후방 십자인대 대치형 Medial Pivot Knee와 NexgenⓇ LPS 슬관절 전치환술의 단기 추시 결과 비교

조성도,염윤석,정지영,전형민,신승명 대한슬관절학회 2010 대한슬관절학회지 Vol.22 No.3

Purpose: We wanted to compare the clinical and radiological results after performing total knee arthroplasty (TKA) with the PCL sacrificing (PS) Medial Pivot Knee (MPK) and the NexgenⓇ LPS. Materials and Methods: Seventy knees in 48 patients after TKA with the PS ADVANCEⓇ MPK (group I) and 67 knees in 45 patients with the NexgenⓇ LPS (group II) were retrospectively evaluated. All the patients were followed up for more than 2 years. The evaluations included the preoperative and postoperative range of motion (ROM), the Knee Society (KS) scores, the tibiofemoral angle and the postoperative complications. Results: For group I, the ROM increased from a mean flexion contracture of 6.3o and further flexion of 116.4o to 1.9o and 120.5o, respectively, and for group II, from 12.6o and 117.6o to 0.9o and 123.0o, respectively. For group I, the KS knee and function scores increased from 46 and 37 to 87 and 83, respectively, and for group II, from 50 and 48 to 87 and 83, respectively. For group I, the tibiofemoral angle changed from varus 4.0o to valgus 5.5o, respectively, and for group II, from varus 4.1o to valgus 5.3o, respectively. The complications were 2 knees (2.8%) with periprosthetic patellar fractures and 1 knee (1.4%) with a tibial component failure in group I, and 1 knee (1.5%) with early femoral component failure and 1 knee with arthrofibrosis (1.5%) in group II. Conclusion: The minimum 2-year follow-up results of PS MPK TKA were comparable to those of NexgenⓇ LPS TKA. However, we think that the MPK system has the advantage of more bony preservation at the femoral intercondylar notch area. 목적: 후방 십자 인대 대치형 (PCL sacrificing, PS) Medial Pivot Knee (MPK)와 NexgenⓇ LPS 슬관절 전치환술의 임상적, 방사선학적 결과를 비교하였다. 대상 및 방법: PS ADVANCEⓇ MPK (1군)와 NexgenⓇ LPS (2군)로 슬관절 전치환술을 시행받고 2년 이상 추시가 가능했던 1군 48명 70예와 2군 45명 67예를 후향적으로 분석하였다. 수술 전후 운동범위, 슬관절 점수와 기능 점수, 대퇴경골간 내외반 변형 및 술 후 합병증에 관해 알아보았다. 결과: 슬관절 운동범위는 제 1군에서 술 전 평균 굴곡구축 6.3o, 후속굴곡 116.4o에서 술후 1.9o, 120.5o로, 제 2군에서 각각 술 전 12.6o, 117.6o에서 술 후 0.9o, 123.0o로 향상되었다. 슬관절 점수와 기능 점수는 제 1군에서 각각 46점, 37점에서 87점, 83점으로, 제 2군에서 각각 50점, 48점에서 87점, 83점으로 호전되었다. 대퇴 경골간 각은 제 1군에서 평균 내반 4.0o에서 외반 5.5o로, 제 2군에서 내반 4.1o에서 외반 5.3o로 개선되었다. 합병증으로 1군에서 슬개 치환물 주변의 슬개골 골절 2예(2.8%)와 경골 치환물의 실패 1예(1.4%)가 있었으며, 2군에서 대퇴골 치환물의 조기 실패 1예(1.5%)와 관절섬유증 1예(1.5%)가 있었다. 결론: PS MPK 슬관절 전치환술의 최소 2년 이상의 추시 결과 NexgenⓇ LPS와 유사한 만족할 만한 결과를 얻을 수 있었으며, 대퇴부의 골을 상대적으로 많이 보존할 수 있는 장점을 갖는 치환물인 것으로 생각된다.

CⓇ SigmaTM RP-F Knee System을 이용한고도 굴곡 회전형 슬관절 전치환술 후 결과 -술 전 슬관절 운동범위 90o 미만 군과 90o 이상 군의 비교-

전철홍,김광미,임재창 대한슬관절학회 2010 대한슬관절학회지 Vol.22 No.4

Purpose: The purpose of this study was to evaluate the clinical and radiological results of using the P.F.CⓇ SigmaTM RP-F Knee System for high flex rotating platform-flexion total knee arthroplasty in 2 groups of patients with a preoperative range of motion (ROM) less than 90 degrees or more than 90 degrees, respectively. Materials and Methods: From January 2005 to November 2006, eighty-two patients received the P.F.CⓇ SigmaTM RP-F Knee System for high flex rotating platform total knee arthroplasty, and they were evaluated for a minimum of 3 years. We subdivided the patients into two groups: the preoperative ROM less than 90o group and the more than 90o group. The clinical results were assessed using the ROM, the Hospital for Special Surgery (HSS) score, the Knee Society Score (KSS) and the Western Ontario and MacMaster Universities Osteoarthritis (WOMAC) score. The radiological results were evaluated using the tibio-femoral angle and the presence of loosening or osteolysis of the components. Results: The ROM increased in the two groups at the last follow-up. The mean ROM range at the last follow up was significantly increased more in the less than 90o group compared to that in the more than 90o group. The HSS score, KSS, and WOMAC score significantly increased in the two groups, but there was no statistical difference between the two groups. The tibio-femoral angle improved in the two groups. There was no aseptic loosening or osteolysis. Conclusion: The postoperative clinical and radiological measures were significantly improved using the P.F.CⓇ SigmaTM RP-F Knee System on the short term follow-up, and especially for the patients whose preoperative ROM was poor. 목적: 퇴행성 슬관절염 환자에서 P.F.CⓇ SigmaTM RP-F Knee System을 이용한 고도 굴곡 회전(rotating platform-flexion)형 슬관절 전치환술 후, 술 전 관절운동범위가 90o 미만인 군과 90o 이상인 군의 임상적, 방사선학적 결과를 비교하고자 한다. 대상 및 방법: 2005년 1월부터 2006년 11월까지 P.F.CⓇ SigmaTM RP-F Knee System을 이용하여 슬관절 전치환술을 시행한 후, 이중 최소 3년 이상 추시가 가능한 82예를 대상으로 술 전 관절 운동 범위가 90o 미만인 34예와 90o 이상인 48예로 구분하여 수술 전과 최종 추시시 관절 운동 범위, Hospital for Special Surgery (HSS) 점수, Knee Society Score (KSS), Western Ontario and MacMaster Universities Osteoarthritis (WOMAC) 점수를 이용한 임상적 평가와 대퇴경골각, 치환물의 해리 및 방사선 투과선 등의 방사선적 평가를 비교 분석하였다. 결과: 술 후 최종 추시상 술 전 관절 운동 범위가 90o 미만인 군과 90o 이상인 군에서 관절 운동 범위는 두 군 모두에서 증가되었으며, 90o 미만인 군에서 운동 범위의 증가폭이 통계학적으로 유의하게 증가되었다(p=0.038). 또한 각각의 HSS 점수, KSS 점수, WOMAC 점수는 두 군에서 모두 유의하게 증가되었으나, 두 군간의 비교에서는 통계학적 의미는 없었다. 방사선 검사상 대퇴경골각은 두 군에서 모두 술 전에 비해 술 후 평균 외반 4.8o로 교정되었으며, 치환물의 조기 해리나 방사선 투과선 등은 발견되지 않았다. 결론: P.F.CⓇ SigmaTM RP-F Knee System을 이용한 슬관절 전치환술은 고도 굴곡을 원하는 환자에게 좋은 수술 방법으로 생각되며, 특히 술 전 운동 범위가 불량한 환자에서 유용하게 사용될 수 있는 것으로 생각된다.

