3D CT를 이용한 비구 컵 주위 골용해 측정 및 임상 결과와의 관련성

손원용 ( Won Yong Shon ),오종건 ( Jong Gun Oh ),윤호현 ( Ho Hyun Yun ),윤지열 ( Ji Yeol Yoon ),김승주 ( Seung Ju Kim ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.1

목적: 골반골 주위에서 발생한 골 용해 크기 및 위치를 측정하고 임상 성적과의 관련성을 알아 보고자 하였다. 대상 및 방법: 무 시멘트형 비구컵을 사용한 인공 고관절 전치환술을 받은 환자 97명(116례)에게 3D CT가 시행되었고, 이중 명확한 골 용해를 가진 40례(31환자)에 대해 연구를 시행하였다. 대상 환자들은 수술 후 6-12주에 방사선 사진을 촬영하였고, 추시 기간이 18개월 이상이며 감염의 과거력이 없었다. 골 용해의 크기 1 cm3미만(A), 1 cm3에서 2 cm3미만(B), 2 cm3에서 3 cm3미만(C), 3 cm3(D) 이상의 4개의 군으로 분류 하였으며, 골 용해의 위치를 전방, 후방, 상방, 하방, 중앙의 5 군으로 분류하였다. 골 용해 크기, 골 용해 위치, 폴리에틸렌 마모와 임상결과(Harris hip score)간의 관련성을 통계학적으로 분석하였다. 결과: 골 용해군의 평균 체적은 3.2 cm3이었으며(A군 14례, B군 11례, C군 4례, D군은 11례) 골 용해 크기와 임상성적간에 통계적으로 유의한 상관관계를 보였다(Rs=-0569). 그러나 골 용해의 위치에 따른 분류 상 전방 18례, 상방 5례, 후방 10례, 하방 33례, 중앙 32례이었으며 골 용해 위치와 임상성적간에 통계적으로 유의한 차이는 없었다(P=0.35). 결론: 골 용해 크기와 임상 성적 사이에는 의미있는 상관 관계가 보였고(Rs=-0569), 특히 3 cm3 이상의 골 용해 군에서는 통계학적으로 유의한 임상성적의 감소가 관찰 되었다(P=0.022). 이는 추 후 골 용해에 대한 치료를 결정하는데 있어 하나의 지침이 될 수 있으리라 사료된다. Purpose: We wanted to measure the size of the osteolysis of the pelvis and to quantify its location and we wanted to assess the correlation of these measurements with the clinical result. Materials and methods: We evaluated 40 hips (31 patients) that showed definitive osteolysis among 116 hips (97 patients) that underwent 3 dimensional CT scanning post-operatively after total hip arthroplasties with using cementless acetabular cups. The inclusion criteria were a follow up duration of more than 18 months and no history of infection. The radiographs were obtained at the 6th to 12th week postoperatively. The size of pelvic osteolysis was divided into 4 groups (less than 1 cm3 (A), between 1 cm3 to 2 cm3 (B), between 2 cm3 to 3 cm3 (C), more than 3 cm3 (D)), and the location of osteolysis was divided into 5 groups (anterior, posterior, superior, inferior and central) The size and location of osteolysis and the wear of the polyethylene were analysed in relation to the clinical outcome, which was assessed using the Harris Hip Score). Results: The average size of the osteolysis was 3.2 cm3 (A 14 cases in group A, B 11 cases in group B, C 4 cases in group C, and D 11 cases in group D). There was significant correlation between the size of the osteolysis and the clinical outcome (Rs=-0569). However, there was no significant correlation between the osteolysis location (Anterior: 18 cases, Superior: 5 cases, Posterior: 10 cases, Inferior: 33 cases and Central: 32 cases) and the clinical outcome (P=0.35). Conclusion: There is a significant correlation between the size of the osteolysis and the Harris Hip Score (Rs=-0569). Especially, a pelvic osteolysis of more than 3 cm3 was found to be correlated with a decreased postoperative HHS (P=0.022). We hope that these results may be useful to help guide the treatment of osteolysis.

골시멘트를 사용한 Versys-TM(R) 대퇴 스템의 3~5년 추시결과

손원용 ( Won Yong Shon ),허창룡 ( Chang Yong Hur ),문준규 ( Jun Gyu Moon ),남혁우 ( Hyuk Woo Nam ),이영구 ( Young Koo Lee ),최재혁 ( Jae Hyuck Choi ) 대한고관절학회 2004 Hip and Pelvis Vol.16 No.3

골시멘트를 사용한 Precoat 대퇴 스템

손원용 ( Won Yong Shon ),전승주 ( Seung Ju Jeon ),나경욱 ( Kyoung Wook Rha ),김학준 ( Hack Jun Kim ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.1

