07-09 김의창(국)

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1 ORIGINAL ARTICLE Hip Pelvis 25(2): , Print ISSN Online ISSN Recovery of Limitation of Motion in Secondary Osteoarthritis of the Hip Using Arthroscopy Eui-Chang Kim, MD*, Deuk-Soo Hwang, MD, Chan Kang, MD, Yoo-Sun Jeon, MD, Gi-Soo Lee, MD Department of Orthopedic Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea, On Orthopedic Clinic, Suwon, Korea*, Department of Orthopaedic Surgery, Bumin Hospital, Busan, Korea Purpose: To analyze the arthroscopic findings and treatment results of patients with a limitation of hip motion caused by early degenerative osteoarthritis. Materials and Methods: Retrospective analysis was performed on 13 patients who underwent arthroscopic treatment from May 2009 to March 2010, among patients with a limitation of hip motion and femoroacetabular impingement symptoms by early degenerative osteoarthritis. Head-neck offset, anteversion, and a change in the alpha angle was compared. At the final follow up, the V (Visual analogue scale), modified Harris hip score, and range of motion were compared. Results: The arthroscopic findings showed diffused synovitis in all 13 cases. Among them, 9 cases were accompanied with a labral tear, and 2 cases showed a labral deformity. The V decreased from 7.5 preoperatively to 1.8 postoperatively and the modified Harris hip score improved from 49.3(35-60) before surgery to 90.1(85-95) after surgery. Each flexion and internal rotation improved significantly (P<0.05) from 95.2(60-120) to 127.7( ) and 4.6(-5-25) to 25.4(15-30), respectively. Conclusion: This study shows that the arthroscopic treatment of femoroacetabular impingement with a limitation of the range of motion by early degenerative arthritis can be expected with an improvement in flexion and internal rotation of the hip. Key Words: Secondary degenerative osteoarthritis, Limitation of motion of hip, Arthroscopy Submitted: April 21, st revision: May 15, nd revision: May 30, rd revision: June 14, 2013 Final acceptance: June 16, 2013 Address reprint request to Deuk-Soo Hwang, MD Department of Orthopedic Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, 33 Munwha-ro, Jung-gu, Daejeon , Korea TEL: FAX: dshwang@cnu.ac.kr 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. Copyright 2013 by Korean Hip Society 121

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3 Eui-Chang Kim et al.: Recovery of Limitation of Motion in Secondary Osteoarthritis of the Hip Using Arthroscopy Table 1. Summary of Cases No Sex Age Diagnosis Treatment Preoperative* Alpha V MHHS Flex Ext IR ER Abd Add Postoperative* Alpha V MHHS Flex Ext IR ER Abd Add 01 M 60 FAI (Cam) ALT, 02 F 46 ALT 03 M 20 SCFE ALT F 26 Achondroplasia ALT Acetabuloplasty 05 M 20 ALT M 17 ALT M FAI (cam) 08 M 35 ALT M M 20 FAI (cam) FAI (cam) M 28 FAI (cam) ALT 12 M 69 FAI (Pincer) DISH Loose Body Removal Chondromatosis 13 M 32 FAI (Mixed) Partial Labrectomy LCP** Acetabuloplasty Loose Body ALT Loose Body Removal Avr * Alpha: alpha angle, V: visual analogue scale, MHSS: modified Harris hip score, Flex: flexion, Ext: extension, IR: internal rotation, ER: external rotation, Abd: Abduction, Add: Adduction, FAI: femoroacetabular impingement, ALT: acetabular labral tear, SCFE: slipped capital femoral epiphysis, : ankylosing spondylitis of the hip, DISH: diffuse idiopathic skeletal hyperostosis, ** LCP: Legg-Calve-Perthes disease

Hip Pelvis 25(2): 121-126, 2013 부터 전방 삽입부까지 관절낭 절개술을 모두 시행하였다. 고관절은 기하학적 형태에 의해 고유의 안정성을 가지고 있는 관절로써 관절낭의 해부학, 기능, 생리학에 대하여는 널리 알려져 있다10,11).

