Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
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연결형(반구속형) 주관절 인공 관절 치환술

Linked (Semi-constrained) Total Elbow Arthroplasty

  • 정홍준 (국립경찰병원 정형외과) ;
  • 전인호 (울산대학교 의과대학 서울아산병원 정형외과학교실) ;
  • 전재명 (울산대학교 의과대학 서울아산병원 정형외과학교실) ;
  • 이태균 (울산대학교 의과대학 서울아산병원 정형외과학교실)
  • Jung, Hong Jun (Department of Orthopedic Surgery, National Police Hospital) ;
  • Jeon, In-Ho (Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Chun, Jae-Myeung (Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Lee, Tae Kyoon (Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine)
  • 투고 : 2013.10.02
  • 심사 : 2013.10.29
  • 발행 : 2013.12.31
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초록

주관절 인공 관절 치환술은 고관절이나 슬관절 인공 관절 치환술에 비해 아직은 발전 단계에 있는 수술이다. 많은 임상 경험을 통해 여러 형태의 치환물이 개발되어 사용되고 있지만, 이에 대한 장기 추시 결과는 여전히 부족한 실정이다. 현대의 주관절 치환물은 크게 두 가지 디자인 범주로 나누어지는데, 연결형 치환물과 비연결형 치환물이 그것이며, 이들은 다른 말로 반구속형과 비구속형으로 불리기도 하며, 이에 추가적으로 비구속형/구속형 전환 가능한 치환물도 사용되고 있다. 연결형 치환물과 비연결형 치환물의 선택은 우선적으로 주관절의 안정성 및 골성 구조물의 적절성에 의해 결정된다. 연결형 치환물의 경우 전통적으로 마모, 조기 이완, 해리 등과 같은 합병증으로 인해 장기 추시 결과가 좋지 않았던 것이 사실이다. 하지만, 최근 들어 적절한 환자의 선택, 새로운 디자인의 개발, 수술 술기의 발달, 그리고 수술 후 적절한 재활 치료 등으로 인해 이러한 문제점이 많이 해결되었다. 하지만, 여전히 신체적인 활동에 대한 요구가 높은 환자에 있어서는 마모나 이완 등과 같은 문제점으로 인해 연결형 치환물이 적절한 선택이 되지 못하는 경우가 있다. 본 종설에서는 연결형 (반구속형) 주관절 인공 관절 치환물에 대해서 자세히 살펴보고자 한다.

Total elbow arthroplasty is still in its infancy compared with other arthroplasties, such as knee or hip arthroplasties. Implant design has been evolving with clinical experiences; however, there are only limited data on the long-term clinical outcome of elbow arthroplasty in the literature. The design of total elbow prostheses can be divided into three categories: linked (constrained or semi-constrained), unlinked (unconstrained), and convertible types. The choice between an unlinked (unconstrained) implant and a linked (semi-constrained) implant depends on joint stability and adequacy of the bone stock. Linked elbow arthroplasty has provided high patient satisfaction, and pain relief thanks to proper patient selection, advancement of implant design, improvement in cement techniques, meticulous surgical technique, and appropriate postoperative rehabilitation. Concerns remain about the use of this implant in young or high-demand patients. This article focuses on the linked (semi-constrained) prostheses, which provides an overview of the current state of linked total elbow arthroplasty.

키워드

참고문헌

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