05-03 장세앙(국)

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1 ORIGINAL ARTICLE Print ISSN Online ISSN Arthroscopic Treatment of Cam Type Femoroacetabular Impingement: Short Term Results Se-Ang Jang, MD, Young-Ho Cho, MD, Young-Soo Byun, MD, PhD, Ki-Hong Park, MD, Han-Sang Kim, MD, Chul Jung, MD Department of Orthopedic Surgery, Daegu Fatima Hospital, Daegu, Korea Purpose: We evaluated the short term results after treatment of cam type femoroacetabular impingement (FAI) by arthroscopy. Materials and Methods: We evaluated the clinical and radiological results of arthroscopically treated cam type FAI in patients who had failed conservative treatment with hip pain, with at least 12 months follow-up, from November 2010 to December There were 19 males and six females. Mean age of patients was 32.9 years (19-57 years) and mean follow up period was 17.2 months (13-31 months). We analyzed the alpha angle, head neck offset, visual analogue scale (VAS), and modified Harris hip score (MHHS). Results: Mean alpha angle improved from 64.8 to 39.9 and mean head neck offset also improved from 0.8 to 7.6 mm. Peripheral longitudinal and radial fibrillated labral tear was the most common in the anterosuperior quadrant. Damage to acetabular cartilage was identified in 14 patients. Mean VAS improved from 6.3 to 0.9 and mean MHHS improved from 51.7 to Complications associated with the operation included three cases of femoral head articular cartilage injury, two cases of pudendal nerve injury, and two cases of lateral femoral cutaneous nerve injury. Conclusion: Although the short term results for arthroscopically treated cam type FAI were satisfactory, care must be taken to reduce the complications associated with arthroscopy and long term follow is needed in order to determine whether or not it can reduce osteoarthritis of the hip. Key Words: Cam type, Femoroacetabular impingement, Arthroscopic treatment Submitted: December 17, st revision: February 11, nd revision: February 18, 2014 Final acceptance: February 20, 2014 Address reprint request to Young-Ho Cho, MD Department of Orthopedic Surgery, Daegu Fatima Hospital, 99 Ayang-ro, Dong-gu, Daegu , Korea TEL: FAX: This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 서 론 대퇴비구충돌은젊고활동적인환자에서고관절동통의원인으로알려져있으며또한원인이알려지지않았던퇴행성고관절염의원인으로주목받고있다 1-9). 대퇴비구충돌은전외측대퇴골및비구부의해부학적이상으로인해발생하며, 대퇴골의골성이상인 cam 형과비구부의이상인 pincer 형으로나뉜다 1,3,4,7). 증상이있으며보존적치료에반응하지않는대퇴비구충돌의치료를위해개방적술식과 10) 관절경을이용한최소침습적방법이소개되었으며 11-15), 이외에도관절경과개방적술식을혼합하여치료하는경우도 Copyright c 2014 by Korean Hip Society 29