4 Hip Pelvis 25(2): , 2013 부터 전방 삽입부까지 관절낭 절개술을 모두 시행하였다. 고관절은 기하학적 형태에 의해 고유의 안정성을 가지고 있는 관절로써 관절낭의 해부학, 기능, 생리학에 대하여는 널리 알려져 있다10,11). Shindle 등12)은 관절낭의 나선형 모 양과 둘레띠(zona orbicularis)에 의해 과잉신전과 외회전 시에 안정성 유지에 기여를 한다고 하였다. 또한 Myer 등13) 은 관절낭이 고관절의 안정성에 기여를 하며 카대바 연구 에서 관절낭 절개술 시행시 외회전과 전방전이를 증가 시 킴을 보고하였다. 그러나 본 연구에서는 절개된 관절낭을 A 모든 예에서 봉합하지 않았고 전방전이는 알 수 없으나 신 전과 외회전의 경우 크게 증가 소견을 보이지는 않았다. 이 는 고관절의 일치성이 유지가 되고 있으며 관절 운동을 보 이는 골성 변형만 제거를 하였기 때문으로 생각된다. 그러 나 관절낭의 절개에 의한 관절 운동범위의 증가를 무시할 수는 없을 것으로 사료되며 통계학적 유의성은 없었으나 외회전과 신전 역시 평균 운동 범위는 약간의 증가 소견을 보이고 있어 관절낭 절개가 관절 운동 범위 증가에 기여를 할 수 있을 것으로 생각되고 이에 대한 연구가 필요할 것이다. B C D Fig year old male patient showed limitation of ROM due to sequelae of LCP of the left hip. (A A) 3D CT image. (B B) C) Arthroscopic findings of the hip after Preoperative measurement of flexion degree of the hip under general anesthesia. (C D) Postoperative 3D CT findings. performing femoroplasty, and flexion degree of the hip after operation. (D 124

5 Eui-Chang Kim et al.: Recovery of Limitation of Motion in Secondary Osteoarthritis of the Hip Using Arthroscopy REFERENCES 01.Byrd JW, Jones KS. Adhesive capsulitis of the hip. Arthroscopy. 2006;22: Kelly BT, Weiland DE, Schenker ML, Philippon MJ. Arthroscopic labral repair in the hip: surgical technique and review of the literature. Arthroscopy. 2005;21: McCarthy JC. Hip arthroscopy: when it is and when it is not indicated. Instr Course Lect. 2004;53: Sampson TG. Complications of hip arthroscopy. Clin Sports Med. 2001;20: Kim KW, Lee TH, Nam WD, Rhyu KH. Normal adult hip range of motion focusing hip flexion. J Korean Orthop Assoc. 2006;41: Philippon MJ, Christensen JC, Wahoff MS. Rehabilitation after arthroscopic repair of intra-articular disorders of the hip in a professional football athlete. J Sport Rehabil. 2009;18: Kubiak-Langer M, Tannast M, Murphy SB, Siebenrock KA, Langlotz F. Range of motion in anterior femoroacetabular impingement. Clin Orthop Relat Res. 2007;458: Eijer H, Myers SR, Ganz R. Anterior femoroacetabular impingement after femoral neck fractures. J Orthop Trauma. 2001;15: Siebenrock KA, Schoeniger R, Ganz R. Anterior femoroacetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am. 2003;85: Torry MR, Schenker ML, Martin HD, Hogoboom D, Philippon MJ. Neuromuscular hip biomechanics and pathology in the athlete. Clin Sports Med. 2006;25:179-97, vii. 11.Ito H, Song Y, Lindsey DP, Safran MR, Giori NJ. The proximal hip joint capsule and the zona orbicularis contribute to hip joint stability in distraction. J Orthop Res. 2009;27: Shindle MK, Ranawat, Kelly BT. Diagnosis and management of traumatic and atraumatic hip instability in the athletic patient. Clin Sports Med. 2006;25:309-26, ix-x. 13.Myers CA, Register BC, Lertwanich P, et al. Role of the acetabular labrum and the iliofemoral ligament in hip stability: an in vitro biplane fluoroscopy study. Am J Sports Med. 2011;39 Suppl:85S-91S

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Lumbar spine

Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical