Pub Date : 2010-06-01DOI: 10.5371/JKHS.2010.22.2.97
K. Moon, D. Kwon, J. Jung
술 전 검사의 목적은 치환 실패의 기전을 알아보고, 치 환실패에 따른 골 손실의 정도를 알아보며, 수술적 재건술 이 필요한자를 알아 보는 데 있다. 재치환술의 절대적 적응증은 장애의 원인이 되는 진행 성의 동통 (progressive disabling pain) 및 기능의 제한, 대퇴 주대 골절(stem fracture), 조립형 삽입물의 해리 (dissociation of modular components), 폴리에틸렌 골 절과 같은 기계적 삽입물 실패, 패혈증과 진행성 골 용해 등이 있다. 그러나 가끔 고관절 탈구가 발생하는 경우, 대 퇴 주대 혹은 비구부에 혹은 양쪽 모두에 해리 소견이 보 이나 증상이 거의 없는 경우, 골 소실이 극미한 경우 재치 환술이 필요한지 의문점이 발생하게 된다. 이러한 의문점 을 해소하기 위하여 다음과 같은 술 전 평가가 필요하다
术前检查的目的是了解置换失败的作用、治疗失败导致的骨损失程度、了解需要进行手术重建手术的人。再置换手术的绝对适应症包括，导致障碍的进展性疼痛(progressive disabling pain)及功能限制、大腿骨折(stem fracture)、组装型插入物的解离(dissociation of modular components)、机械插入物如聚乙烯骨节的失败、败血症和进行性骨溶解等。但是偶尔会发生骨关节脱臼，大腿骨或比丘，或双方都诊断出解离或几乎没有症状，或骨消失极微小时，会产生是否需要再手术的疑问。为了消除这些疑点，有必要进行以下术前评价
{"title":"Revision of the Femoral Stem","authors":"K. Moon, D. Kwon, J. Jung","doi":"10.5371/JKHS.2010.22.2.97","DOIUrl":"https://doi.org/10.5371/JKHS.2010.22.2.97","url":null,"abstract":"술 전 검사의 목적은 치환 실패의 기전을 알아보고, 치 환실패에 따른 골 손실의 정도를 알아보며, 수술적 재건술 이 필요한자를 알아 보는 데 있다. 재치환술의 절대적 적응증은 장애의 원인이 되는 진행 성의 동통 (progressive disabling pain) 및 기능의 제한, 대퇴 주대 골절(stem fracture), 조립형 삽입물의 해리 (dissociation of modular components), 폴리에틸렌 골 절과 같은 기계적 삽입물 실패, 패혈증과 진행성 골 용해 등이 있다. 그러나 가끔 고관절 탈구가 발생하는 경우, 대 퇴 주대 혹은 비구부에 혹은 양쪽 모두에 해리 소견이 보 이나 증상이 거의 없는 경우, 골 소실이 극미한 경우 재치 환술이 필요한지 의문점이 발생하게 된다. 이러한 의문점 을 해소하기 위하여 다음과 같은 술 전 평가가 필요하다","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130577574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01DOI: 10.5371/JKHS.2010.22.2.104
H. Ko, Woo-Han Bae
Deep infection after total hip arthroplasty is one of the most serious post operative complications. Treatment of infection of the hip joint can be made very difficult by poor response to antibiotic therapy. Infection rates of total hip arthroplasty have decreased due to prophylactic antibiotics, sterilization of surgical instruments, cleaner operation environments, Improvement of surgical methods and proper patient selection. Recently, post operative infection rates of primary or revision arthroplasties were reported to still be as high as 1% to 2%. Therefore, the aim of this article is to review the recent literature and to evaluate the cause, environment diagnosis and treatment of infection after total hip arthroplasty.
