감염된 인공 슬관절 전치환술의 2단계 재치환술(가압 멸균한 대퇴골 치환물 및 폴리에틸렌 삽입물을 이용한 방법)
Two-Stage Reimplantation in Infected Total Knee Arthroplasty (A Method of Reinsertion of the Autoclaved Femoral Component and a Polyethylene Liner)
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목적: 감염된 인공 슬관절 치료에서 항생제 함입 시멘트와 가압 멸균한 대퇴골 치환물 및 폴리에틸렌을 이용한 2단계 재치환술의 결과를 분석하고자 한다. 대상 및 방법: 2003년 3월부터 2008년 3월까지 인공 슬관절 전치환술 후 심부 감염으로 진단되어 2단계 재치환술을 시행받은 25명의 환자를 대상으로 하였다. 모든 예에서 1단계로 변연 절제술을 시행하고 치환물과 시멘트를 모두 제거한 후 대퇴골 치환물과 폴리에틸렌 삽입물을 가압 멸균하여 항생제 함입 시멘트를 이용하여 관절형 삽입물을 제작하였다. 수술 전, 후 관절 운동 범위, Knee Society 슬관절 점수와 기능 점수, Hospital for Special Surgery (HSS) 점수, 합병증을 분석하였다. 결과: 최종 추시 시까지 한 예에서 31개월 후 감염이 재발하여 2단계 재치환술을 다시 시행하였다. 관절 운동 범위는 술 전 평균 83o에서 최종 추시 상 평균 110o로 증가하였으며, Knee Society 슬관절점수와 기능 점수는 술 전 평균 46, 31점에서 술 후 평균 82, 50점으로 증가하였고, HSS 점수는 술 전 평균 60점에서 술 후 평균 86점으로 증가하였다. 합병증으로 내측 측부 인대 파열, 대퇴골 외상과 골절, 대퇴골 상과 골절이 각각 1예씩 발생하였다. 결론: 가압 멸균한 대퇴골 치환물 및 폴리에틸렌 삽입물을 이용한 2단계 재치환술은 감염된 인공 슬관절의 치료에 있어 우수한 결과를 보였다.
Abstract
Purpose: We wanted to evaluate the results of treating infected total knee arthroplasty with an autoclaved femoral component and polyethylene liner. Materials and Methods: From March 2003 to March 2008, 25 knees were diagnosed as infected total knee arthroplasty (TKA) and they underwent two-stage re-implantation. These knees were treated with debridement, reinsertion of the removed femoral component and a polyethylene liner, which were autoclaved, and antibiotic cement was used as an articulating spacer during the interim period to allow maintenance of motion and function. The range of motion and the Hospital for Special Surgery (HSS) score, the Knee Society Knee Score and the Function Score were evaluated. Results: The mean follow up period was 52 months. There was one recurrence of infection. Prior to revision, the average range of motion was 83° and the average HSS score was 60 points. At final follow-up, the average range of motion was 110° and the average HSS score was 86 points. The knee score and function score showed an increase from a mean of 46 and 31 points preoperatively to a mean of 82 and 50 points postoperatively. The complications during reimplantation were one medial collateral ligament rupture, one lateral condyle fracture and one femoral distal metaphyseal fracture. Conclusion: The articulating spacer using an autoclaved femoral component and polyethylene can improve knee function and motion in two stage revision TKA.
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