2 있다 16,17). 특히 Byrd 와 Jones 12) 는대퇴비구충돌자체가고관절의통증을유발하지는않으나이로인해관절내병변, 즉비구순파열이나관절연골의손상이동반된환자들이고관절특히서혜부의동통을호소한다고하였다. 이에서혜부동통을호소하며방사선사진에서전외측대퇴골두경부에골성이상을가진 cam 형대퇴비구충돌환자들에대해관절경을이용하여골성병변을치료한후관절경소견과합병증및임상적방사선적결과를알아보고하고자하였다. 대상및방법 2010 년 11 월부터 2012 년 12 월까지대구파티마병원정형외과에서고관절동통이있는환자가운데 cam 형대퇴비구충돌로진단되고최소 3 개월이상의보존적치료에실패한환자들중방사선촬영상확실한고관절의이형성, LCP 병등의소아기고관절질환자, 비구에 pincer 형변형이동반된환자및추시기간이짧은환자를제외한 25 명 (30 예 ) 에대해관절경적치료후 12 개월이상추시관찰된환자들을후향적으로분석하였다. 남자는 19 명 (24 예 ), 여자는 6 명 (6 예 ) 이었다. 평균연령은 32.9 세 (19-57 세 ) 였고, 평균추시기간은 17.2 개월 (13-31 개월 ) 이었으며, 술전평균동통의기간은 23.6 개월 (1-120 개월 ) 이었다. 술전이학적검사로고관절을굴곡, 내전, 내회전시에통증의발생유무를확인하는충돌검사 (impingement test) 를하였고, 방사선검사로골반전후 (anteroposterior) 와개구리다리상 (frog leg view) 및 3 차원컴퓨터단층촬영, 혹은자기공명영상촬영을시행하였다. 특히컴퓨터단층촬영이나자기공명영상촬영시대퇴골의경부에대해사면축상 (oblique axial) 영상을찍어대퇴골의변형을확인하였다. 수술은근육의충분한이완을위해전신마취를시행하였으며, 골절대에환자를앙와위 (supine position) 로눕힌후회음부신경보호를위해두꺼운패드를이용하였고, 반대측다리를고정한후관절간격이약 10 mm 확보될정도로견인을시행하였다. 전외측및전방삽입구를이용하여중앙구획 (central compartment) 에접근한뒤비구순및관절연골의손상을확인하고치료하였다. 그후견인을풀고고관절을약 30 정도굴곡한상태에서전방관절낭을 T- 형으로절개하고변연구획 (peripheral compartment) 에접근하였으며, 대퇴골두경부의융기 (bump) 및줄어든 offset 을확인한후 5.5 mm 관절경절삭기 (arthroscopic burr) 를이용하여대퇴골성형술을시행하였다. 골절제의적절성은영상증폭장치를통해확인하였으며, 수술을끝내기전고관절을굴곡, 내전및내회전하여관절내충돌여부를한번더확인하였고절개한관절낭은봉합하지않았다. 술후모든환자에게다음날부터능동적관절운동및보행을허용하였으나고관절을 90 이상굴곡하거나관절의갑작스런비틀림이일어나는동작은피하도록하였다. 수술과 관련된합병증을조사하였으며, 수술전후방사선적지표로알파각및 offset 을평가하였고 18,19), 임상적지표로변형된 Harris 고관절점수 (modified Harris hip score) 및 visual analogue scale (VAS) 을조사하였다. 통계적분석을위해비모수 Wilcoxon Signed Ranks Test 를이용하였다. 결 과 환자들의병력에서뚜렷한외상력이있는환자는없었으며, 술전이학적검사에서모든환자에서충돌검사는양성이었다. 방사선검사상골반전후면에서권총손잡이변형 (pistol grip deformity) 20,21) 을보인환자는 11 예였고, Tönnis 분류 22) 에서 1 단계의관절염소견을보인환자가 1 명이었으며나머지는모두단순방사선촬영에서관절염소견을보이지는않았다. 수술시간은평균 121 분 ( 분 ) 이었고이가운데견인을시행한시간은평균 29.8 분 (14-60 분 ) 이었다. 관절경소견에서모든환자가정도의차이는있었으나비구순파열을동반하고있었고, 파열은모두전상방구획에서확인되었다 (Fig. 1). 변연부종파열과방사형소섬유성파열 (peripheral longitudinal and radial fibrillated tear) 이복합된형태가 17 예로가장많이관찰되었다. 비구순파열은전예에서관절면부분 (articular side) 만파열이확인되고관절낭부분 (capsular side) 은견고하게부착되어있어재고정을필요로하는경우는없었고변연절제만시행하였다 (Table 1). Cam 형대퇴비구충돌에서비구연골에발생하는특징적인병변인 carpet 병변도 6 예에서관찰되었다. 6 예모두에서변연부가비교적안정적 Fig. 1. Arthroscopic finding shows the labral contusion (arrow head) and peripheral longitudinal tear (arrow) at anterosuperior quadrant of the acetabulum. 30

