인공 주관절 전 치환술의 장기 추적시 기구에 따른 합병증과 재치환율 (Complications and Revision Rate as the Type of Prosthesis of Total Elbow Replacement: Long-term Follow-up in Korea)

서지정보

· 발행기관 : 대한정형외과학회
· 수록지 정보 : 대한정형외과학회지 / 45권 / 1호 / 10 ~ 15페이지
· 저자명 : 김정만, 이상명, 박재철, 송석환, 정양국, 부기현, 이승구

초록

목적: 주관절 전 치환술의 기구에 따른 기능 및 합병증, 재치환율에 대한 보고는 많지 않다. 저자들은 반구속형과 비구속형 주관절 전 치환술을 시행한 환자들을 비교하여 기능 및 합병증, 재치환율을 평가하였다.
대상 및 방법: 78예 71명의 환자를 대상으로 연구를 시행하였으며 평균 나이는 54세였고, 류마티스 관절염 42예, 외상성 관절염 24예, 퇴행성 관절염 5예였다. 35예에서 비구속형 치환술, 43예에서 반구속형 치환술을 시행하였다. 최종 결과는 Mayo 주관절 수행 점수(MEPS) 및 주관절 운동 범위, 합병증 및 재치환술 비율로 측정하였다.
결과: MEPS 및 능동 굴곡-신전은 술 전에 비해 술 후 호전되었다(p＜0.001, p＜0.001). 비구속형 군과 반구속형 군 간의 수술 후 MEPS와 운동 범위는 차이가 없었다(p=0.764, p=0.728). 합병증은 비구속형 군이 반구속형 군보다 높았다(p=0.014). 그러나 재치환율과 기구 이완은 비구속형 군과 반구속형 군 간에 차이가 없었다(p=0.402, p=0.382).
결론: MEPS 및 운동 범위는 비구속형 군과 반구속형 군 모두 호전되었다. 그러나 반구속형 치환술이 비구속형 치환술에 비해 합병증이 낮으므로 반구속형 치환술이 추천된다.

영어초록

Purpose: Few studies have compared the outcomes, complications and revision rate of a total elbow replacement (TER) prosthetic design. This study examined a series of patients with semiconstrained and unconstrained total elbow replacements (TER) and evaluated them for any functional differences, complications and revision rates that might be attributable to the prosthetic design.
Materials and Methods: A total 78 cases of primary TER was performed in 71 patients. Their mean age at TER was 54 years.
The causes of TER were rheumatoid arthritis in 42, post-traumatic arthritis and osteoarthritis 24 and 5 patients, respectively.
Unconstrained and semiconstrained TER was employed in 35 and 43 cases, respectively. The end results of TER by the Mayo elbow performance score (MEPS), their elbow range of motion before and after surgery, their complications and revision rates after an average 13 year follow-up were evaluated.
Results: The MEPS was improved from 33 points pre-operatively to 87 points post-operatively (p<0.001). Active flexion-extension elbow motions were also improved markedly from 27o-86o pre-operatively to 16o-128o postoperatively (p<0.001). There was no significant difference between the semiconstrained and unconstrained TER in the post-operative MEPS (p=0.764) and range of motion (p=0.728). The complication rate was much higher in the unconstrained groups than in the semiconstrained group (p=0.014). The mean total revision rate was 29.5%. There was no significant difference in revision rate between the unconstrained and semiconstrained groups (p=0.402). Loosening was found in a total of 12 cases (15.4%). There was also no significant difference in loosening between the semiconstrained and unconstrained groups (p=0.382).
Conclusion: Favorable results of MEPS and elbow motion were obtained in both the unconstrained and semiconstrained types after an average 13 year follow up after TER. However, the semiconstrained type of TER showed a lower complication rate than the unconstrained type of TER.

참고자료

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