{"title":"Treatment of Infected Total Hip Arthroplasty","authors":"H. Ko, Woo-Han Bae","doi":"10.5371/JKHS.2010.22.2.104","DOIUrl":"https://doi.org/10.5371/JKHS.2010.22.2.104","url":null,"abstract":"Deep infection after total hip arthroplasty is one of the most serious post operative complications. Treatment of infection of the hip joint can be made very difficult by poor response to antibiotic therapy. Infection rates of total hip arthroplasty have decreased due to prophylactic antibiotics, sterilization of surgical instruments, cleaner operation environments, Improvement of surgical methods and proper patient selection. Recently, post operative infection rates of primary or revision arthroplasties were reported to still be as high as 1% to 2%. Therefore, the aim of this article is to review the recent literature and to evaluate the cause, environment diagnosis and treatment of infection after total hip arthroplasty.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116780683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.5371/JKHS.2010.22.1.1
Jong-Oh Kim, Tae Ho Kim
Femur intertrochanteric and subtrochanteric fractures are extracapsular hip fractures and they show a bimodal age distribution. Most hip fractures in young patient are subtrochanteric or basicervical fractures that are caused by high energy injury. Most of the hip fractures in old patients are intertrochanteric fractures related to osteoporosis and low energy injury. For proximal hip fractures, the muscles around the hip joint make reduction difficult and the position of the lag screws affects healing of the fracture. To lower the complications of these fractures, surgeons can use an appropriate implant along with performing good reduction and good lag screw positioning. We report here on our review of femur intertrochanteric and subtrochanteric fractures, the characteristics of compression hip screws, the intramedullary devices and the technical pitfalls.
{"title":"Surgical Treatment of Femur Intertrochanteric and Subtrochanteric Fracture","authors":"Jong-Oh Kim, Tae Ho Kim","doi":"10.5371/JKHS.2010.22.1.1","DOIUrl":"https://doi.org/10.5371/JKHS.2010.22.1.1","url":null,"abstract":"Femur intertrochanteric and subtrochanteric fractures are extracapsular hip fractures and they show a bimodal age distribution. Most hip fractures in young patient are subtrochanteric or basicervical fractures that are caused by high energy injury. Most of the hip fractures in old patients are intertrochanteric fractures related to osteoporosis and low energy injury. For proximal hip fractures, the muscles around the hip joint make reduction difficult and the position of the lag screws affects healing of the fracture. To lower the complications of these fractures, surgeons can use an appropriate implant along with performing good reduction and good lag screw positioning. We report here on our review of femur intertrochanteric and subtrochanteric fractures, the characteristics of compression hip screws, the intramedullary devices and the technical pitfalls.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126780063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.5371/JKHS.2010.22.1.79
S. Choo, H. Oh, J. Choi
Purpose: This study compared sliding between (a) lag screws of PFN (Proximal Femoral Nail, AO synthes) and (b) the helical blade of PFNA (Proximal Femoral Nail Antirotation, AO synthes) for femoral intertrochanteric fractures. Materials and Methods: We include in our study thirty seven cases who were classified as AO/OTA type A1 femoral intertrochanteric fractures and who underwent hip operations between October 2006 and December 2008. There were 19 patients in the PFN group and 18 in the PFNA group. Degrees of sliding were also measured with postoperative radiology on last follow up compared with immediate postoperative radiology. Both groups were also compared with regard too walking ability using the method of Koval. Results: Average sliding was 5.0±2.3 mm for lag screws of the PFN group and 2.8±1.3 mm for the helical blade of the PFNA group. The difference was statistically significant (p=0.04). Ambulatory abilities were not statistically different (p=0.33). Conclusion: Patients in the PFNA group have less sliding of the implant, but their walking abilities are similar to patients in the PFN group.
