CAJ | 학술논문

目的：探讨髋关节翻修术中臀中肌功能修复重建的方法及疗效。方法2012年4月至2014年4月，接受髋关节翻修术同期修复重建臀中肌者8例，男2例，女6例；年龄31~69岁，平均50岁。右侧7例，左侧1例。初次关节置换原因：股骨颈骨折1例，行半髋关节置换；创伤性关节炎7例，行全髋关节置换。髋关节翻修原因：1例半髋关节置换术后反复脱位，5例全髋关节置换术后髋部疼痛、行走困难，2例全髋关节置换术后感染。入院时髋关节中度疼痛1例、重度疼痛7例，8例均有重度跛行，需双拐或支具辅助行走，外展肌力均≤3级，Trendelenburg征阳性。髋关节翻修术中臀中肌修复重建方法：1例臀中肌于大转子附着处完全断裂并回缩，行臀中肌及肌腱编织后贯穿大转子缝合；1例大转子骨折连同臀中肌上移，行大转子复位克氏针固定后捆绑带加强固定；3例臀中肌缺如，行臀大肌阔筋膜瓣成形术；3例臀中肌缺如、大转子缺如，行臀大肌肌瓣固定。结果8例患者均获得随访，随访时间为14~35个月，平均18个月。Harris髋关节评分从术前平均57分（40~60分）提高至术后平均85分（79~90分），髋部疼痛症状均明显缓解，步态改善，术后6个月患肢外展肌力平均提高1~2级。所有病例术后均未发生再次脱位，大转子处无压痛。结论髋关节翻修术中臀中肌修复重建可改善翻修术后患者的髋关节活动度、关节功能及外展肌力。
목적：탐토관관절번수술중둔중기공능수복중건적방법급료효。방법2012년4월지2014년4월，접수관관절번수술동기수복중건둔중기자8례，남2례，녀6례；년령31~69세，평균50세。우측7례，좌측1례。초차관절치환원인：고골경골절1례，행반관관절치환；창상성관절염7례，행전관관절치환。관관절번수원인：1례반관관절치환술후반복탈위，5례전관관절치환술후관부동통、행주곤난，2례전관관절치환술후감염。입원시관관절중도동통1례、중도동통7례，8례균유중도파행，수쌍괴혹지구보조행주，외전기력균≤3급，Trendelenburg정양성。관관절번수술중둔중기수복중건방법：1례둔중기우대전자부착처완전단렬병회축，행둔중기급기건편직후관천대전자봉합；1례대전자골절련동둔중기상이，행대전자복위극씨침고정후곤방대가강고정；3례둔중기결여，행둔대기활근막판성형술；3례둔중기결여、대전자결여，행둔대기기판고정。결과8례환자균획득수방，수방시간위14~35개월，평균18개월。Harris관관절평분종술전평균57분（40~60분）제고지술후평균85분（79~90분），관부동통증상균명현완해，보태개선，술후6개월환지외전기력평균제고1~2급。소유병례술후균미발생재차탈위，대전자처무압통。결론관관절번수술중둔중기수복중건가개선번수술후환자적관관절활동도、관절공능급외전기력。
Objective The aim of this study is to observe the effect of our surgical treatment method for abductor defects in hip revision cases. Methods We retrospectively evaluated a consecutive series of eight patients (eight hips) with a defect of the hip gluteus medius muscle from April 2012 to April 2014 who underwent revision and gluteus medius muscle reconstruction. 7 patients with loosening of components (2 periprosthetic joint infections), 1 repeated dislocation after hemiarthroplasty. There was one case with moderate pain and 7 cases with severe pain. 8 cases were severe limp, needed crutches or braces walking aids, glu?teal medius muscle strength was ≤3, and the Trendelenburg sign was positive in all patients. The average age was 50 years old (31-69 years old), 2 men and 6 women. One patient with a gluteus medius muscle completely disrupted from insertion at greater trochanter, which underwent knit suture. One patient had a greater trochanter fracture resulted in ascending of gluteus medius mus?cle. During revision, fracture was reducted and fixed by 2.0 Kirschner wire and cable. Three patients with defects of gluteus medi?us muscle;we applied gluteus maximus fascia lata muscle valvuloplasty. One patient with deficiency of both gluteus medius mus?cle and greater trochanter. Gluteus maximus was directly reattached to the proximal of femoral stem. Results All patients were followed up for an average of 18 months (range, 14-35 months). The mean Harris Hip score increased from 57 to 85, pain was remarkably relieved, ROM of hip and myodynamia was improved. Preoperative abductor strength ≤3, 6 months after surgery abductor strength was increased with average of 1-2 level. Conclusion Reconstruction of hip abductor tendon of gluteus medi?us muscle deficiency would be effective in hip revision surgery.