연령에 따른 미세포말형 고관절 전치환술의 장기 추시 결과 비교

문경호,William J. Culpopper II,Christi Sychterz,Charles A. Engh (Kyoung Ho Moon) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.1

A total of 223 total hip arthroplasties(THAs) in 215 consecutive patients were operated using the Anatomic Medullary Locking hip system. In this study, we compared the incidences of reoperation, clinical results, and radiographic findings between young(<60 years old: 1 1 1 hips in 105 patients) and elderly patients((>-60 years old; 88 hips in 86 patients) at a minimum of five year follow-up. Twelve patients(1 young and 11 elderly) died before five year follow-up and twelve patients(8 hips in 7 young patients and 4 hips in 4 elderly patients) were lost to follow-up. The incidence of reoperation of the young group(15.3%) was significantly higher than that of the elderly group(3.4%). Excellent clinical results were obtained in both groups with 96% of the young group and 93% of the elderly group reporting they were satisfied with their hip arthroplasty. In radiological analysis, the incidences of osteolysis(acetabular and femoral) and acetabular mechanical failure in the young group(15.3%) were significantly higher than those in the elderly group(5.7%). These results suggest that porous-coated total hip arthroplasty is an effective treatment option for painful arthritic hips in elderly patients.

Deep Vein Thrombosis after Cementless Total Hip Replacement Arthroplasty Using Doppler Ultrasound

Kyoung-Ho Moon(문경호),Won-Hong Kim(김원홍),Jung-Youn Lee(이정윤) 대한정형외과학회 1998 대한정형외과학회지 Vol.33 No.6

P-M(Pathofer-Mouch)형 고관절 전치환술

문경호 ( Kyoung Ho Moon ),박승림 ( Seung Rim Park ),김형수 ( Hyoug Soo Kim ),강준순 ( Joon Soon Kang ),김명호 ( Myung Ho Kim ),최현 ( Hyoun Choi ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.1

We reviewed the results of the 71 cases of total hip replacements that had been done with the P-M type cementless total hip prosthesis for 60 patients. This type of prosthesis consist of threaded acetabular component and anatomically adapted femoral stem. The following check-up for more than two year to 5 years(average 40 months) at the Department of Orthopedic Surgery, Inha General hospital, Inha med- ical school, during the period of Jan. 1987 to Dec. 1992. The result were followings; 1. Modified Harris hip score wps 39.4 before operation but it raised to average 86 after 4 years of operation and it become decreased after on. 2. The pain in the thigh were shown on 15 patients(21%) of the patients after 2 years of surgery as more than the slight pain, then in increased aftertime. 3. The fixation of femoral stem consisted with 27(38.0%) of excellent fixation, 30(42.3%) of good fixation, and 14 cases(20.7%) of poor fixation. 4. The 12 cases(16.9%) showed more than 2mm of radiolucent zone around the femoral stem. 5. The 13 cases(18.3%) showed more than 5mm of vertical subsidence, and the ver- tical subsidence frequently occured with poor fixation of the femoral stem on the radiographic image(P<0.05), and function of the hip joint was decreased thereafter (P=0. 0199).

Metal-Backed 비구컵 내의 Polyethylene 마모의 측정 -새 이차원적 방법-

문경호 ( Kyoung Ho Moon ),오승재 ( Sung Je Oh ),이정윤 ( Jung Youn Lee ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.2

We measured the wear of polyethylene liners in a group of 34 hips(27 patients) in which a metal-backed acetabular cup had been implanted. Each patients was evaluated radiographically and clinically at a minimum of four different postoperative intervals. The initial evaluation was performed just postoperatively, and the last evaluation was performed at a mean of 5.9 years(range, three to eight years) postoperatively. Two-dimensional wear that is, penetration by the femoral head into the ultra-high molecular weight polyethylene liner was determined from anteroposterior radiographs of the pelvis with a computer analysis system that calculated the change in the position of the center of the head relative to the center of the cup. The results were as follows: There was a large difference (mean, 0.46 millimeters) between the center of the head and that of the cup as measured on the initial postoperative radiographs. The difference underscores the need for researchers to consider the initial displacement of the head when measuring and reporting polyethylene wear. The wear rate was mean 0.17 millimeters per year. The wear rate of male group was higher than that of female group. There were no statistically significant difference in each groups regarding age, body weight, cup inclination, head size and the production company. This new computer assisted 2-dimensional method could be a good method for clinical evaluation of the polyethylene wear in metal-backed acetabular cups.

