Cam형 대퇴비구 충돌의 관절경적 치료: 단기 추시 결과 = Arthroscopic Treatment of Cam Type Femoroacetabular Impingement: Short Term Results

국문 초록 (Abstract)

목적: 증상이 있는 cam형 대퇴비구 충돌에 대해 관절경으로 치료한 환자들의 단기 추시 결과를 알아보고자 하였다. 대상 및 방법: 2010년 11월부터 2012년 12월까지 고관절 동통을 동반한 cam형 대퇴비구 충돌 중 보존적 치료에 실패하여 관절경 치료 후 최소 12개월 이상 추시 관찰된 환자들에 대해 임상적 및 방사선적 결과를 알아보고자 하였다. 남자는 19명, 여자는 6명, 평균 연령은 32.9세(19-57세), 평균 추시 기간은 17.2개월(13-31개월)이었다. 알파 각, offset, 변형된 Harris 고관절 점수 및 visual analogue scale (VAS)을 조사하였다. 결과: 알파 각은 평균 64.8°에서 39.9°, offset은 평균 0.8 mm에서 7.6 mm로 호전되었다. 비구순 파열은 전상방 구획에서 변연부 종파열 및 방사형 소섬유성 파열이 가장 많았다. 비구 연골 손상은 14예에서 확인되었다. VAS는 술 전 평균 6.3에서 0.9로, 변형된 Harris 고관절 점수는 51.7에서 73.6으로 호전되었다. 수술과 관련된 합병증으로 관절경 삽입 시 발생한 대퇴골 두 연골 손상이 3예, 회음부 신경 손상이 2예, 외측 대퇴피 신경 손상이 2예였다. 결론: 관절경을 이용한 cam형 대퇴 비구충돌의 단기 추시 결과는 만족할 만하였으나, 관절경 술식과 관련된 합병증을 줄이기 위해 좀 더 세심한 주의를 필요로 하며, 관절염 발생을 줄일 수 있는지에 대한 장기적인 연구가 필요하리라 생각된다.

다국어 초록 (Multilingual Abstract)

Purpose: We evaluated the short term results after treatment of cam type femoroacetabular impingement (FAI) by arthroscopy. Materials and Methods: We evaluated the clinical and radiological results of arthroscopic ally treated cam type FAI in patients who had failed conservative treatment with hip pain, with at least 12 months follow-up, from November 2010 to December 2012. There were 19 males and six females. Mean age of patients was 32.9 years (19-57 years) and mean follow up period was 17.2 months (13-31 months). We analyzed the alpha angle, head neck offset, visual analogue scale (VAS), and modified Harris hip score (MHHS). Results: Mean alpha angle improved from 64.8。to 39.9。and mean head neck offset also improved from 0.8 to 7.6 mm. Peripheral longitudinal and radial fibrillated labral tear was the most common in the anterosuperior quadrant. Damage to ace tabular cartilage was identified in 14 patients. Mean VAS improved from 6.3 to 0.9 and mean MHHS improved from 51.7 to 73.6. Complications associated with the operation included three cases of femoral head articular cartilage injury, two cases of pudendal nerve injury, and two cases of lateral femoral cutaneous nerve injury. Conclusion: Although the short term results for arthroscopic ally treated cam type FAI were satisfactory, care must be taken to reduce the complications associated with arthroscopy and long term follow is needed in order to determine whether or not it can reduce osteoarthritis of the hip.

참고문헌 (Reference)

1 Stulberg SD, "Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip" Mosby 212-228, 1975

2 Clohisy JC, "Treatment of anterior femoroacetabular impingement with combined hip arthroscopy and limited anterior decompression" 25 : 164-171, 2005

3 Ganz R, "The etiology of osteoarthritis of the hip: an integrated mechanical concept" 466 : 264-272, 2008

4 Outerbridge RE, "The etiology of chondromalacia patellae" 43-B : 752-757, 1961

5 No¨tzli HP, "The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement" 84 : 556-560, 2002

6 Leunig M, "The concept of femoroacetabular impingement: current status and future perspectives" 467 : 616-622, 2009

7 Lage LA, "The acetabular labral tear: an arthroscopic classification" 12 : 269-272, 1996

8 Ganz R, "Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis" 83 : 1119-1124, 2001

9 Goodman DA, "Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip" 79 : 1489-1497, 1997

10 Byrd JW, "Prospective analysis of hip arthroscopy with 2-year follow-up" 16 : 578-587, 2000

11 Philippon MJ, "Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction:minimum two-year follow-up" 91 : 16-23, 2009

12 Tanzer M, "Osseous abnormalities and early osteoarthritis: the role of hip impingement" (429) : 170-177, 2004

13 Lee YK, "Learning curve of basic hip arthroscopy technique: CUSUM analysis" 21 : 1940-1944, 2013

14 Neumann M, "Impingement-free hip motion : the ‘normal’ angle alpha after osteochondroplasty" 467 : 699-703, 2009

15 Beck M, "Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip" 87 : 1012-1018, 2005

16 Tannast M, "Hip damage occurs at the zone of femoroacetabular impingement" 466 : 273-280, 2008

17 Ganz R, "Femoroacetabular impingement: a cause for osteoarthritis of the hip" (417) : 112-120, 2003

18 Laude F, "Femoroacetabular impingement treatment using arthroscopy and anterior approach" 467 : 747-752, 2009

19 Tannast M, "Femoroacetabular impingement : radiographic diagnosis-what the radiologist should know" 188 : 1540-1552, 2007

20 Crawford JR, "Current concepts in the management of femoroacetabular impingement" 87 : 1459-1462, 2005

21 Guanche CA, "Arthroscopic treatment of femoroacetabular impingement" 22 : 95-106, 2006

22 Byrd JW, "Arthroscopic management of femoroacetabular impingement: minimum 2-year followup" 27 : 1379-1388, 2011

23 Larson CM, "Arthroscopic management of femoroacetabular impingement : early outcomes measures" 24 : 540-546, 2008

24 Byrd JW, "Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement" 467 : 739-746, 2009

25 Beck M, "Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment" (418) : 67-73, 2004

26 Lavigne M, "Anterior femoroacetabular impingement: part I. Techniques of joint preserving surgery" (418) : 61-66, 2004

27 To¨ nnis D, "Acetabular and femoral anteversion: relationship with osteoarthritis of the hip" 81 : 1747-1770, 1999

28 Siebenrock KA, "Abnormal extension of the femoral head epiphysis as a cause of cam impingement" (418) : 54-60, 2004