Original Article J Korean Knee Soc, Vol. 23, No. 2, June 2011 The Correlation of Postoperative Femoral Component Rotation Angle and Patella Tilt Angle with Clinical Results in Total Knee Arthroplasty Jae-Wook Jung, M.D., Sang-Ho Cheon, M.D. and Hee-Soo Kyung, M.D., Ph.D. Department of Orthopedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea Purpose: The aim of this study was to analyze the correlation of postoperative femoral component rotation angle and patella tilt angle with clinical results for total knee arthroplasty. Materials and Methods: Ninety-six cases in 48 patients who underwent total knee arthroplasty between March 2002 and February 2010 were enrolled. Femoral component rotation angle (FRA) and patella tilt angle (PTA) were measured with postoperative computed tomography. Clinical results were evaluated using American Knee Society knee score & function score and Feller's patella score. We analyzed the correlation of FRA and PTA with clinical outcomes. We also compared clinical results between the PFC R Sigma group and the Scorpio NRG R group, and the patello-femoral symptom group and a symptom-free group. Results: The mean FRA was 1.40 o of internal rotation. The patellar tilt angle was 3.79 o of lateral tilt. The mean knee score was 90.5, the function score was 77.4, and the patella score was 23.9. There was a significant difference between FRA and knee scores (p=0.031, r= 0.284). There were no significant differences between FRA and function score or patella score. The correlation of PTA and clinical results was not significant. The mean FRA was 2.00 o of internal rotation in the PFC R Sigma group, and it was significantly different than for the Scorpio NRG R group which had 0.81 o of internal rotation; but there were no significant differences between the two groups in clinical results. The patello-femoral symptom group deviated more from the mean FRA than did the symptom-free group. Conclusion: Internal rotation of the femoral component is correlated with poor clinical results after total knee arthroplasty. The correlation of patella tilt angle and clinical results was not significant. Key Words: Total knee arthroplasty, Femoral component rotation angle, Patella tilt angle 서 슬관절전치환술에서대퇴치환물의적절한회전각은슬개- 대퇴관절의안정성은물론슬관절의운동역학에서 Received: January 29, 2011 Revised: (1st) February 24, 2011, (2nd) April 23, 2011 Accepted: May 1, 2011 Corresponding author: Hee-Soo Kyung, M.D., Ph.D. Department of Orthopedic Surgery, Kyungpook National University Hospital, 50 Samdeok 2-ga, Jung-gu, Daegu 700-721, Korea TEL: 82-53-420-5636, FAX: 82-53-422-6605 E-mail: hskyung@knu.ac.kr 론 도매우중요한요소이다 2,27). 