AML(Anatomical Medullary Locking) 대퇴 스탬을 이용한 무시멘트 고관절 치환술

문경호 ( Kyoung Ho Moon ),박승림 ( Seung Rim Park ),김형수 ( Hyoung Soo Kim ),강준순 ( Joon Soon Kang ),권순철 ( Soon Cheul Kwon ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.1

The author tried to get result after clinical and radiological studies with 39 patients (50 hip Joints) who have been operated non-cemented bipolar hemiarthroplasty or total hip replacement arthroplasty with using AML(Courtesy Depuy, Warsaw, Ind. ) femoral stem and who could be followed for the period of more th two years(average 39 months) at the INHA University Hospital, Dept. Of Orthopaedic Surgery from the Feb, 1989 through the Feb, 1992. The results were as rollows 1. There were 41 cases of press-fit on the radiogram after operation, 9 cases of no press fit. 2. Pre-operative Harris hip score was average 37. 4, but it was raised to 82. 9 after operation, Amomg them, Harris hip score for the press fit group was 86. 1 ynd those of no press fit group was 79.6, it shows significant statistical differences (p<0. 05). 3. The vetical subsidence, calcar resorption and reactive white lines were relatively higher incidence at the case of no press fit femoral stem, but here were no significant statistical meanings compared with press fit group(p>0.05). 4. The formation of spot welds were shown higher frequency at the press fit group than no press fit group and had statistically significances(p<0.05). 5. The 39(78%) cases were assessed with bony remodeling by the stress shielding effect and press fit group was on the 3rd degree stress shield effect which was nuch higher in those of no press fit, it shows significant statistical meanngs(p<0.05) 6. The fication with bony ingrowth which was estimated through the final radiologic evaluations, were 25 cases (50%), stable fibrous ingrowth fication were 23 cases(46%), and unstable fication were 2 cases (4%). The higher incidences of bony ingrowth fication were shown ft the cases of press fit stem, and stable fibrous ingrewth fication for the no press fit of it. There were significant statistical meanings between the incidences(p<0.05). According to the conclusion of this retrospective study, the noncemented hip arthroplasty using AML femoral stem in initial press fit froup had much better clinical results than no press fit group.

Crowe IV 선천성 고관절 탈구 환자에서 전자하 단축 절골술과 동반하여 시행한 무시멘트 고관절 전치환술

문경호 ( Kyoung Ho Moon ),박현우 ( Hyun Woo Park ),이정윤 ( Jung Youn Lee ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.2

Hip dysplasia in its end stage may require arthroplasty, and the pathological anatomy of chronically dislocated hips makes reconstruction far more difficult in them than in most cases. Total hip arthroplasty with subtrochanteric shortening osteotomy was performed on five Crowe VI developmental dysplasia of the hip in four women. The clinical and radiological results of this operative technique were excellent in short term follow-up. This operative technique is useful method in Crowe VI developmental dysplasia of the hip for correcting the leg length discrepancy without permanent neurologic deficit.