目的:本研究比较了(a) PFN(股骨近端钉，AO合成物)拉力螺钉与(b) PFNA(股骨近端钉反旋转，AO合成物)螺旋刀片治疗股骨粗隆间骨折的滑动情况。材料和方法:我们纳入了37例在2006年10月至2008年12月间接受髋关节手术的AO/OTA型A1股骨粗隆间骨折患者。PFN组19例，PFNA组18例。与术后立即放射学相比，最后一次随访时还测量了术后放射学的滑动程度。采用Koval法比较两组患者的步行能力。结果:PFN组拉力螺钉的平均滑动量为5.0±2.3 mm, PFNA组螺旋刀片的平均滑动量为2.8±1.3 mm。差异有统计学意义(p=0.04)。行走能力差异无统计学意义(p=0.33)。结论:PFNA组患者种植体滑动较少，但行走能力与PFN组相似。
{"title":"PFNA and PFN in Intertrochanteric Fractures - Comparison Study of Sliding -","authors":"S. Choo, H. Oh, J. Choi","doi":"10.5371/JKHS.2010.22.1.79","DOIUrl":"https://doi.org/10.5371/JKHS.2010.22.1.79","url":null,"abstract":"Purpose: This study compared sliding between (a) lag screws of PFN (Proximal Femoral Nail, AO synthes) and (b) the helical blade of PFNA (Proximal Femoral Nail Antirotation, AO synthes) for femoral intertrochanteric fractures. Materials and Methods: We include in our study thirty seven cases who were classified as AO/OTA type A1 femoral intertrochanteric fractures and who underwent hip operations between October 2006 and December 2008. There were 19 patients in the PFN group and 18 in the PFNA group. Degrees of sliding were also measured with postoperative radiology on last follow up compared with immediate postoperative radiology. Both groups were also compared with regard too walking ability using the method of Koval. Results: Average sliding was 5.0±2.3 mm for lag screws of the PFN group and 2.8±1.3 mm for the helical blade of the PFNA group. The difference was statistically significant (p=0.04). Ambulatory abilities were not statistically different (p=0.33). Conclusion: Patients in the PFNA group have less sliding of the implant, but their walking abilities are similar to patients in the PFN group.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116249810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.5371/JKHS.2010.22.1.66
Y. Sung, Jong-Seok Oh
Purpose: When the femoral stem was well fixed in patients with a deep prosthetic hip infection, the authors performed a two-stage revision procedure using antibiotic-loaded cement spacers (ALCS) without removal of the stem, and the efficacy of this treatment was assessed. Materials and Methods: For 12 cases of infected hip arthroplasties, a two-stage procedure was performed, and the patients were followed up for over 2 years. After the acetabular component and head was removed, debridement was done. The molded ALCS was inserted. Revision was then performed after eradication of the infection. The results were analyzed, including the changes in the clinical manifestation, the radiologic findings, the laboratory results, the functional score and the complications. Results: Of all 12 cases, the two-stage revision arthroplasty using an ALCS with retention of the stem was performed in 11 cases (92%), on an average of 66 days (range: 40~152 days). In the 11 revised cases, there was no evidence of recurrence of infection. In the 11 cases, the mean Harris hip score improved from 40.1 points preoperatively to 91.8 points at last the follow-up. The mean WOMAC score improved from 41.8 points preoperatively to 81 points at the last follow-up. The mean Harris hip score was 85.3 points and the WOMAC score was 72.4 points during the ALCS insertion- period. Conclusion: For the case of a perioprosthetic hip infection with a well-fixed femoral stem, two-staged revision using an ALCS without stem removal could be an alternative method in terms of effective infection control and preservation of the joint function.
