무시멘트형 비구컵을 이용한 비구부 재치환술
Acetabular Revision Using Cementless Acetabular Cup
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목적: 무시멘트형 비구컵을 이용한 비구부 재치환술 후 임상적 및 방사선학적 결과를 알아보고자 하였다. 대상 및 방법: 1998년 1월부터 2005년 10월까지 무시멘트형 비구컵을 이용하여 비구부 재치환술을 시행 받고 최소 2년 이상 (평균 54.1 개월) 추시가 가능하였던 27예를 대상으로 하였다. 임상적 평가는 Harris 고관절 점수를 기준으로 하였으며, 방사 선학적 평가는 최종 추시 시 비구컵 주위의 방사선 투과 음영, 골용해 및 해리 등을 기준으로 판단하였다. 결과: 최종 추시시 비구컵의 실패는 한 예에서도 발생하지 않았다. Harris 고관절 점수는 수술 전 평균 67.1점에서 최종 추시 시 91.4점으로 증가하였으며, 방사선학적 분석에서 비구컵 주위의 방사선 투과 음영이 7예(25.9%)에서 관찰되었으나 그 중 4예 가 한 개의 구역에 국한되어 관찰 되었다. 비구부의 골용해와 비구컵의 해리는 한 예에서도 관찰되지 않았으며 감염 또한 발생 하지 않았다. 합병증으로는 이소성 화골, 탈구, 심부 정맥 혈전증이 각 각 한 예에서 발생하였다. 결론: 무시멘트형 비구컵을 이용한 비구부 재치환술은 단기 추시 결과에서 만족스러운 결과를 보였으며 비교적 비구골 결손이 심한 경우에도 구조적 골이식을 병행하여 안정적인 고정을 얻을 수 있었다.
Abstract
Purpose: To evaluate implant survivorship and clinical outcomes after acetabular revision using cementless acetabular cups. Materials and Methods: We evaluated 27 cementless acetabular revision cases performed between January 1998 and October 2005. All patients were followed up for more than 2 years, and the mean follow-up period was 54.1 months (range: 24~120 months). In all cases, morselized allografting was performed. Five cases needed structural allografting to achieve stability of the acetabular cup. The clinical results were analyzed using the Harris hip score, and radiological analysis was performed for evaluation of radiolucent lines, osteolysis, loosening, and changes in the hip center. Results: At the time of latest follow-up, no cups showed failure requiring re-revision. The average Harris hip score improved from 67.1 points preoperatively to 91.4 points postoperatively. Radiologically, 7 cases (25.9%) showed radiolucent lines around the acetabular cup, but there was no loosening or osteolysis. Conclusion: Cementless acetabular revision showed satisfactory radiological and clinical results on short-term follow-up analysis. Even in cases with considerable amounts of acetabular bone loss, stable fixation could be obtained with structural bone grafting.
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