3 Se-Ang Jang et al. Arthroscopic Treatment of Cam Type FAI 이어서전기소작기 (electrocautery) 로정리만하였을뿐연골제거후미세천공술 (microfracture) 등의추가적인시술은하지않았다. Carpet 병변이외의비구부관절연골손상이확인된환자는 9 명이었고, 2 명은 Carpet 병변과동반되어있었다. Outerbridge 의분류 23) 에따라관절연골손상을분류하였을때 2 단계가 8 예, 3 단계가 2 예, 4 단계가 1 예였다 (Fig. 2). 알파각은술전평균 64.8 (55-74 ) 에서술후평균 39.9 (34-42 ) 로호전되었고 (Z= 4.940, P<0.001), offset 은술전평균 0.8 mm ( 1-3 mm) 에서술후평균 7.6 mm (6-9 mm) 로호전되었다 (Z= 4.956, P<0.001)(Table 2, Fig. 3). VAS 는술전평균 6.3 (5-9) 에서최종추시시 0.9 (0-3) 로 (Z= 5.017, P<0.001), 변형된 Harris 고관절점수는 51.7(13-63) 에서최종추시시 73.6 (58-79) 로호전되었다 (Z= 4.947, P<0.001). 수술과관련된합병증으로관절경삽입시발생한대퇴골두연골손상이 3 예, 회음부신경손상이 2 예, 외측대퇴피신경손상이 2 예였다. 회음부신경손상은대부분 1 개월이내완전회복되었으며, 외측대퇴피신경의경우 3 개월정도지나서모두회복되었다. A B C Fig. 2. Variable articular cartilage lesions. According to Outerbridge classification, (A) grade 2 partial thickness defect of cartilage (arrow); (B) grade 3 partial thickness defect with diameter more than 1.5 cm (arrow head); and (C) grade 4 full thickness acetabular cartilage defect (asterisk) can be seen. Table 1. Radiographic and Arthroscopic Findings of the Patients Variable Patient Pistol grip deformity 11 (36.6) Tönnis grade 0 29 (96.6) 1 01 (03.4) Labral tear Longitudinal and radial fibrillated 17 (56.6) Radial fibrillated 07 (23.4) Longitudinal 3 (10). Radial flap and fibrillated 3 (10). Carpet lesion 6 (20). Values are presented as number (%). Table 2. Pre and Post-operative Radiographic Parameters Parameter Pre-operation Post-operation Alpha angle ( ) 64.8 (55-74) 39.9 (34-42) Head-neck offset (mm) 0.8 (1-3) 7.6 (6-9) Values are presented as mean (range). 31

4 고 찰 원인미상의고관절퇴행성관절염이대퇴골두경부나비구부의비정상적인해부학적구조로인한대퇴비구충돌의결과로발생한다는사실이알려진후충돌이일어나지않도록하기위한치료로골절제술이주목받고있다 1-18). 일찍이 Stulberg 등 21) 은근위대퇴골의권총손잡이변형 (pistol-grip deformity) 에대해기술하였고, 이러한작은변형이고관절관절염의원인이므로조기에발견하여치료하는것이좋다고하였다. 하지만이러한내용은주목받지못하다가 Ganz 등 10) 에의해대전자 flip 절골술후고관절을전방탈구시켜충돌부위를확인하고비정상적인부위의골에대해골절제술과동반된비구순손상에대해치료한결과가발표되면서다시주목받고있다 5,6,10). 그러나이러한수술방법은절개부위가커수술후회복시간이많이걸리고, 대전자절골부의불유합, 대퇴골두무혈성괴사등의합병증이발생할수있다. 고관절에대한관절경술식은여타의관절에비해수술에익숙해지기위해서는상대적으로긴학습곡선을필요로하지만 24), 개방적술식에비해적은절개로인해수술후회복시간이빠르며, 입원기간이단축되고, 관절경을통해관절을관찰할경우확대해서보게되므로미세한병변까지확인할수있는장점이있다. 이러한이유로인해현재대퇴비구충돌에대해서는고관절관절경을이용한치료가확대되고있다 11-15). Cam 형대퇴비구충돌을확인하기위한방사선적지표로알파각과 offset 이주로사용되고있다. Nötzli 등 18) 은자기공명영상을이용하여대퇴골경부의장축에대한축상영 상에서대퇴골두의중심을지나는영상을이용해알파각을측정하였다. 이에따르면알파각의경우대퇴비구충돌에의한증상이없는대조군은평균 42 (33-48 ), 증상이있는환자군은평균 74 (55-94 ) 를보인다고하였다. 이에따라알파각이 55 보다큰경우비정상인것으로해석한다. 그러나 Neumann 등 25) 은정상비구에대해알파각이 43 이하일경우충돌없는고관절을만들수있다고하여 Nötzli 등 18) 보다엄격한기준을제시하였다. Offest 의경우 Tannast 등 19) 은 10 mm 를기준으로이보다작은경우 cam 형충돌이일어날수있다고하였다. 본연구에서는자기공명영상이고비용인이유로좀더저렴한컴퓨터단층촬영을이용해 Nötzli 등 18) 과동일한방법으로측정하였으며이또한유용한방법이라생각된다 (Fig. 4). 