{"title":"Staged Revision of Infected Hip Arthroplasty Using an Antibiotics-Loaded Intra-Articular Cement Spacer with Retention of the Stem","authors":"Y. Sung, Jong-Seok Oh","doi":"10.5371/JKHS.2010.22.1.66","DOIUrl":"https://doi.org/10.5371/JKHS.2010.22.1.66","url":null,"abstract":"Purpose: When the femoral stem was well fixed in patients with a deep prosthetic hip infection, the authors performed a two-stage revision procedure using antibiotic-loaded cement spacers (ALCS) without removal of the stem, and the efficacy of this treatment was assessed. Materials and Methods: For 12 cases of infected hip arthroplasties, a two-stage procedure was performed, and the patients were followed up for over 2 years. After the acetabular component and head was removed, debridement was done. The molded ALCS was inserted. Revision was then performed after eradication of the infection. The results were analyzed, including the changes in the clinical manifestation, the radiologic findings, the laboratory results, the functional score and the complications. Results: Of all 12 cases, the two-stage revision arthroplasty using an ALCS with retention of the stem was performed in 11 cases (92%), on an average of 66 days (range: 40~152 days). In the 11 revised cases, there was no evidence of recurrence of infection. In the 11 cases, the mean Harris hip score improved from 40.1 points preoperatively to 91.8 points at last the follow-up. The mean WOMAC score improved from 41.8 points preoperatively to 81 points at the last follow-up. The mean Harris hip score was 85.3 points and the WOMAC score was 72.4 points during the ALCS insertion- period. Conclusion: For the case of a perioprosthetic hip infection with a well-fixed femoral stem, two-staged revision using an ALCS without stem removal could be an alternative method in terms of effective infection control and preservation of the joint function.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"2012 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127386201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.5371/JKHS.2010.22.1.86
Jeong Han Yoo, Y. Park, Jin soo Park, Kyu Cheol Rowe, Kuk Jin Chung, H. Kim, Young suk Song, J. Hwang
골 반문증(Osteopoikilosis)은 파종성 치밀성 골병증 (osteopathia condensans disseminate)이라고도 알려져 있으며 1915년 Alber-Schönber 등에 의해 최초 보고된 이후 아직까지도 매우 드물게 발생하는 병이다. 이는 원 인이 알려지지 않았으며 상 염색체 우성으로 유전되거나 산발적으로 발생한다. 종종 유전성 피부 질환과 동반되기 도 한다. 남 여 비율은 동일하며 대부분에서 무증상으로 우연히 발견되어 진단되는 경우가 많다. 국내에서는 김 등 과 윤 등에 의해 가족 간에 발생한 골 반문증을 보고하였 고 김 등은 피부 질환과 동반된 Buschke-Ollendorf Syndrome을 보고하였다. 본 교실에서는 이와는 달리 가족력 없이 산발적으로 발생하였고 양측 고관절에 심하 게 이환된 전형적인 골 반문증 환자의 단순 방사선 촬영과 핵의학 검사 및 자기 공명 영상을 얻었으며 이에 문헌 고 찰과 함께 보고하는 바이다. 증례 보고
{"title":"Non-Familial Osteopoikilosis around the both Hip Joints - a Case Report -","authors":"Jeong Han Yoo, Y. Park, Jin soo Park, Kyu Cheol Rowe, Kuk Jin Chung, H. Kim, Young suk Song, J. Hwang","doi":"10.5371/JKHS.2010.22.1.86","DOIUrl":"https://doi.org/10.5371/JKHS.2010.22.1.86","url":null,"abstract":"골 반문증(Osteopoikilosis)은 파종성 치밀성 골병증 (osteopathia condensans disseminate)이라고도 알려져 있으며 1915년 Alber-Schönber 등에 의해 최초 보고된 이후 아직까지도 매우 드물게 발생하는 병이다. 이는 원 인이 알려지지 않았으며 상 염색체 우성으로 유전되거나 산발적으로 발생한다. 종종 유전성 피부 질환과 동반되기 도 한다. 남 여 비율은 동일하며 대부분에서 무증상으로 우연히 발견되어 진단되는 경우가 많다. 국내에서는 김 등 과 윤 등에 의해 가족 간에 발생한 골 반문증을 보고하였 고 김 등은 피부 질환과 동반된 Buschke-Ollendorf Syndrome을 보고하였다. 본 교실에서는 이와는 달리 가족력 없이 산발적으로 발생하였고 양측 고관절에 심하 게 이환된 전형적인 골 반문증 환자의 단순 방사선 촬영과 핵의학 검사 및 자기 공명 영상을 얻었으며 이에 문헌 고 찰과 함께 보고하는 바이다. 증례 보고","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123367424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.5371/JKHS.2010.22.1.45
J. Yoo, Sung Guk Kim, C. Han, Hyun Chul Oh, H. Yoon