적절한대퇴삽입물의회전각은슬개골정렬과내반및외반안정성에영향을미치게되며, 대퇴삽입물의회전정렬이맞지않을경우슬관절동통및슬개 -대퇴관절의탈구나아탈구를조장하게되고, 슬개삽입물의마모와해리를유발하여슬관절재치환술의주요한원인이될수있으며 1,2), 이와같은슬개골과관련된합병증은슬관절전치환술의합병증중가장많은빈도를차지하고있다 1,2,27). 슬관절전치환술시대퇴치환물의적절한회전각을얻기위하여원위부대퇴골절제시기준축을정하여외회전의각도를결정하게되는데, 양측대퇴상과 (epicondyle) 96
정재욱외 : 슬관절전치환술후대퇴치환물의회전각및슬개골경사각과임상결과의상관관계 97 를연결하는대퇴상과간축 (transepicondylar axis, TEA) 과양측대퇴과의후면을잇는대퇴후과간축 (posterior condylar axis, PCA) 이주로이용된다 3,6,7). 대부분의슬관절전치환술에사용되는기구들에서대퇴후과간축에대해 3 o 외회전하여대퇴골회전정렬을맞추고있는데 12), 대퇴후과간축에대한회전각의값은저자에따라다양하게보고되고있어일률적으로 3 o 외회전하며맞추는것은여러문제를야기할수있다 18). 기존의연구에서대퇴및경골치환물의회전정렬과술후임상결과와의관계를규명하였다 5,21). 또한, 슬관절치환술에서슬개골경사각이증가하면슬개골이부적절한주행을하게되어수술후슬관절운동범위의제한, 슬관절전방동통및슬개골대치물의부적절한마모를야기시킬수있으므로적절한슬개골의주행획득은중요하다 15,17). 이를평가하기위해슬개골경사각이많이이용되고있다 22,29). 본연구는슬관절전치환술후컴퓨터단층촬영을이용하여측정한대퇴치환물의회전각및슬개골경사각과술후임상결과와의연관성에대해분석하였다. 대상및방법양군간의비교를위한짝짓기방법으로 2002 년 3월부터 2010 년 2월까지양측슬관절전치환술을시행한환자중한쪽은 PFC R (Press Fit Condylar) Sigma (DePuy R, Warsaw, IN, USA), 반대쪽은 Scorpio NRG R (Non- Restrictive Geometry, Stryker R, Allendale, NJ, USA) 를사용한 48명, 96예를대상으로하였다. 남자 5명, 여자 43 명이었고, 수술당시평균나이는 68.3 세 ( 범위 : 52-86 세 ) 였으며, 체중은평균 60.8 kg ( 범위 : 45-81 kg), 체질량지수 (body mass index, BMI) 는평균 25.3 kg/m 2 ( 범위 : 19.8-30.5 kg/m 2 ) 이었다. 술전진단은퇴행성관절염이 46명, 류마티스관절염이 2명이었다. 평균추시관찰기간은 34.3 개월 ( 범위 : 12-102 개월 ) 이었다. 수술은모든예에서후방십자인대대치형 (posterior stabilized-type) 으로시멘트사용슬관절전치환술을시행하였고, 외측인대유리술을시행하지않았다. 대퇴치환물의회전정렬은 PFC R Sigma 군에서는모두대퇴후과간축에대하여 3 o 외회전하여대퇴치환물을삽입하였으며, Scorpio NRG R 군에서는대퇴후과간축에대하여 3 o 외 회전하여대퇴치환물을삽입하되, 미리표시한대퇴상과간축과비교하여약 2 o 이상차이를보일경우대퇴상과간축을기준으로대퇴치환물을삽입하였다. 슬개골치환술을시행한예가 16명 32예, 비치환술을시행한예가 32 명 64예였다. 양측성슬관절전치환술을받은환자중외반변형이있는경우, 대퇴후과의골결손이심한경우는본연구에사용된치환물의모델이달라서제외하였다. 슬개골치환술은슬개골표면의 1/2 이상이 grade IV인경우에실시하였으나, 변형이아주심한경우, 술전탈구 / 아탈구등이있는경우는본연구에서제외하였다. 모든환자는술후 7일째에양측슬관절을 20 o 굴곡한상태에서컴퓨터단층촬영을시행하였으며 16), 대퇴치환물의회전각 (femoral component rotation angle, FRA) 과슬개골경사각 (patella tilt angle, PTA) 및경골치환물의회전각 (tibial component rotation angle, TRA) 을축상면 (axial plane) 에서측정하였다. 대퇴골내-외측상과의가장돌출된부분을이은선인임상적대퇴상과간축 (clinical transepicondylar axis, c-tea) 과대퇴치환물의내-외과후면의가장돌출된부분을이은선인대퇴후과간축 (posterior condylar axis, PCA) 사이의각도를대퇴치환물의회전각으로정하였다 (Fig. 1) 5). 슬개골경사각은슬개골의내- 외연을연결한선과대퇴골의내- 외과전면의가장돌출된부분을이은선인대퇴전과간축 (anterior Fig. 1. Femoral component rotation angle is formed by the clinical transepicondylar axis and posterior condylar axis. Positive values are internal rotation of the femoral component.