이러한방법으로측정한알파각은술전평균 64.8 (55-74 ) 에서술후평균 39.9 (34-42 ) 로통계적으로유의하게호전되었고 (Z= 4.940, P<0.001), offset 은술전평균 0.8 mm ( 1-3 mm) 에서술후평균 7.6 mm (6-9 mm) 으로호전되었다 (Z= 4.956, P<0.001). Offset 의경우 Tannast 등 19) 가제시한값에비해적었으나수술시관절경을통해충돌이일어나지않는것을확인하였다. 이는서양인들을기준으로측정된값으로저자들은뼈의크기가작은동양인들에대해서는새로운기준이마련되어야한다고생각한다. 개방적술식에서와마찬가지로관절경을이용한술식에서도골절제술이끝난후수술을마치기전충돌이일어나는지를확인하는것이중요하며이러한과정이알파각과 offset 을측정하는것보다더중요하리라생각된다. 고관절비구순파열은외상에의해발생하는경우는드 A B C D Fig. 3. Pre-operative anteroposterior (A) and frog leg (B) radiographs of the left hip show asphericity of femoral head and mild pistol-grip deformity and negative head-neck offset and alpha-angle. Alpha angle is shown at B and D. Post-operative anteroposterior (C) and frog leg (D) radiographs show restored sphericity of the femoral head and restored impingement free head-neck offset. The head-neck offset is distance between two parallel lines (B, D). 32

5 Se-Ang Jang et al. Arthroscopic Treatment of Cam Type FAI 물며대부분은대퇴비구충돌이나고관절이형성증에서발견된다 26,27). 이러한이유로저자들은 Cam 형대퇴비구충돌이확인된환자에서는비구순파열을확인하기위해자기공명영상을촬영하지않고골성변형을확인하기위해컴퓨터단층촬영을활용하였다. 하지만자기공명영상이나자기공명관절조영술은대퇴골두무혈성괴사나비구순병변, 그외관절주변의연부조직의병병을확인하기위해서는유용한검사이다. Lage 등 28) 은비구순파열에대해관절경소견을기초로형태학적으로분류하였는데이에따른저자들의관절경소견상비구순파열중변연부종파열 (peripheral longitudinal tear) 과방사형소섬유성파열 (radial fibrillated tear) 이복합된형태가 17 예 (56.6%) 로가장많이관찰되었다. 변연부종파열의경우 Cam 형대퇴비구충돌에서고관절굴곡시비구변연부와대퇴두경부사이에발생하는전단력으로인해발생하며특징적인소견이라할수있다. 병변이진행하더라도관절면부분 (articular side) 만파열이발생하며이보다더오랫동안충돌이발생한경우관절낭부분 (capsular side) 까지도파열이확장될수있다. 본연구에서확인된전예에서는관절면부분만파열이발생하여비구순에대한재고정이필요한환자는없었다. 이는본연구가순수한 Cam 형환자들만을대상으로하였기때문으로판단되며 pincer 형과복합된환자들의경우관절낭부분까지도파열이확장된것을확인할수있다. Cam 형대퇴비구충돌에서연골에발생하는특징적인병변인 carpet 병변은비구부관절연골이연골하골에서박리되는상태를말하며이는 Cam 형충돌에서보이는특징적인소견이다 7). 본연구에서는 6 예의 carpet 병변을확인할수있었다. 그러나그범위가크지않고불안정하지않아부착을위한추가적인술식이나제거후미세천공술등은하지않았다. 저자들은대퇴골연골성형 (femoral Fig. 4. Alpha angle is shown at oblique axial view of the femur neck on computed tomogram. osteochondroplasty) 시발생하는출혈과여기서나오는여러가지물질들이접합에도움이될것이라생각하며, 대퇴골연골성형술을시행함으로써병변부위에더이상의전단력이가해지지않도록하는것또한병변의치유를촉진하리라생각한다. 하지만이는 2 차관절경시술등을통해밝혀져야할것이다. Carpet 병변을제외하고도 11 예에서관절연골손상이확인되었는데 Outerbridge 의분류 23) 에따라관절연골손상을분류하였을때 2 단계가 8 예, 3 단계가 2 예, 4 단계가 1 예였다. 이는방사선소견에서는정상적인관절로보이나관절염이있는것을확인한것으로대퇴비구충돌이고관절퇴행성관절염의원인이라는사실을뒷받침한다. 특히연골손상의정도가 4 단계였던환자의경우약 10 년간의고관절동통이있었던환자로보존적치료만을시행한경우였다. 파열된비구순에대해변연절제술을시행하였고, 수술중관류액으로관절내부를충분히세척함으로수술후부분적인동통의완화를확인할수있었지만정상적인관절로만들어줄수는없기에조기발견및치료의중요성을새삼확인하는계기가되었다. 임상적지표로 VAS 와변형된 Harris 고관절점수를사용하였다. VAS 는술전평균 6.3 (5-9) 에서최종추시시 0.9 (0-3) 로 (Z=5.017, P<0.001), 79 점만점의변형된 Harris 고관절점수는 51.7 (13-63) 에서최종추시시 73.6 (58-79) 으로호전되었다 (Z=4.947, P<0.001). 