Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지

Risk Factors for Dislocation after Primary Total Hip Arthroplasty with the Transtrochanteric Approach

경전자 도달법을 이용한 일차성 인공 고관절 전치환술 후 고관절 탈구 발생의 위험 요인

  • Hwang, Kyu-Tae (Department of Orthopedic Surgery, College of Medicine, Hanyang University) ;
  • Kim, Young-Ho (Department of Orthopedic Surgery, College of Medicine, Hanyang University) ;
  • Kim, Yee-Suk (Department of Orthopedic Surgery, College of Medicine, Hanyang University) ;
  • Bong, Hyun-Jong (Department of Orthopedic Surgery, College of Medicine, Hanyang University) ;
  • Choi, Il-Yong (Department of Orthopedic Surgery, College of Medicine, Hanyang University)
  • 황규태 (한양대학교 의과대학 정형외과학교실) ;
  • 김영호 (한양대학교 의과대학 정형외과학교실) ;
  • 김이석 (한양대학교 의과대학 정형외과학교실) ;
  • 봉현종 (한양대학교 의과대학 정형외과학교실) ;
  • 최일용 (한양대학교 의과대학 정형외과학교실)
  • Published : 2010.03.31
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Abstract

Purpose: We wanted to evaluate the risk factors that predispose a patient to dislocation after undergoing primary total hip arthroplasty with the transtrochanteric approach. Materials and Methods: Between July 1995 and May 2007, 593 consecutive total hip arthroplasties using the trantrochanteric approach were performed. A matched comparative study was performed for the dislocated group(18hips) and the non-dislocated control group(18 hips). The patient-related factors and mechanical factors were retrospectively reviewed to evaluate the risk factors for dislocation. Results: Dislocation occurred in 18 hips(3.04%). The mean age was 57.1 years in the dislocated group and 55.2 years for all of the patients (p>0.05). Statistical analyses of the BMI, inclination and anteversion of the cup, lowering of the hip center, a leg length discrepancy, the size of the femoral head and nonunion of the greater trochanter revealed no significant differences between the two groups. Nonunion of the greater trochanter was observed in 16 hips(2.84%). The risk of dislocation was 8.5 times higher in the patients with excessive alcohol intake (p<0.05). The combination of more than 3 risk factors significantly affected the incidence of dislocation after total hip arthroplasty (p<0.05). Conclusion: After primary total hip arthroplasty with the transtrochanteric approach, in the cohort of this study, excessive alcohol intake was the main risk factor for dislocation and a combination of risk factors contributed to dislocation.

목 적: 경전자 도달법을 이용한 일차성 인공 고관절 전치환술 후 고관절 탈구 발생률과 그 위험요인에 대해 알아보고자 한다. 대상 및 방법: 1995년 1월부터 2007년5월까지 경전자 도달법을 이용하여 일차성 고관절 전치환술을 시행 받았던 환자 중 2년 이상 추시가 가능했던 593예를 대상으로 하였다. 수술 후 탈구가 발생한 18예를 대상으로 하였으며 위험 요소 분석을 위해 나이, 성별 및 수술 시기가 비슷하고 원인 질환과 사용된 인공 삽입물이 같은 18예를 대조군으로 선정하여 비교하였다. 탈구에 미치는 요인을 측정하기 위하여 환자 및 기계적 요인을 조사하여 비교하였다. 결과: 탈구는 18예 (3.0 %)에서 발생하였다. 탈구군의 평균 연령은 57.1세이었으며 탈구가 없었던 전체 환자의 평균 연령은 55.2세이었으나 통계학적으로 유의한 차이는 없었다. 탈구군과 대조군의 비교에서 비구컵의 평균 경사각은 탈구군이 $48.3{^{\circ}C}$, 대조군이 $47.7{^{\circ}C}$로 나타났으며, 비구컵의 평균 전염각은 탈구군이 평균 $15.6{^{\circ}C}$, 대조군이 $16.7{^{\circ}C}$로 나타났으나 두 군간의 통계학적으로 유의한 차이는 없었다. 체질량지수, 고관절의 중심 이동, 하지 부동, 사용된 골두 크기의 비교에서도 두 군간의 통계학적 차이는 없었다. 대전자 절골술 후 대전자의 불유합은 16예(2.8 %)이었으나 탈구와 관련된 통계학적 유의성은 없었다. 그러나 습관적 음주력을 가진 경우, 탈구 위험도가 8.5배 높았으며 이는 통계학적으로도 유의한 차이를 보였다(p<0.05). 또한 환자 및 기계적 요인 중 3개 이상의 위험 요인이 복합된 경우, 통계학적으로 유의한 차이를 나타내었다(p<0.05). 결론: 경전자 도달법을 이용하여 일차성 인공 고관절 전치환술을 시행한 본 연구의 대상 환자군에서 탈구 발생은 환자의 습관적인 음주력이 중요한 위험 요인으로 나타났으며 그 외 복합적인 환자 및 기계적 요인에 의해 발생하는 것으로 나타났다.

Keywords

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