98 대한슬관절학회지 : 제 23 권제 2 호 2011 Volume 23, Number 2, June 2011 Fig. 2. Patella tilt angle is formed by the anterior condylar axis and the line connecting the medial and lateral patella margin. Positive values are lateral tilt of the patella. condylar axis) 사이의각도로하였다 (Fig. 2) 22). 그리고경골회전각은경골치환물의후과간축에수직인선과경골결절부의내측 1/3 지점과경골면의중심이만나는선사이의각으로하였다 (Fig. 3) 19). 측정은정형외과전문의 3명에의해일주일이상의간격으로각각 3회반복측정하였다. 임상결과는미국슬관절학회의슬관절점수및기능점수 (American Knee Society knee score & function score) 13) 와 Feller의슬개골점수 (Feller's patellar score) 9) 를이용하여평가하였다. 각각측정된대퇴치환물의회전각과슬개골경사각및경골치환물의회전각이슬관절점수, 기능점수와슬개골점수와의상관관계에있어서유의성이있는지에대해 Pearson 상관계수분석을하였고, PFC R Sigma 군과 Scorpio NRG R 군에서의각각의방사선학적회전각및경사각과임상결과간의차이가있는지와슬개골치환여부에따라임상결과에차이가있는지에대해 Student t-test 를이용하여분석하였다. 좌- 우측측정에따른편견을배제하기위해각각좌-우측으로나누어 repeated measured ANOVA 를시행하여측정자내및측정자간재현성을확인하였다. 그리고외래추시관찰중슬개- 대퇴증상 ( 탄발음, 슬개골동통 ) 이나타났던 11명을슬개-대퇴증상군으로나누어평균분산분석을시행하였다. 통계 Fig. 3. Tibial component rotation angle is defined as the angle between the line perpendicular to the posterior condylar line of the tibial component and the line from the center of the tibial surface to the medial third of the tibial tuberosity. 학적분석은 SPSS/WIN ver. 10.0 (SPSS Inc., Chicago, IL, USA) 을사용하였다. 유의수준은 p값이 0.05 이하인경우를통계학적으로유의한것으로평가하였다. 결 전체 96예에서대퇴치환물의회전각은평균 1.40 o ( 범위 : 3.30-8.04 o ) 내회전, 슬개골경사각은평균 3.79 o ( 범위 : 6.66-13.40 o ) 외측경사였으며, 경골치환물의회전각은평균 6.17 o ( 범위 : 3.53-9.05 o ) 외회전이었다. 그리고슬관절점수는평균 90.5 점 ( 범위 : 80-99 점 ), 기능점수는평균 77.4 점 ( 범위 : 60-90 점 ), 슬관절점수는평균 23.9 점 ( 범위 : 19-29 점 ) 으로나타났다. 대퇴치환물의회전각과슬관절점수사이에유의한상관관계가있었으며 (p=0.031), 대퇴치환물이내회전될수록슬관절점수가감소하는양상의상관관계를보였다 (r= 0.284). 대퇴치환물의회전각과기능점수및슬개골점수사이에서는유의한상관관계가없었다. 슬개골경사각과및경골치환물의회전각과슬관절점수, 기능점수및슬개골점수사이에서도유의한상관관계가없었다 (Table 1). 슬개골경사각의측정에있어슬개골치환여부에따라 과
정재욱외 : 슬관절전치환술후대퇴치환물의회전각및슬개골경사각과임상결과의상관관계 99 Table 1. Correlation of FRA, PTA, and TRA with Clinical Outcome Table 3. Comparisons between PFC R NRG R Sigma and Scorpio FRA PTA TRA Knee score Function score Patellar score p=0.031 a) r=-0.284 p=0.096 r=0.197 p=0.085 r=-0.103 p=0.536 r= 0.094 p=0.609 r=0.055 p=0.571 r= 0.066 p=0.319 r= 0.121 p=0.912 r=0.018 p=0.519 r= 0.084 FRA: femoral component rotation angle, PTA: patella tilt