임상적호전의정도는관절연골손상정도및대퇴골성형술의정확성과관련이있으며초기에수술한환자들의경우숙련되지못한관절경기술로인해대퇴골성형술이정확히되지않아결과가만족스럽지못한것으로분석되었으며수술이거듭될수록양호한결과를얻었다. 수술과관련된합병증으로관절경삽입시발생한대퇴골두연골손상이 3 예, 회음부신경손상이 2 예, 외측대퇴피신경손상이 2 예였다. 관절경을처음삽입할때관절을충분히견인하지않거나너무대퇴골로치우칠경우관절연골의손상을초래할수있으므로주의해야하며, 비구부쪽으로치우칠경우비구순에손상을줄수있으므로주의를요한다. 적절한견인에대해서는논란의여지는있으나저자의경험상관절이약 10 mm 정도견인되고, 60 분이내로견인할경우회음부신경손상을피할수있었다. 그리고신경손상을막기위해회음부에적적한패드를사용하는것도권장된다. Cam 형대퇴비구충돌의경우중앙구획의확인및처치를위해오랜시간이걸리지않으므로대부분에서견인시간은 60 분이내였다. 그러나본연구에서회음부신경손상이발생한 2 명의환자들은모두체질량지수가 29 이상이었던환자들로, 관절의충분한견인을위해과도한힘이작용했던것으로판단된다. 회음부신경손상은압박에의해발생하므로모든환자에서 1 개월이내에완전히회복되었다. 전방삽입구의피부바로아래에는외측대퇴피신경이주행하는데이의손상을방지하기위해피부 33

6 만절개하고, 피하는모두뭉툭한절개 (blunt dissection) 를하여신경이절단되는것을방지하도록하여야한다. 저자들의증례에서발생한 2 예의외측대퇴피신경손상은 3 개월이내모두회복되었다. 원인으로전방삽입구를통해관절경기구가자주이동하였고, 이러한기구들의과도한움직임으로인해주변신경이자극되었으나날카로운칼에의해절단된것은아닌것으로판단된다. 본연구의단점은적은증례수및짧은추시기간으로, 향후더많은환자들에대해장기간의연구가필요하리라생각된다. 결 론 관절경을이용한 cam 형대퇴비구충돌의단기추시결과는비교적만족할만하였으나, 관절경술식과관련되어합병증을줄이기위해좀더세심한주의를필요로하며, 관절염발생을줄일수있는지에대한장기적인연구가필요하리라생각된다. REFERENCES 01.Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003; (417): Tannast M, Goricki D, Beck M, Murphy SB, Siebenrock KA. Hip damage occurs at the zone of femoroacetabular impingement. Clin Orthop Relat Res. 2008;466: Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466: Siebenrock KA, Wahab KH, Werlen S, Kalhor M, Leunig M, Ganz R. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res. 2004;(418): Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: part I. Techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;(418): Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004; (418): Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005; 87: Crawford JR, Villar RN. Current concepts in the management of femoroacetabular impingement. J Bone Joint Surg Br. 2005;87: Leunig M, Beaulé PE, Ganz R. The concept of femoroacetabular impingement: current status and future perspectives. Clin Orthop Relat Res. 2009;467: Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83: Byrd JW, Jones KS. Arthroscopic management of femoroacetabular impingement: minimum 2-year followup. Arthroscopy. 2011;27: Byrd JW, Jones KS. Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin Orthop Relat Res. 2009;467: Guanche CA, Bare AA. Arthroscopic treatment of femoroacetabular impingement. Arthroscopy. 2006;22: Larson CM, Giveans MR. Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy. 2008;24: Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br. 2009; 91: Clohisy JC, McClure JT. Treatment of anterior femoroacetabular impingement with combined hip arthroscopy and limited anterior decompression. Iowa Orthop J. 2005;25: Laude F, Sariali E, Nogier A. Femoroacetabular impingement treatment using arthroscopy and anterior approach. Clin Orthop Relat Res. 2009;467: Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84: Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis-what the radiologist should know. AJR Am J Roentgenol. 2007;188: Goodman DA, Feighan JE, Smith AD, Latimer B, Buly RL, Cooperman DR. Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip. J Bone Joint Surg Am. 1997;79: Stulberg SD, Cordell LD, Harris WH, Ramsey PL, MacEwen GD. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. In: Cordell LD, Harris WH, Ramsey PL, MacEwen GD, eds. The Hip: Proceedings of the third open scientific meeting of The Hip Society. St Louis, MO: CV Mosby; Tönnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81: Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43-B: Lee YK, Ha YC, Hwang DS, Koo KH. Learning curve of basic hip arthroscopy technique: CUSUM analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21: Neumann M, Cui Q, Siebenrock KA, Beck M. Impingement-free hip motion: the normal angle alpha after osteochondroplasty. Clin Orthop Relat Res. 2009; 467: Byrd JW, Jones KS. Prospective analysis of hip arthroscopy 34

7 Se-Ang Jang et al. Arthroscopic Treatment of Cam Type FAI with 2-year follow-up. Arthroscopy. 2000;16: Tanzer M, Noiseux N. Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res. 2004;(429): Lage LA, Patel JV, Villar RN. The acetabular labral tear: an arthroscopic classification. Arthroscopy. 1996;12: 국문초록 Cam 형대퇴비구충돌의관절경적치료 : 단기추시결과 장세앙 조영호 변영수 박기홍 김한상 정정철대구파티마병원정형외과 목적 : 증상이있는 cam 형대퇴비구충돌에대해관절경으로치료한환자들의단기추시결과를알아보고자하였다. 대상및방법 : 2010 년 11 월부터 2012 년 12 월까지고관절동통을동반한 cam 형대퇴비구충돌중보존적치료에실패하여관절경치료후최소 12 개월이상추시관찰된환자들에대해임상적및방사선적결과를알아보고자하였다. 남자는 19 명, 여자는 6 명, 평균연령은 32.9 세 (19-57 세 ), 평균추시기간은 17.2 개월 (13-31 개월 ) 이었다. 알파각, offset, 변형된 Harris 고관절점수및 visual analogue scale (VAS) 을조사하였다. 결과 : 알파각은평균 64.8 에서 39.9, offset 은평균 0.8 mm 에서 7.6 mm 로호전되었다. 비구순파열은전상방구획에서변연부종파열및방사형소섬유성파열이가장많았다. 비구연골손상은 14 예에서확인되었다. VAS 는술전평균 6.3 에서 0.9 로, 변형된 Harris 고관절점수는 51.7 에서 73.6 으로호전되었다. 수술과관련된합병증으로관절경삽입시발생한대퇴골두연골손상이 3 예, 회음부신경손상이 2 예, 외측대퇴피신경손상이 2 예였다. 결론 : 관절경을이용한 cam 형대퇴비구충돌의단기추시결과는만족할만하였으나, 관절경술식과관련된합병증을줄이기위해좀더세심한주의를필요로하며, 관절염발생을줄일수있는지에대한장기적인연구가필요하리라생각된다. 색인단어 : Cam 형, 대퇴비구충돌, 관절경적치료 35

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