역행성 견관절 전치환술의 합병증

• Published in: The journal of the Korean Orthopaedic Association Vol. 50; no. 6; pp. 491 - 500
• Main Authors: 박상은(Sang-Eun Park), 정재중(Jae-Jung Jeong), 김영율(Young-Yul Kim), 이세원(Se-Won Lee), 박민규(Min-Gyu Park), 이재민(Jae-Min Lee), 지종훈(Jong-Hun Ji)
• Format: Journal Article
• Language: Korean
• Published: 대한정형외과학회 01.12.2015
• Subjects: 정형외과학; 재치환술; complication; 역행성 견관절 인공관절 전치환술; 합병증; reverse total shoulder arthroplasty; revision
• ISSN: 1226-2102; 2005-8918

목적: 견관절 역행성 인공관절 전치환술 후 합병증을 분석하고, 임상 결과를 보고하고자 한다. 대상 및 방법: 견관절 역행성 인공관절 전치환술 후 최소 6개월 이상(평균, 22개월) 추시한 98예의 환자(남 22명, 여 76명; 평균연령, 75세)를 대상으로 최종 추시 시 합병증 및 임상결과를 분석하였다. 회전근 개 관절병증 43예, 회전근 개 거대 파열 33예, 골절 및 후유증 16예, 감염 4예, 기타 2예였다. 결과: 총 98예 중 18.4%에서 합병증이 발생하였다. 견관절 탈구(2예)에 개방적 정복술을, 삽입물 주위 골절(2예)에 금속판 내고정술을, 감염, 상완골 및 관절와 기구 해리 각각 1예에 재치환술을 시행하였다. 견봉 골절(2예)과 이소성 골화증(8예)에서 보존적 치료를 시행하였다. 합병증의 최종 추시 임상 점수는 의미있는 향상을 보였다(p＜0.05). 견갑골 절흔은 43.9%에서 발생하였다. 합병증과 절흔의 유무 비교 시, 추시 임상 점수상 유의한 통계적 차이는 없었다(p＞0.05). 결론: 18%의 합병증이 발생하였고, 3예에서 재치환술을 시행하였으나, 최종 추시 시 임상 결과는 유의하게 호전되었다. 견갑골 절흔이 44%에서 발생하였으나 단기 추시상 임상 결과에서 의미있는 영향을 미치지는 않았다. Purpose: The purpose of this study was to analyze complications after reverse total shoulder arthroplasty and report the clinical outcomes with review of previously reported studies. Materials and Methods: Complications after reverse total shoulder arthroplasty were analyzed for 98 patients who underwent reverse total shoulder arthroplasty and were followed-up for at least 6 months. Of 98 patients, 22 were men and 76 were women. The mean age was 75.0±6.5 years (range, 59-92 years) with a mean follow-up period of 22±19 months (range, 6-74 months). The types and time of occurrence of complications, methods of treatment, and clinical outcomes at the final follow-up were analyzed. Results: Complications occurred in 18 of 98 patients (18.4%). Seven of them received operative treatment and 11 were treated conservatively. Two cases had postoperative dislocations and were addressed with open reduction. In 2 cases, periprosthetic fractures occurred and were treated with open reduction and plate fixation. Two acromial stress fractures and 8 cases of heterotopic ossification were managed conservatively. Infection and humeral component loosening occurred in one case, respectively, and were treated with revision arthroplasty. Glenoid component loosening occurred in 2 cases, one of which was treated with revision arthroplasty and the other was managed conservatively. At the final follow-up, clinical outcomes showed a statistically significant improvement. Compared to groups with no complications, there were no significant differences in final clinical outcomes. Scapular notching occurred in 43.9% (43/98 cases). No statistically significant differences of clinical outcomes were observed between the scapular notching group and the no notching group (p＞0.05). Conclusion: In our study, 18% of complications occurred after reverse total shoulder arthroplasty and final clinical outcomes of these complications showed significant improvement. Scapular notching developed in 44% and did not provide a significant clinical effect at short term follow-up. KCI Citation Count: 0