angle, TRA: tibial component rotation angle. a) p-value: statistical significance (p<0.05), r-value: correlation coefficient. FRA ( o ) PTA ( o ) TRA ( o ) Knee score Function score Patella score PFC R Sigma (N=48) 2.00±0.55 4.24±1.37 6.39±0.36 90.3±1.2 77.2±1.7 23.9±0.7 Scorpio NRG R (N=48) 0.81±0.56 3.34±1.37 5.95±0.33 90.7±1.1 77.6±2.2 24.0±0.7 p-value 0.004 a) 0.368 0.085 0.595 0.784 0.812 FRA: femoral component rotation angle, PTA: patella tilt angle, TRA: tibial component rotation angle. a) p-value: statistical significance (p<0.05). Table 2. Comparisons between Patella Retention Group and Patella Resurfacing Group FRA ( o ) PTA ( o ) TRA ( o ) Knee score Function score Patella score Retention group (N=64) 1.72±0.49 3.84±1.22 6.18±0.32 89.9±1.1 76.3±1.5 23.1±0.6 Resurface group (N=32) 0.77±1.4 3.68±0.69 6.16±0.37 92.2±1.3 79.5±2.3 25.7±0.7 p-value 0.031 a) 0.876 0.959 0.016 a) 0.027 a) <0.001 a) FRA: femoral component rotation angle, PTA: patella tilt angle, TRA: tibial component rotation angle. a) p-value: statistical significance (p<0.05). Table 4. Comparisons of Patello-femoral Symptom Group with Symptom-free Group FRA Mean PTA Mean FRA Mean deviation PTA Mean deviation Symptom group (N=11) 1.12±2.34 3.43±3.40 3.08±1.21 4.35±1.88 Symptom-free group (N=85) 1.42±0.37 3.83±1.01 1.42±0.22 3.85±0.59 p-value 0.879 0.691 <0.001 a) 0.728 Mean value of all case: FRA=1.40, PTA=3.79. FRA: femoral component rotation angle, PTA: patella tilt angle. a) p-value: Statistical significance (p<0.05). 그값이차이가있을수있다는예상하에슬개골치환군과비치환군간의비교분석을시행하였으며, 대퇴치환물의회전각은슬개골비치환군 1.72±0.49 o, 슬개골치환군 0.77±1.4 o 로유의한차이가있었으나 (p=0.031), 슬개골경사각의차이는슬개골비치환군 3.84±1.22 o, 슬개골치환군 3.68±0.69 o 로유의한차이가없었고 (p=0.876), 슬개골치환군에서슬관절점수, 기능점수및슬개골점수가모두유의하게높은결과를보였다 (Table 2). 대퇴치환물의회전각은 PFC R Sigma 군에서평균 2.00 o ( 범위 : 2.26-8.04 o ) 내회전, Scorpio NRG R 군에서평균 0.81 o ( 범위 : 3.30-4.60 o ) 내회전이었으며, 양군간에유의한차이가있었다 (p=0.004). 그러나슬개골경사각은 PFC R Sigma 군이평균 4.24 o ( 범위 : 6.66-13.07 o ) 외측경사, Scorpio NRG R 군은평균 3.34 o ( 범위 : 5.15-13.40 o ) 외측경사로유의한차이가없었으며 (p=0.368), 경골치환물의회전각에서도 PFC R Sigma 군은평균 6.39 o ( 범위 : 3.53-8.99 o ) 외회전, Scorpio NRG R 군은 5.95 o ( 범위 : 3.77-9.05 o ) 외회전으로유의한차이가없었다 (p=0.085). 