We now report the results of Harris Precoat femoral stem(Zimmer, Inc.,Warsaw,IN) of fourty hips in twenty-nine patients at a 5-7.5 year follow up.In this study, cemented precoat femoral stem was used in sixty-one, nonselected hip patients from October 1990 to May 1993 in our department. Twelve patients(13 hips) had been lost to follow up. At the final follow up, seven patients(7 hips) had died and one hips were too ill for detailed follow up. Radiographies were available for 36 hips of 26 patients who were alive for the entire follow up period. The average age at the time of the procedure was 54 years(range 27-76). There were twenty-three men(thirty-four hips) and six women(six hip). The femoral component had been revised for aseptic loosening in three hips(8%).One additional hip showed definite radiographic loosening. Hence, the prevalaence of radiographic failure was 11%(four hips). Three of them had suboptimal cement mantle(C1 or C2) Subsidence without radiolucency between cement interface occured in one hip. No femoral osteolysis was seen in stable component. These results show that cementation techinques is one of the most important factors for durability of cemented femoral stem, early debonding between stem-cement interface may develop even in this precoated femoral stem and also once debonding may produce premature failure of cemented femoral fixation.

대퇴골두 무혈성 괴사의 조직학적 분석과 자기공명영상과의 관계

손원용(Won Yong Shon),김학준(Hack Jun Kim),심재학(Jae Hak Shim),김성연(Sung Yon Kim),김철환(Chul Hwan Kim) 대한고관절학회 1999 Hip and Pelvis Vol.11 No.1

We performed a retrospective study on 20 patients to correlate MRI findings with histopathologic results upon avascular necrosis of femoral head which were obtained after total hip arthroplasties. 17 femoral heads were male and 3 femoral heads were female. The average age of the patients at surgery was 50 years(ranging from 21 to 75 years old). The etiologies of AVN in the femoral head were alchol overuse in 17 and idiopathic in 3 femoral heads. The specimens were analysed histologically using Arlet and Durroux classification and 4 types of histological findings were drawn on the map of femoral head. Contiguous, 4.8 mm coronal 1.5 Tessler MRI (Magnetic 63 SP4000, Siemens, Germany) sections were compared with the corresponding histologic sections. Type 4 lesion was seen as a low intensity signal on both Tl and T2 weighted MRI images. Type 3 lesions showed as intermedite to low intensity signals in Tl and T2 weight MRI images. Type 1,2 lessions were not distinguishable on MRI findings. The MRI signal cannot predict particular histopathologic pattern in the later stages of avascular necrosis of femoral head

Zimmer Centralign 대퇴스템의 Centralizing 효과에 대한 연구

손원용 ( Won Yong Shon ),문우남 ( Woo Nam Moon ),박동 ( Dong Park ) 대한고관절학회 1995 Hip and Pelvis Vol.7 No.2

Adequate femoral stem position and circumferential cement mantle are important factor preventing mechanical loosening of the femoral component. In an attempt to improve and facilitate the positioning of the femoral component, Zimmer Centralign Precoat femoral stem with attachment of a few small wings on the proximal and distal part of the stem was developed. To investigate the effect of Zimmer centralizing femoral stem, we studied two series of the patients with Zimmer Precoat femoral stem and Zimmer Centralign femoral stem. We assessed the stem position and cement mantle thickness on postoperative radiographs of 44 cases(36 Pts.) Zimmer Precoat femoral stem without centralizing device and 44(42 Pts.) Zimmer Centralign femoral stem, which were performed from December, 1990 to December, 1994 by one surgeon at Guro hospital, Korea University. 29 hips(65.9%) of neutral, 10(22.7%) of mild valgus, 1(2.3%) of mild varus, 3(6.8%) of valgus and 1 of varus position in group I and 20(45.3%) of neutral, 16(36.4%) of mild valgus, 2(4.6%) of mild varus, 3(6.8%) of valgus and 3 of varus position in group ][ were observed. In cases of 3ma to 6ea cement mantle thickness in each 1,3,5,7 zone, 24 hips(54.5%), 24(54.5%), 13(29.5%) and 24(54.5%) in group I, 27(61.4%), 24(54.5%), 18(40.9%) and 31(70.5%) in group ][ in A-P radiography and there were no significant difference in each group(p>0.5), but the number of less than 2aw cement mantle thickness of group 3 were significantly smaller than group I in zone 1,5,7 in A-P radiography and zone 1,5 in lateral radiography(p<0.01, 0.05). Our results could suggest that there were somewhat benefit of the Zimmer Centralign femoral stem regarding to the cement mantle thickness but not the stem position in the proximal femur and the cen-tralizing wing of the femoral stem seem to be more extended in width for the centralizing effect, also care should be taken when inserting the femoral stem even though Zimmer Centralign stem.