대퇴골 전자하 골절에서 발생한 좌골 신경 포착

문경호(Kyoung-Ho Moon),박승림(Seung-Rim Park),김명구(Myung-Gu Kim),이동주(Tong-Joo Lee),배주한(Joo-Han Bae) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.6

좌골 신경 손상은 대부분 관통상 등의 개방창에서 발생되거나, 부적절한 자세로 장시간 고정되어 있는 경우 또는 고관절의 인공관절 수술 이후 발생할 수 있으나, 폐쇄성 대퇴골의 전자하 골절에 의한 좌골 신경 손상은 매우 드문 것으로 알려져 있다. 저자들은 대퇴골 전자하 골절 환자에서 임시적 골 견인 후 신경 마비가 진행된 좌골 신경 포착의 1예를 경험하였고, 이에 대한 처치로 신속한 진단 및 조기에 신경 탐색술을 시행하여 성공적인 결과를 얻었기에 이에 보고하는 바이다. A sciatic nerve injury can arise from a penetrating injury of the thigh, a longstanding malposition or after hip arthroplasty. However, it rarely occurs after a subtrochanteric fracture of the femur. We report a case of sciatic nerve entrapment associated with a subtrochanteric fracture of the femur, which was aggravated after skeletal traction.

NexGen<SUP>®</SUP> 인공 슬관절을 이용한 슬관절 전치환술

문경호(Kyoung-Ho Moon),조규정(Kyu Jung Cho),이동주(Tong Joo Lee),김형기(Hyoung-gi Kim) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.2

목적: NexGen<SUP>®</SUP> 인공 슬관절 전치환술 후 최소 2년 이상 추시가 가능하였던 환자를 대상으로 임상적 및 방사선학적 결과를 분석 평가하고자 하였다. 대상 및 방법: 1996년 7월부터 2002년 6월까지 NexGen<SUP>®</SUP> 인공 슬관절 전치환술을 시행받고 최소 2년 이상 관찰이 가능하였던 67명 100 슬관절을 대상으로 평균 3년 2개월(2-7년) 추시한 결과를 미국 슬관절학회의 평가기준에 따라 슬관절 점수 및 기능 점수를 구하였으며, 방사선학적 평가를 실시하여 비교, 분석하였다. 결과: 평균 운동범위는 퇴행성 관절염 환자 및 류마티스 관절염 환자에서 각각 수술 전 평균 107.4° (50-140˚) 및 105.8˚ (70-120˚)이었고, 최종 추시시 127.2˚ (85-140˚) 및 125.6˚ (90-140)˚로 증가되었으며 굴곡 구축도 각각 수술 전 11.3° (0-30˚) 및 10.6˚(0-30˚)에서 수술 후 1.3˚ (0-15˚) 및 3˚ (0-15˚)로 호전되었다. 미국 슬관절학회의 슬관절 점수 및 기능점수는 퇴행성 관절염 환자에서 각각 수술 전 평균 62점(35-82) 및 40점(0-70)에서 최종 추시시 95.8점(87-100) 및 97점(70-100)으로 향상되었고, 류마티스 관절염 환자에서 수술 전 평람 53.8점(32-73) 및 36점(0-50)에서 최종 추시시 95.1점(89-98) 및 79점(55-95)으로 향상되었다. 합병증으로는 감염이 2예 있어 재수술을 시행하였다. 결론: NexGen<SUP>®</SUP> 인공 슬관절 전치환술은 수술 후 통증감소 및 슬관절 운동범위 등의 기능 회복에 양호한 결과를 보였으며, 낮은 합병증의 발생률을 보였다. Purpose: To evaluate the clinical and radiological results of patients that underwent total knee replacement arthroplasty (TKRA) using a NexGen<SUP>®</SUP> implant, and who were followed up for at least 2 years. Materials and Methods: Between July 1996 and June 2002, 100 knees in 67 patients, and followed up for at least 2 years following TKRA using a NexGen<SUP>®</SUP> implant were retrospectively assessed for clinical and radiological results using the assessment standards of the Knee and Functional Score of the American Knee Society. Results: The average preoperative range of motion in patients with osteoarthritis and rheumatoid arthritis were 107.4° (50-140°) and 105.8° (70-120°), respectively, which had improved to 127.2° (85-140°) and 125.6° (90-140°), respectively, at the final follow up. In addition, the preoperative flexion contracture improved from 11.3° (0-30°) and 10.6° (0-30°) to 1.3° (0-15°) and 3° (0-15°) postoperatively. The results using the assessment standards of the Knee and Functional Score of the American Knee Society were improved from 62 (35-82) and 40 (0-70) to 95.8 (87-100) and 97 (70-100) in patients with osteoarthritis, whereas the patients with rheumatoid arthritis were improved from 53.8 (32-73) and 36 (0-50) to 95.1 (89-98) and 79 (55-95). As a complication, infection occurred in 2 cases; they were given a reimplantation. Conclusion: TKRA using a NexGen<SUP>®</SUP> implant showed satisfactory improvement in pain relief and function, such as range of motion, as well as a lower occurrence rate of complications.

