무시멘트형 인공고관절 전치환술에서 내반 삽입된 대퇴 스템의 임상적 결과

국문 초록 (Abstract)

목적: 무시멘트 근위부 고정형 인공고관절전치환술 후 내반 고정된 스템이 치료결과에 미치는 영향을 평가하고자 하였다.
대상 및 방법: 무시멘트 근위부 고정형 인공고관절전치환술을 시행한 136명의 환자 144예 중 내반 고정된 21예를 대상으로 나머지 중립위로 고정된 123예와 임상적 및 방사선학적으로 비교 분석하였다. 임상적 평가는 대퇴부동통 및 Harris Hip Score에 의거하였으며, 방사선학적으로는 Gruen 구역에 따른 방사선 음영감소, pedestal formation, 대퇴골 비후 및 위축, 골내측 신생골 형성, 침강 등의 해리 및 골 용해 소견과 스템 골절 여부를 관찰하였다.
결과: 내반 고정된 경우 대퇴부동통 1예, Harris Hip Score 평균 96점이었으며 중립 고정된 경우 대퇴부 동통은 6예, Harris Hip Score 평균 97점이었다. 방사선학적으로 내반 고정된 경우 대퇴 스템의 해리나 스템 골절의 소견 없었으며, 국소적 골용해소견 1예, 대퇴골 골막비후 1예, 비진행성방사선음영감소 2예 관찰되었다. 중립위의 경우 대퇴 스템의 해리 나 스템 골절의 소견 없었고, 국소적 골용해소견 8예, 대퇴골 골막비후 9예, 비진행성 방사선음영감소 7예 관찰되었다.
결론: 무시멘트 근위부 고정형 인공고관절전치환술에서 내반 고정된 대퇴스템의 경우 중립위와 비교하여 임상적으로나 방사선학적으로 치료 결과에 차이가 없었다.

다국어 초록 (Multilingual Abstract)

Purpose: This study examined the effect of a varus positioned femoral stem after cementless proximal fitting total hip arthroplasty.
Materials and Methods: A total of 144 hips in 136 patients who underwent cementless total hip arthroplasty, were followed-up. Twenty-one varus positioned hips were compared with 123 neutral positioned hips. The clinical results were analyzed according to the level of thigh pain and the Harris Hip score. The radiological outcome was assessed according to osteolysis, loosening and stem failure.
Results: In the varus positioned hips, thigh pain was present in 1 hip, and the average Harris Hip Score was 96 points. None of the implants showed radiological evidence of loosening or impending failure. Localized osteolysis was identified in 1 hip, non-progressive radiolucencies in 2 hips, and cortical hypertrophy in 1 hip. In the neutral positioned hips, thigh pain was present in 6 hips, and the average Harris Hip Score was 97 points. Localized osteolysis was identified in 8 hips, non-progressive radiolucencies in 7 hips, cortical hypertrophy in 9 hips.
Conclusion: Patients with varus alignment of the stem did not present poorer clinical outcomes than those with neutral alignment of the stem.

목차 (Table of Contents)

• 서론
• 대상 및 방법
• 결과
• 고찰
• 결론
• 참고문헌
• 국문초록

참고문헌 (Reference)

1 "its effect on strain in bone-cement. J Arthroplasty" 23-26, 1993.

2 "Unceme-neted total hip arthroplasty. Prospective analysis of the tri-lock femoral component. Clin Orthop Relat Res" Smith SE 43-50, 1991.

3 "The prevalence of femoral 무시멘트형 인공고관절 전치환술에서 내반 삽입된 대퇴 스템의 임상적 결과 591osteolysis associated with components inserted with or without cement in total hip replacement. A retrospective matched-pair series. J Bone Joint Surg Am" 1121-1129, 1994.

4 "The offset problem in total hip arthroplasty. Contemp Orthop" 556-562, 1992.

5 "The femoral component in low friction arthroplasty after ten years. Clin Orthop Relat Res" 163-175, 1992.

6 "The effect of varying femoral offset on com-ponent fixation in cemented total hip arthroplasty. 63rd Annual Meeting Proceedings. Rosemont American Aca-demy of Orthopaedic Surgeons" 1993.

7 "The effect of femoral component offset in uncemented total hip arthroplasty. Procs Canadian Orthopaedic Society 48th Annual Meeting" 1993.

8 "The anatomic basis of femoral component design. Clin Orthop Relat Res" 148-165, 1988.

9 "The Richards Series 2 total hip prosthesis: a 13-year study and radiographic evalua-tion" 21 : 277-282, 1998

10 "The Harris-Galante uncemented femoral componet in primary total hip replacement at 10 years" 14 : 915-917, 1999

11 "Soft tissue balancing: the hip" 17 : 17-22, 2002

12 "Results of tapered cementless femoral stem implanted in varus" 17 : 463-466, 2002

13 "Radiologic assessment of cementless femoral components. Correation with intraoperative mechanical stability. J Arthroplasty" 137-141, 1994.

14 "Predisposing factors in fixation failure of femoral prosthesis following primary Charnley low friction arthroplasty. A 10- to 20-years folowup study. Clin Orthop Relat Res" 73-83, 1994.

15 "Mode of failure a radiographic analysis of loosening. Clin Orthop Relat Res" 17-27, 1979.

16 "Mini-mum 10-year results of a tapered cementless hip replacement" 362 : 138-144, 1999

17 "Measurement of polyethylene wear in acetabular component inserted with and without cement: a randomized trial" 79 : 682-689, 1997

18 "Long term results of use of the anatomic medulary locking prosthetic in total hip arthroplasty" 79 : 177-184, 1997

19 "Lateral insufficiency fractures of the femur caused by osteopenia and varus angul-ation: a complication of total hip arthroplasty" 14 : 982-987, 1999

20 "Its effect on micromotion in stance and stair climbing loading. Orthop Trans" 394-395, 1989.

21 "Incidence of thigh pain after uncemented total hip arthroplasty as a funtion of femoral stem size" 11 : 304-311, 1996

22 "Femoral component offset: Its effect on micromotion strain in the cement, bone, and prosthesis" 1989.

23 "Femoral component loosening after total hip arthroplasty. Clin Orthop Relat Res" 66-70, 1979.

24 "Failure of the femoral componet in the howse total hip arthroplasty. Clin Orthop Relat Res" 142-147, 1984.

25 "Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty" 77 : 865-869, 1995

26 "Effect of femoral component offset on polyethylene wear in total hip arthroplasty" 38 : 125-134, 2001

27 "Clinical and radiographic outcome of a cementless, titanium, plasma spray-coated total hip arthroplasty femoral component. Justification for conti-nuance of use." 11 : 653-660, 1996

28 "Biomechanics in low frictional arthroplasty of hip. New York" Springer-Verlag 1979.

29 "Assessment of polyethylene wear in total hip replacement" 369 : 59-72, 1999

30 "Apparent changes in the alignment of the femoral component in hip arthroplasties asociated with limb positioning. Clin Orthop Relat Res" 242-245, 1987.

31 "A collarles cobalt-chrome femoral component in uncemented total hip arthroplasty. Five-to eight-year folow-up. J Bone Joint Surg Br" 814-821, 1992.