대퇴 경부 골절에 대한 이극성 반치환술의 결과 분석

손원용(Won Yong Shon),임홍철(Hong Chul Lim),서승우(Sung Woo Suh),홍성준(Song Jun Hong) 대한정형외과학회 1995 대한정형외과학회지 Vol.30 No.6

고관절 전치환술에서 후방관절낭 봉합술을 시행한 후외방도달법

손원용 ( Won Yong Shon ),임홍령 ( Hong Chul Lim ),나경욱 ( Kyong Uk Na ),김태형 ( Tae Hyeong Kim ) 대한고관절학회 1997 Hip and Pelvis Vol.9 No.2

The posterior approach to the hip is the most popular approach for primary total hip arthroplasty. It is technically simpler than other approaches, but is said to carry an increased risk of postoperative dislocation. Several variations of this approach have been reported, but all cause injury to the posterior capsule and short external rotators. A posterior approach to the hip is described, which preserves the posterior hip capsule and short external rotators. These structure are reflected during exposure and are securely repaired to bone as a single capsulomuscular flap during wound closure. This approach has been used exclusively since January 1995 for uncomplicated primary hip arthroplasty. In 64 consecutive cases, there have been three dislocation, two of these associated with trauma. Our researches showed that the posterior approach with posterocapsulorrhaphy by trained operating team reduce the frequency of postoperative dislocation and less morbidity with no lengthening operation time as a simple procedure in uncomplicated primary total hip arthroplasty.

시멘트형 Polished Versys Heritage<SUP>®</SUP> 대퇴 스템의 2-5년 추시 결과

손원용(Won-Yong Shon),허창룡(Chang-Yong Hur),문준규(Jun-Gyu Moon),한상환(Sang-Whan Han),양재혁(Jae-Hyuk Yang),장기모(Ki-Mo Jang) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.1

목적: 현대 시멘트 기법을 이용한 인공 고관절 전치환술 후 대부분의 결과는 우수한 것으로 보고되어 있으나, 아직도 대퇴 스템의 표면 처리에 대해서는 논란이 많이 있다. 저자는 polished Versys Heritage 대퇴 스템을 이용한 인공 고관절 전치환술에 대한 결과를 보고하고자 한다. 대상 및 방법: 2000년 10월부터 2003년 8월까지 131고관절(117명)에 cemented Versys Heritrage 대퇴 스템을 이용하여 인공 고관절 전치환술을 시행하였다. 117명의 환자 중 남자는 81명, 여자는 36명이었으며 수술시 연령은 최소 25세에서 78세였고 평균 연령은 52.9 세였다. 평균 추시 기간은 49.2개월(24-71개월)이었고, 임상적 결과는 Harris Hip Score 및 대퇴부 동통 유무를 이용하여 평가하였으며 방사선학적 평가에 있어서는 Barrack 등의 시멘트 등급과 대퇴 스템 주위의 해리 및 대퇴 근위부의 stress shielding을 평가하였다. 결과: 술후 마지막 추시 임상적인 평가에서 Harris hip score는 평균 59.1점(17-91점)에서 평균 92.8점(78-100점)으로 향상되었다. 방사선학적 평가에서 Barrack 등의 시멘트 등급은 A 등급 75예, B 등급 54예, C1 등급 2예였다. 추시기간동안 방사선학적 대퇴 스템 이완의 소견을 보였던 예는 없었으며 전예에서 골용해 소견은 관찰되지 않았고 약 45%에서 Engh의 1 및 2 등급의 응력 방패 현상이 관찰되었다. 결론: 시멘트형 polished Versys Heritage 대퇴 스템을 이용한 인공 고관절 전치환술에서 24-71개월 추시에서 우수한 결과를 보였다. 그러나 향후 장기적인 추시가 필요하리라 사료된다. Purpose: Surface finishing of a cemented femoral stem is a subject of controversy even though contemporary cementing techniques have improved results. Versys Heritage femoral stem was used with a contemporary cementing technique to determine the outcome of using a polished surface. Materials and Methods: Between October 2000 and August 2003, 131 primary hybrid hip arthroplasty procedures were performed in 117 patients. The mean age at the time of the index arthroplasty was 52 years and 9 months (24-78 years). The average follow up period was 49 months (range, 24-71 months). All the hips were evaluated clinically by the Harris hip score and radiologically by the cement grade, osteolysis as well as stress shielding. Results: At the final follow up, the Harris hip score for all patients had improved from preoperative 59.1 (range, 17-91) to post operative 92.8 (range, 78-100). The cement grade was measured using Barrack's method. Of 131 hips, 75, 54 and 2 were grade A, grade B and grade C1 at the final follow up, respectively. None of the hips showed a C2 or D grade. There was no evidence of aseptic loosening or osteolysis on the femoral side during follow up. 45% of stems showed grade 1 and 2 stress shielding according to Engh's criteria. Conclusion: In this study, the Polished Versys Heritage femoral stem<SUP>®</SUP> showed excellent results at the short to mid term follow up period. However, a longer-term follow-up study will be needed to clarify the implications of the femoral prosthesis surface finish or design.

혼합형 인공 고관절 전치환술에서의 비구컵의 폴리에틸렌 마모율

손원용(Won Yong Shon),이석현(Seok Hyun Lee),임홍철(Hong Chul Lim),나경욱(Kyong Wook Rha),김학준(Hack Jun Kim) 대한정형외과학회 2000 대한정형외과학회지 Vol.35 No.1

혼합형 인공고관절 전치환술에서의 비구컵의 골용해 (5~11.5년 추시 결과)

손원용 ( Won Yong Shon ),허창용 ( Chang Yong Hur ),문준규 ( Jun Gyu Moon ),황진호 ( Jin Ho Hwang ) 대한고관절학회 2004 Hip and Pelvis Vol.16 No.3