세라믹-세라믹 관절면의 광범위 세공 피복 AML(R)형 고관절 전치환술의 단기 추시 결과

문경호 ( Kyoung Ho Moon ),강준순 ( Joon Soon Kang ),조중모 ( Joong Mo Cho ) 대한고관절학회 2005 Hip and Pelvis Vol.17 No.4

목적: 본 연구는 세라믹-세라믹 관절면을 갖는 무시멘트 광범위 세공 피복 주대를 이용한 일차 인공 고관절 전치환술의 단기 추시 결과를 보고자 하였다. 대상 및 방법: 2001년 4월부터 2003년 1월까지 81명, 86고관절에 세라믹-세라믹 무시멘트성 인공 치환물을 이용한 인공 고관절 전치환술을 시행하였다. 이중 2년 이상 추시가 가능했던 79명, 84 고관절을 연구 대상으로 평가하였다. 수술 당시 평균 연령은 51세 (19~83)였다. 진단으로는 대퇴골두 무혈성 괴사가 44예, 일차성 퇴행성 관절염 8예, 외상성 관절염 7예, 발달성 비구 이형성증 7예, 화농성 고관절염 후유증 7예, 고관절 강직 4예, 대퇴 경부 골절 3예, 기타 4예였다. 결과: 최종 추시 방사선 소견 상 비구컵의 무균성 해리를 보인 경우는 없었으며, 1예에서 의미 있는 대퇴 삽입물의 무균성 해리가 있었고 2예에서 무균성 해리를 의심할 만할 소견을 보였다. 이외에는 전예에서 골침습성 고정을 얻었고 치환물 주위 골용해는 없었다. 합병증으로 수술 중 발생한 세라믹 라이너의 조각 골절이 2예 있었다. 수술 후 3주째에 발생한 후방 탈구가 1예 있었으며 수술 후 6주째에 세라믹 라이너의 해리를 동반한 전방 탈구가 1예 있었다. 결론: 세라믹-세라믹형 인공 고관절 전치환술의 단기 추시 결과는 비교적 만족스러웠으나 정확한 결과를 위하여 장기 추시가 필요할 것으로 사료된다. Purpose: To analyze the prognostic factors influencing clinical outcomes and to aid the surgeon`s decision making concerning conversion of ankylosed hip to total hip arthroplasty (THA). Materials & Methods: Forty-six patients (53 hips) with a mean follow-up duration of 3 years 4 months were studied. Prognostic factors including type of ankylosis, age at fusion, abductor development, fusion duration, preceding diseases, leg length discrepancy, implant type, and trochanteric osteotomy were analyzed. Clinical results were evaluated retrospectively using Harris hip score (HHS; pain, gait, activity), pain scale of adjacent joints, and range of motion. Results: Favorable prognosis factors were severe fibrous ankylosis, spontaneous ankylosis, and age at fusion over 15 years. Unfavorable factors were bony ankylosis, surgical ankylosis, and age at fusion under 15 years in HHS and pain scale of adjacent joints. Strong contraction of the abductor muscle was also an important prognosis factor in HHS, especially in gait. Conclusion: In conversion of ankylosed hip to THA, it is important to recognize the possible prognostic factors and to meet the patient`s various demands and needs.

대퇴골두 무혈성 괴사에서 인공 고관절 치환술적 치료

문경호 ( Kyoung Ho Moon ) 대한고관절학회 2007 Hip and Pelvis Vol.19 No.3