시멘트를 이용한 고관절 전치환술에서 장기 추시 결과 무균성 해리와 시멘트 주위의 과도한 골용해 등의 여러 합 병증이 발생하여, 생물학적 고정(biologic fixation)을 이용한 무시멘트 고관절 치환술이 1970년대 말부터 개발 되어 일반적으로 사용되고 있고 만족할 만한 결과가 보고 되었다. 그러나 소위 1세대 무시멘트형 대퇴스템인 Harris-Galante Porous (HGP; Zimmer, Warsaw, IN), Anatomic Porous Replacement-I (APR-1; Intermedics, Autisn, Texas), Porous-Coated Anatomic (PCA; Howmedica, Rutherford, NJ)에 대한 장기 연구 결과에 서 대퇴부 동통, 파행(limping gait), 골용해(osteolysis) 및 응력방패(stress shielding)에 의한 근위부 골흡수 등 의 문제점이 제기되었으며, 이에 따라 수술 초기에 기계 적인 안정성을 증가시키고, 응력방패에 의한 대퇴골 근위 부의 골흡수를 줄이며, 폴리에틸렌 마모 입자가 골수강 원위부로 이동하는 것을 방지하는 새로운 디자인의 소위 2세대 대퇴스템이 개발되었다. 본 연구는 근위부에 환 형 미세포말(circumferential porous-coating) 처리 및 칼시코트 (hydroxyapatite and tricalcium phosphate) 제재를 도포한 collarless VerSys fiber metal midcoat 대 퇴스템(Zimmer, Warsaw, IN)을 사용하여 고관절 전치 환술을 시행한 후 3년 이상 추시가 가능하였던 환자를 대 상으로 임상적 및 방사선학적 결과를 후향적으로 평가하 여 보고하고자 한다. Submitted: July 27, 2009 1st revision: August 14, 2009 2nd revision: October 20, 2009 Final acceptance: November 30, 2009
利用水泥的骨关节前置皖酒在长期点结果无菌冷省哈利和水泥周围的过度发生骨质溶解等的各种病症,生物学固定(biologic fixation)利用平水泥骨关节置换酒从1970年代末开始被开发出来,一般沿用了可喜的结果报告了。但是所谓的第一代无水泥型大腿系统Harris-Galante Porous (HGP;Zimmer, Warsaw, IN)， Anatomic Porous Replacement-I (APR-1;Intermedics, Autisn, Texas)， Porous-Coated Anatomic (PCA;howmedica, rutherford, nj)站在长期研究结果对大腿疼痛、跛行(limping gait)、骨溶解(osteolysis)及应力盾(stress shielding)卫队部骨吸收等的问题被提出了,因此,手术初期增加机械的稳定性,应力盾的股骨胗部和降低骨吸收,开发出了防止聚乙烯磨损粒子向骨髓腔胃部移动的新设计的所谓第二代大腿系统。本研究采用近卫环状泡沫处理及hydroxyapatite and tricalcium phosphate制裁的collarless VerSys fiber metal midcoat大驱魔器(Zimmer, Warsaw;使用IN)进行骨关节前置环术后，对3年以上可追尾的患者进行临床及放射线学结果的后向评价并报告。Submitted: July 27, 2009 1st revision: August 14, 2009 2nd revision: October 20, 2009 Final acceptance: November 30, 2009
{"title":"Cementless Total Hip Arthroplasty Using VerSys Fiber Metal Midcoat Stem: a Minimum 3-Years Follow-up","authors":"J. Yoo, Sung Guk Kim, C. Han, Hyun Chul Oh, H. Yoon","doi":"10.5371/JKHS.2010.22.1.45","DOIUrl":"https://doi.org/10.5371/JKHS.2010.22.1.45","url":null,"abstract":"시멘트를 이용한 고관절 전치환술에서 장기 추시 결과 무균성 해리와 시멘트 주위의 과도한 골용해 등의 여러 합 병증이 발생하여, 생물학적 고정(biologic fixation)을 이용한 무시멘트 고관절 치환술이 1970년대 말부터 개발 되어 일반적으로 사용되고 있고 만족할 만한 결과가 보고 되었다. 그러나 소위 1세대 무시멘트형 대퇴스템인 Harris-Galante Porous (HGP; Zimmer, Warsaw, IN), Anatomic Porous Replacement-I (APR-1; Intermedics, Autisn, Texas), Porous-Coated Anatomic (PCA; Howmedica, Rutherford, NJ)에 대한 장기 연구 결과에 서 대퇴부 동통, 파행(limping gait), 골용해(osteolysis) 및 응력방패(stress shielding)에 의한 근위부 골흡수 등 의 문제점이 제기되었으며, 이에 따라 수술 초기에 기계 적인 안정성을 증가시키고, 응력방패에 의한 대퇴골 근위 부의 골흡수를 줄이며, 폴리에틸렌 마모 입자가 골수강 원위부로 이동하는 것을 방지하는 새로운 디자인의 소위 2세대 대퇴스템이 개발되었다. 본 연구는 근위부에 환 형 미세포말(circumferential porous-coating) 처리 및 칼시코트 (hydroxyapatite and tricalcium phosphate) 제재를 도포한 collarless VerSys fiber metal midcoat 대 퇴스템(Zimmer, Warsaw, IN)을 사용하여 고관절 전치 환술을 시행한 후 3년 이상 추시가 가능하였던 환자를 대 상으로 임상적 및 방사선학적 결과를 후향적으로 평가하 여 보고하고자 한다. Submitted: July 27, 2009 1st revision: August 14, 2009 2nd revision: October 20, 2009 Final acceptance: November 30, 2009","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117260772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.5371/JKHS.2010.22.1.38
S. Kweon, H. Han, Y. Yi
Purpose: This study evaluated the results of acetabular medial wall osteotomy to reconstruct the acetabulum in dysplastic hip during total hip arthroplasty. Materials and Methods: We clinically and radiologically evaluated 30 hips of 30 patients with secondary hip osteoarthritis caused by congenital hip dislocation or acetabular dysplasia who underwent total hip arthroplasty (THA) between March 1999 and October 2002. The average age of subjects was 46.5 years(17 to 73 years), and the mean follow-up period was 5 years(5.3 to 8.7 years). In 26 cases, a cementless hemispherical acetabular cup was inserted in the true acetabulum; in 4 cases a reinforced ring was inserted. Only 2 hips needed structural bone grafting. Results: The average Harris hip score improved from 56.3 points preoperatively to 93.2 points at the last follow up. Radiographic analysis revealed no aseptic loosening or radiolucent line, and showed stable bony fixation at the true acetabulum. The mean thickness of the medial acetabular wall postoperative was 20.5 mm(10 to 36 mm). Bone union of the medial wall was observed at a mean of four months postoperatively. Conclusion: Acetabular medial wall osteotomy can maintain the integrity of the acetabular medial wall while achieving enhanced acetabular coverage and more normal hip biomechanics.