그리고각각의슬관절점수, 기능점수및슬개골점수결과에서도유의한차이가없었다 (Table 3). 추시경과관찰중 11예의슬관절에서슬개-대퇴증상 ( 탄발음 5예, 슬개골동통 4예, 탄발음과슬개골동통이동시 1예, patella clunk 1예 ) 이있었으며, PFC R Sigma 6 예, Scorpio NRG R 5예이었다. 슬개 -대퇴증상군 (patellofemoral symptom group) 과비증상군 (patello-femoral symptom free group) 을비교할때양군의평균대퇴치환물의회전각은증상군에서 1.12 o 내회전, 비증상군에서 1.42 o 내회전으로차이가없었으나, 증상군에서대퇴치환물의
100 회전각의평균분산이 3.08 o 로, 비증상군의 1.42 o 보다차이를보여증상군에서의대퇴치환물의회전각이평균보다좀더벗어나는값을보였다. 슬개골경사각은양군에서차이가없었다 (Table 4). 대퇴치환물의회전각 3회측정에대한측정자내 (intraobserver) p값은모두 0.05 이상 ( 측정자 1 Rt=0.4565, Lt=0.1908; 측정자 2 Rt=0.4917, Lt=0.1394; 측정자 3 Rt=0.6291, Lt=0.3052) 으로유의한차이가없었으며, 측정자간 (inter-observer) 에서도유의한차이가없었다 (p: Rt=0.2957, Lt=0.5032). 고찰슬관절전치환술에있어서삽입물의적절한회전정렬을맞추기위하여그기준축이필요하다. 대퇴삽입물의회전정렬의기준으로전후방축 (Whiteside's line), 외과적상과간축, 임상적상과간축, 후과간축및경골에수직으로절제한절단면을기준으로내측및외측관절간격의균형을맞추는데이용한다. 이들기준축의신뢰성에대한많은연구가이루어졌으나다양한결과가보고되고있다. 외측상과의정점과내측상과의정점아래홈 (sulcus) 을연결한외과적상과간축 (surgical transepicondylar axis) 이대퇴내- 외측상과를연결하는임상적상과간축 (c-tea) 보다더욱신뢰할만하고재현성있는축으로보고하였으나 6,11), 외과적상과간축은관절염이심한경우관찰하기어려우며, 연부조직에싸여있어오차가발생할수있어둘중어느것이재현성있는척도인가에대해서는아직많은논란이있다 24,26,28). 그리고후과간축을가장재현성있는축으로보고하기도하나, 관절염에따른후과의변화로신뢰성에대해부정적인보고가많다 20,25). 대퇴상과간축과대퇴후과간축의차이를정상인군에서평균 3.3-6.7 o, 내반변형을동반한슬관절염군에서평균 5.4-6.0 o 로보고하는등저자에따라다양하게보고되고있다 4,10,18,23,28). 본연구에서는 PFC R Sigma 군에서대퇴후과간축에대해모두 3 o 외회전하여대퇴치환물을삽입하였는데, 대퇴치환물회전각은 2 o 내회전으로측정되어대퇴상과간축이대퇴후과간축에대해평균약 5 o 외회전되어있다고추정할수있다. 대퇴치환물의회전각은수술시대퇴상과간축과후과간축사이의각을임의로 3 o 로정하여대퇴후과간축에 대한슬관절학회지 : 제 23 권제 2 호 2011 Volume 23, Number 2, June 2011 대해외회전하여치환물을삽입하였으므로이론적으로 0 o 가되어야한다. 하지만, 저자들의연구에서대퇴치환물의회전각은평균 1.40 o 내회전되어있었는데, 이는대퇴상과간축과대퇴후과간축의차이가동양인에서주로 4-5 o 의정도로서 4,18,23,28), 일괄적으로 3 o 외회전하여회전정렬을맞추는것이부정확할수있다는것을확인할수있었다. 회전정렬을맞추는데있어치환물의종류에따라일률적으로 3 o 외회전한 PFC R Sigma 군은평균 2.00 o 내회전, 대퇴상과간축으로참고로한 Scorpio NRG R 군에서는평균 0.81 o 내회전을보여, 수술시대퇴상과간축으로참고로하는것이좋을것으로생각된다. 여러연구에서대퇴골및경골의회전정렬이맞지않을때슬개골아탈구및탈구가생길수있으며이는주로대퇴골및경골치환물의내회전과관련된다고보고하였다. Berger 등 5) 은경골과대퇴골내회전의합이 1-4 o 의경도내회전일때는슬개골의외측주행 (tracking) 과슬개골경사 (tilting), 3-8 o 의중등도내회전은슬개골아탈구와연관되며, 7-17 o 의고도의내회전은초기의슬개골탈구또는후기의슬개골치환물의실패와연관된다고보고하였다. 본연구에서도대퇴치환물의내회전이증가할때슬관절점수가감소하는결과를보였다. 경골치환물의부적절한회전정렬이술후슬관절동통과연관된다는보고되고있다 5,21). 