Follow up Results-
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목적: 경골 내측 골 결손을 보이는 심한 내반 변형의 슬관절염 환자에서 자가 지주골 이식과 금속 나사못 고정을 이용한 슬관절 전치환술 후 조기 보행을 실시하고, 임상적, 방사선학적 결과를 조사하여 수술 방법의 유용성을 알아보았다. 대상 및 방법: 1996년 8월부터 2004년 3월까지 5년 이상 추시 가능한 34명 43예를 대상으로 하였다. 골 결손 형태는 주변부 결손형 43예를 대상으로 평균 68세였고, 추시 기간은 평균 72개월이었다. 임상적 평가와 이식 골의 평가 및 방사선학적 평가도 시행하였다. 결과: Hospital for Special Surgery 슬관절 평가 지수는 수술 전 평균 46점에서 술 후 1주 평균 89점, 최종 추시 상 평균 87점을 보였으며, 관절 운동 범위는 수술 전 평균 71o에서 술 후 1주 평균 113o, 최종 추시 상 평균 118o를 보였다. 방사선적 결과에서 대퇴 경골 각은 수술 전 평균 23.5o 내반에서 술 후 1주 평균 6.2o 외반, 최종 추시 상 평균 6.1o외반을 보였다. 결론: 심한 내반 변형 환자에서 경골 내측 골 결손 시 자가 지주골 이식과 금속 나사못 고정을 이용한 슬관절 전치환술은 조기 보행이 가능하며 골 결손 치료에 유용한 방법으로 생각된다.
Abstract
Purpose: We evaluated the results of early full weight bearing after an autogenous bone graft and metal screw fixation of severe varus deformity with a medial tibial bone defect in total knee arthroplasty. Materials and Methods: From August 1996 to March 2004, 34 patients (43 cases) were selected for the analysis. The average age was 68 and the mean follow up period was 72 month. The clinical results were evaluated using the knee range of motion and the Hospital for Special Surgery (HSS) score. The radiological results were evaluated using the tibiofemoral angle, the presence of loosening, radiolucent lines and osteolysis and the component’s location. Results: The mean HSS score increased from 46 to 87 points on the final follow up. The mean range of motion was increased from 71o to 118o on the final follow up. The mean femorotibial angle showed varus deformity angulation (23.5o) at pre-operative surgery, 6.2o valgus deformity for the first 7 postoperative days and 6.1 valgus at the last follow up. Conclusion: These findings suggest that an autogenous structural bone graft and metal screw fixation has fine results and makes early ambulation possible for the patient who has severe varus deformity with a medial tibial bone defect.
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