60세 이상 노년층에서의 자발성 슬관절 골 괴사증 (Spontaneous Osteonecrosis of the Knee in the Elderly over 60 Years Old)

서지정보

· 발행기관 : 대한정형외과학회
· 수록지 정보 : 대한정형외과학회지 / 42권 / 5호 / 571 ~ 577페이지
· 저자명 : 임홍철, 노경선, 양재혁, 장기모

초록

=목 적: 60세 이상 노년층에서의 자발성 슬관절 골 괴사증의 병변의 크기와 진행시기에 따른 치료의 결과에 대해 분석하고자 한다. 대상 및 방법: 2000년 1월부터 2004년 6월까지 60세 이상의 환자로 자발성 슬관절 골 괴사증으로 진단받고 추후 경과 관찰이 가능하였던 19명(슬관절 22예)의 환자를 대상으로 하였으며 추시 기간은 평균 20.7개월이었다. 병변의 크기는 슬관절 전후면 단순 방사선 사진에서 병변의 대퇴과에 대한 비율(대퇴과 율, condylar ratio) 및 전후면 사진과 측면 사진에서의 크기를 곱한 값으로 측정하였으며, 단순 방사선상 질환의 진행 시기를 분류하였고 각의 시기에서 병변의 크기를 측정하여 대퇴과 율이 40% 이하이면서 병변의 면적이 5.0 cm2 이하인 경우 보존적 치료를 시행하였으며, 대퇴과 율이 40% 이상이거나 면적이 5 cm2이상인 경우 슬관절 반 치환술 또는 슬관절 전 치환술을 시행하였다. 통계적 분석 방법으로 T-테스트, 스피어만 분석법 및 윌콕슨 분석법을 사용하였다. 결 과: 성별은 여성(15명 79%)에서 많았으며, 발생부위는 좌우 슬관절에 차이가 없었으나 양쪽 슬관절을 침범한

영어초록

Purpose: This study examined the results of treatment according to the stage and size of a
spontaneous osteonecrosis lesion of the knee (SONK) in the patients over 60 years of age.
Materials and Methods: Twenty-two knees from 19 patients over 60 years of age were treated
for spontaneous osteonecrosis of the knee at our institution between January, 2000, and June, 2004.
The mean follow time was 20.7 months. The condylar ratios, proportion of the lesion size to the
condyle were measured. The size was obtained by multiplying the values from the anteroposterior
and lateral radiographs. The stages were classified radiographically, and the treatment results were
analyzed according to the size and stage. Conservative treatment was performed if the ratio and
size were ＜40% and 5.0 cm2, respectively. Arthroplasty was performed if the ratio or size was ＞40%
or 5.0 cm2. A paired T-test, Spearman correlation test and Wilcoxon test were used for the statistical
evaluation.
Results: There was a higher prevalence in females (15 patients, 79%), and the mean age was 65
years (46-77 years). Bilateral involvement was observed in 3 patients. The lesions involved mainly
the medial femoral condyle (21 cases, 95%). Seven cases (31%) had a condylar ratio ＜40% and
15 cases (69%) had a condylar ratio ＞40%. Conservative treatments were performed in 5 cases
staged radiographically as I or II and there were no significant changes in the knee scores (ρ=0.931).
Of the 17 cases staged III and IV radiographically, conservative treatment and arthroplasty were
performed in 7 and 10 cases, respectively. Seven cases, in whom conservative treatments had been
performed, showed a decreased in the knee scores compared with the increased knee scores in
10 patients treated with arthroplasty (ρ=0.943).
Conclusion: An accurate diagnosis and measurement of the size and staging of spontaneous
osteonecrosis of knee in patients over 60 years of age is important for proper treatment. Clinically,
no further progression of symptoms is visible on grade I and II spontaneous osteonecrosis of the
knee after conservative treatment. However, arthroplasty improves the clinical results in patients
with radiological grade III and IV osteonecrosis compared with conservative treatment.

참고자료

· 없음