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Mallory-Head Hip System을 사용한 무시멘트 고관절 전치환술 (HA Coating v.s. Non-HA Coating)
황성관 ( Sung Kwan Hwang ),이한규 ( Han Kyu Lee ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.1
The use of total hip arthroplasty is steadily increasing. The development of bone cement as a filler between bone and hip prosthesis was a revolutionary step in orthopedics in the 1960s since the short-term results were excellent with consistent relief of pain and disability. However, long-term results revealed an increased rate of mechanical loosening in younger, active patients whereas the revision rate in older patients is significant lower. Improvement in cementation techniques have reduced the incidence of mechanical loosening. The process of biologic ingrowth into porous metal surfaces has evolved as a possible solution for high-risk, younger, and heavier patients. Under ideal cirumstances, where good bone quality exists and rigid initial implant stability is achieved, bone ingrowth will occur. However, failure to achieve solid bony fixation may be a source of thigh pain in cementless femoral stems and the clinical result of cementless prosthesis was not better than that of cemented ones. Synthetic hydroxyapatite is highly biocompatible and has chemical and crystalline structure same as the major mineral component of biologic apatite. Numerus experimental studies and several clinical datas tell us that bone has an affinity for hydrox- yaptite, resulting in rapid and early bone bonding. The clinical and radiologic observation during short-term period revealed there was no significant difference between two groups. However, during early postop. period, clinical results of HA-coating group were superior than those of NON-HA coating group. HA coating may be effective on early bone ingrowth, resulting early weight bearing and less thigh pain.
황성관 ( Sung Kwan Hwang ),박융 ( Yung Park ) 대한고관절학회 1997 Hip and Pelvis Vol.9 No.1
One hundred twenty eight patients underwent 128 primary unilateral total hip arthroplasties from January 1992 to December 1995. Patients were divided into two groups based on the type of anesthesia utilized for their procedure. Group I consisted of 56 patients (35 women and 21 men; average age 56 years) who had general endotracheal anesthesia. Group II consisted of 72 patients (40 women and 32 men; average age 58 years) who had spinal anesthesia. Data were analyzed by anesthesia group to compare a variety of clinically relevant factors. No statistically significant differences in each groups were noted regarding average age at the time of surgery, the underlying diseases, the number of preexisting medical conditions, surgical time, length of hospitalization, deep venous thrombosis, deep infections, death and intraoperative blood transfusion. Significant differences were observed for two factors: 1) estimated intraoperative blood loss was higher in Group I (p <0.05), and 2) postoperative hemovac output was also greater in Group I (p <0.05). In conclusion, spinal anesthesia appears to be a safer modality for patients, especially with pulmonary problems undergoing primary unilareral total hip replacement.
Hydroxyapatite Coating 과 Porous Coating 된 비구컵의 방사선학적 변화 비교
황성관 ( Sung Kwan Hwang ),박융 ( Yung Park ) 대한고관절학회 1996 Hip and Pelvis Vol.8 No.2
The purpose of this study was to compare the radiological changes of Hydroxyapatite-coated cups with those of porous-coated cups. From January 1992 to December 1994, we carried out 125 total hip arthroplasties in 101 patients; 61 hips in 49 patients had H-A coated acetabular implants of Omnifit' system and 64 hips in 52 patients with porous coated acetabular implants of Mallory-Head' Hip system. And the average follow up period was 32 months (1S to 56 months). Radiologic evaluation of both acetabular components reveals that bone condensation begins to occur in over 40% of cases by one year with both H-A and porous-coated cups, but by five years, condensation with HA cups was seen in 93% of cases in zone 1 and 5796 in zone 3, compared with 89% in zone 1 and 44% in zone 3 with porous cups. Reactive line formation was found in only 2% of the HA-coated cups, whereas with porous-coated cups it was seen in 3% of cases. Prosthetic migra- tion was noted with two HA- and four porous-coated cups. Comparing the use of HA-and porous-coated acetabular cups, the radiological results over threeto-five years appear similiar. Continued follow-up of this patient population is desirable to establish the durability of these three-to-five year results.
