대한골관절종양학회지 (The Journal of the Korean bone and joint tumor society)

  • 제17권1호
  • /
  • Pages.44-50
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  • 2011
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  • 1226-4962(pISSN)
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  • 2233-9841(eISSN)
대한근골격종양학회 (The Korean Musculoskeletal Tumor Society)
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근위 대퇴골에 발생한 전이성 골종양의 병적 골절의 수술적 치료: 종양대치 인공관절 치환술과 골절 고정술의 치료 성적 비교

Surgical Treatment for Pathologic Fracture of Skeletal Metastatic Lesion of the Proximal Femur: Comparison of Clinical Outcomes for Prosthetic Joint Replacement and Osteosynthetic Fixation

  • 신덕섭 (영남대학교 의과대학 정형외과학교실) ;
  • 김의식 (영남대학교 의과대학 정형외과학교실) ;
  • 곽해준 (영남대학교 의과대학 정형외과학교실) ;
  • 고영진 (영남대학교 의과대학 정형외과학교실)
  • Shin, Duk-Seop (Department of Orthopedic Surgery, Yeungnam University College of Medicine) ;
  • Kim, Ui-Sik (Department of Orthopedic Surgery, Yeungnam University College of Medicine) ;
  • Kwak, Hae-Jun (Department of Orthopedic Surgery, Yeungnam University College of Medicine) ;
  • Ko, Young-Jin (Department of Orthopedic Surgery, Yeungnam University College of Medicine)
  • 투고 : 2011.03.21
  • 심사 : 2011.05.30
  • 발행 : 2011.06.30
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초록

목적: 근위 대퇴골에 발생한 전이성 골종양의 병적 골절 혹은 임박 골절의 수술적 치료방법 중 광범위 절제술 후 종양대치 인공관절 치환술과 골절의 정복 후 골수강정을 이용한 고정술의 치료 성적을 비교하는데 있다. 대상 및 방법: 1994년 5월에서 2009년 5월까지 근위 대퇴골 전이성 골종양으로 인한 임박골절 및 병적골절로 본원에서 수술한 37명(38예))을 종양대치 인공관절 치환술을 시행한 군(1군; 22명)과 골유합 고정술을 시행한 군(2군; 15명, 16예)으로 나누었다. 평균 연령은 1군은 59세, 2군은 60세였으며, 평균 추시 기간은 수술 후 1군은 23개월, 2군은 11개월이었다. 두 수술군의 치료성적은 종양학적 성적과 Musculoskeletal Tumor Society (MSTS) scoring system, 1993의 기능적 평가방법, Kaplan-Meier 생존분석을 시행하였으며, 통계학적 분석은 Log rank test, T-test를 이용하여 평가하였다. 결과: 수술 후 평균 생존기간은 1군은 24개월(3-110개월), 2군은 11개월(1-33개월)이었으며, 1년 생존율은 1군은 86% (19/22명), 2군은 50% (8/16명), 2년 생존율은 1군은 30% (5/22명), 2군은 9% (1/16명)였다. MSTS scoring system, 1993의 기능적 평가방법을 이용한 종합적인 성적에서 1군은 평균 26점(19-30점), 88%, 2군은 평균 15점(10-23점), 51%로 평가되었다. 결론: 근위 대퇴골에 발생한 전이성 골종양의 치료 방법 중 선택된 환자에서 실시한 광범위 절제술 후 종양대치 인공관절 치환술은 골절 고정술 보다 종양학적 성적 및 기능적 성적이 우수한 것으로 나타났다.

Purpose: To compare clinical outcomes of the tumor prosthetic replacement and osteosynthetic fixation for pathologic fracture of skeletal metastatic lesion of the proximal femur. Materials and Methods: From 1994 May to 2009 May, medical records of 22 patients who underwent tumor prosthetic replacement with tumor resection (group 1) and 15 others (16 hips) who underwent osteosynthetic fixation without tumor resection (group 2) were reviewed. The mean age of overall patients were 59 (group 1) and 60 (group 2). Mean follow up periods were 23 and 11 months. The oncological and functional results were evaluated with Kaplan-Meier methods and Musculoskeletal Tumor Society (MSTS) scoring system, 1993. The statistical evaluation was assessed with Log rank test and t-test. Results: The mean survival periods were 24 months in group 1 and 11months in group 2. The 1 year survival rates were 86% in group 1 and 50 % in group 2, and 2 year survival rates were 29.7% in group 1 and 9.4% in group 2. The mean MSTS functional score were 26.4 (19-30), 87.9% in group 1 and 15.3 (10-23), 51.0% in group 2. Conclusion: The results of tumor resection and prosthetic replacement in selected cases was better than osteosynthetic fixation without tumor resection for metastatic bone tumors around proximal femur in oncological and functional aspects.

키워드

참고문헌

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