골 시멘트고정 : 최신 골시멘트기법이 해답인가?

손원용(Won Yong Shon) 대한고관절학회 1999 Hip and Pelvis Vol.11 No.2

안정된 무시멘트 비구컵에서 폴리에틸렌 삽입물 교환과 동종골 이식술을 시행한 비구컵 골용해의 치료

손원용 ( Won Yong Shon ),허창용 ( Chang Yong Hur ),석창우 ( Chang Woo Seok ),정효섭 ( Hyo Sub Jung ) 대한고관절학회 2006 Hip and Pelvis Vol.18 No.3

목적: 안정된 무시멘트 미세 포말형 비구컵에서 심한 폴리에틸렌의 마모를 동반한 비구컵 주위 골 용해에 대하여 폴리에틸렌 liner의 교환과 동종골 이식술만을 시행하여 치료하고 20례의 결과를 후향적으로 평가하고 보고하고자 한다. 대상 및 방법: 1996년 6월부터 2003년 5월까지 안정된 비구컵 주위에 발생한 골용해 및 폴리에틸렌 삽입물의 마모 소견을 보여 폴리에틸렌 라이너의 교환만을 시행한 23례 중 2년 이상 추시 관찰이 가능하였던 20례를 대상으로 하였다. 18례 에서는 동종골 이식을 시행하였다. 재수술 당시의 환자의 평균 연령은 55(36~75)세 이었고, 첫 수술 후 재수술까지의 기간은 평균 8.2(5.6~12.4)년 이었다. 평균 추시 기간은 3.8(2.4~9.3)년 이었다. 수술 후 평가는 Harris Hip Score을 이용한 임상적 결과와 최종 방사선 사진상의 비구컵의 고정 및 골용해를 술 전 사진과 비교 측정하였다. 결과: 임상 결과는 HHS는 술전 67 점에서 최종 추시시 88점으로 향상되었으며, 추시기간 동안 비구컵 이완이나 폴리에틸렌 삽입물의 실패등으로 인한 재수술의 예는 없었다. 수술 후 고관절 탈구는 1례에서 3차례(수술후 1개월, 29개월, 38개월) 발생하였으며, 고관절 외전 보조기로 치료하였다. 비구컵 주위 골용해 병소의 크기는 전체 20 례에서 수술 전 평균 25.2×12.5 mm (최소 5×10 mm ~ 최대 42×12 mm)이었으며, 골이식술 시행 후 12 례에서는 술 전 골용해병소가 이식골로 완전히 충진되었고, 8 례에서는 부분적 충진되었으며, 추시 기간 중에 골용해가 진행되거나 새로이 발생된 례는 없었다. 결론: 저자들의 결과는 선택적으로 시행한 폴리에틸렌 라이너의 교환술은 폴리에틸렌의 뚜렷한 마모를 동반한 미세포말형 무시멘트 비구컵의 심한 골용해에 대한 한가지 치료 방법이 될 수 있음을 보여주고 있으며, 폴리에틸렌의 교환술은 안정된 무시멘트 비구컵에서 비구골을 보존 할 수 있고, 수술의 규모가 적으며, 수술 후 회복이 빠른 장점이 있다. 그러나 보존된 무시멘트 비구컵의 장기 수명에 대해서는 향후 장기 추시 관찰이 필요 할 것으로 사료된다. Purpose: We evaluated, retrospectively, twenty hips that had undergone revision surgeries because of massive pelvic osteolysis in order to determine the retention rate of acetabular metal shells and polyethylene liner exchanges.. Materials and Methods: We performed liner exchanges for massive osteolysis around stable HG acetabular cups with severe polyethylene wear in twenty-three hips, between June 1996 and May 2003. Clinical and radiological follow-up was available for 20 hips for more than 2 years. In 18 hips, we performed curettage of the granulomatous tissue and tightly packed morselized cancellous allografts into the screw holes or the peripheral rims for the acetabular osteolytic lesions. The mean follow-up period was 3.8 years (range, 2.4 to 9.3 years) and the mean of time from the primary total hip arthroplasties to the component exchanges, was 8.2 years (range, 5.6 to 12.4 years). Results: During the follow-up period, all of the hips were functioning well, and none required any subsequent repeat surgeries. Dislocations occurred three times after the repeat operations in one hip, which was treated successfully with an abduction brace. None of the hips demonstrated a progression of the pre-existing osteolytic lesions or the development of any new osteolytic lesions. At the final follow-up, none of the acetabular components demonstrated any evidence of loosening. Conclusion: Our results demonstrated that isolated liner exchanges and debridement of the granulomatous tissue, with or without bone grafting, can be an effective alternative solution to revision of the cup for massive osteolysis around well-fixed, cementless, acetabular cups in selected patients. Retention of the pre-existing cementless acetabular cup provides less intra-operative and post-operative morbidity. However, in order to determine the longevity of the retained cementless acetabular cups, further long-term studies are necessary.

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

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

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.

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.

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.

한국인의 특발성 대퇴골두 무혈성 괴사에서 혈액응고 장애

손원용(Won Yong Shon),이준영(Joon Young Lee),박정호(Jung Ho Park) 대한정형외과학회 2002 대한정형외과학회지 Vol.37 No.2

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