골다공증을 동반한 70세 이상 고령의 고관절부 골절에서 시행한 무시멘트 양극성 반치환술
황성관 ( Sung Kwan Hwang ),심영준 ( Young Jun Shim ),양재형 ( Jea Heung Yang ),강동현 ( Dong Hyon Kang ) 대한고관절학회 2008 Hip and Pelvis Vol.20 No.2
목적: 골다공증을 동반한 70세 이상 고령 환자에서 대퇴 경부 및 전자간부 골절 치료로 무시멘트 대퇴 주대를 이용한 양극성 반치환술의 단기 추시 결과를 임상적 및 방사선학적으로 확인 하고자 하였다. 대상 및 방법: 1997년 7월부터 2006년 5월까지 대퇴 경부와 전자간부 골절로 무시멘트 대퇴 주대를 이용한 양극성 고관절 반치환술을 시행 받은 환자 중 진단 당시의 연령이 70세 이상이고 골다공증이 동반된 환자로 2년치상 추시가 가능하였던 83명 (84예)을 대상으로 하였다. 임상평가는 최종 추시 Harris 고관절 점수와 Koval의 분류에 의한 수상전 및 최종 추시 보행상태를 분석하였으며, 단순 방사선 사진을 통해 방사선학적 평가를 하였다. 결과: 환자의 평균 추시기간은 31.4개월이었다. 수술시간은 평균 35분이었고, 술 후 보행 보조기 사용을 포함한 보행시까지의 기간은 평균 6일이었다. 최종 추시시 Harris 고관절 평균점수는 82.7점 이었으며, Koval에 의한 보행 능력정도는 수상전 보행능력으로 회복 25명(30.1%), 수상전보다 1단계 감소 56명(67.5%) 2단계 감소 2명(2.4%)로 나타났으며, 방사선학적 평가상 최종 추시시 1예(1.2%)에서 피질골 과성장이 관찰되었으며, 전예에서 대퇴주대의 안정 삽입을 보였다. 결론: 고령 고관절 주위 골절 환자에서 무시멘트 대퇴주대를 이용한 양극성 고관술 반치환술의 2년이상 단기 추시 결과 임상적 및 방사선학적으로 만족스러운 결과를 얻을 수 있었다. Purpose: This study evaluated the effectiveness of bipolar hemiarthroplasty with a cementless femoral stem for hip fractures in patients older than 70 years with osteoporosis. Materials and Methods: This study examined 84 hips with osteoporosis that are available to follow up of more than 2 years, between July 1997 and May 2006. The clinical evaluation was carried out using the Koval classification before the fracture and at the last follow-up, and the Harris hip score at the last follow up. The radiological evaluation was carried out using the plain radiographs. Results: The average follow up period was 31.4 months. The Koval classification was as follows: recovery to the condition before the fracture in 25 cases (30.1%), degradation by 1 class in 56 cases (67.5%) and degradation by 2 classes in 2 cases (2.4%). The Harris hip score was 82.7 points at the last follow-up. One case (1.2%) showed cortical hypertrophy and all cases showed stable insertion of the femoral stem. Conclusion: Bipolar hemiarthroplasty with a cementless femoral stem is effective and satisfactory, both clinically and radiologically, for the treatment of elderly patients with fractures around the hip.
동시에 시행한 양측성 고관절 무시멘트 전치환술에 관한 임상적 고찰
황성관 ( Sung Kwan Hwang ),김호성 ( Ho Sung Kim ) 대한고관절학회 1992 Hip and Pelvis Vol.4 No.1
We compared the clinical results of 27 one-stage bilateral cementless total hip replacements. with the results of 20 two-stage bilateral cementless total hip replacements. The hospital time for patient in the one-stage group averaged 1 week shorter than the twostage group. The cost in patients of one-stage group was saved as much as 12.8% of that in two stage group. The anesthesia time, blood loss and ineideace of local and systemic complications were similar for two groups. We think one-stage bilateral cementless total hip replacements can be done in patients who have bilateral hip lesions and have no serious systemic medical problems.