10^o 이상의 술 전 경골 후방경사각을 가진 후방십자인대 대치형 슬관절 전치환술

김종헌,김순명 대한슬관절학회 2011 대한슬관절학회지 Vol.23 No.1

Purpose: We wanted to evaluate the effects of a preoperative posterior tibial slope of more than 10^o on the extension gap and patellar height during posterior substituted total knee arthroplasty. Materials and Methods: One hundred ten posterior substituted total knee arthroplasties were divided into group I (more than 10^o of preoperative posterior tibial slope, n=56) and group II (less than 10^o of slope, n=54). Each group was evaluated to compare the frequency of additional distal femoral resections due to an insufficient extension gap and the correlation with the decrease of the patellar bone height. Results: In each group, the preoperative tibial slope was 12.77^o (±3.22^o) vs. 6.72^o (±2.58^o), respectively (p=0.000) and the decrease of the posterior slope was 10.74^o (±3.54^o) vs. 4.78^o (±2.66^o), respectively, (p=0.000). The frequencies of additional distal femoral resection were 54.5% vs. 46.1%, respectively, (p=0.448) with flexion contracture and 11.8% vs. 34.1%, respectively, (p=0.022) without flexion contracture. The decrease of the patellar bone height was 0.35 (±4.79) mm vs. 1.99 (±4.78) mm, respectively, (p=0.075). There was weak correlation between the decrease of the patellar bone height and the decrease of the posterior tibial slope (r=−0.253, p=0.016). Conclusion: In the group having more than 10^o of preoperative posterior tibial slope without flexion contracture, the decrease of the posterior tibial slope had to be considered as one of the factors that affected making the extension gap significantly greater during the gap technique and to preserve the patellar bone height. 목적: 10^o 이상의 술 전 경골 후방경사각을 가진 환자의 후방십자인대 대치형 슬관절 전치환술에서 경골 후방경사각이 신전 간격 및 슬개골의 높이 변화에 미치는 영향을 알아보고자 하였다. 대상 및 방법: 후방십자인대 대치형 슬관절 전치환술 110예를 대상으로, 술 전 경골 후방경사각이 10^o 이상인 group I; 56예와 10^o 미만인 group II; 54예로 분류하여 수술중 상대적인 신전 간격의 부족에 따른 원위 대퇴골 추가 절제의 시행빈도와 슬개골 높이 감소를 비교 분석하였다. 결과: Group I, II에서의 술 전 경골 후방경사각은 평균 12.77^o (±3.22^o)와 6.72^o (±2.58^o)(p=0.000), 경골 후방경사각 감소는 10.74^o (±3.54^o)와 4.78^o (±2.66^o)(p=0.000)이었다. 굴곡 구축이 있는 경우 수술 중 원위 대퇴골 추가 절제 빈도는 54.5%와 46.1% (p=0.448)이었으나, 굴곡 구축이 없는 경우는 11.8% (4예)와 34.1% (14예)(p=0.022)이었다. 슬개골 높이 감소는 0.35 (±4.79) mm와 1.99 (±4.78) mm (p=0.075)의 차이를 보였다. 경골 후방경사각 감소와 슬개골 높이 감소는 약한 상관관계가 있었다(r=−0.253, p=0.016). 결론: 후방십자인대 대치형 슬관절 전치환술시 10^o 이상의 경골 후방경사각을 가진 환자에서 술 후 경골 후방경사각의 감소는 굴곡 구축이 없는 경우, 10^o 미만의 경골 후방경사각을 가진 환자에 비교하여 상대적인 신전간격의 증가를 초래하여, 수술 중 굴곡 및 신전 간격을 일치시키는 과정에 고려되어야 할 요소이며, 또한 수술 전후의 슬개골의 높이 유지에 영향을 주는 요소로 생각되었다.

슬관절 전치환술시 슬개골 비치환과 슬개골 치환의 비교

김윤종 ( Yoon Jong Kim ),민학진 ( Hak Jin Min ),윤의성 ( Eui Seong Yoon ),서재성 ( Jae Seong Suh ),김희선 ( Hee Seon Kim ),허정민 ( Jeong Min Heo ) 대한슬관절학회 2004 Knee Surgery and Related Research Vol.16 No.1

한국 성인여성 슬관절 주변골의 신체계측학적 특성

문정석 ( Jeong Seok Moon ),유건식 ( Kun Sik Yu ),하철원 ( Chul Won Ha ) 대한슬관절학회 2006 Knee Surgery and Related Research Vol.18 No.2

Purpose: This study is to establish a detailed anthropometric data of Korean female knee and to compare the data with current total knee prostheses. Materials and Methods: 476 consecutive osteoarthritic knees were measured intraoperatively about anteroposterior(AP) dimension of medial and lateral condyle, and mediolateral (ML) dimension of distal femur as well as proximal tibia. Dimensions of 5 total knee arthroplasty (TKA) systems were compared with these measurements. Results: The AP dimension of medial and lateral condyle, and ML dimension of distal femur were 60.3±3.5 mm, 60.9±3.2 mm and 68.4±3.9 mm, respectively. Those of proximal tibia were 47.4±2.8 mm, 39.5±3.1 mm and 67.4±2.9mm, respectively. Korean femurs below -1 standard deviation (SD) in lateral AP dimension had narrower ML dimension than femoral prostheses. And most femurs above -1 SD in lateral AP dimension had wider ML dimension than femoral prostheses. Korean tibias had wider ML dimension than tibial prostheses. Conclusion: Current total knee prostheses had tendency to ML overhang in small femurs and ML undercoverage in other femurs, and tendency to ML undercoverage or posterolateral overhang in tibias. Thus, Korean anthropometric data should be considered in Korean-friendly prostheses.

