무시멘트형 대퇴골 삽입물을이용한 고관절 재치환술
Revision Hip Arthroplasty with a Cementless Femoral Stem
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목적: 무시멘트형 대퇴 삽입물을 이용하여 인공 고관절 재치환술을 시행한 후 임상적 및 방사선학적결과를 알아보고자 하였다. 대상 및 방법: 2000년 1월부터 2010년 5월까지 본원에서 무시멘트형 대퇴 삽입물을 이용하여 인공고관절 재치환술을 시행하고 2년 이상 추시가 가능하였던 26예를 대상으로 하였다. 재치환술 당시나이는 평균 63.8세이었다. 추시 기간은 평균 45개월이었다. 재치환술의 원인은 무균성 해리 11예,골절 6예, 골용해 6예, 감염 3예이었다. 방사선학적 결과는 삽입물의 침강, 해리, 응력 방패 현상을관찰하였으며, 임상적 결과는 대퇴부 동통과 해리스 고관절 점수를 이용하여 평가하였다. 결과: 재치환술 전 해리스 고관절 점수는 평균 41.2점에서 최종 추시시 평균 85.8점이었으며 18예(69%)에서 양호 이상의 결과를 얻었다. 5예에서 대퇴부 동통을 호소하였다. 대퇴골 삽입물 침강은 3예에서 10 mm 이상 발생하였으며 평균 14 mm이었다. 2예에서 최종 추시시 해리 소견이 관찰되었다. 응력 방패 현상은 6예에서 관찰되었다. 지주 동종골 이식을 시행한 3예는 숙주골과 골유합 소견이 관찰되었다. 합병증은 2예에서 수술 중 발생한 대퇴 삽입물 주위 골절로 금속판과 강선을 이용하여 고정하였고, 3예에서 수술 후 탈구가 발생하여 정복 후 보조기를 착용시켰다. 결론: 무시멘트형 대퇴 삽입물을 이용한 인공 고관절 재치환술에서 임상적 및 방사선학적으로 만족할 만한 결과를 얻을 수 있었다. 그러나 직경이 너무 큰 삽입물을 사용한 경우에서 대퇴부 동통과 응력방패가 발생하였다.
Abstract
Purpose: To evaluate the clinical and radiographic results of patients who received revision total hip arthroplastyusing cementless femoral stems. Materials and Methods: This study included 26 patients who underwent revision total hip arthroplasty using acementless femoral stems in our hospital, between Jan 2000 and May 2010, and were able to be evaluated in thefinal follow-up. The mean age was 63.8 years at the time of the revision surgery, and the follow up period was anaverage of 45 months. The causes of revision were aseptic loosening in 11 cases, periprosthetic fracture in 6 cases,femoral osteolysis in 6 cases, and infection in 3 cases. The radiologic results were evaluated in term of subsidence,loosening, and the stress shielding. The clinical results were evaluated by the Harris hip score and thigh pain. Results: Harris hip score improved from 41.2 points preoperatively to 85.8 points at the final follow-up. Therewere 5 cases that complained of thigh pain at the last follow-up. Subsidence of femoral stem of more than 10mm was observed in 3 cases. Stress shielding was noticed in 6 hips. The 3 grafted strut allografts werecompletely fused with the host bone. Complications included 2 cases of intraoperative periprosthetic fracture and3 cases of dislocation. Conclusion: We obtained favorable clinical and radiologic outcomes in revision total hip arthroplasty using acementless femoral stems. However, thigh pain and stress shielding resulted from the diameter of femoral stembeing too large.
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