금속-금속 관절면을 이용한 인공고관절 전치환술 = Total Hip Arthroplasty with Use of Metal-on-Metal Articulation금속-금속 관절면을 이용한 인공고관절 전치환술

국문 초록 (Abstract)

목적: 최소 5년 이상 추시가 가능하였던 제 2세대 금속-금속 관절면을 사용한 인공 고관절 전치환술을 시행 받은 환자들의 임상적, 방사선학적 결과에 대해 살펴보고자 하였다. 대상 및 방법: 1995년 6월부터 2002년 3월까지 금속-금속 인공고관절 전치환술을 시행 받은 환자 중 최단 5년 이상 추시가 가능하였던 41명, 43예를 대상으로 하였으며 평균 추시 기간은 93개월(범위, 66~146개월)이었다. 환자들의 연령 분포는 평균 54세였으며 남자가 26명, 여자가 15명이었다. 술 전 진단명은 무혈성 괴사가 24예, 골관절염이 17예, 대퇴경부골절 수술 후 불유합이 2예였다. 임상적 평가는 VAS-통증 점수, WOMAC 점수 및 Harris 고관절 점수를 측정하였으며, 수술 후 6주, 3개월, 6개월, 이후 1년마다 촬영한 방사선 사진에서 마모, 골 용해와 해리의 유무와 정도 및 그 진행 여부를 평가하였다. 결과: VAS-통증 점수는 술 전 평균 8.1점에서 최종 추시 시 평균 3.1점으로 개선되었고, WOMAC 점수는 술전 평균 76.4점에서 최종 추시 점수는 13.3이었다. Harris 고관절 점수는 술 전 42.7점에서 최종 추시 시 90.8점으로 향상되었다. 방사선 사진에서 마모는 측정이 불가능한 수준이었다. 합병증으로는 심부감염 3예, 스템 주위 대퇴골 골절 1예, 비구 골 용해 1예, 탈구가 1예 있었다. 결론: 금속-금속 관절면을 사용한 인공 고관절 전치환술의 최소 5년 이상 추시 결과에서 마모 및 해리에 대한 뛰어난 저항성 및 통증과 기능에 있어서 높은 만족도를 보이나 금속입자의 인체에 대한 영향에 대해서는 보다 장기적인 추시 관찰이 필요한 것으로 생각된다.

다국어 초록 (Multilingual Abstract)

Purpose: This paper reports the clinical and radiologic consequences in a group of patients who underwent metal on metal total hip arthroplasty based on a follow-up of at least five years. Materials and Methods: Forty-three cases (41 patients) were enrolled in this study. The patients underwent surgery from June 1995 to March 2002. The mean follow-up period was 93 month. The evaluation focused on the VAS-pain score, WOMAC score and Harris Hip score. Follow-up radiographs were taken at 6 weeks, 3 months, 6 months, and 12 months after surgery. Results: At the last follow-up, the VAS-pain score, WOMAC score and Harris Hip score improved from 8.1 to 3.1, 76.4 to 13.3, and 42.7 to 90.8, respectively. The X-rays showed no signs of detectable wear. However, some complications were encountered; 3 infections, 1 periprosthetic femoral fracture, 1 pelvic osteolysis and 1 dislocation. Conclusion: The results appear quite satisfactory considering the wear resistance, pain and function after surgery irrespective of age. However, a long-term follow-up will be needed to obtain reliable information on the influence of metal particles on the human body.

참고문헌 (Reference)

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