회전정렬에서대퇴골및경골회전정렬이모두관여하게되므로, 저자들은경골치환물의회전각을따로분석하였고, 경골치환물의회전각은평균 6.17 o 외회전되었으나, 경골치환물의회전각과임상결과사이에유의한상관관계가없었음을확인하였다 (Table 1). Nicoll과 Rowley 21) 는 39명의통증군과 26명의비통증군과의비교에서경골치환물의부정정렬이통증군에서경골치환부가평균 4.3 o 내회전되어있으며, 그에비해비통증군은 2.2 o 외회전되어있었다고보고하였다. 부가적으로대퇴치환물의부정정렬이비통증군에하나도없었던것에비해, 통증군중 6예에서대퇴치환물이 6 o 이상내회전되어있었다고보고하였다. Classen 등 8) 은외측지대유리술및슬개골치환을하지않은 48명의슬관절전치환술환자를대상으로한후향적연구에서대퇴치환물의외회전의증가와슬개골경사각의감소가강하게관련있다고보고하였다. 외회전정도는 Kanekasu's 테크닉 14) 을이용하였고, 슬개골경사각은 Merchant's view 를이용한 Laurin 각을이용하여측정
정재욱외 : 슬관절전치환술후대퇴치환물의회전각및슬개골경사각과임상결과의상관관계 101 하였다. 그러나본연구에서는대퇴치환물의외회전의정도와슬개골경사각의관계가통계학적으로유의하지않았는데, 저자들의연구는 CT를이용하여측정하였으며, 슬개골치환술을시행한예가모두포함되어있다는차이가있었다. 본연구의제한점으로후향적으로시행되었으며, PFC R Sigma 군과 Scorpio NRG R 군의설정에있어무작위추출을하지않은점, 두삽입물의차이를고려하지않은점, 임상점수의측정시점의다양성과슬개골치환군및비치환군이모두연구에포함되었다는점에서제한이있을수있다. 결 슬관절전치환술후대퇴치환물의회전각이내회전될수록낮은임상결과를보였다. 그러나슬개골경사각과임상결과들사이의상관관계는유의하지않았다. 슬관절전치환술시대퇴상과간축을함께이용하여적절한대퇴치환물의회전각을결정하는것이술후더정확한회전각을얻을수있으며, 대퇴치환물의회전정렬을맞추는데있어그기준축인대퇴상과간축과후과간축이개개인마다차이가있으므로여러가지를고려하여할것으로생각된다. 론 CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported. REFERENCES 1. Akagi M, Matsusue Y, Mata T, Asada Y, Horiguchi M, Iida H, Nakamura T: Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res, (366); 155-163: 1999. 2. Anouchi YS, Whiteside LA, Kaiser AD, Milliano MT: The effects of axial rotational alignment of the femoral component on knee stability and patellar tracking in total knee arthroplasty demonstrated on autopsy specimens. Clin Orthop Relat Res, (287); 170-177: 1993. 3.Arima J, Whiteside LA, McCarthy DS, White SE: Femoral rotational alignment, based on the anteroposterior axis, in total knee arthroplasty in a valgus knee. A technical note. J Bone Joint Surg Am, 77; 1331-1334: 1995. 4. Asano T, Akagi M, Nakamura T: The functional flexion-extension axis of the knee corresponds to the surgical epicondylar axis: in vivo analysis using a biplanar image-matching technique. J Arthroplasty, 20; 1060-1067: 2005. 5. Berger RA, Crossett LS, Jacobs JJ, Rubash HE: Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res, (356); 144-153: 1998. 6.Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS: Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res, (286); 40-47: 1993. 