{"title":"Acetabular Medial Wall Displacement Osteotomy in Total Hip Arthroplasty for Dysplastic Hips","authors":"S. Kweon, H. Han, Y. Yi","doi":"10.5371/JKHS.2010.22.1.38","DOIUrl":"https://doi.org/10.5371/JKHS.2010.22.1.38","url":null,"abstract":"Purpose: This study evaluated the results of acetabular medial wall osteotomy to reconstruct the acetabulum in dysplastic hip during total hip arthroplasty. Materials and Methods: We clinically and radiologically evaluated 30 hips of 30 patients with secondary hip osteoarthritis caused by congenital hip dislocation or acetabular dysplasia who underwent total hip arthroplasty (THA) between March 1999 and October 2002. The average age of subjects was 46.5 years(17 to 73 years), and the mean follow-up period was 5 years(5.3 to 8.7 years). In 26 cases, a cementless hemispherical acetabular cup was inserted in the true acetabulum; in 4 cases a reinforced ring was inserted. Only 2 hips needed structural bone grafting. Results: The average Harris hip score improved from 56.3 points preoperatively to 93.2 points at the last follow up. Radiographic analysis revealed no aseptic loosening or radiolucent line, and showed stable bony fixation at the true acetabulum. The mean thickness of the medial acetabular wall postoperative was 20.5 mm(10 to 36 mm). Bone union of the medial wall was observed at a mean of four months postoperatively. Conclusion: Acetabular medial wall osteotomy can maintain the integrity of the acetabular medial wall while achieving enhanced acetabular coverage and more normal hip biomechanics.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"426 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132657112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.5371/JKHS.2010.22.1.20
W. Park, K. Moon, K. Suh
고관절 전치환술의 목적은 통증을 완화하고 고관절의 기능과 안정성을 회복하며 하지 길이를 반대편과 일치하 도록 하는 것이다. 그러나, 일반적으로 통증 완화와 고관 절의 안정성을 증가시키는 것이 하지 길이를 회복하는 것 보다 중요하며 하지 길이와 안정성 사이에서 어려운 술 중 결정을 내려야 하는 상황에 흔히 직면하게 되는데, 대개는 안정적인 고관절의 재건을 위해서 하지 길이의 연장을 택 하게 된다. 여러 보고들에 의하면 고관절 전치환술 후 하지 길이 차 이는 1~15.9 mm로 다양하게 나타내고 있다. 6~32%의 환자들이 하지 길이 차이를 인지할 수 있다고 보고하고 있 는데, 대개 10 mm 이상의 하지 길이 단축이나 6 mm 이상의 하지 길이 연장이 있는 경우에 환자들이 하지 길이 차이를 인지할 수 있다고 한다. 하지 길이 차이로 인한 불만족스러운 임상 결과는 고관절 전치환술 이후의 가장 흔한 소송의 원인이 되고 있다. 고관절 전치환술 후의 하지 길이 차이는 좌골 신경, 대 퇴 신경, 비골 신경의 손상, 요통, 그리고 파행을 초래할 수 있다. 신경 손상은 하지 부동과 관련된 가장 심각한 합 병증이다. 신경 손상은 일차 고관절 전치환술의 경우 1%, 재치환술의 경우는 6% 정도로 보고되고 있으며, 여성에 서 더 흔히 발생하는 것으로 알려져 있다. 경도나 중등 도의 신경 손상이 발생한 환자의 80%에서 회복되고 추가 적인 수술은 필요하지 않다. 그러나 약 15~20%의 환자에 서는 심한 이상감각을 호소하게 되고 회복이 어렵다. Edwards 등은 고관절 전치환술 후 23예에서 비골 신경 손상시 평균 2.7 cm(1.9~3.7 cm), 좌골 신경 손상시 평균 4.4 cm(4.0~5.1 cm)의 하지 길이 연장을 보고하였다. Pritchett는 고관절 전치환술 후 심한 신경학적 결손과 지속적인 이상감각통을 호소하는 19명의 환자에서 1.3 cm부터 4.1 cm 까지의 하지 길이 연장을 보고하였다. 하 지 연장의 허용 한계에 대해서는 아직 정확히 밝혀져 있지 Submitted: July 27, 2009 1st revision: August 14, 2009 2nd revision: October 20, 2009 Final acceptance: November 30, 2009
骨关节前置手术的目的是缓解疼痛，恢复骨关节的功能和稳定性，使下肢长度与另一边一致。但是,一般疼痛缓解和高官节的不稳定性增加的长度比恢复不重要,在长度和稳定性之间困难的酒中作出决定的情况下,往往面临,通常是稳定的高官节为了重建,不选择长度延长。根据许多报告，骨关节前置手术后下肢长度差异有1 - 15.9毫米。据报告，6至32%的患者可以知道下肢长度的差异，如果10毫米以上的下肢长度缩短或6毫米以上的下肢长度延长，患者就可以知道下肢长度的差异。下肢长度差异引起的不令人满意的临床结果是骨关节前置手术后最常见的诉讼原因。骨关节前置手术后的下肢长度差异会导致坐骨神经，大腿神经，腓骨神经损伤，腰痛和跛行。神经损伤是与下肢不动有关的最严重的病症。据报告，第一次骨关节前置手术的神经损伤为1%，再手术的神经损伤为6%，而且在女性中更常见。80%的轻度或中度神经损伤患者已经恢复，不需要再做手术。但约15~20%的患者会出现严重的异常感觉，难以恢复。Edwards等人在骨关节前置换手术后的23个例子中报告了腓骨神经损伤时平均2.7厘米(1.9~3.7厘米)，左骨神经损伤时平均4.4厘米(4.0~5.1厘米)的下肢长度延长。Pritchett报告19名在骨关节前置换手术后出现严重神经学缺损和持续异常感觉痛的病人的下肢长度从1.3厘米延长到4.1厘米。Submitted: July 27, 2009 1st revision: August 14, 2009 2nd revision: October 20, 2009 Final acceptance: November 30, 2009
{"title":"Leg Length Discrepancy after Total Hip Arthroplasty","authors":"W. Park, K. Moon, K. Suh","doi":"10.5371/JKHS.2010.22.1.20","DOIUrl":"https://doi.org/10.5371/JKHS.2010.22.1.20","url":null,"abstract":"고관절 전치환술의 목적은 통증을 완화하고 고관절의 기능과 안정성을 회복하며 하지 길이를 반대편과 일치하 도록 하는 것이다. 그러나, 일반적으로 통증 완화와 고관 절의 안정성을 증가시키는 것이 하지 길이를 회복하는 것 보다 중요하며 하지 길이와 안정성 사이에서 어려운 술 중 결정을 내려야 하는 상황에 흔히 직면하게 되는데, 대개는 안정적인 고관절의 재건을 위해서 하지 길이의 연장을 택 하게 된다. 여러 보고들에 의하면 고관절 전치환술 후 하지 길이 차 이는 1~15.9 mm로 다양하게 나타내고 있다. 6~32%의 환자들이 하지 길이 차이를 인지할 수 있다고 보고하고 있 는데, 대개 10 mm 이상의 하지 길이 단축이나 6 mm 이상의 하지 길이 연장이 있는 경우에 환자들이 하지 길이 차이를 인지할 수 있다고 한다. 하지 길이 차이로 인한 불만족스러운 임상 결과는 고관절 전치환술 이후의 가장 흔한 소송의 원인이 되고 있다. 고관절 전치환술 후의 하지 길이 차이는 좌골 신경, 대 퇴 신경, 비골 신경의 손상, 요통, 그리고 파행을 초래할 수 있다. 신경 손상은 하지 부동과 관련된 가장 심각한 합 병증이다. 신경 손상은 일차 고관절 전치환술의 경우 1%, 재치환술의 경우는 6% 정도로 보고되고 있으며, 여성에 서 더 흔히 발생하는 것으로 알려져 있다. 경도나 중등 도의 신경 손상이 발생한 환자의 80%에서 회복되고 추가 적인 수술은 필요하지 않다. 그러나 약 15~20%의 환자에 서는 심한 이상감각을 호소하게 되고 회복이 어렵다. Edwards 등은 고관절 전치환술 후 23예에서 비골 신경 손상시 평균 2.7 cm(1.9~3.7 cm), 좌골 신경 손상시 평균 4.4 cm(4.0~5.1 cm)의 하지 길이 연장을 보고하였다. Pritchett는 고관절 전치환술 후 심한 신경학적 결손과 지속적인 이상감각통을 호소하는 19명의 환자에서 1.3 cm부터 4.1 cm 까지의 하지 길이 연장을 보고하였다. 하 지 연장의 허용 한계에 대해서는 아직 정확히 밝혀져 있지 Submitted: July 27, 2009 1st revision: August 14, 2009 2nd revision: October 20, 2009 Final acceptance: November 30, 2009","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125166355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.5371/JKHS.2010.22.1.52
K. Hwang, Young-Ho Kim, Yeesuk Kim, Hyun-Jong Bong, I. Choi
Purpose: We wanted to evaluate the risk factors that predispose a patient to dislocation after undergoing primary total hip arthroplasty with the transtrochanteric approach. Materials and Methods: Between July 1995 and May 2007, 593 consecutive total hip arthroplasties using the trantrochanteric approach were performed. A matched comparative study was performed for the dislocated group(18 hips) and the non-dislocated control group(18 hips). The patient-related factors and mechanical factors were retrospectively reviewed to evaluate the risk factors for dislocation. Results: Dislocation occurred in 18 hips(3.04%). The mean age was 57.1 years in the dislocated group and 55.2 years for all of the patients (p>0.05). Statistical analyses of the BMI, inclination and anteversion of the cup, lowering of the hip center, a leg length discrepancy, the size of the femoral head and nonunion of the greater trochanter revealed no significant differences between the two groups. Nonunion of the greater trochanter was observed in 16 hips(2.84%). The risk of dislocation was 8.5 times higher in the patients with excessive alcohol intake (p<0.05). The combination of more than 3 risk factors significantly affected the incidence of dislocation after total hip arthroplasty (p<0.05). Conclusion: After primary total hip arthroplasty with the transtrochanteric approach, in the cohort of this study, excessive alcohol intake was the main risk factor for dislocation and a combination of risk factors contributed to dislocation.
{"title":"Risk Factors for Dislocation after Primary Total Hip Arthroplasty with the Transtrochanteric Approach","authors":"K. Hwang, Young-Ho Kim, Yeesuk Kim, Hyun-Jong Bong, I. Choi","doi":"10.5371/JKHS.2010.22.1.52","DOIUrl":"https://doi.org/10.5371/JKHS.2010.22.1.52","url":null,"abstract":"Purpose: We wanted to evaluate the risk factors that predispose a patient to dislocation after undergoing primary total hip arthroplasty with the transtrochanteric approach. Materials and Methods: Between July 1995 and May 2007, 593 consecutive total hip arthroplasties using the trantrochanteric approach were performed. A matched comparative study was performed for the dislocated group(18 hips) and the non-dislocated control group(18 hips). The patient-related factors and mechanical factors were retrospectively reviewed to evaluate the risk factors for dislocation. Results: Dislocation occurred in 18 hips(3.04%). The mean age was 57.1 years in the dislocated group and 55.2 years for all of the patients (p>0.05). Statistical analyses of the BMI, inclination and anteversion of the cup, lowering of the hip center, a leg length discrepancy, the size of the femoral head and nonunion of the greater trochanter revealed no significant differences between the two groups. Nonunion of the greater trochanter was observed in 16 hips(2.84%). The risk of dislocation was 8.5 times higher in the patients with excessive alcohol intake (p<0.05). The combination of more than 3 risk factors significantly affected the incidence of dislocation after total hip arthroplasty (p<0.05). Conclusion: After primary total hip arthroplasty with the transtrochanteric approach, in the cohort of this study, excessive alcohol intake was the main risk factor for dislocation and a combination of risk factors contributed to dislocation.","PeriodicalId":410202,"journal":{"name":"The Journal of the Korean Hip Society","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126360423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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