슬관절 전치환술에서 대퇴치환물의 회전정렬 -수동조작 시 연부조직 긴장을 고려한 방법-
Rotational Alignment of the Femoral Components in Total Knee Arthroplasty -A Modified Gap Technique Using Manual Distraction-
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목적: 슬관절 전치환술에서 수동조작 시 연부조직의 긴장을 고려하여 대퇴 치환물의 회전정렬을 결정하는 방법을 기존의 고식적 방법 및 자동항법장치를 이용한 방법과 비교하여 그 장단점을 알아 보고자 하였다. 대상 및 방법: 전향적 비교연구로, 일차성 퇴행성 관절염 환자 92예를 대상으로 무작위로 3가지 수술법을 사용하였다. 제1군(31예)은 후과 축에서 3o 외회전한 축을 기준으로 대퇴과 전후방 절단을 시행하였다. 제2군(30예)은 경골의 역학적 축에 대하여 직각으로 경골 근위부를 절단한 후 90o 굴곡위에서 수동으로 하퇴부를 견인하여 내외측 연부조직 긴장을 유지하면서 굴곡간격이 대칭되도록 0o∼6o 범위의 외회전 축을 기준으로 대퇴골 전후방 절단을 시행하였다. 제3군(31예)은 비영상적 자동항법장치(OrthoPilotⓇ)를 이용하여 대칭 굴곡 간격을 얻도록 전후방 절단을 시행하였다. 전 예에서 슬관절 전치환술 전 및 술 후 컴퓨터 단층 촬영을 시행하여 대퇴골 후과각(상과간 축과 후과에 접선인 선간의 각)을 측정하였다. 결과: 각 군간의 인구학적 변수(나이, 키, 체중, body mass index)는 차이가 없었으며, 술 전 평균 후과각은 제1군 5.45o, 제2군 5.34o, 제3군 5.24o였고, 술 후 평균 후과각은 제1군 1.91o, 제2군 1.17o, 제3군 1.37o로 군간 차이를 보이지 않았다(p＞0.05). 그러나 술 후 후과각이 ±3o 이상 벗어난 경우는 제1군이 제2, 3군에 비하여 유의하게 많았으며(p=0.028), 제2군과 제3군 사이에는 차이가 없었다(p=0.731). 결론: 수동조작 시 연부조직 긴장을 고려한 방법은 후과축에 대하여 3o 외회전하는 방법에 비하여 대퇴 치환물의 회전 정렬에 있어 우월하였으며, 자동항법장치를 이용한 방법과 차이를 보이지 않았다.
Abstract
Purpose: This study was undertaken to introduce a modified gap technique using manual distraction for achieving proper rotational alignment of the femoral components in total knee arthroplasty (TKA) and we compared the accuracy of the rotational alignment of the femoral components in TKAs when using a navigation system with that of another conventional technique. Materials and Methods: We randomly used three different methods and implants (group 1: 3o external rotation from the posterior condylar axis method, group 2: a modified gap technique using manual distraction and group 3: a navigation system, OrthopilotⓇ) in 92 patients. We measured the posterior condylar angles (PCA: the angle between the posterior condylar line and the transepicondylar axis) on computed tomography before and after surgery. Results: The analysis showed no significant differences of the demographic data (age, height, weight, body mass index) and of the mean PCAs for the rotational alignment of the femoral components between the three groups (preoperative PCA: 5.45o vs. 5.34o vs. 5.24o, respectively; postoperative PCA: 1.91o vs. 1.17o vs. 1.37o, respectively, p＞0.05). However, the conventional 3o external rotation method showed a higher frequency of outliers (p=0.028). Conclusion: The modified gap technique using manual distraction showed a higher accuracy of the femoral rotational alignment compared with that of the 3o external rotation method by reducing the outliers, and the modified gap technique using manual distraction showed similar results compared with those of the navigation method.
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