내측 광근 절개 접근법과 내측 슬개골 주위 절개 접근법을 이용한 전 슬관절 치환 성형술 결과의 비교

강승백 ( Seung Baik Kang ),윤강섭 ( Kang Sup Yoon ),이지호 ( Ii Ho Lee ),이동호 ( Dong Ho Lee ),조현철 ( Hyun Chul Jo ) 대한슬관절학회 2004 Knee Surgery and Related Research Vol.16 No.1

슬관절 삼출을 알기 위해 이용되는 부구 검사에 대한 정량적 분석

윤정로 ( Jung Ro Yoon ),김택선 ( Taik Seon Kim ),한승범 ( Seung Beom Han ),김학준 ( Hak Jun Kim ),서동훈 ( Dong Hoon Seo ),윤재은 ( Jae Eun Yoon ) 대한슬관절학회 2006 Knee Surgery and Related Research Vol.18 No.1

Purpose: The purpose of this study was to detect the amount of the saline which was injected into a knee joint and made the patella ballottable. Materials and Methods: From January 2002 to June 2003, into 37 knees, saline was instilled through a needle inserted at 2 cm distant form superolateral aspect of the patella. The patellar ballottement was examined after every 1 cc injection of the saline. We checked the amount of the injected saline when the ballottement of the patella was developed and when ballottement was disappeared by milking fluid distally from suprapatellar pouth.my. Results: The patella tap test was positive when the amount of instilled saline was between 14 cc and 45 cc, and the pattern of distribution was biphasic. A patella tap disappeared if more than 39~110 cc of fluid was injected, which showed triphasic pattern of the distribution. Conclusion: The amount of knee effusion between 14~110 cc got the patella ballottable. And the pattern of distribution was variable. Therefore we need more numbers of data to analyze the differences.

퇴행성 슬관절염에서 전방 슬관절 동통

조우신 ( Woo Shin Cho ),이기원 ( Ki Won Lee ),김민영 ( Min Young Kim ),이수원 ( Su Won Lee ) 대한슬관절학회 2006 Knee Surgery and Related Research Vol.18 No.1

Purpose: The purpose of this study were to evaluate the relationship between anterior knee pain and changes of patellofemoral joint in osteoarthritic knee. Materials and Methods: We analyzed 200 patients who had undergone total knee arthroplasty and divided them into two groups ; the group 1(100 cases) with anterior knee pain and the group 2(100 cases) without it. We prospectively measured congruence angle and patellar height, and compared radiologic degenerative changes and operative findings(Outerbridge classification) of patella. Results: The average congruence angle of patella was 11.2±1.6˚ in the group 1 and 2.8±1.3˚ in the group 2(p<0.05). Patellar height had no significant difference between two groups(p=0.62). For radiologic patellofemoral(PF) degenerative change, the group 1 showed mild degenerative change in 16, moderate change in 47 and severe change in 37 in plain radiographs. The group 2 showed mild degenerative change in 53 and moderate change in 47 in plain radiographs(p<0.05). For cartilage degenerative change in patella(Outerbridge classification), whereas grade 3 & 4 were dominant in the group 1 with 71 cases, grade 1 & 2 were representative in the group 2 with 91 cases(p<0.05). Conclusion: Anterior knee pain seemed to be related with congruence angle and degenerative changes in radiologic and operative findings.

슬관절 재치환술 추시 결과

최충혁 ( Choong Hyeok Choi ),강석근 ( Suk Keun Kang ),이봉근 ( Bong Keun Lee ),정현기 ( Hyun Kee Chung ) 대한슬관절학회 2004 Knee Surgery and Related Research Vol.16 No.1

제19차 대한슬관절학회 정기학술대회 : 4 . Mobile bearing joint 를 이용한 슬관절 전치환술

조우신,정용갑,신재명 대한슬관절학회 2001 정기학술대회 초록집 Vol.2001 No.-

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