인공구조물 동종골 복합체를 이용한 주관절 인공관절 재치환술: 환자군 연구 및 수술기법 = Revision Total Elbow Replacement Arthroplasty with an Allograft-Prosthesis Composite: Case Series and Technical Points

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this study was to report the results of revision total elbow replacement arthroplasty (TERA) with an allograft-prosthesis composite (APC). Methods: We retrospectively reviewed 6 patients with an average age of 75 years who had undergone revision TERA with an APC for periprosthetic fracture or loosening of the component. The mean follow-up period was 13 months. We assessed serial radiographs for bone union and evaluated the outcomes in terms of pain visual analogue scale (VAS), the Mayo Elbow Performance Score (MEPS), range of motion, and complications. Results: The APC was used for the humerus in 5 patients and for the ulna in 1 patient. The clinical bone union was achieved at average 9 months after surgery. The mean pain VAS score improved from 6.8 to 1.7, the mean elbow joint range of motion increased from 95° to 129° and the MEPS score improved from 40 to 79 at the last follow-up. There were no major complications such as infection, nonunion, malunion, limitation of motion or refracture. One patient experienced transient radial nerve palsy and another patient a prominent edge of the humeral allobone that needed a trimming surgery later. Conclusion: Revision TERA with an APC provides good functional outcomes and can be recommended as one of the options for failed total elbow arthroplasty.

국문 초록 (Abstract)

목적: 인공구조물 동종골 복합체를 이용한 주관절 인공관절 재치환술에 대한 수술적 치료 결과를 알아보고자 한다.
방법: 주관절의 인공관절 전치환술을 받은 후 발생한 인공관절주위골절, 인공구조물 해리 등으로 인공구조물 동종골 복합체를 이용한 재치환술을 받은 6명의 환자들을 후향적으로 연구하였다. 평균 연령은 75세, 평균 추시 기간은 13개월이었다. 수술 후 단순방사선 검사를 통해 골유합 시기를 확인하였고, 임상적으로는 시각통증척도, MEPS 점수, 관절운동 범위 및 합병증 발생여부를 조사하였다.
결과: 수술 환자들 중 상완골 재건은 5명, 척골 재건은 1명이었다. 평균 골유합 소요 기간은 9개월이었다. 수술 전후 평균 시각 통증 척도는 6.8에서 1.7로 호전을 보였고, 주관절의 평균 능동 운동 범위는 95˚에서 129˚, 그리고 평균 MEPS 점수는 40에서 79로 주관절 기능이 회복되었다. 감염, 부정유합, 불유합, 운동제한 및 재골절을 포함한 합병증은 관찰되지 않았다. 1명 환자에서 수술 후 요골신경 이상을 호소하였고, 다른 1예에서 동종골의 돌출로 인한 압통을 호소하였다.
결론: 인공구조물 동종골 복합체를 이용한 주관절의 인공관절 재치환술은 주관절의 기능회복에 효과적이며 재치환술시 고려해 볼 수 있는 수술법의 하나로 추천한다.

참고문헌 (Reference)

• 1 Zhao Y, "Use of polyvinylpyrrolidone-iodine solution for sterilisation and preservation improves mechanical properties and osteogenesis of allografts" 6 : 38669-, 2016
• 2 Renfree KJ, "Total elbow arthroplasty with massive composite allografts" 13 : 313-321, 2004
• 3 Soyer J, "The effect of 10% povidone: iodine solution on contaminated bone allografts" 50 : 183-187, 2002
• 4 Head WC, "Revision total hip arthroplasty in the deficient femur with a proximal load-bearing prosthesis" (298) : 119-126, 1994
• 5 Ramirez MA, "Revision total elbow arthroplasty" 25 : e166-e174, 2017
• 6 Day JS, "Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015" 19 : 1115-1120, 2010
• 7 Little CP, "Outcomes of total elbow arthroplasty for rheumatoid arthritis: comparative study of three implants" 87 : 2439-2448, 2005
• 8 Geurts EJ, "Outcomes after revision total elbow arthroplasty: a systematic review" 28 : 381-386, 2019
• 9 Gautam D, "Megaprosthesis versus allograft prosthesis composite for massive skeletal defects" 9 : 63-80, 2018
• 10 Rhee YG, "Impaction grafting in revision total elbow arthroplasty due to aseptic loosening and bone loss" 95 : e741-e747, 2013
• 11 Lee DH, "Impaction allograft bone-grafting for revision total elbow arthroplasty: a case report" 81 : 1008-1012, 1999
• 12 Morshed S, "Current options for determining fracture union" 2014 : 708574-, 2014
• 13 Urbaniak JR, "Clinical use of bone allografts in the elbow" 18 : 311-321, 1987
• 14 Urbaniak JR, "Cadaveric elbow allografts: a six-year experience" (197) : 131-140, 1985
• 15 King JJ, "Allograft-prosthetic composite reverse total shoulder arthroplasty for reconstruction of proximal humerus tumor resections" 25 : 45-54, 2016
• 16 Morrey ME, "Allograft-prosthetic composite reconstruction for massive bone loss including catastrophic failure in total elbow arthroplasty" 95 : 1117-1124, 2013
• 17 Amirfeyz R, "Allograft-prosthesis composite reconstruction for the management of failed elbow replacement with massive structural bone loss: a medium-term follow-up" 93 : 1382-1388, 2011
• 18 Mansat P, "Allograft-prosthesis composite for revision of catastrophic failure of total elbow arthroplasty" 86 : 724-735, 2004
• 19 Bicknell RT, "A new technique for management of ulnar bone loss in revision total elbow arthroplasty using a tuberized tricortical iliac crest autograft: a case report" 17 : e15-e18, 2008