재발성 인공고관절 탈구 및 탈구의 고 위험인자를 가진 환자에서 constrained 비구컵을 이용한 인공고관절 전치환술-단기추시보고- = Total hip arthroplasty with Constrained cup performed on recurrent dislocation and the patients with high risk factor for dislocation

다국어 초록 (Multilingual Abstract)

Purpose: When the dislocation after total hip arthroplasty occurs, ⅓ of patients need surgical treatment, but the overall success rate of surgical procedures is less than 60%. So, we performed total hip arthroplasty with constrained cup on recurrent dislocations and the patients with high risk factors for dislocation and evaluate the worthy of constrained cup as a treatment and preventive method for the dislocation.
Materials and Methods: From March, 1999 to March, 2002 we performed total hip arthroplasty with constrained cup on 18 patients, 18 hip with recurrent dislocation or with high risk factors for dislocation. There were 8 males and 10 females and recurrent dislocation were 8 hips, the patients with high risk factors for dislocation were 10. The
average age of patients was 75.2 years (68~91 years old) and the mean follow up period was 20 months (16 month to 60 months). We assessed the dislocation and the radiologic failure among the patients.
Results: There were only one case of dislocation and one case of loosening need revision surgery in 18 patients, 18 hips. There was no dislocation or failure in recurrent dislocation group but the dislocation occurred in old patient with dementia and severely comminuted intertrochanteric fracture undergone constrained cup arthroplasty at postoperative 7 days. And the patient undergone constrained cup arthroplasty due to the multidirectional instability developed during original revision surgery needed the revisional arthroplasty because of loosening of acetabular componentat at 5 months after constrained cup arthroplasty.
Conclusion: Despite short term follow up, total hip arthroplasty with constrained acetabular component performed on recurrent dislocation and the patients with high risk factors for dislocation is a good treatment and preventive method for dislocation after hip arthroplasty.

국문 초록 (Abstract)

목적: 인공 고관절의 탈구가 발생할 경우 환자의 ⅓에서 수술적 치료가 필요하나 다양한 수술적 치료방법의 성공률은 60% 정도에 그치고 있다. 이에 저자들은 재발성 탈구 및 탈구의 고 위험인자를 가진 환자들에 대하여 constrained 비구컵을 이용하여 인공 고관절 전치환술을 시행하고, constrained 비구컵의 탈구에 대한 치료법 그리고 예방책으로서의 가치를 알아보고자 한다.
대상 및 방법: 1999년 3월부터 2002년 3월까지 재발성 인공 고관절 탈구 및 탈구의 고위험인자를 가진 환자 18명, 18 고관절에 대하여 constrained 비구컵을 이용하여 고관절 전치환술을 시행하였다. 이들을 대상으로 탈구의 발생 여부와 방사선학적 실패 여부를 조사하였다. 환자들은 남자가 6명, 여자가 12명이었고 재발성 인공 고관절 탈구가 8명, 탈구의 고위험인자를 가진 환자가 10명이었으며 평균 연령은 75.2세(68~91세)였다. 추시 기간은 최소 16개월에서 최장 60개월로 평균 추시 기간은 20개월 이었다.
결과: 18명, 18례의 constrained 비구컵을 이용한 인공 고관절 중 1례의 탈구와 1례의 비구컵 실패로 인한 재치환술이 있었다. 재발성 탈구 8례 중에서는 탈구나 기구의 실패는 없었으나 고령의 치매를 가진 환자의 전자간부 분쇄골절에 대하여 실시한 전치환술에서 술후 1주에 탈구가 발생하였으며, 재치환술 과정에서 다방향 불안정성이 발생하여 constrained 비구컵을 이용한 환자에서 술후 5개월에 비구컵의 실패로 재치환술을 시행하였다.
결론: 인공 고관절의 재발성 탈구와 탈구의 고 위험인자를 가진 환자에서 실시한 constrained 비구컵을 이용한 전치환술은 단기 추시 이기는 하나, 비교적 만족할만한 결과를 보여 재발성 탈구의 치료법으로서, 또한 탈구의 고 위험인자를가진 환자에서 탈구의 예방책으로서 만족스러운 가치를 가진다고 사료된다.

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