슬관절 골관절염에서 개방형 경골 근위부 절골술과 관절경적 수술 후 결과

국문 초록 (Abstract)

목적: 슬관절 내측 대퇴 경골 구획 퇴행성 관절염 환자에서 개방형 경골 근위부 절골술 및 관절경 치료 후 2년 이상 추시한 환자에서 후향적으로 임상결과 및 방사선학적 분석을 하였다.
대상 및 방법: 1999년 1월부터 2002년 5월까지 개방형 경골 근위부 절골술 및 관절경술을 시행받은 29명 30예를 대상으로 하였다. 평균 추시 기간은 3년 9개월(2년 1개월-5년 4개월)이었고, 평균연령은 44.7 (20-56)세였다. 개방성 절골 간격이 1 ㎝ 이상 4예에서는 Puddu 금속판 고정과 tricortical 자가골 이식술을 시행하였고, 1㎝ 이하 26예에서는 Puddu 금속판을 이용한 고정술만 시행하였다. 임상적 평가는 HSS 슬관절 점수를 사용하였으며, 방사선적 분석은 체중 부하 시 촬영한 전후면 방사선 사진에서 대퇴 경골각 및 후 경골각을 측정하였다.
결과: HSS 슬관절 점수상 수술 전 평균 64.7 (52.0-69.5)점에서 최종추시 시 82.4 (78-90)점이었다. 방사선 소견상 모든 예에서 골유합은 이루어졌으며, 수술 전 체중부하 전후면 방사선 사진상 평균 6.3 (3.5-8.0)도 내반각에서 수술 직후 평균 8.2 (5-10)도 외반각으로, 최종 추시상 외반각은 평균 7.3 (4.5-9.0)도로 교정되었다. 후경골각의 변화는 수술 전 평균 6.6 (5.0-7.3)도에서 추시상 평균 7.0 (5.0-8.5)도로 유의한 차이는 없었다(p=0.075). 방사선 소견 및 2차 관절경 소견상 더 이상의 진행변화 소견은 없었다.
결론: 개방형 경골 근위부 절골술과 함께 관절경을 이용한 슬관절내 병변을 치료하여, 향상된 슬관절 기능을 얻을 수 있었다.

다국어 초록 (Multilingual Abstract)

Purpose : To evaluate the clinical and radiographic outcomes of high tibial open wedge osteotomy combined with arthroscopic surgery in patients with medial unicompartmental osteoarthritis.
Materials and Methods : Between January 1999 and May 2002, 29 patients with 30 cases were treated with high tibial open wedge osteotomy combined with arthroscopic surgery for the treatment of osteoarthritis. The mean age of the study group was 44.7 years old (range, 20 to 56 years old). 4 cases with more than 1 cm openings were treated by autologous bone grafts, and another 26 cases were treated by Puddu plates alone after osteotomy. The clinical assessment was performed using the Hospital for Special Surgery (HSS) knee rating system. The radiologic analysis was performed by measurement of the femorotibial angle and posterior inclination of the tibial articular surface.
Results : The mean knee rating score by the HSS knee rating system improved from 64.7 points (range, 52.0 to 69.5 points) to 82.4 points (range, 78 to 90) at the last follow-up. Radiologic bone union was accomplished in all cases. Preoperative varus angles of 6.3° (range, 3.5 to 8.0 degrees) and posterior inclinations of 6.6° (range, 5.0 to 7.3 degrees) improved, on average, to postoperative valgus angles of 8.2° (range, 5 to 10 degrees) and posterior inclinations of 7° (range, 5.0 to 8.5 degrees). At the last follow-up valgus angles had improved, on average, to 7.3° (range, 4.5 to 9.0 degrees).
Conclusion : High tibial open wedge osteotomy combined with arthroscopic surgery significantly improved knee joint function.

목차 (Table of Contents)

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

참고문헌 (Reference)

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