7. Churchill DL, Incavo SJ, Johnson CC, Beynnon BD: The transepicondylar axis approximates the optimal flexion axis of the knee. Clin Orthop Relat Res, (356); 111-118: 1998. 8. Classen T, Wegner A, Muller RD, Von Knoch M: Femoral component rotation and Laurin angle after total knee arthroplasty. Acta Orthop Belg, 76; 69-73: 2010. 9. Feller JA, Bartlett RJ, Lang DM: Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br, 78; 226-228: 1996. 10. Griffin FM, Insall JN, Scuderi GR: The posterior condylar angle in osteoarthritic knees. J Arthroplasty, 13; 812-815: 1998. 11. Griffin FM, Math K, Scuderi GR, Insall JN, Poilvache PL: Anatomy of the epicondyles of the distal femur: MRI analysis of normal knees. J Arthroplasty, 15; 354-359: 2000. 12. Hungerford DS, Kenna RV: Preliminary experience with a total knee prosthesis with porous coating used without cement. Clin Orthop Relat Res, (176); 95-107: 1983. 13. Insall JN, Dorr LD, Scott RD, Scott WN: Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res, (248); 13-14: 1989. 14. Kanekasu K, Kondo M, Kadoya Y: Axial radiography of the distal femur to assess rotational alignment in total knee arthroplasty. Clin Orthop Relat Res, (434); 193-197: 2005.
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정재욱외 : 슬관절전치환술후대퇴치환물의회전각및슬개골경사각과임상결과의상관관계 103 슬관절전치환술후대퇴치환물의회전각및슬개골경사각과임상결과의상관관계 경북대학교의과대학정형외과학교실 정재욱ㆍ천상호ㆍ경희수 목적 : 슬관절전치환술후대퇴치환물의회전각및슬개골경사각과임상결과와의연관성에대해분석하고자하였다. 대상및방법 : 2002 년 3 월부터 2010 년 2 월까지양측슬관절전치환술을시행한환자 48 명, 96 예를대상으로하였다. 대퇴치환물의회전각및슬개골경사각은컴퓨터단층촬영을이용하여측정하였으며, 임상결과는미국슬관절학회의슬관절점수및기능점수와 Feller 의슬개골점수로평가하였다. 대퇴치환물의회전각, 슬개골경사각과임상결과간의상관관계를분석하였고, 부가적으로 PFC R Sigma 군과 Scorpio NRG R 군, 슬개 - 대퇴증상군과비증상군사이를비교하였다. 결과 : 대퇴치환물의회전각은평균 1.40 o 내회전, 슬개골경사각은평균 3.79 o 외측경사였다. 그리고슬관절점수는평균 90.5 점, 기능점수는평균 77.4 점, 슬개골점수는평균 23.9 점이었다. 대퇴치환물의회전각과슬관절점수사이에유의한상관관계가있었고 (p=0.031, r= 0.284), 기능점수및슬개골점수와의상관관계는유의하지않았다. 슬개골경사각과임상결과들사이의상관관계는유의하지않았다. 대퇴치환물의회전각은 PFC R Sigma 군에서평균 2.00 o 내회전, Scorpio NRG R 군에서평균 0.81 o 내회전이었으며, 양군간에유의한차이가있었으나 (p=0.004), 임상결과에서는차이가없었다. 슬개 - 대퇴증상군과비증상군을비교할때대퇴치환물의평균회전각은증상이있는군에서전체평균보다좀더벗어나는값을보였다결론 : 슬관절전치환술시술후대퇴치환물의회전각이내회전될수록낮은슬관절점수를보였다. 그러나슬개골경사각과임상결과들사이의상관관계는유의하지않았다. 색인단어 : 슬관절전치환술, 대퇴치환물의회전각, 슬개골경사각